All About

Anorexia Nervosa
A booklet for those wanting to
know more about anorexia nervosa
This booklet w as w ritten by
C harlotte Stark, Inform ation
O fficer.
Published by:
The M ental H ealth Foundation
U K O ffice
83 Victoria Street
London SW 1H 0H W
Tel: 020 7802 0300
Fax: 020 7802 0301
Scotland O ffice
24 G eorge Square
G lasgow G 2 1EG
Tel: 0141 572 0125
Fax: 0141 572 0246
E-m ail: m hf@ m hf.org.uk
W eb: w w w .m entalhealth.o rg.uk
R eg C harity N o: 801130
C opyright 1997, 2000
C artoons draw n by
Sim on W hitem an
The M ental H ealth Foundation
ISBN : 090 1944 79 3
Price 1.00
The Mental Health Foundation has
published two booklets on eating
disorders. This one looks at anorexia
nervosa and its companion booklet
covers bulimia nervosa. We have
produced two separate booklets
because there are some very important
differences between the two. There is
however inevitably some overlap,
particularly in the discussion about
causes. There are also people who
have experience of some or all of the
symptoms of both conditions or who
alternate between the two at different
times.
If you would also nd it useful to have
a copy of the bulimia nervosa booklet,
please call us on 020 7802 0300.
What is anorexia nervosa?
A norexia nervosa is a disorder w hich m akes eating very
distressing. It m akes people obsessively anxious to m aintain
or reduce their body w eight through rigid control of their calorie
intake. People w ith anorexia nervosa often have a very
distorted perception of how they look and continue to feel the
need to lose w eight even w hen they are so thin that their
health is very seriously at risk. They have an intense fear of
gaining w eight and feel that their value as a person is directly
affected by their body shape.
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Who has anorexia nervosa?
C urrent estim ates suggest that up to 1% of w om en in the U K
betw een the ages of 15 and 30 suffer from anorexia nervosa.
G irls under 15 can also be affected and it seem s that anorexia
nervosa is becom ing an increasing problem in these younger
children. Som e w om en over 30 also have anorexia nervosa,
although the condition generally rst occurs earlier than this.
90-95% of people w ith anorexia are w om en, but it is im portant
to realise that it is a condition w hich can occur in young m en as
w ell as w om en. There is also evidence to suggest that in the
younger age group (7-14 yrs) up to 25% of cases are boys.
It is difficult to judge exact num bers of people w ho have
anorexia nervosa as m any cases are not reported or not
diagnosed. Som e people experience m any of the sym ptom s
of the condition but w ould not be form ally diagnosed. This
m ay be because their w eight has not fallen below the level
identi ed by eating disorder experts (usually 15% below
`norm albody w eight) or because they do not t the
diagnostic m odels in som e other w ay.
What causes anorexia nervosa?
There is a lot of uncertainty about the causes of all form s of
eating disorder. M any people still think of them as `slim m ers
diseases. W hile it is true that both anorexia and bulim ia
nervosa can develop from a strict diet, the reasons for a diet
turning into an eating disorder involve m ore than just the w ish
to lose w eight. The nam e `anorexiais confusing as literally it
m eans `loss of appetite. People w ith anorexia nervosa do not
lose their appetite, they still feel hungry, but fear w eight gain
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so m uch that they lose the ability to eat a norm al diet.
Som e people attribute anorexia nervosa to m edia and fashion and
it is clear that they both play their part. M any people w ho do not
conform to the ideals presented by the fashion industry and the
m edia feel that they need to diet. For som e people this presents
no problem w hile for others it can turn into anorexia nervosa.
The m edia can also perpetuate problem s for people w ho have an
eating problem as it is very difficult to break aw ay from the dieting
cycle if you are constantly being presented w ith im ages of
desirable thin m odels.
People w ith anorexia nervosa develop a fear of fatness w hich
goes far beyond that w hich m ost dieters feel. For som eone w ith
anorexia nervosa, the need to m ake them selves thinner
dom inates all other em otions. Som e people w ith the condition
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lose their ability to see them selves as they really are, and instead
becom e terri ed that they are fat even w hen they have becom e
seriously m alnourished and underw eight. O thers are able to see
that they are thinner than m ost other people, but still strive to lose
w hatever body fat they feel rem ains. In m any cases, they feel
driven to continue to lose w eight because they feel that their
value as a person depends on their w eight and body shape and
that they w ill only be liked and appreciated if they are able to
m ake them selves increasingly thinner.
People w ho develop anorexia nervosa often have em otional
needs w hich are not being m et in their lives. They m ay not have
a stable fam ily background, m ay have trouble m aking friends
socially or at w ork or feel uncom fortable about sexual
relationships. It is im portant to realise though that anorexia
nervosa is not anyones fault. It cannot be seen to hinge entirely
on relationships, this is sim ply one factor w hich m ay play a part.
People can develop anorexia nervosa even if they have very
supportive fam ilies and partners and a w ide circle of friends.
Anorexia nervosa often starts in teenage years and can be a
m echanism for dealing w ith all the com plicated em otions
connected w ith becom ing an adult. Som e teenage girls are
t e r r i ed of becom ing w om en. This m ay be because they have
been abused as children, because they have seen their m other
or other fem ale relatives being unhappy, because they are
concerned about their sexuality or sim ply because they are
anxious about all the changes w hich they can feel taking place
w ithin them . Anorexia nervosa can offer them a w ay of delaying
som e of the physical signs that they are becom ing w om en.
Teenage girls w ith anorexia nervosa do not have such developed
breasts or hips as other girls their age because they have so little
body fat. They m ay also delay the start of their periods. This can
be very com forting for girls w ho do not feel ready for these
physical developm ents.
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People w ho have anorexia nervosa often feel that they are
underachievers in academ ic or w ork life. This is usually not the
case and evidence has show n that m any people w ith anorexia
nervosa are in fact very high achievers. They are, how ever, often
people w ho set them selves standards w hich are sim ply
im possible to achieve and leave them w ith feelings of
inadequacy.
For a person w ith little con dence, their eating problem s m ay
seem to be the only thing about them w hich is special or
different. Their ability to feel hungry and yet refuse to eat can feel
like a special talent that m ost people are unable to achieve and
can give a real sense of pride. It feels very disciplined to be able
to count calories and to be able to im pose strict lim its on how
m uch you consum e. For people w ho have low self-esteem and
w ho can see virtually no other area in their lives in w hich they are
successful, this can suddenly offer them a sense of purpose.
5
Anorexia nervosa can also be a w ay of coping w ith difficult
em otions. The am ount of tim e and energy spent thinking about
food and w eight loss can leave very little room to deal w ith any
other em otions. A norexia nervosa can therefore act as a kind of
protective barrier against the difficulties and em otional pressures
of everyday life.
It is im portant to understand that anorexia nervosa can ful l som e
needs and not to expect som eone to give it up w ithout having
their needs m et in som e other w ay.
What are the effects of anorexia
nervosa on someones health?
A signi cant num ber of people w ith anorexia nervosa die as a
result of the condition, either as a direct physical consequence
of the w eight loss or through suicide.
People w ith anorexia nervosa have very low body w eight and
this can cause serious m edical problem s. The m ost com m on of
these are:
G Poor circulation
G Low blood pressure
G B rittle bones
G Increased facial hair
G Loss of periods/infertility
G Fainting and dizziness
G H air loss
G D ehydration
G Kidney dam age
G Low body tem perature
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Som e of these problem s w ill get better w hen the person
recovers from anorexia nervosa. O ther problem s, particularly
dam age caused to bones, m ay never im prove. It is im portant to
seek help as early as possible as m any of the m ore serious
m edical consequences of anorexia nervosa are only associated
w ith long-term eating problem s.
Will someone with severe anorexia
nervosa have to go into hospital?
O ccasionally w hen w eight loss becom es so severe that it is a
threat to som eones life, hospital m ay need to be considered as
an option. D octors need to be very careful about taking people
into hospital, how ever, as the im m ediate physical need for
m edical intervention can im pact on the m ore long-term need for
autonom y. W hat people w ith anorexia nervosa generally need
above all else is to feel that they are in control of their ow n lives.
B eing adm itted to hospital and having responsibility for their
intake of food or uids m anaged by others can be extrem ely
distressing.
If doctors feel that som eones life is in im m ediate danger, and
they see no other option, they can force som eone to go into
hospital for treatm ent - this is allow ed under the M ental H ealth
A ct. C om pulsory treatm ent is alw ays seen as a last resort and
w ill only be continued for as long as doctors and other
professionals see it as the only solution. If hospital treatm ent
is going to be effective, then it m ust be seen as part of a m uch
w ider approach to the anorexia nervosa w hich includes looking
at the reasons w hy the condition rst started and w hy it is so
difficult to give up.
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How can I help if I suspect someone
has anorexia nervosa?
If you suspect that som eone you know has anorexia nervosa or
is show ing signs of developing it, you should try to talk to them
about your w orries and urge them to seek help. If they seem
unw illing to discuss their eating problem s w ith you, or becom e
aggressive, try suggesting that they at least read about the
condition. This w ill help to get them used to being confronted
w ith som e of the term inology as w ell as alerting them to som e
of the dangers. They m ay not realise that they have such a
serious a problem or m ay be anxious about giving up
som ething w hich they feel helps them to cope.
Try to learn as m uch as you can about the condition and be
prepared to offer w hatever support your friend or relative
needs. B e guided by w hat they say they need rather than by
w hat you think they should be doing. You m ust realise that it
can be very frightening to give up a regim e w hich is at the very
centre of som eones life. Talk to your friend about w hy they
8
think they need their anorexia nervosa and w hat they fear about
giving it up. It m ay be that they need som ething to feel proud
of, or som ething over w hich they have com plete control. If this
is the case, then you m ay be able to help them to think of other
areas in their lives in w hich this can be achieved.
You m ay nd it helpful to use som e of the self-help books listed
at the end of this booklet. They are generally w ritten by m edical
professionals w ith m any years experience in treating eating
disorders but m ost of them also have input from people w ho
have lived w ith the condition them selves. These books can be
very helpful in show ing you how you can structure the recovery
process, giving practical suggestions for w ays forw ard and
explaining w hy people m ay act as they do. You and your friend
or relative m ay also nd it very reassuring to see that the w ay
they are feeling is a recognised condition and that there are
effective w ays of dealing w ith these feelings.
O nce you have got som eone to talk about their condition, you
should try to stress the im portance of getting professional help.
There are effective treatm ents for anorexia nervosa, and the
earlier your friend or relative has access to these treatm ents,
the better their chance of recovery (see G etting help below ).
What should I do if I have anorexia
nervosa?
The rst thing you should try to do is to talk to som eone about
your anorexia nervosa. If you are already very underw eight, you
m ay not need to tell anyone that you have a problem , but you
should try to talk to som eone about w hy you think you are
starving yourself. U nlike bulim ia nervosa, anorexia nervosa is
a difficult condition to keep secret because there are very
9
obvious changes in your appearance. Your friends and fam ily
w ill have noticed that you are losing w eight and w ill alm ost
certainly be w orried about you.
Try to explain to som eone you trust w hat you get from having
anorexia nervosa. If you feel you need to starve yourself in
order to m aintain control over your life, or to suppress other
em otions you m ay not feel able to deal w ith - then tell
som eone this. The people close to you w ill be able to
understand the dangers associated w ith your extrem e w eight
loss. Those w ho have been on diets or w ho struggle to control
their ow n w eight m ay also be able to understand how
frightened you feel about gaining any w eight. W hat people m ay
need help w ith is understanding that in som e w ays your
anorexia nervosa can help you to cope w ith other pressures
you face. Try to be honest w ith yourself about your condition
and share your thoughts w ith som eone else if you can.
You probably feel very afraid of putting on any w eight. You
m ust try to begin to understand that this fear is part of your
condition and try to listen to people w hen they tell you that you
should not be losing any m ore w eight.
You m ay also nd it helpful to read m ore about anorexia
nervosa or talk to other people w ho live w ith it. The Eating
D isorders A ssociation can send you inform ation and has self
help groups you can join. There are useful books and lea ets
listed at the back of this booklet.
Getting help
B efore you decide to get help, you m ust be honest w ith
yourself about w hether you are ready. N obody w ill be able to
help you get better unless you are able to accept that you w ill
have to at least m aintain your current body w eight. There are all
10
sorts of w ays you can approach your condition and you m ust
chose one w hich suits you. R em em ber that if you have
m anaged to open up to som eone and started to think and talk
about your anorexia nervosa, you have already taken a big step
forw ard. D o not try to rush your recovery, but feel proud of
each advance you m ake.
Professional help
If you decide that you are ready to seek professional help, you
should rst approach your ow n doctor (G P) for advice. N ot all
G Ps are expert in eating disorders, but they can help you to
access specialist services. They can also be very helpful in
discussing your physical needs and in helping you to adjust to
a healthier w ay of eating. If you have been fasting for a long
tim e you m ay nd that you have problem s w ith certain food.
Your digestive system w ill not be used to coping w ith norm al
am ounts of food and you m ay need to start by eating sm all
portions of easily digested foods until your system catches up.
Your G P can tell you w hich foods should cause you least
11
problem s w hilst still providing you w ith the nourishm ent you
need. H e/she m ay also w ant to w eigh you regularly as a m eans
of m onitoring your progress. D o not be afraid of this - try to see
it as a challenge and aim to have m aintained your body w eight
or even have gained a few pounds each tim e.
Your G P should also refer you to a psychiatrist or therapist
specialising in eating disorders. This can be very helpful as
they w ill have experience of treating m any people w ith anorexia
nervosa and w ill be used to the challenges. If you are sent
for specialist help, see this as a valuable opportunity and try
to be open to the suggestions they m ake. You should also
be prepared to tell them w hat you feel w orks best for you
or w hat your particular fears are - after all, w e are all different.
If you are very thin, your doctor m ay w ant to adm it you to
hospital for a short tim e (see previous section - w ill som eone
w ith severe anorexia nervosa have to go into hospital?).
This m ay be frightening and m ake you feel as if you are losing
control. M ake sure you keep as m uch control as you can
- ask questions, m ake sure you understand w hat is happening
and w hy and challenge anything you are not happy about.
Your tim e in hospital should only be a sm all part of your overall
treatm ent and you should try to see it in this context.
Self help
There are a num ber of very good self help books available.
Som e of these are listed at the back of this booklet. These
books can tell you about w ays other people have found to
get better, can suggest som e of the reasons w hy you m ay
be feeling as you do and can give practical suggestions of
m easures you can take in your life to try to recover. They
are alm ost alw ays w ritten w ith the help of people w ho have
anorexia nervosa them selves and so do not m ake unrealistic
claim s.
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You w ill probably nd that as w ell as providing you w ith som e
practical w ays forw ard, these books w ill also be very
com forting as they w ill show you that others think and act as
you do. The books are m ost effective w hen used by you and
som eone else together. If you can get som eone to read
through the advice and help you apply it to your ow n set of
circum stances, then you should be able to develop a w orkable
plan for getting better. If you do not have a friend or relative
that you feel can help you w ith this, then your G P or practice
nurse m ay be able to help.
Friends and family
D o not underestim ate the effect of friends and fam ily on your
recovery. Their support can be invaluable. N ot only can they
help w ith practicalities, they can also support you through the
bad tim es and help you celebrate your successes.
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R ecovering from anorexia nervosa is difficult. M any people only
seek help w hen they have been living w ith the condition for
years. A ny w ay of thinking and behaving w hich has been
established for a long period of tim e is difficult to overcom e.
People trying to recover from anorexia nervosa should be
prepared for the process to take som e tim e and be really
com m itted to achieving results. A norexia nervosa can be
beaten and there are a range of very effective treatm ents
w hich can be tried. O n the next page you w ill nd are
addresses w here you can get further help, inform ation and
support.
14
15
Eating Disorders Association
First Floor
W ensum H ouse
103 Prince of W ales R oad
N orw ich
N orfolk N R 1 1D W
H elpline: 0845 634 1414
(8.30am -8.30pm M on-Fri)
Youth H elpline - 18yrs and under:
0845 634 7650
(4.00pm -6.30pm M on-Fri)
R ecorded m essage about
eating disorders: 0906 302 0012
(m essage lasts approx 10
m inutes and costs 50p per
m inute)
w w w .edauk.com
The EDA provides telephone
helplines, information sheets,
leaets and newsletters and runs
a national network of self-help
groups. They are able to advise
on both bulimia and anorexia
nervosa.
MIND
G ranta H ouse
15-19 B roadw ay
Stratford
London E15 4B Q
Tel: 020 8519 2122
Inform ation Line: 0845 660163
w w w .m ind.org.uk
National charity which offers
information on all mental
illnesses. MIND have leaets and
information sheets on eating
disorders and sell some of the
self-help guides listed below.
The Samaritans
Tel: 0845 909090
w w w .sam aritans.org.uk
UK Helpline for anyone
experiencing emotional distress.
Someone to talk to in condence
24 hours a day.
The Womens Therapy Centre
6-9 M anor G ardens
London N 7 6LA
Tel: 020 7263 6200
(M on-Fri 10am -12pm and 2-4pm )
Individual and group
psychotherapy for women.
Where to get further help
Further reading about
anorexia nervosa
The follow ing list is intended as a guide to seeking further inform ation
and the M ental H ealth Foundation does not necessarily endorse or
support the content of the publications listed.
General reading
Anorexics on Anorexia
R osem ary Shelley. Jessica Kingsley, 1997
The Anorexic Experience
M arilyn Law rence. The W om ens Press, 1995.
Eating Disorders: the facts
Suzanne A braham and D erek Llew ellyn-Jones.
O xford U niversity Press, 1989.
Talking About Anorexia
M M onro. Sheldon, 1996.
Self-help books
Anorexia and Bulimia: your questions answered
Julia B uckroyd. Elem ent B ooks Ltd, 1996.
Anorexia Nervosa: a guide for sufferers and their families
PL Palm er, Penguin, 1989.
Leaets
Anorexia and Bulimia. Help is at Hand Guide
R oyal C ollege of Psychiatrists - call 020 7235 2351.
Understanding Eating Distress
M IN D - call 020 8519 2122
The Eating D isorders A ssociation also produces a range of lea ets on
eating disorders - call them on 0870 770 3256 for further details.
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A s the U Ks only charity concerned w ith both m ental health and
learning disabilities, the M ental H ealth Foundation plays a vital
role in pioneering new approaches to prevention, treatm ent and
care. The Foundations w ork includes: allocating grants for
research and com m unity projects, contributing to public
debate, educating and in uencing policy m akers and health
care professionals.