Anorexia Nervosa

October 10, 2021

Team Mindsum

About the author: This article is written by our team of researchers and writers. Our content is published after careful review and approval by the editorial board.

What is Anorexia Nervosa?
Causes of Anorexia Nervosa in children and young adults.
Symptoms of Anorexia Nervosa in young children
Comorbidity with other mental health disorders
Long-term effects on the body
Admission to Hospital
Treating Anorexia Nervosa
What types of professionals are involved?
The journey of treating Anorexia Nervosa
How to support someone with Anorexia Nervosa
How can parents support their child with Anorexia Nervosa?
Useful resources

What is Anorexia Nervosa?

‍Anorexia nervosa is a type of eating disorder that affects body weight because the person restricts the amount of food they eat. This is also due to an intense fear of gaining weight and a distorted view of their body shape.

An eating disorder is not a lifestyle or a personal choice. It is a complex illness that needs specialist treatment. Although it is more common in young adolescent girls, it can affect people of all ages, genders, ethnicities and backgrounds.

It is important to recognise the signs of anorexia nervosa early on. If left untreated, this disorder can lead to death due to starvation or suicide.

Causes of Anorexia Nervosa

‍There is no specific cause for eating disorders such as anorexia nervosa. It is likely due to a combination of genetic, neurobiological, psychosocial and sociocultural factors.

These are listed below:

Hormonal imbalances
Being overweight as a child
Being in a society, group or workplace that emphasises the need to be slim (e.g. dance group, modelling, athletics)
Having anxiety, depression, low self-esteem
Having a tendency for perfectionism
Bullying/criticism about body shape or eating habits
Family history of an eating disorder, psychiatric disorder or substance misuse
History of sexual abuse

The symptoms of Anorexia Nervosa

Anorexia nervosa is a progressive and chronic disorder. The symptoms are not always obvious, especially when they first begin to develop. There are behavioural and physical changes that can be considered as warning signs.

Emotional and behavioural warning signs:

‍Pre-occupation with food control (e.g. monitoring calories/grams of fat)
Refusal to eat certain foods
Checking the body regularly or avoiding mirrors/scales
Social withdrawal or being secretive (e.g. avoiding going out to eat)
Exercising excessively
May eat a lot of food at once followed by purging
Misusing laxatives
Comments about being “fat”
Challenges the idea of gaining weight
Mental health issues (e.g. anxiety, low self-esteem, depression, self-harm)

Physical warning signs:‍

Unusually low Body Mass Index for their age
Rapid weight loss
Stomach cramps, constipation, reflux, gastrointestinal problems
Dizziness, fainting, palpitations
Feeling cold all the time
Menstrual irregularities (e.g. period stops)
Dry skin, brittle nails
Loss or thinning of hair
Dental problems (e.g. teeth discolouration, cavities)

There is also a type of anorexia where the person might not be underweight at the time but can show other symptoms of the disorder. This is known as atypical anorexia nervosa

Anorexia nervosa can cause many complications in the life of a young person. It can lead to social isolation, low mood, suicidal thoughts/intentions, and self-harm and it can be very stressful for other family members to deal with.
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“Jade is 15 years old. A year ago she experienced severe bullying by a group of students at school because of her body shape. This caused her to feel so terrible that she decided to start exercising and changing her eating. As she lost weight, the thought of gaining it back would terrify her. Now, she skips lunch entirely and burns off dinner by exercising intensely for 5 hours every night. At first, Jade’s mum was pleased to see her being healthier but has become more concerned since teachers reported her fainting at school on several occasions. Her mum thinks that it might be helpful for her to speak to a professional.”

Comorbidities with other Mental Health Disorders

Individuals diagnosed with eating disorders have a likelihood of developing co-occurring psychiatric conditions and psychological distress. Around 55-97% of individuals who have an eating disorder have a diagnosis of a psychiatric disorder.

Below are a few examples:

Mood disorders – e.g. depression (major depressive disorder)
Anxiety disorders – e.g. obsessive-compulsive disorder (OCD), panic disorders and social anxiety disorders
Personality disorders – e.g. borderline personality disorder, obsessive-compulsive personality disorder (OCPD), bipolar disorder
Post-traumatic stress disorder (PTSD)
Sleep disorders
Substance abuse or dependence
Suicide ideation

Long-term effects on the body

Anorexia nervosa can have several long-term effects on the body. In most cases, severe and persistent anorexia leads to irreversible damage as compared to anorexia which is treated quickly. Restriction of calories, loss of weight and malnutrition can negatively impact the body in a permanent way. Reproductive problems result from drastic loss of body fat. The hormone cycle is damaged. This will cause infertility, miscarriages, compromised foetal growth etc.

Furthermore, cardiovascular issues are caused by the deprivation of calories and nutrients required by the heart. This can lead to a weakened heart, poor circulation or even cardiac arrest. Neurological damage is uncommon but still occurs. Anorexia can cause structural changes and nerve damage. Lastly, the skeletal system will deteriorate without vitamins and nutrients causing bones to weaken and issues such as easily getting fractures or having brittle bones.

Admission to Hospital

In cases where the effects of anorexia nervosa are severe with life-threatening complications, the person may be admitted to the hospital. This is where they will receive care that is focused on physical conditions, weight gain and mental health. This will ensure that the person is safe and can begin to recover from the serious effects of starvation.

When hospitalised they are directed to the psychiatric children's ward, especially for eating disorders and their treatment revolves around stabilizing their health and recovery therapies. Examples of treatments include individual talking therapy, mindful group activities (e.g. art therapy) and workshops (e.g. creative writing, practical activities, cooking). Their behaviour is observed throughout to avoid signs of exercising too much and purging.

Treating Anorexia Nervosa

Psychological therapies are important when treating anorexia nervosa. It is used to help young people to improve normal eating behaviours and reduce body-image disturbances. There are two types of therapies that can be involved.

Anorexia-nervosa-focused family therapy (FT-AN) is a type of family therapy that focuses on helping family members play a role in the young person’s recovery. There is strong research evidence that shows FT-AN to be effective in treating anorexia nervosa in adolescents.

The idea behind FT-AN is that the family is the main source of recovery. Therefore, by joining forces and standing up against the disorder, they can help their loved one to overcome it.

In FT-AN, the family members are given the task of getting the young person to eat enough to gain weight and continue to grow. The therapist will help parents to learn the best ways to supervise and encourage this process. Eventually, with the help of the family, the young person will be able to take steps towards recovery from this disorder.

Cognitive behavioural therapy for eating disorders (CBT-E) is a specialised form of cognitive behavioural therapy that uses different stages in treatment to change the behaviours that keep the disorder going. Research shows that it is effective in helping adolescents with anorexia nervosa to successfully regain weight.

The idea behind CBT-E is to target the eating habits, behaviours and thinking processes that form the eating disorder. The sessions can involve stages such as psycho-education, learning to cope with emotions, monitoring, behavioural changes and planning for the future. Parents might also be involved in the sessions to play a role in helping the young person take steps towards recovery from this disorder.

Medication can be prescribed in combination with therapy to help the person cope with health problems and other mental issues, such as depression and anxiety. However, medication is not usually prescribed for young people under 18 years old.

What types of professionals are involved?

There are different professionals that may or may not be involved throughout the treatment process of anorexia nervosa in young people. These might include psychotherapists and doctors/psychiatrists, dieticians, mental health nurses, support workers and social workers. These terms might be confusing, but the main difference is in the training that each of these professionals has received.

Psychotherapists

Psychotherapists provide an in-depth approach by exploring the history and causes of certain behaviours and emotional issues. The psychotherapist will then treat the anorexia nervosa in this specialised way. Here at Mindsum, we have psychotherapists who are available to provide support.

Doctors

‍These are professionals who are trained in medicine. This will likely be the family GP, who might find it necessary to prescribe certain medications that might help the young person cope with physical conditions due to the eating disorder.

Psychiatrist

These are professionals who are also trained in medicine. However, they also specialised in the field of psychiatry. So they are able to provide consultation and medication for a wide range of mental disorders. They might provide medication to help the young person cope with other mental health issues such as depression and anxiety, as they recover from anorexia nervosa.

Dietician

These are professionals who specialise in nutrition. They give education and advice on nutrients and the way these are important for health. They are able to provide meal plans to help the young person to stop unhealthy eating habits and to regain weight successfully.

Mental health nurses

Nurses trained in mental health might also be involved with the young person. If the young person is admitted to a hospital, a mental health nurse will care for their physical needs and monitor their psychological health. They might also administer medications prescribed by the psychiatrist.

Support workers

Workers trained in helping vulnerable people to live better lives might also be involved with the young person. This might be within a community setting or a crisis situation. Their role is to provide emotional and practical support (e.g. helping parents to cope, helping with paperwork, making child-care arrangements).

Social workers

Workers trained in protecting vulnerable individuals might also be involved with the young person. This might also be within a community or a crisis situation. Social workers will problem-solve and organise the right support for the young person to ensure their protection.

The journey of recovery from Anorexia Nervosa

‍The journey of recovery from anorexia nervosa can look different for each young person. For most people, the recovery process takes place over several months or years. Below are some things that are expected when going through therapy for anorexia nervosa.

Assessment

This is an important phase, where the psychotherapist will get a feel of what is going on. They might ask questions about eating habits along with other important background information. This will help to create a full picture of what is going on and to know what type of treatment will be most helpful.

Therapy sessions

These sessions will take place at a time and regularity that suits the needs of the young person. An important aspect of the therapy session is the relationship the psychotherapist will build with the young person and family members. The young person and the family will team up with the therapist to find the best ways to tackle the eating disorder. This might involve specialised techniques for managing emotions, mealtimes and thinking processes related to food and body image.

Homework

This is an important part of treatment for anorexia nervosa. This is because anorexia nervosa affects everyday situations in the young person’s life, especially at home. The family as a whole might be assigned homework to help the young person to complete their meals. Homework tasks will allow the young person to practice and have better chances of gaining weight and tackling the eating disorder.

Progress and setbacks

When having treatment for anorexia nervosa, there will be progress and there may be setbacks. It is common for young people to relapse and start engaging in restrictive eating habits again during their recovery. It is important not to feel discouraged when this happens. These situations provide opportunities to discover new ways to move forward together with the therapist.

Ending therapy

When treating anorexia nervosa, this stage is very important. The therapist might help the young person and the family to develop a relapse prevention plan. This will help them to take steps to prevent the eating disorder from becoming a problem again. The end of therapy will take place once the young person has made a lot of progress or has completely recovered from the eating disorder.

The young person and the family will leave therapy with many skills that they can use without the help of the therapist.

Follow up

There might be an agreement with the therapist to have a follow-up meeting. This is to check how the young person and the family are coping. If they are doing well, there will be no need for more support. But if they continue to have challenges with the eating disorder or any other issues, this will be an opportunity to have extra support.

How to support someone with Anorexia Nervosa

It can be challenging when you have a loved one who struggles with an eating disorder, such as anorexia nervosa. Especially, as it is a mental health disorder that also affects the person’s physical health. Fortunately, there are some things that you can do to help. These are discussed below.

Understand anorexia nervosa

‍It is a good idea to read as much information about anorexia as you can. Understanding anorexia and how it works can help you to recognise the ways that your loved one is affected and the ways you can help.

Help them to feel supported

‍Anorexia nervosa is a disorder that can make your loved one feel extremely isolated because others can have a hard time understanding their difficulties. It is important to make sure that you try to understand how this is a problem for them so that they feel understood and supported. To do this, you can:

Show acceptance: They are most likely struggling with negative and often critical thoughts about themselves. One of the best things you can do is to remind them that they are valued and loved, no matter what.

Separate the person from the disorder: This is very important. It is good to remember that the person is not the disorder. This will allow you to have fewer feelings of frustration and resentment towards your loved one because it is not their fault. Your loved one can also recognise that they are not the disorder and can feel less guilty about it.

Be persistent: When supporting a loved one with an eating disorder, it is common for you to receive a lot of resistance. This might happen when you are trying to encourage them towards healthier eating habits or inviting them out to a social event. Try not to feel discouraged and continue to encourage and invite them, even if they refuse.

Help them to find the right support

Encourage them to find support through a GP or therapist. If this involves your young child, you can contact these services. You might:

Help them to search for a therapist
Help them to book an appointment with a GP or therapist
Offer support when they attend appointments (e.g. waiting in the waiting room or attending some sessions if you need to)
Help them search for support groups or self-help resources
Encourage them to keep attending sessions and to not give up

Know when to get urgent support

When your loved one is dealing with anorexia nervosa, it is good to keep an eye out for signs of self-harm or suicide. If you suspect that your loved one is at risk of hurting themselves, you should get them immediate support.

You should contact a GP or the NHS urgent helpline.

Ask them what they need

They may or may not tell you what they need, but it is always good to ask. They might let you know other ways that you can help them. This way you won’t have to figure it out on your own.

Support them during mealtimes

‍Mealtime is the most stressful part of the day for a person with an eating disorder. It will be helpful for them if you find ways to make this time less distressing, without enabling the disorder. For example, you might:

Plan the meals with them in advance, so that they feel less anxious during mealtime
Involve other siblings that can help to distract them
Have neutral conversations that do not involve weight, shape or dieting
Encourage them to do an enjoyable activity during mealtime (e.g. colouring, watching TV, doing a puzzle)
Reassure them that you are there for them

Be patient in difficult situations

When supporting a loved one with an eating disorder, it is common for them to respond with resistance by being angry or shutting down. It is important for you to not take this personally and realise that it is the eating disorder that is being challenged.

Here are some ways that you can manage these situations:

Give them some space until they calm down
Try to resist the urge to respond back in an angry tone
It is reasonable to express your frustrations but try to do it while they are absent
Take some time out to compose yourself during these difficult situations
Encourage them in a calm way without putting too much pressure on them
Take the time to come up with creative ways to encourage them

Look after yourself too

It is extremely important for you to look after yourself. Whether you are a parent, family member or a friend, you will be in a better position to give help, as long as you are taking care of your own well-being too.

How can I support my child during recovery?

As a parent or legal guardian, if you are worried about your child's unhealthy eating habits and whether they have an eating disorder, they should seek medical help immediately. Furthermore, there are several things you, as a parent, can do to support your child during recovery.

These include:

Attend family therapy sessions if suggested
Inform the child’s teachers and healthcare providers, so they can also contribute to generating a recovery plan
Educate yourself about dealing with eating disorders, to empathize with them
Keep reminding them that they are loved and have all your support
Propose ideas for activities to do with their friends that do not involve eating, to avoid your child isolating them from their friends
Encouraging your child to maintain a healthy lifestyle and pragmatic attitude towards weight and diet, by being a good role model by maintaining a balanced diet and a healthy exercise routine.
Join local community support groups to hear and get support from other parent’s experiences with children with eating disorders (their concerns, worries and coping mechanisms)