Anorexia nervosa is perhaps the best-known eating disorder, causing its sufferers to fear weight gain and restrict their diet in an unhealthy way. An individual with anorexia is likely to perceive themselves as overweight, even if they are of a normal or below normal weight. This distorted perception combined with other emotional factors typically lead to the sufferer limiting their intake of food and effectively starving themselves to get to the lowest weight possible.
The condition often stems from low self-esteem and an inability to cope or manage difficult feelings. Those with anorexia may believe that they will only be happy once they reach a certain weight, but sadly this is rarely the case. Soon the eating disorder takes over, becoming a habitual coping mechanism that is difficult to stop.
If you have anorexia, it may feel as if there is no way out - but there are many professionals out there who can support you during your recovery. Whether it is yourself you are concerned about or a loved one, keep reading to find out more about the disorder and how counselling can help.
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If you have an eating disorder, one of the key symptoms will be the way you think about food. Rather than viewing food as something to enjoy or to provide sustenance, you are likely to view food in a negative way. You may see it as something that makes you fat, something to avoid and even something that frightens you. Your thoughts are also likely to revolve around your weight, body shape and the way you feel about them.
Common behavioural symptoms of anorexia include:
- lying about what or when you have eaten
- wearing baggy clothes to hide your body
- cooking for others, but not eating yourself
- feeling eager to please others
- exercising excessively to compensate for eating
- feeling fearful of high-calorie foods
- skipping meals or only eating low-calorie foods
- constantly weighing yourself.
As anorexia is a mental illness there are typically a range of psychological symptoms as well, these may include:
- feeling depressed/anxious
- developing obsessive behaviours
- hearing a voice/voices telling you to lose weight
- low confidence and self-esteem
- a desire to disappear or self-harm.
These thoughts, feelings and behaviours are what ultimately lead to a low body weight, and this can cause a range of physical side effects. Such effects may include:
- difficulty sleeping
- dizziness or fainting episodes
- feeling cold
- difficulty concentrating
- hair falling out
- growth of fine hair on the body
- disruption or cessation of periods (in women)
- stomach pains/digestive issues.
If anorexia is left untreated, medical intervention may be required and in some cases the disorder can be fatal. With the right treatment and support however, the disorder can be overcome with many sufferers going on to make a full recovery.
Causes of anorexia
What causes eating disorders is a hotly debated topic and while there is no singly identified 'cause' of anorexia, experts and sufferers alike agree that it is normally a combination of factors that lead to the development of anorexia. These include psychological factors, environmental factors and biological/genetic factors.
It has been found that many of those who develop anorexia tend to share similar personality or behavioural traits. Some of these traits include the following:
- a tendency towards anxiety and depression
- difficulty in handling stress
- excessive worrying, especially about the future
- bottling up feelings and being emotionally restrained
- feelings of obsession or compulsion.
Perhaps the most debated cause of eating disorders - certain environmental factors are thought to also contribute to the development of anorexia. These include:
- occupations or hobbies that idealise being thin (i.e. ballet, athletics or modelling)
- outside stress such as difficulties at home or problems at school
- cultural pressures regarding an ideal body shape
- a stressful life event
- experiencing physical or sexual abuse.
Biological and genetic factors
Research into the possibilities of biological or genetic causes for anorexia is inconclusive, however it has been noted that the risk of developing the disorder is increased if there is a family history of eating disorders. This may be due to a genetic predisposition, or due to behaviours 'rubbing off' on other family members.
Additionally it has been suggested that changes in hormone levels or brain function may have a part to play, but it is not clear if these lead to anorexia or if they develop later due to malnutrition.
For some sufferers life-events that cause hormonal changes (such as puberty, getting pregnant or giving birth), trigger eating disorders. What we do know is that further research is needed to establish how big a part genetics and hormones play in the development of anorexia.
Diagnosing any eating disorder can be difficult as the affected person is likely to be incredibly secretive about their behaviours or may even be in denial. If you are concerned you might have anorexia, your first port of call should be your doctor.
In order to diagnose you, they will begin by asking some questions about your eating habits and how you feel about yourself and your relationship with food. While this may be difficult to talk about, it is important to answer these questions honestly so your doctor can accurately assess your emotional state.
Physically your doctor may want to check certain things such as your body mass index (BMI) or your blood pressure. This is to ensure your physical health is not in any immediate danger. If your doctor suspects that you have anorexia, they will give you advice on how to get further help - usually this will entail psychological therapy.
When you are suffering from an eating disorder you may initially not want anyone else to know, or you may think that there isn't a problem and that you don't need help. Without the support of those around you, the way you feel is unlikely to change and you could risk harming yourself physically and emotionally.
Going through the turmoil of an eating disorder alone is an incredibly hard thing to do, and by telling someone how you're feeling you will lighten this burden and start to feel more confident about recovery. Talking to someone you trust is a great start and, when you're ready, talking to a professional - such as a doctor or counsellor - will help you overcome anorexia.
There are several different approaches to the treatment of anorexia and what will work for you will depend on your personal circumstances and the severity of your condition. To ensure you are getting the best treatment plan, your doctor will initially need to assess you, this will be done by the methods described above.
In most cases, anorexia treatment will involve a combination of psychological therapy (to help you mentally) and tailored advice on nutrition (to help you physically). For most anorexia sufferers this treatment will take place on an outpatient basis, but in severe cases a stay in hospital or specialist eating disorder clinic may be required.
There are many different types of psychological treatments available for those with eating disorders. Due to the complex nature of anorexia, you may find that you need treatment over a longer period of time, however this will depend on individual circumstances.
The following therapy types are considered useful when treating anorexia:
Cognitive analytic therapy (or CAT for short) is a therapy type that looks at your past to establish any unhealthy patterns of behaviour or thinking. Understanding how past events may have contributed to your eating disorder will give you a better insight into your condition. Once this identification has been made, your therapist can help you to establish what changes you can make to break these unhealthy patterns.
An increasingly popular therapy used for eating disorders is cognitive behavioural therapy (CBT). This therapy is based on the theory that the way we think or feel about a certain situation affects how we behave and vice versa. In terms of anorexia, a CBT therapist will look to show how the disorder is associated with unrealistic or unhealthy beliefs regarding food and body image.
After uncovering why/how your thoughts and behaviours affect each other, the task to change begins. Your therapist will guide you through this process, helping you to establish new ways of thinking and coping strategies.
This therapy revolves around relationships - those with other people and those with the world around us - and how they affect our mental health. When applied to anorexia, IPT will explore any issues or negative associations you have with your interpersonal relationships. Often, anorexia comes in tandem with feelings of anxiety, low self-esteem and self-doubt, all areas that can be explored through interpersonal therapy.
Eating disorders have a significant impact, not only on the person suffering but on those around them. For this reason it may be beneficial to consider family therapy. This can help those close to you understand why you feel the way you do and help to remove some of the secrecy that often comes with anorexia.
Together with your therapist your family can discuss their feelings, allowing them to air their own concerns. Family therapy can be especially important for younger people with anorexia.
As well as overcoming anorexia mentally, a big part of recovery takes place physically. Your support team will work with you to introduce more food into your diet so you become a healthy weight. This is the part of recovery many anorexic sufferers struggle with as it involves putting on weight, however it is also one of the most important parts.
Your doctors may ask you to introduce certain foods to your diet in a slow and controlled manner, while your therapist discusses with you how it makes you feel. As you make changes to your diet, your doctor will monitor your physical health, including body weight, to ensure you are getting the nutrients you need for physical rehabilitation.
Medication is not usually prescribed for those with anorexia alone, however it may form part of your treatment plan in order to tackle associated psychological concerns. The most common medication used in the treatment of anorexia is selective serotonin reuptake inhibitors (SSRIs), an antidepressant that can help with depression and anxiety.
During your recovery, and indeed sometimes after you have recovered, you may find you slip back into old habits and have what is known as a relapse. This is a common occurrence for those with eating disorders and does not mean you have failed in your recovery. Within your psychological treatment you are likely to discuss how to spot signs of a relapse as well as developing an action plan should this happen.
Telling someone you trust that you are having disordered thoughts/feelings surrounding food again will put the wheels in motion to ensure you are fully supported should you need further treatment. Internalising your fears and beating yourself up over a relapse will only fuel the fire, so try to resist this urge and talk to a professional.
What should I be looking for in a counsellor or psychotherapist?
Whilst there is no law stipulating a required level of training for counsellors working in this area, the National Institute for Health and Care Excellence (NICE) have put together some clinical guidelines that outline recommendations about psychological treatments, treatment with medicines and what kind of services help individuals with eating disorders.
Key recommendations include the following:
- Most individuals with anorexia nervosa should be treated on an outpatient basis with psychological treatment provided by a service that is competent in carrying out that treatment and assessing the risk of the patient.
- Therapies to be considered for the psychological treatment of anorexia nervosa include cognitive analytic therapy (CAT), cognitive behaviour therapy (CBT), interpersonal psychotherapy (IPT), focal psychodynamic therapy and family interventions.
- The delivery of psychological interventions should be accompanied by regular monitoring of a patient’s physical state including weight and specific indicators of increased physical risk.
- The aims of psychological treatment should be to reduce risk, to encourage weight gain and healthy eating, to reduce other symptoms related to an eating disorder, and to facilitate psychological and physical recovery.
- Dietary counselling should not be provided as the sole treatment for anorexia nervosa.
For more information, please visit the full NICE guidelines:
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- Understanding anorexia
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