Understanding anorexia
Anorexia nervosa is a mental health condition that affects the way you think, especially around food, weight and appearance. This can lead to behaviour changes that may harm wellbeing and create relationship difficulties.
This type of eating disorder can affect anyone, at any stage of their life.
Misconceptions about anorexia
Anorexia is often misunderstood and stereotyped. Some believe it is something that happens when a diet is taken 'too far' but, in fact, eating disorders are rarely about food. They often come from other underlying issues, including low self-esteem, a poor sense of self-image and/or feelings of depression and anxiety.
These issues can be very difficult to cope with and, in some people, an eating disorder becomes their way of coping. Fixating on their weight (something they can control) can feel easier than processing difficult emotions.
Those affected can become trapped in this way of thinking and believe they need to lose weight. This can lead to behaviours like limiting how much they eat, purging after eating, and/or over-exercising.
Over time, this way of thinking and behaving can lead to additional mental health problems like depression, self-harm and substance abuse.
If concerns about food, eating or body image are persistent, upsetting, or are affecting work, relationships or wellbeing, it can be valuable to seek appropriate professional support. Therapy can offer time to explore the experiences, feelings and relational patterns involved and can help.
- Mandy Atkinson UKCP accredited psychotherapist, supervisor and trainer
There is also a common misconception that those with anorexia must be very underweight. The truth is, anorexia, like other eating disorders, is a mental health condition, meaning it affects your thoughts and behaviours. In some cases, those behaviours can lead to dramatic weight loss, but not always.
You cannot tell if someone has anorexia by looking at them. This is why it's important for us to understand anorexia and to recognise its signs and symptoms so we're not relying on the way someone looks to identify if they need help.
Integrative counsellor Kel O'Neill Reg MBACP (Accred.), Fellow ISPC, explains how counselling can support anorexia recovery.
Signs and behaviours of anorexia
An important point to remember when discussing eating problems is that, while many behaviours and symptoms are ‘typical’ and commonly seen in those with that particular eating problem, no two people will experience it in exactly the same way.
If you are concerned about the way you approach eating and your weight but don’t feel you ‘fit’ the following signs and behaviours, please don’t hesitate to get support. Everyone is deserving of support.
If you have anorexia, you may experience the following:
- worrying about gaining weight
- feeling anxious about eating high-calorie/fatty foods
- thinking about the way your body looks a lot
- thinking about food, when and what you’ll eat a lot
- not being honest when friends/family ask about what you’re eating
- hiding food or trying to get out of eating
- exercising or purging to 'undo' what you’ve eaten
- feeling low/depressed after eating
- withdrawing from social situations
- feeling that you’re overweight even when others say you’re not.
You may find yourself covering up any weight loss you experience or trying to hide the fact that you’re trying to lose weight. Because of this, it can be hard for others to recognise what is going on.
When you’re going through anorexia, you may feel like you don’t have a problem and that you have control of the situation. Recognising that your thinking is not supportive can be the first step to moving forward.
Getting support for anorexia
When you have an eating disorder like anorexia, the thought of getting support may feel scary. You might worry about what the recovery process will involve. Getting support, however, isn’t about doctors telling you what to do. It's about helping you understand why you think the way you do, how you can break the cycle and, ultimately, feel better physically and mentally.
Identifying my eating disorder voice was the most pivotal aspect of my recovery. I had to recognise that this part of my mind was not healthy, and was not going away. So if I wanted to get better, I’d have to call out my eating disorder voice every single time it popped up.
Here are some ideas to help you take that first step to feeling better:
- Talk to a friend or family member. Let them know you’re not happy and that you want help to change this.
- See your GP and tell them how you feel. If you’re nervous about going alone, take a friend or family member with you.
- Make an appointment with a counsellor. Find someone who resonates with you and explain that you’re worried about the way you feel.
- If appropriate, join a support network for people with eating disorders (avoid any sites that promote or encourage eating problems).
How to help someone with anorexia
If you think someone you care about has an eating problem like anorexia, it can help to encourage them to speak to someone. They may not think they have a problem or may be afraid to seek help initially. Starting the conversation can let them know you are there for them.
Keep including them in social activities so they don’t feel any more isolated. You may want to consider avoiding occasions that revolve around food, as this can be stressful for someone struggling with an eating problem.
Be sure not to neglect yourself during this. When caring for others, it can be easy to put your own needs on the back burner. If you’re struggling, you may find our carer support page helpful.
Anorexia treatment
Once you have acknowledged that you want to make a change or need support, you can start exploring what can help. Everyone is different, but below are some avenues to explore.
Psycotherapy
Counsellors and psychotherapists are trained to help people having difficulties with their mental health. Therapy offers a safe space to talk about how you feel and work with the professional to navigate conditions like anorexia.
According to the National Institute for Health and Care Excellence (NICE), the following therapy options should be considered when treating adults with anorexia:
- individual eating-disorder-focused cognitive behavioural therapy (CBT‑ED)
- Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
- specialist supportive clinical management (SSCM).
Alongside psychological support, your doctor can also monitor your physical health. You may work with a nutrition professional for advice on nourishing your body.
Challenging negative thoughts
Many people with anorexia describe it as a voice in their head, telling them negative things and telling them not to eat. Acknowledging that this is the eating disorder and not you can help you start fighting back and challenging it.
Medication
Medication should not be offered as the sole treatment for anorexia. Some medications may be advised to help while you receive psychological support. Your doctor will discuss this with you and may recommend these if they feel they're right for you.
Spending time in a clinic
If you don’t get help for anorexia, it can make you very unwell. If your doctor or counsellor is concerned for your health, they may recommend you spend some time at an eating disorder clinic. Here you can get a higher level of care, depending on your circumstances.
You may be required to stay as an inpatient so you have constant support. Your mental and physical health will be monitored, and the ultimate aim will be to get you healthy.
Talking about how you feel
Anorexia can be a lonely experience. You may think that nobody understands you, or that you don't deserve to be heard. Anorexia can make people believe this, but the truth is, everyone deserves support.
Opening up and telling others how you're feeling can help reduce any feelings of shame and isolation you may be experiencing. Some people may also find it helpful to write about their feelings in a journal.
What should I be looking for in a counsellor or therapist?
While no law sets a required level of training for counsellors working in this area, it is recommended to work with someone who has had specific training in eating disorders.
Eating disorder specialist, Linda Snape MBACP (Accred), MSc, shares tips for choosing the right support for an eating disorder.
When you're ready, you can use our site to connect with a therapist.
