Anorexia nervosa

Written by Katherine Nicholls

Katherine Nicholls

Counselling Directory Content Team

Last updated on 15th February, 2022

Anorexia is an eating disorder that sees sufferers restrict their food intake. Often this is due to a fear of weight gain, an attempt to regain control and/or as a way to cope with difficult emotions.

Anorexia is a mental health condition that affects the way you think, especially around food, weight and appearance. This can lead to changes in behaviour which can damage well-being and lead to problems in relationships. 

This type of eating disorder can affect anyone, at any stage of their life. Statistics show that it is more commonly reported in young women, however, there are increasingly more reports of men, boys and older women being affected.


Understanding anorexia

Anorexia is often misunderstood, especially by the media. Many believe it is something that happens when someone takes a diet too far. In fact, eating disorders are rarely about food. They often come from other underlying issues. These may include 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. Being able to fixate on their weight, something that they can control feels easier than processing the other emotions.

What often happens is that sufferers become trapped in this way of thinking and truly believe that they need to lose weight. For those with anorexia, this leads to certain behaviours like limiting the amount of food they eat, purging after eating and/or over-exercising.

This way of thinking and behaving is exhausting for both body and mind and can cause sufferers to develop associated mental health problems like depression, self-harm and substance abuse.

During times of stress or trauma, the pre-occupation with food, weight and appearance can become a welcome distraction from difficult feelings and everyday life pressures. Being able to control ones food or body provides a sense of power and control that serves as a coping mechanism for feeling scared and overwhelmed.

- Sonja Antony MBACP(accred) MSc Psychol

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. 


Signs and behaviours of anorexia

An important point to remember when discussing eating problems is that while many of the behaviours and symptoms are ‘typical’ and commonly seen in those with that particular eating problem, no two people will experience it in the exact 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 needs a helping hand and everyone is deserving of support. 

If you have an eating problem such as 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 at mealtimes
  • 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 try to hide the fact that you’re trying to lose weight. Because of this, it can be hard for others to recognise there is something 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. Understanding that the way you’re thinking is unhelpful and making you unhappy is the first step to moving forward. Things don’t have to be this way. Your life doesn’t have to revolve around your weight, food or the way you look. You are so much more than that and life has so much to offer.

Everyone needs help sometimes, so don’t be afraid to reach out. 

Therapists who can help with anorexia

Getting support for anorexia

When you’re in an anorexic state of mind, the thought of getting support can be scary. You may worry about what the recovery process will involve and that you will lose ‘control’. 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 change this, break the cycle and ultimately help you feel better, both 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. 

- Read Laura's story

Here are some ideas to help you take that first step to feeling better:

  • Join online support networks for people with eating problems and share your story (avoid any sites that promote or encourage eating problems as these will make you feel worse).
  • 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 that resonates with you and explain that you’re worried about the way you feel.

What can help - anorexia treatment

Once you have acknowledged that you want to stop thinking the way you do about yourself and food, you can start to explore some things that can help. Everyone is different, but below we have listed some ideas to get the ball rolling.

Talking about how you feel

Anorexia can be a very lonely experience. You may think that nobody understands you, or that you don't deserve to be heard. This is the anorexia talking. Anorexia makes people believe they are not worthy of food, love or even support. This is simply not true. You will no doubt have people in your life who are worried about you and are ready and waiting to support you.

Open up and tell them the way anorexia makes you think sometimes. You may even find it helpful to show them this page to help them understand it better. Talking about your feelings helps you not bottle them up. You may also find it helpful to write about your feelings in a journal.

Counselling

Counsellors are trained to help people having difficulties with their mental health. What counselling offers people is a safe space to talk about how they feel and work together with the counsellor to navigate problems.

There are certain talking therapies that have been found useful for people with anorexia, these include:

Alongside the psychological support, your doctor will also keep an eye on your physical health and you may work with a nutrition professional to give you 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 is key. Then you can start fighting back and challenging it.

When this voice speaks to you negatively, argue with it. You may feel silly or even that you’re lying at first, but stick with it. As you improve you will be able to start doing the opposite of what it’s telling you to do, for example eating when it tells you not to.

Medication

There are some medications that may be able to help whilst you receive psychological support. Your doctor will recommend these if they feel it’s the right choice for you, but be sure to ask questions and come to a conclusion together.

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 well-being, they may recommend you spend some time at an eating disorder clinic. Here you can get a higher level of care, depending on your individual 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.


How to help someone with anorexia

If you think someone you love has an eating problem like anorexia, it can help to encourage them to speak to someone. Often they will not think they have a problem or may be afraid to seek help. Starting the conversation can let them know you are there for them.

Try not to force anything on them or give them ultimatums. This may make them withdraw and be more secretive about their eating habits. Instead, express your love and concern for them and explain that you want them to be happy.

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.

Encourage them to find support online. It can help them to understand more about the way they’re thinking and to talk to others going through something similar.  

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.

What happens after they recover?

Recovery can be a long road for some and may involve relapses (when the person goes back to old thinking/eating habits). They will likely have good days and bad days. They may even feel scared of ‘giving up’ their eating disorder. It can become so ingrained into a person’s identity that it feels alien to be without it.

After recovery, they will still need your support. You can help them rediscover who they are as a person without an eating disorder. Most people who have had eating problems are able to lead a fulfilling life and develop better ways of coping, but it can return during times of high stress.

Being mindful of this and always offering your support is the best way to be there for them. If you notice any similar behaviours from when they first had problems with eating, you may want to gently encourage them to talk about how things are.

I consider myself blessed to have come this far; the journey is certainly not over, it might not ever end, but as long as my feet are facing forward there will always be two pairs of footprints in the sand, as I will not walk alone in this battle.

- Read Hannah's story

What should I be looking for in a counsellor or therapist?

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) has put together some clinical guidelines that outline recommendations about psychological treatments, treatment with medicines and what kind of services help individuals with eating disorders.

For more information, please visit the full NICE guidelines:

Eating disorders: NICE guidelines


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