Anorexia nervosa

Anorexia nervosa is characterised by an overwhelming fear and phobia of normal body size. The individual severely restricts food intake in order to lose weight and may also use other behaviours such as self-induced vomiting, misuse of laxatives or excessive exercise. The four features a doctor checks for when assessing whether a person has anorexia are:

  • Intentional weight loss leading to a body mass index of less than 17.5 kg/m
  • Phobia of normal weight
  • Distorted body image
  • Periods stop in girls and women, loss of libido in both men and women

There are many other characteristics and behaviours of people with anorexia. Those affected are likely to have some but not always all of these characteristics:

  • Abnormal/extreme means of weight control
  • Calorie counting
  • Frequent weighing
  • Eating slowly and cutting up food very small
  • Chewing food and spitting it out
  • Irregular food intake, conflict at meal times and concern about eating with others
  • Preoccupation with food
  • Excessive exercise
  • Abdominal pain, gastrointestinal disturbance, headache
  • Mood swings, depression, anxiety, self-harm
  • Low self esteem
  • Social withdrawal
  • School refusal
  • Anxieties about psychosexual development

Some patients with anorexia nervosa achieve weight loss by dietary restriction alone (restrictive subtype) while others also show bulimic behaviours such as bingeing, vomiting and laxative misuse (binge-purge subtype).

How common is anorexia?

Anorexia affects between 0.2 and 0.8 per cent among young women. The peak age of onset is between the ages of 15 and 19 and high risk groups include dancers, models and athletes.

What causes anorexia?

There is always a complex number of causes behind an eating disorder and every individual will experience a unique set of difficulties. They can include some or all of the following:

  • Genetic predisposition
  • Childhood trauma and abuse
  • Family difficulties
  • Stressful life events
  • Personality factors
  • Low self esteem

Dieting is also a risk factor but most dieters do not develop an eating disorder, so other factors must be involved. There is continuing debate about the role of socio-cultural factors such as media pressure to conform to an unrealistic body shape.

Anorexia in children

It is very important to identify anorexia in children and begin treatment at an early stage. In children, significant nutritional compromise can occur without weight loss and a static weight can indicate significant under-nutrition at a time of growth. BMI norms differ according to age and BMI centile chats should therefore be used to assess weight in those under sixteen. Children may decompensate physically more rapidly than adults and become dehydrated more easily. Urgent action is required of the child’s physical health is significantly compromised. Longer term medical complications include growth retardation, pubertal arrest and reduction in peak bone mass. Physical causes of weight loss should always be excluded in children and referral to a paediatrician may be indicated. Newbridge House specialises in the treatment of children and young people, admitting patients aged between 12 and 18.

How is anorexia treated?

All individuals with anorexia should see a psychiatrist specialising in eating disorders who will make an initial assessment. This assessment will be cover their physical and psychological health, risk factors, physical and psychological complications and their treatment needs. Many people with anorexia are suitable for outpatient treatment. However some people will need to be admitted for inpatient treatment, which means moving to a specialist eating disorder centre for a period of normally several months. People who are likely to require inpatient admission for anorexia treatment are likely to have some of the following difficulties and characteristics:

  • Very low weight or rapid weight loss
  • Serious physical complications
  • Severe psychiatric difficulties
  • Failure of outpatient treatment
  • Need for separation from family

Treatment should be delivered by a range of different professionals who are all specialists in eating disorders. A multi-disciplinary approach is very important in order to effectively address all the difficulties the individual is facing and helping them to find ways of overcoming their eating disorder. At Newbridge House we use a established, effective psychological treatments which include family therapy, cognitive behavioural therapy, mindfulness-based CBT, and motivational enhancement therapy. A variety of professionals provide support and meet individual needs in different ways, including a dietitian, occupational therapy and full-time counselling service within our eating disorders centre in Newbridge House. Because of the age of our patients, we also have a full education service to enable individuals to continue with their school and college work throughout treatment.