What are the symptoms of Anorexia?

Introduction

Anorexia nervosa is a very serious mental illness characterised by an overwhelming fear of being a normal weight (it is not a fear of ‘being fat’). The first signs of anorexia are usually sudden and significant weight loss but it can be hard to know exactly what this means; people regularly go on diets, lose weight and are congratulated for doing so. How much should be considered signs of anorexia? The SCOFF questionnaire, constituted of five simple questions for GPs to ask patients, suggests losing a stone in less than three months is a ‘red light’ of anorexia symptoms. The traditional diagnosis for anorexia is based on a Body Mass Indicator (BMI) of less than 17.5 in adults (the measurement used for children and young people under 18 is different).

It is important when considering whether you have symptoms of anorexia, to consider more than just weight loss and also, to think about your weight loss in other ways than simply BMI or amount lost. For example, an individual may have had a normal BMI or been overweight and then start losing weight very rapidly. We would be very concerned about signs of anorexia in an individual whose BMI may still be in the normal range but whose weight loss is very rapid. We consider the full range of signs of anorexia in this section.

 

Understanding anorexia symptoms

People often think of anorexia as a ‘fear of being fat’ but this is not the case; people with anorexia have an overwhelming fear of being a normal weight. In other words, one of the signs of anorexia is you may believe need to lose more weight, or ‘are fat’ while your family and friends are worried about you and say you have become too thin. You find yourself being highly focused on your appearance and extremely critical of it. Your own view of your body and your appearance is very different from other people’s.

It is important to think about and try to understand anorexia symptoms beyond food and eating. All eating disorders are based on an individual’s difficulty with their thoughts and emotions. Feeling unable to manage or control these feelings, the individual expresses this in their relationship with food. The root causes of these emotional difficulties with being different for every individual and there will always be a number of factors interacting together to drive the eating disorder. These might include some of the following: traumatic events, difficulties at school and/or with peers, personality factors (perfectionism, autistic spectrum disorder, obsessive-compulsive disorder), the influence of social media, family factors such as parental separation or relationship difficulties.

 

Signs and symptoms of anorexia

There are many different symptoms of anorexia: behaviours which affected individuals use to restrict their food intake and the psychological distress which is integral to the illness. People may have some of the following symptoms and behaviours:

  • 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

An individual may not have all of the listed symptoms of anorexia. It is very important that if you (or a relative or a friend) are experiencing a number of these signs of anorexia, help and treatment is sought as early as possible. It is widely recognised that treating anorexia is most successful, with the best outcomes (full and lasting recovery) if the diagnosis is made at an early stage so that anorexia does not continue untreated for a long period of time, becoming more difficult to treat.

If your periods stop, this is something that should be taken very seriously as a likely indicator of anorexia symptoms, especially if your periods stop for three to six months and there is no other medical explanation for this. This is medically known as Secondary Amenorrhea. If your periods have not started by the age of 16 but you are at a low weight, this may be one of the signs of anorexia. This is known medically as Primary Amenorrhea. Your periods are important when considering whether you have anorexia symptoms because if your body does not have sufficient calories and nutrients to function normally, it begins to ‘shut down’ some processes and your menstrual cycle is one such process. In men and boys, the way this occurs is in loss of libido (sexual drive). This is one of the effects of anorexia which is more difficult to measure in males because if an individual has anorexia, they are likely to have other symptoms such as depression and low self esteem which are likely to also affect sex drive.

 

Treatment and support

As we have discussed, recognising anorexia symptoms is not straightforward, as they may be masked by other issues, problems may develop over time and if you are unwell, it is may be difficult to evaluate yourself clearly. If you are trying to understand symptoms of anorexia in your child or in a friend, bear in mind, they may be deliberately hiding some of the signs.

The most important thing is to seek a professional opinion, so that if you do need help, anorexia treatment can commence as soon as possible. The best person to go to is your GP, who can assess your risk of anorexia and refer you to specialist services. Although many GPs are very skilled in assessing eating disorders, it is recognised that some people would like to go directly to a specialist in eating disorders, may want a second opinion, or may not feel comfotable speaking to their GP. Young people who are at school or college may be able to speak to a school nurse or counsellor.

At Newbridge House, we specialise in treating anorexia: as an inpatient service, most of our patients are referred to us by health professionals (usually Child and Adolscent Eating Disorders Services, or CAMHS) because they have been diagnosed with anorexia and have a community based treatment programme, but are not gettting on well with the programme. Young people only come into residential (inpatient) care if they are unsafe and unlikely to make an anorexia recovery without coming into an eating disorders unit. You are welcome to contact us and we would be happy to provide more help and advice about how to access anorexia treatment.

 

Outpatient Clinic

In addition to our main inpatient service, we have an outpatient clinic. It is important to say that our outpatient clinic is not primarily for anorexia treatment; it is designed for people aged 14 and over who have bulimia nervosa or binge eating disorder. This is because our outpatient clinic provides a programme of Cognitive Behavioural Therapy which works very well for people with bulimia and binge eating disorders, with individuals coming to Newbridge once a week for hourly sessions with a consultant psychologist.

People with anorexia, particularly children and young people with anorexia, often require more intensive support and monitoring than this outpatient clinic model.

*The measurement which should be used for anyone under the age of 18 is not standard BMI but percentage BMI. This is a measurement of how the child or teenager compares to other people of the same age, height and weight, looking at variation compared to the average.

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