Anorexia: The signs, symptoms and treatment

Anorexia Nervosa, often referred to as anorexia, is a serious mental health condition that causes changes in a person’s relationship with food and eating habits. For people with anorexia, the idea of gaining weight can make them feel extremely anxious or frightened. This can cause them to try to keep their weight as low as possible, usually by limiting what they eat and exercising too much. This can eventually lead the person to develop compulsive behaviours and can also have a serious impact on their physical, emotional and mental health. 

Anorexia is a type of eating disorder. Media often only represents anorexia as a condition affecting young women, but anyone of any gender can develop anorexia. The symptoms of anorexia most commonly develop during teenage years, but they can begin at any age. People of any body shape and size can develop anorexia, but research shows they may be less likely to be diagnosed because of social prejudice. Some people may be diagnosed with atypical anorexia nervosa which is where they experience many symptoms, but may not be underweight or lose weight.

Why do people develop anorexia?

It is not always clear why someone develops anorexia, and the specific causes are different for different people. Worries about body image can often play a role, but while anorexia can seem like it’s all about food and body size on the surface, the root causes are usually linked to how the person feels about themselves and what they’re going through in their lives. The behaviours around eating that other people can see are often just the external expression of an internal struggle.

Mental health difficulties like anxiety and low self-esteem, a family history of eating disorders, addiction, or traumatic experiences like sexual abuse are all associated with developing anorexia. To better understand how anorexia affects a person, it can be helpful to think of it as a coping mechanism. Like any eating disorder, anorexia causes a person to control food and their body to manage distress and feel in control when something else in their life is making them feel out of control or unsafe. Understanding this makes it easier to understand how scary it can be to stop engaging in eating disorder behaviours.  

Signs and symptoms of anorexia

Anorexia is a mental health condition characterised by symptoms in 3 main areas.

1. People with anorexia restrict their food intake which, over time, can cause them to become underweight. 
2. People with anorexia have a fear of gaining weight or becoming bigger.
3. People with anorexia often perceive their body shape or weight in a distorted way and spend a lot of time thinking about their body shape or weight. 

Not everyone who experiences anorexia will have the exact same profile of symptoms and different symptoms can emerge as the condition develops over time. The behaviours associated with anorexia can cause you to experience physical symptoms in your body and can lead to physical health complications over time.

Because some symptoms of anorexia don’t develop straight away, it’s important to keep in mind that you should still reach out for help and support, even if you aren’t experiencing physical symptoms or complications.

Like all eating disorders, anorexia begins in the mind, affecting how you think and feel. Mental distress and inner turmoil significantly impact on wellbeing and they do not have to be accompanied by physical complications to justify care and support. Below is a list of common signs and symptoms of anorexia.

This list doesn’t capture all the signs and symptoms associated with anorexia, as each individual’s experience with anorexia is different. 

Your behaviour when dealing with anorexia

• Missing meals and limiting what you eat and how often you eat
• Weighing yourself all the time
• Not being truthful about when you’ve eaten and what your weight is
• Exercising too much
• Purging food by vomiting or using medications such as laxatives or diuretics to make you need to go to the toilet
• Obsessively thinking about food and how much you’ve eaten
• Avoiding meals with other people 
• Keeping strict rituals around the meals you eat
• Secretly getting rid of food
• Having a fear of gaining weight
• Seeing your weight loss as a good thing
• Not recognising the seriousness of your weight loss

Psychological symptoms of anorexia

• Low self-esteem
• Feeling irritable and having mood swings
• Feelings of guilt or shame
• Being preoccupied with food and calories
• Anxiety and low mood
• You might withdraw from friends and family and end up socially isolated
• Struggling with your body image and believing your body looks different to how others might see it
• Depression may set in and you might develop obsessive and/or compulsive thoughts and behaviour
• Marked change in personality

Physical symptoms of anorexia

• Your weight is lower than what is considered healthy for your age and height
• Being overly active and spending too much time exercising
• Feeling tired after minimal effort
• Feeling dizzy or having brain fog
• Poor circulation, causing you to feel cold
• Your tummy is bloated and retaining fluid
• You might also have constipation and abdominal pain
• Your hair is dry and thinning while your skin is dry and off colour
• Fine, downy hair may start growing on your face and body because your system is trying to keep warm
• If you get periods, these can change, become irregular, or stop entirely
• Loss of interest in sex

Complications of anorexia

Anorexia can lead to malnutrition if the person is starving themselves or trying to eat as little as possible. This causes your body to slow down bodily processes because it doesn’t have enough energy to fuel them. Experiencing physical complications can be frightening, but many of these issues can be reversed and improved with appropriate treatment. Some of the complications that can arise with anorexia include:

• Malnutrition
• Weak or tired muscles and problems with the bones in the body
• Fertility issues 
• Heart problems
• Stomach or digestive problems like acid reflux and stomach pain, diarrhea, bloating, and constipation
• Skin problems
• Hair loss
• Issues with the brain and your nerves, for example, having trouble focusing or forgetting things
• Dehydration and kidney or bowel issues
• Having problems sleeping
• Anaemia (low levels of red blood cells, causing you to feel weak or tired)
• Bloated stomach and fluid retention
• A weakened immune system, making it harder to fight off sickness
• In extreme cases, anorexia can cause death due to heart failure

Anorexia can be a life-threatening condition – it is important to seek treatment if you think you or someone you care about may have anorexia.

Treatment for anorexia

Thinking that you might be experiencing anorexia can be a scary thought, but you deserve to reach out for help and support. No matter how hard it may seem, it is possible to make a recovery. Recovery is not always linear. It can be one step forward and one step back sometimes, and what recovery means to you might be different to what it means for someone else. Everyone’s recovery journey is different and it may take time, but recovery is always possible, at any stage. Recovery also cannot be forced on someone.

Getting help for anorexia

If you think you may have anorexia, going to your GP as soon as you can and letting them know what’s going on is an important first step. They will be able to point you in the right direction to get treatment. Sometimes the idea of speaking to your GP about concerns around eating habits can be daunting. If you feel like you’re not ready to take that step just yet, you could call the Bodywhys helpline. Their helpline is open to anyone, and is delivered by a team of trained volunteers. It offers non-judgemental and confidential support and information about eating disorders.

If you are worried about a friend or family member, talk to them about it and encourage them to go see their GP. You can also offer to go with them if they don’t want to go alone.  Trying to recover from anorexia by yourself can be isolating and difficult. Reach out for support from professionals, family, and friends to help to get you to take care of yourself and recover. 

How treatment works

The types of treatment you receive can depend on your situation, but in general, the treatment will help you address the behaviours that are affecting your food intake and body size, but also work on the thoughts, feelings and experiences that are driving these behaviours. Getting treatment that is evidence-based and specialised for eating disorders makes a substantial difference to a person’s recovery and quality of life. Most people will engage in a mix of talking therapy to help with the psychological side of anorexia and supervised weight gain to help you maintain a healthy weight. People receiving treatment for anorexia sometimes receive some other medical tests and treatments to support their physical health. For example, this could include scans to check the health of your bones and treatment if your bone-density has been affected. 

Talking therapy and family therapy

Talking therapy is usually a part of treatment for anorexia. Some people will take part in individual talking therapy, or group therapy, while others (especially young people) might do family-based treatment with members of their family. The aim of talking therapy is to help you understand the root causes of your eating disorder, and to work towards feeling more comfortable with food.

A form of Cognitive Behavioural Therapy (CBT) called CBT-E is often used to support recovery from anorexia. CBT-E has been enhanced in certain areas, and particular strategies have been added to specifically address eating disorders and their core symptoms. CBT-E looks at the ways that our thoughts affect our behaviours and feelings. Through CBT-E, you can develop strategies to help you build self-awareness and identify triggers, create helpful routines, and manage compulsive thoughts and unhelpful behaviours. All of these are important steps towards a future free from anorexia. 

If you’re younger, you may take part in family-based treatment (FBT), involving you and your family talking with a therapist. FBT will look at how you have been affected by your anorexia, and what your family can do to support you in getting better. 

In-patient treatment

It is often possible to stay at home during treatment. However, in some cases, when someone with anorexia has serious physical symptoms associated with low weight and malnutrition, they may need in-patient treatment in a hospital where specially trained health professionals give them the care they need during their recovery journey. At extremes of low weight, restoring weight should be monitored by doctors and dietitians to make sure it’s managed safely.

In some cases, a period of inpatient psychiatric treatment may also be recommended to support weight restoration and to make sure all of the relevant professionals can be a part of the recovery process. 

Other sources of support for anorexia

You can reach out to Bodywhys for advice or information on anorexia. Bodywhys is the Eating Disorders Association of Ireland and provides confidential support, information, understanding and a listening ear to those affected by eating disorders. You do not need a diagnosis to talk to Bodywhys.

How friends and family can help

Setting out on a recovery journey can be daunting, but you don’t have to do it alone. Recovering from anorexia can be made easier if the people around you take the time to learn about the condition, how it impacts you, and how they can show understanding and support you. If you found the information in this article helpful, it could be a good idea to share it with some of the people in your life.   

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