Information on Anorexia Nervosa

Commonly thought of as a 'slimmers' disease', anorexia nervosa is an expression of much deeper issues. It is a way of coping with uncomfortable feelings and difficult problems - a way of controlling something in life. The person with anorexia nervosa is starving and has a fear of being of a normal weight. They believe that if they eat normally they will become fat and lose control of eating, so they become obsessed with food, counting calories and working out elaborate ways of avoiding food.

Diagnostic criteria:

  • Loss of at least 15% of body weight and a refusal to maintain a minimum normal weight appropriate for the person's age and height.
  • Intense fear of becoming fat.
  • Disturbance of body image.
  • Absence of three consecutive menstrual cycles, when menstruation has previously been established (in males lack of libido).

Symptoms include:

  • Loss of weight.
  • Food intake (number of calories and variety of foods) increasingly restricted.
  • Food cravings, thoughts dominated by food, eating and cooking all the time.
  • Fear of becoming fat, which often intensifies as weight decreases.
  • Inflexible, rigid, black and white attitude and thinking.
  • Need for control - especially around food.
  • Slow pulse, low blood pressure.
  • Body temperature reduced.
  • Feeling cold, poor blood circulation to extremities, so cold hands and feet and chilblains.
  • Laguno (fine downy) hair grows on the body to conserve heat.
  • Tiredness and reduced concentration, but often still striving for perfectionism, working and exercising harder.
  • Lack of essential fatty acids so hair becomes dry and falls out and skin becomes dry.
  • Imbalance of minerals in blood - low potassium, low calcium (possible osteoporosis).
  • Lack of sufficient fat cells to secrete oestrogen, which protects against osteoporosis.
  • Lack of menstrual periods. Low libido (sex drive). Menstruation usually stops below BMI 15, and usually (but not always) restarts at BMI 18/19.
  • High cortisol levels producing night waking and palpitations.
  • Frequently the person will deny that anything is wrong.

The body survives by shutting down non-essential processes

Starvation results in the release of endorphins (morphine like hormones) by the body. These give a "euphoric high" which is lost when the person eats, resulting in them going "cold turkey". This is the same sort of effect as is experienced by people coming off drugs and suffering withdrawal symptoms.

Some observable signs:

  • Refusal to maintain body weight.
  • Obsessive fear of gaining weight ~ continuing to diet when goal weight has been reached.
  • Increased interest in food eg cooking, recipe books.
  • Needing to eat less than others. Wanting to cook for others and encouraging them to eat more.
  • Rigidity and perfectionism around all things and especially food.
  • Eating at rigidly prescribed times, carefully controlled amounts.
  • Calorie counting.
  • Reducing the range of foods eaten (a common first sign is vegetarianism) ~ going on fad diets with poor nutrition.
  • Becoming phobic about eating with others. Worrying that others are watching them when they eat.
  • Skipping meals and avoiding social pursuits which involve eating.
  • Body image disturbance ~ complaining of being fat when they look thin.
  • Wearing baggy clothes.
  • Menstrual irregularities.
  • Personality change ~ moody, secretive, irritable, previously flexible personality becoming intractable.
  • Hoarding, concealing, throwing away food, avoiding meals.
  • Thinking becoming rigid ~ black and white.
  • Social isolation.
  • Perfectionism ~ spending increasing amounts of time studying.
  • Becoming indecisive ~ not handing work in on time.
  • Obsessive exercise.
  • Cold hands and feet, chilblains, feeling cold.
  • Laguno hair (downy hair to conserve heat) growing on body.
  • Dry skin.
  • Hair loss.
  • Lack of balance in life - obsessive about study and diet.