Anorexia
People suffering from anorexia nervosa are starving themselves. They have an intense fear of putting on weight/of being fat. They take strict control of their eating, so they become obsessed with food, counting calories and working out elaborate ways of avoiding food and restricting their food intake.
They may also try to lose weight by excessive exercise, using slimming pills, and/or by various purging methods, e.g. vomiting or using laxatives.
The diagnostic criteria used by the NHS:
Significantly lower body weight than appropriate for the person's age and height, caused by their refusal to maintain a minimum anorexia normal weight
Intense fear of gaining weight
Disturbance of body image or denial of the dangers of their low weight
Symptoms include:
Significant loss of weight
Food intake increasingly restricted: number of calories and variety of foods
Thoughts dominated by food, eating and cooking
Fear of becoming fat, which often intensifies as weight decreases
A distorted view of their body shape/weight – think they are fat when they are underweight
Inflexible, rigid, black-and-white thinking
Need for control - especially around food
Slow pulse, low blood pressure
Feeling cold, poor blood circulation to extremities, so cold hands and feet and chilblains
Fine downy hair grows on the face and body to conserve heat (lanugo)
Hair becomes dry and falls out and skin becomes dry
Swollen hands and feet
Constipation and bloating - stomach pains
Loss of muscle and bone strength (osteoporosis); weak and dizzy
Lack of menstrual periods
Low libido (sex drive)
Heart problems, palpitations
Some observable signs:
Refusal to maintain body weight
Obsessive fear of gaining weight, continuing to diet when a supposed “goal weight” has been reached
Increased interest in food eg cooking, recipe books, talking about food
Eating less than others, while wanting to cook for others and encouraging them to eat more
Eating at rigidly prescribed times, carefully controlled amounts
Obsessive calorie counting
Cutting food up into tiny pieces
Reducing the range of foods eaten, strict dieting, avoiding fattening food, only eating low-calorie food, periods of fasting
Hiding and throwing away food
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
Repeated weighing and measuring of body, checking body shape in mirror
Lie about what and when they ate, lie about their current weight – find ways to “cheat” the scales
Personality change: moody, secretive, irritable, previously flexible personality becoming intractable
Social isolation
Tiredness and reduced concentration, but often still striving for perfection, so studying, working and exercising harder
Self-harming and suicidal thoughts
Underestimate/deny how serious their condition is
Some people with anorexia also purge to keep their weight low – see bulimia for the problems caused by vomiting and laxative use.