What is Anorexia Nervosa?

Anorexia Nervosa

Anorexia nervosa is a serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss.
Symptoms

• Inadequate food intake leading to a weight that is clearly too low.
• Intense fear of weight gain, obsession with weight and persistent behavior to prevent weight gain.
• Self-esteem overly related to body image.
• Inability to appreciate the severity of the situation.
• Binge-Eating/Purging Type involves binge eating and/or purging behaviors during the last three months.
• Restricting Type does not involve binge eating or purging.

Eating disorders experts have found that prompt intensive treatment significantly improves the chances of recovery.  Therefore, it is important to be aware of some of the warning signs of anorexia nervosa.
Warning Signs

• Dramatic weight loss.
• Preoccupation with weight, food, calories, fat grams, and dieting.
• Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g. no carbohydrates, etc.).
• Frequent comments about feeling “fat” or overweight despite weight loss.
• Anxiety about gaining weight or being “fat.”
• Denial of hunger.
• Development of food rituals (e.g. eating foods in certain orders, excessive chewing, rearranging food on a plate).
• Consistent excuses to avoid mealtimes or situations involving food.
• Excessive, rigid exercise regimen--despite weather, fatigue, illness, or injury, the need to “burn off” calories taken in.
• Withdrawal from usual friends and activities.
• In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.

Health Consequences of Anorexia Nervosa
Anorexia nervosa involves self-starvation.; The body is denied the essential nutrients it needs to function normally, so it is forced to slow down all of its processes to conserve energy. This “slowing down” can have serious medical consequences:

• Abnormally slow heart rate and low blood pressure, which mean that the heart muscle is changing.  The risk for heart failure rises as heart rate and blood pressure levels sink lower and lower.
• Reduction of bone density (osteoporosis), which results in dry, brittle bones.
• Muscle loss and weakness.
• Severe dehydration, which can result in kidney failure.
• Fainting, fatigue, and overall weakness.
• Dry hair and skin, hair loss is common.
• Growth of a downy layer of hair called lanugo all over the body, including the face, in an effort to keep the body warm.

About Anorexia Nervosa

• Approximately 90-95% of anorexia nervosa sufferers are girls and women.
• Between 0.5–1% of American women suffer from anorexia nervosa.
• Anorexia nervosa is one of the most common psychiatric diagnoses in young women.
• Between 5-20% of individuals struggling with anorexia nervosa will die.  The probabilities of death increases within that range depending on the length of the condition.
• Anorexia nervosa has one of the highest death rates of any mental health condition. 
• Anorexia nervosa typically appears in early to mid-adolescence.

ating disorder treatment step #1: Ask for help

It can be scary and embarrassing to seek help for an eating disorder but gaining support from a trusted friend, family member, religious leader, school counselor, or work colleague is for many people the first step on the road to recovery. Alternately, some people find it less threatening to confide in a treatment specialist, such as an eating disorder counselor or nutritionist.
Whoever you select as a confidant, set aside a specific time to discuss your situation with them, ideally in a quiet, comfortable place away from other people and distractions. Remember, your friend or family member may be shocked when you disclose details of your eating disorder. They may even be angry or confused, unsure of how to respond or the best way to help you. It’s important to remain patient. Take time to educate them about your specific eating disorder and the ways you’d like them to support you during the recovery process.

How to talk to someone about your eating disorder

The more specific the information you offer, the better the person you’re speaking with will understand and be able to help. Answer the following questions and include the answers you are comfortable revealing:

• When did you begin having different thoughts regarding food, weight, or exercise? What were the thoughts?
• When did the different behaviors start? What was the behavior and did you hope to accomplish something specific (lose weight, gain control of something, get someone’s attention)?
• Have you noticed any physical health effects (fatigue, loss of hair, digestive problems, loss of menstrual cycle, heart palpitations, etc.)? Or any emotional effects?
• How are you currently feeling physically? Emotionally? Do you feel ready to stop the disordered eating behaviors?
• How can the people in your life best support you? Do you want them to monitor your behavior?
• Do you want them to ask you how you are doing with your recovery or would you rather tell them?

Source: National Eating Disorders Association

Eating disorder treatment step #2: Find a specialist

Eating disorder recovery is much easier when you have experienced, caring health professionals in your corner. It’s important to find a professional counselor or nutritionist who specializes in anorexia or bulimia. As you search, focus on finding the right fit, someone who makes you feel comfortable, accepted, and safe. To find an eating disorder treatment specialist in your area:

• Ask your primary care doctor for a referral.
• Check with local hospitals or medical centers.
• Ask your school counselor or nurse.
• Call the National Eating Disorders Association’s toll-free hotline at 1-800-931-2237 (Mon–Fri, 8:30 a.m. to 4:30 p.m. PST).

Eating disorder treatment step #3: Address health problems

Anorexia and bulimia can be deadly—and not just if you’re drastically underweight. Your health may be in danger, even if you only occasionally fast, binge, or purge, so it’s important to get a full medical evaluation. If the evaluation reveals health problems, they should take top treatment priority. Nothing is more important than your physical well-being. If you’re suffering from any life-threatening problem, you may need to be hospitalized in order to keep you safe.

Eating disorder treatment step #4: Make a long-term treatment plan

Once your health problems are under control, you and your doctor or therapist can work on a long-term recovery plan. First, you’ll need to assemble a complete eating disorder treatment team. Your team might include a family doctor, a psychologist, a nutritionist, a social worker, and a psychiatrist. Then you and your team will develop a treatment plan that’s individualized to meet your needs.
Your eating disorder treatment plan may include:

Inpatient treatment Individual or group therapy Family therapy

Eating disorder education Nutritional counseling Medical monitoring

An effective treatment program for eating disorders should address more than just your symptoms and destructive eating habits. It should also address the root causes of the problem—the emotional triggers that lead to disordered eating and your difficulty coping with stress, anxiety, fear, sadness, and other uncomfortable emotions.

Treatment options for anorexia and bulimia

While there are a variety of different treatment options available for those struggling with eating disorders, it is important to find the treatment, or combination of treatments, that works best for you.

Therapy for eating disorders

Therapy is crucial to treating anorexia and bulimia. There are many ways a therapist can work with you, including addressing any feelings of shame and isolation caused by your eating disorder. Different therapists have different methods, so it is important to discuss with a therapist your goals in working towards recovery.
The most common therapy for eating disorders is cognitive-behavioral therapy. This targets the unhealthy eating behaviors of anorexia and bulimia and the unrealistic, negative thoughts that fuel them. One of the main goals is for you to become more self-aware of how you use food to deal with emotions. The therapist will help you recognize your emotional triggers and learn how to avoid or combat them. Cognitive-behavioral therapy for eating disorders also involves education about nutrition, healthy weight management, and relaxation techniques.

Nutritional counseling for eating disorders

The goal of a nutritionist or dietician is to help you incorporate healthy eating behaviors into your everyday life. A nutritionist can’t change your habits overnight, but over a period of time you can learn to develop a healthier relationship with the food you consume.

Eating disorder support groups

While family and friends can be a huge help in providing support, you may also want to join an eating disorder support group. They provide a safe environment where you can talk freely about your eating disorder and get advice and support from people who know what you’re going through.

Online support for eating disorders

You can find online help for anorexia and bulimia at Internet support groups, chat rooms, and forums. Online resources are particularly helpful if you’re not ready to seek face-to-face help or you don’t have an eating disorder support group in your area. See the Resources & References section below.

There are many types of eating disorder support groups. Some are led by professional therapists, while others are moderated by trained volunteers or people who have recovered from an eating disorder.
To find an eating disorder support group in your area:

• Ask your doctor or therapist for a referral
• Call local hospitals and universities
• Call local eating disorder centers and clinics
• Visit your school’s counseling center
• Search the National Eating Disorders Association’s. See the Resources & References section below.

Self-help for eating disorders: Learning new coping skills

Anorexia and bulimia aren’t about food. They’re about using food to cope with painful emotions such as anger, self-loathing, vulnerability, and fear. Disordered eating is a coping mechanism—whether you refuse food to feel in control, binge for comfort, or purge to punish yourself. But you can learn healthier ways to cope with negative emotions.
The first step is figuring out what’s really eating you up inside. Remember, “fat” is not a feeling, so if you feel overweight and unattractive, stop and ask yourself what’s really going on. Are you upset about something? Depressed? Stressed out? Lonely? Once you identify the emotion you’re experiencing, you can choose a positive alternative to starving or stuffing yourself.
Here are a few suggestions to get you started:

Call a friend Listen to music Play with a pet Read a good book Take a walk

Write in a journal Go to the movies Get out into nature Play a favorite game Do something nice for someone else

Coping with anorexia and bulimia: Emotional Do and Don't lists

Do…

• allow yourself to be vulnerable with people you trust
• fully experience every emotion
• be open and accepting of all your emotions
• use people to comfort you when you feel bad, instead of focusing on food
• let your emotions come and go as they please without fear

Don’t…

• pretend you don’t feel anything when you do
• let people shame or humiliate you for having or expressing feelings
• avoid feelings because they make you uncomfortable
• worry about your feelings making you fall apart
• focus on food when you’re experiencing a painful emotion

Adapted from: The Food and Feelings Workbook, by Karin R. Koenig, Gurze Books

Self-help for eating disorders: Improving your self-image

When you base your self-worth on physical appearance alone, you’re ignoring all the other qualities, accomplishments, and abilities that make you beautiful. Think about your friends and family members. Do they love you for the way you look or who you are? Chances are, your appearance ranks low on the list of what they love about you—and you probably feel the same about them. So why does it top your own list?
Placing too much importance on how you look leads to low self-esteem and insecurity. But you can learn to see yourself in a positive, balanced way:

• Make a list of your positive qualities. Think of all the things you like about yourself. Are you smart? Kind? Creative? Loyal? Funny? What would others say are your good qualities? Include your talents, skills, and achievements. Also think about bad qualities you DON’T have.
• Focus on what you like about your body. Instead of searching for flaws when you look in the mirror, appreciate the things you like about your appearance. If you’re distracted by “imperfections,” remind yourself that nobody’s perfect. Even supermodels get airbrushed.
• Challenge negative self-talk. When you catch yourself being self-critical or pessimistic, stop and challenge the negative thought. Ask yourself what evidence you have to support the idea. What is the evidence against it? Just because you believe something, doesn’t mean it’s true.
  
  

Self-help for eating disorders: Learning healthy eating habits

Learning and establishing healthy eating habits is an essential step in recovery from anorexia and bulimia.

• Stick to a regular eating schedule. You may be used to skipping meals or fasting for long stretches. But when you starve yourself, food becomes all you think about. To avoid this preoccupation, make sure to eat every three hours. Plan ahead for meals and snacks, and don’t skip!
• Challenge your strict eating rules. Strict rules about food and eating fuel anorexia and bulimia, so it’s important to replace them with healthier ones. For example, if you have a rule forbidding all desserts, change it into a less rigid guideline such as, “I won’t eat dessert every day.” You won’t gain weight by enjoying an occasional ice cream or cookie.
• Don’t diet. Healthy eating—not dieting—is the key to avoiding weight gain. Instead of focusing on what you shouldn’t eat, focus on nutritious foods that will energize you and make your body strong. Think of food as fuel for your body. Your body knows when the tank is low, so listen to it. Eat when you’re truly hungry, then stop when you’re full.

Relapse prevention for anorexia and bulimia

The work of eating disorder recovery doesn’t end once you’ve adopted healthy habits. It’s important to take steps to maintain your progress and prevent relapse.

• Develop a solid support system. Surround yourself with people who support you and want to see you healthy and happy. Avoid people that drain your energy, encourage disordered eating behaviors, or make you feel bad about yourself.
• Stick with your eating disorder treatment plan. Don’t neglect therapy or other components of your treatment, even if you’re doing better. Follow the recommendations of your treatment team.
• Fill your life with positive activities. Make time for activities that bring you joy and fulfillment. Try something you’ve always wanted to do, develop a new skill, pick up a fun hobby, or volunteer in your community. The more rewarding your life, the less desire you’ll have to focus on food and weight.
• Avoid pro-ana and pro-mia websites. Don’t visit websites that promote or glorify anorexia and bulimia . These sites are run by people who want excuses to continue down their destructive path. The “support” they offer is dangerous and will only get in the way of your recovery.
• Identify your “triggers.” Are you more likely to revert to your old, destructive behaviors during the holidays, exam week, or swimsuit season? Know what your triggers are, and have a plan for dealing with them, such as going to therapy more often or asking for extra support from family and friends.