Anorexia nervosa is a serious illness characterised by extreme weight loss caused by behaviours of dieting/food restriction and/or excessive exercise to the point of self-starvation, which may result in death. Due to the irrational fear of weight gain an individual develops inappropriate eating habits or rituals and compensatory behaviours in an effort to “burn off” calories. Sufferers may display an obsession with having a thin body and often have a distorted body self-perception; seeing themselves as fat when they are clearly underweight.
Individuals with anorexia tend to experience extreme anxiety and fear around food and eating, which to others will seem irrational or even bizarre. In a seemingly paradoxical way the more the individual tends to lose weight and engage in food avoidance the more extreme their fears and behaviours tend to become.
Anorexia is not a choice nor is it something that one can “snap out of”. Sufferers experience not just anxiety but extreme feelings of guilt, panic, hopelessness and distress that are very frightening to them and those around them. A defining characteristic of the disorder is the individual’s denial of the problem and ambivalence to engage in treatment.
Anorexia occurs in approximately 0.5% of females and in only 0.05% of males, with the average age of onset in early to mid adolescence. However, younger and older adults may also present for treatment.
The factors contributing to the development of anorexia are complex and include a strong genetic component. These genes tend to get switched on through environmental influences such as dieting behaviour or extreme exercising, particularly after puberty. Personality traits of perfectionism and fear of failure, low self esteem, emotion avoidance and obsessionality are very common in individuals with anorexia.
Anorexia nervosa is the third most common chronic disorder affecting adolescent girls, with the highest mortality rate of all psychiatric disorders. Statistically about 40 – 50% of people with anorexia will make a full and complete recovery, a further 30% partial recovery and approximately 20% have a chronic course of illness.
There is a strong statistical association between duration of illness and chances of recovery. Adolescents with an illness duration of up to 3 years have an especially good chance of full recovery when treated with Family Based Treatment (FBT). After an illness duration of 6 years and more, the chances of full clinical recovery, at least statistically, decrease significantly. However, there have been reports of individual cases who have achieved close to full, or at least partial recovery after many years of illness. It is important to always remain recovery oriented and develop realistic and achievable treatment goals that are meaningful for each individual.
Getting help as early as possible is essential.
- Refusal to eat
- Weight loss
- Denial of hunger, even when starving
- Skipping meals
- Avoiding eating with others and the family
- Secrecy around food, lying about what eaten, how much and when
- Only eating perceived “healthy food”
- Cutting out certain food types and whole food groups, usually high calorie, high fat, high carbs
- Adopting rigid meal or eating rituals (e.g. only eating at certain times, cutting food into tiny pieces)
- Weighing or measuring food
- Constant preoccupation with food
- Cooking for others but refusing to eat it themselves
- Obsession with weighing/body size and shape
- Complaining about being fat, bloated or feeling full
- Wearing baggy and layered clothing
- Excessive exercise/ purging/ vomiting
- Difficulty concentrating, lack of motivation (for everything other than food/exercise)
- Changes in personality and patterns of social interaction
- Obsessive compulsive behaviour
- Depression and mood swings
- In females cessation of menstrual periods (amenorrhoea)
- Feeling cold to the touch
- Feeling tired/dizzy
Treatment of anorexia needs to address the medical, nutritional, psychological and behavioural aspects of the illness. NZEDC works closely with medical practitioners who are familiar with the medical monitoring of patients with anorexia. We will also refer to a dietitian if needed.
In all current international treatment guidelines FBT is recommended as the first line treatment with the highest evidence rating for adolescents with an illness duration of up to 3 years, .
For adults presenting with anorexia nervosa, psychological therapy is considered essential. Specialist therapist-led manualised based approaches are being recommended as first line treatment. The Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) , Cognitive Behavioural Therapy (CBT or CBT-E) and Specialist Supportive Clinical Management (SSCM) have all been investigated in several trials and have shown similar outcomes. So far there is no conclusive evidence available yet that can direct to the best choice of treatment modality for each individual.
For extended reading regarding anorexia nervosa and recommendations for treatment please refer to: Royal Australian and New Zealand College of Psychiatrists Clinical Guidelines for the Treatment of Eating Disorders, 2014. http://anp.sagepub.com/content/48/11/977.full