Anorexia Nervosa

What is Anorexia Nervosa?

An anorexic person starves him/herself in order to feel in control. Their whole self-evaluation depends on how much they eat and their body weight.

Anorexics have an irrational and intense fear of gaining weight or becoming obese. To prevent this happening, they restrict the food that they eat. Not all anorexics eat the same type or quantity of food, but their daily energy needs are never met.

Because of the small quantities of food eaten, the person becomes underweight. They refuse to maintain a normal body weight with respect to their age and height.

Anorexics also experience a disturbance in the way they see their body. They imagine themselves to be much bigger than what they truly are.

This means that no matter how little food the person eats, or how much weight they lose, they always need to eat less or lose more weight to feel happy with themselves and with life. They are not able to recognise the seriousness of their disorder. They feel that if they stop their habit, then they would have lost everything in life, they would have lost all control. The truth is that they would not be in control, but rather, the disorder has taken control of them.

Anorexia affects men and women differently. Women may experience the absence of three or more consecutive menstrual cycles (amenorrhea), while men may become impotent and lose their sexual drive.

Types of Anorexia

There are two types of anorexia:

1. Restricting type -the person refuses to eat, often nearing the point of starvation. This may include over-exercise, but the person does not regularly binge-eat or purge.

2. Binge-eating/ purging type - the person regularly makes themselves vomit, over-exercises, or misuses laxatives or other drugs that make them lose weight.

Signs and Symptoms

Physical

Although anorexia causes multiple physical problem which need medical attention, an anorexic will refuse to receive help. An intervention which could possibly threaten their continuation of their eating behaviour is something they would want to avoid.

Behavioural

Probably, the most noticeable behavioural change in a person with anorexia may be seen in the eating habits of the person.

The anorexic would have a diet restricted to only a few “safe” foods, which are low in fat and calories. There is a fixation on weighing food and counting their calorie intake. Since many of these foods are tasteless, salt and pepper, spices or other flavourings may be added to the food.

The person would also eat very little quantities of food. One would also expect to see a person who has been affected skipping meals or making excuses for not eating. In order to get rid of the feeling of hunger they fill up their stomachs by drinking large quantities of water, or other sugar-free drinks.

The preoccupation with food means that they are thinking about food all the time, but they do not let themselves eat. To satisfy this obsession anorexics may collect recipes and cook elaborate meals for others but not eat it themselves.

People affected by anorexia feel very tense around food. They cut food into tiny pieces and eat very slowly. They may even spit food out after chewing it.

Eating food or simply being around food in public is a very traumatic situation. There is rarely food that suits their requirements, and the presence of ‘bad’ foods is threatening to them.  Moreover, they may feel not understood if people urge them to take food that they do not want to eat. The situation makes them feel different to others and very isolated and lonely.

In the purging type of anorexia the person may consume large volumes of water or diet soft drinks to make vomiting easier.

Psychological and Emotional

As previously mentioned, all eating disorders are due to a psychological problem.

Anorexics base their self-evaluation largely or exclusively on their body shape or weight. This disease is about control, and the sufferers believe that the only way they can remain in control of their lives is by controlling what they eat and what they look like. Eating is associated with guilt and shame.

Since they are never satisfied with the weight they lose, they are never at peace with themselves, and have a low self-esteem. It is therefore not uncommon for an element of depression to also be present. Furthermore they live in constant fear of becoming overweight.

Their will to lose weight gives them a poor insight into their problem. A distorted body image makes them think that they are fat even though they are underweight. They often refuse to accept that their weight is dangerously low, even when they may be in danger of dying.

Because of the lack of energy from food anorexics suffer from reduced concentration, low moods and mood swings.

Perfectionism, Obsessive Compulsive Disorder, and once again depression are all predisposing factors and hence might also be present during the disorder.

Social

Socially, anorexic people are unable to lead normal lives. They withdraw from friendships, and relationships with family members also deteriorate. This is due to multiple factors. Firstly the person would be very low on energy and will not be able to socialise. More importantly though, anorexia is a very isolating disorder. The person feels that they are different, not understood, and that any venture into the public is a threat to them eating in a way that they would not feel comfortable. Attending restaurants, planned meals or social events is a living nightmare for them.

Due to the lack of energy and aversion to socialising, the person also cuts off from activities they previously enjoyed or excelled in.