Anorexia Nervosa
What Is Anorexia Nervosa?
Anorexia Nervosa, often termed ‘anorexia,’ is a mental health condition. It is a serious problem, but recovery is possible with the right intervention and support.
A person with anorexia has an intense and persistent fear of gaining weight. This fear drives them to restrict their food intake deliberately, even when their body weight is dangerously low.
While it is commonly associated with teenage girls, anorexia (or any eating disorders) can affect anyone regardless of age, gender, or sex. In fact, research shows that transgender people may have a more increased risk of developing eating disorders than cisgender people.
In some cases, people who display anorexic behaviours but might not have an extremely low body weight or BMI – this is a subtype known as atypical anorexia nervosa.
Hence, anorexia is not measured only through body weight or numbers on a scale. One of the significant factors that is considered is the relationship one has with food and self-image.
Dietary restrictions and excessive preoccupation with food and the body can lead to nutritional deficiencies and mood swings and can impact overall physical and mental health.
Moreover, disordered eating can decrease self-esteem and increase feelings of anxiety and depression.
Managing anorexia often involves counselling, nutritional guidance, and medical interventions. Hospitalisation may be necessary in severe cases to stabilise the person’s health.
Keep reading to learn about the symptoms, signs, and causes, seeking professional support, the history of dieting and the origins of anorexia nervosa.
Symptoms of Anorexia
Various factors – like physical, emotional, social, and cultural – contribute to eating disorders. The most common misconception about anorexia is that one can tell if a person has anorexia just by their appearance or body structure.
A person does not need to look a certain way (eg extremely thin or underweight) to have anorexia. People of all sizes and body types can have this disorder. However, they may be less likely to be diagnosed due to the stigma and misconceptions against fat bodies and obesity.
Moreover, someone can have a healthy relationship with food and still be underweight. Eating disorders are complex, and only professional therapists can diagnose a person with anorexia nervosa.
If you or someone you know may suspect they might have an eating disorder, it is important to seek professional help.
Emotional Symptoms
Emotional signs and symptoms of anorexia nervosa include:
Physical Symptoms
Physically, anorexia nervosa can present as:
Physical symptoms that are side effects of malnutrition and starvation include:
Behavioural Symptoms
Anorexia nervosa can be identified through the below behavioural symptoms:
Causes of Anorexia
All eating disorders, including anorexia, are complex issues. Therefore, the exact cause of anorexia is unknown.
However, research shows that genetic, psychological, environmental, and sociocultural factors can contribute to the onset of anorexia.
Some of these causes include:
Genetic Predisposition
Research indicates that genetics play an essential role in developing eating disorders. People with close family members suffering from an eating disorder are at a heightened risk of developing disordered eating.
Furthermore, alterations in brain chemistry, specifically in neurotransmitters like serotonin and dopamine, can influence mood, appetite, and impulse control.
Traumatic Experiences
Physical or emotional trauma can trigger anorexic behaviour patterns.
Survivors of abuse or assault might resort to extreme dietary restrictions. They use these self-destructive behaviours as a coping mechanism.
To victims of abuse, controlling their diet and food gives them control in a world that feels uncontrollable.
Societal Pressures
The societal glorification of thinness can create immense pressure.
Media portrayals often equate slimness with success, desirability, and happiness. In contrast, it shows that fatness is something undesirable or shameful.
Due to this external pressure and stigma, people often set unrealistic expectations of their bodies, which can thereby cause anorexia.
Peer Influence
Peer influence is when you do something that you wouldn’t otherwise do, especially because you want to fit in and feel validated by your friends.
During childhood or teenage stages, the influence of peers is extremely high.
Pressure by a person to look and behave a certain way can take a toll on one’s emotional well-being. The influence can manifest in several ways, such as bullying, pressure, conformity, and so on.
Teasing or bullying based on appearance can decrease a person’s self-worth and cause social anxiety. These negative experiences could push a person towards anorexia as a means to fit in.
Eventually, these habits also become a defence mechanism to protect themselves from harm.
Emotional Well-being
Several factors could contribute to one’s emotional wellbeing. In the same way, several factors can also decrease self-esteem and confidence.
Some of these factors include:
- Perfectionism
- Impulsivity
- Complicated relationships (eg being in a relationship with a narcissist)
The negative factors could make an individual more likely to develop anorexia.
Managing and Treating Anorexia
Professional help for anorexia involves talk therapy, medication, and supervised weight gain. If you suspect having an eating disorder, you may want to seek treatment as soon as possible to avoid the risk of complications.
Several types of psychotherapy online or in-person, are available to help you recover from anorexia. These therapies aim to help you identify and understand the root causes of your eating problems.
Talking and seeking treatment can help you feel more comfortable with your relationship with food. It can help you unlearn habits that cause you harm and become healthier and stronger.
During therapy, your therapist may recommend the following types of therapy. If you feel some type of therapy is not right for you or prefer something else, you can talk to your therapist about trying something different or using a holistic approach.
Psychotherapy
Interpersonal Therapy (IPT)
Interpersonal therapy helps solve issues and repair social relationships, including:
- Parent-child bonds
- Friendships
- Romantic relationships
- Professional relationships
IPT explores issues such as:
- Grief
- Differences or conflicts in relationship roles or disputes
- Life transitions
- Pressure from loved ones (eg pressure to reduce weight or increase weight)
Over weekly sessions, you will work closely with a professional Therapist to improve communication skills and address problems in your relationships.
IPT also helps remove the strain that these issues may place on your eating habits.
Dialectical Behaviour Therapy (DBT)
DBT is a transformative approach that combines cognitive-behavioural techniques with mindfulness strategies.
Over several sessions, you will learn to accept uncomfortable thoughts and feelings rather than resorting to restrictive eating.
The therapy equips you with tools to regulate emotions, improve interpersonal effectiveness, and handle distress without turning to unhealthy eating patterns.
Narrative Therapy
Your life story matters, and your story may be completely different and unique compared to those around you.
Psychologists may use narrative therapy to help you:
- Externalise your eating disorder (ie perceiving it as something that’s happening to you rather than as a defining personality trait)
- Find new identities that do not involve disordered eating
- Change the narrative you tell yourself about your body, appearance, and self-worth
The perspective shift that you will gain during therapy can empower and help you reclaim control over your life’s narrative.
Exposure and Response Prevention (ERP)
Anorexia often comes with intense fears about food and eating.
ERP helps you confront these fears head-on. In this therapy, you will gradually face food-related anxieties under the guidance of a therapist.
Over time, the aim is to reduce the intense emotional reactions associated with these fears. During your therapy, you will learn how to make the act of eating less intimidating.
Integrative Cognitive-Affective Therapy (ICAT)
ICAT is tailored for those with anorexia. It integrates emotion-focused interventions with traditional cognitive-behavioural approaches.
Over several sessions, you will explore the emotional triggers behind your eating disorder while also developing strategies to challenge and change maladaptive eating behaviours.
Nutritional Counselling
Integral to any anorexia treatment plan is understanding nutrition. A registered dietitian can counsel you through the basics of balanced eating.
Along with psychotherapy, your therapist may suggest getting advice from a nutritionist. This can help you navigate food myths and establish a healthier relationship with food.
This counselling is often combined with other therapies and medications for a holistic approach.
Medication
While medication is not the primary treatment for anorexia, it can reduce associated symptoms.
For instance, alongside therapy, you might be prescribed an antidepressant like fluoxetine. This can help manage coexisting issues like generalised anxiety, social phobia, or depression.
Always consult a healthcare professional before starting any medication.
History of Anorexia Nervosa
The history of anorexia nervosa and dieting is a complex interplay of societal standards, medical understanding, and media influence. Understanding this history is crucial in navigating the modern outlook of body image and health.
The Origins of Dieting and Fatphobia
Dieting, as we understand it today, has roots that stretch back centuries. The late 19th century is often known as the start of the dieting craze.
However, anti-fat sentiments existed even before this, with the earliest public anti-fat campaign documented in the 1670s in Europe.
Interestingly, a fat/large figure was associated with health, prosperity, and beauty during those times. Thinness, on the other hand, was linked to poverty and disease.
The 18th century saw a shift in Great Britain, where obesity began to be classified as a medical concern. This was intertwined with the cultural debate on conspicuous consumption, where individuals consumed more for status than necessity.
Early advice manuals cautioned against overindulgence, associating it with being ungentlemanly. By the 19th century, dieting discourse primarily targeted men, urging them to be better societal members.
The Slimness Craze
The 20th century showed a significant shift in beauty standards. While the 19th century associated dieting with health, the 20th century linked it to aesthetics.
Between 1919 and 1935, the first significant thinness craze emerged. The societal pressure to conform to these standards was immense, with the media playing a pivotal role.
The ‘flapper look’ of the 1920s, characterised by a slender figure, became the ideal.
This era also saw the rise of food science, promoted nutritional value over taste, and introduced calorie counting.
The Dieting Culture
Post World War II, the 1950s to 1970s, witnessed a dieting explosion. This period introduced diet pills, slimming clubs, and influential before-and-after photo advertisements.
The rising middle class, advancements in food technology, and the powerful media were significant contributors.
‘Weight Watchers’ (founded in America, 1963) for example, offered a community space for women to discuss their insecurities, although it also perpetuated the pressure to conform to societal standards.
The History of Anorexia Nervosa
The term ‘anorexia nervosa’ was named by Sir William Gull. While instances of self-starvation can be traced back to the Hellenistic era, it was the “holy anorexics” who stood out.
These individuals, often women, abused their bodies, shunned marriage, and sought religious asylum. The condition then faded from public view until the 19th century.
Although Richard Morton is credited with the first medical definition of anorexia nervosa in 1689, two neurologists, including Ernest Charles Lasegue, separately explained the condition in 1873.
Frequently Answered Questions
What is the difference between anorexia and bulimia?
Anorexia nervosa and bulimia nervosa, while both eating disorders, manifest differently.
Anorexia primarily involves severe food restriction, leading to a low body weight relative to one’s age, gender, and health. Those with anorexia often have a deep-rooted fear of weight gain and may engage in excessive exercise or extreme dieting.
In contrast, bulimia involves cycles of binge eating — consuming vast amounts of food quickly — followed by methods to avoid weight gain, such as vomiting, over-exercising, or using laxatives.
What is the nervosa part of anorexia?
Derived from Latin, “nervosa” translates to “nervous.” Along with “anorexia,” which originates from Latin and Greek, meaning “without appetite,” the term takes on a deeper context.
Historically, “anorexia” described a self-imposed refusal to eat, often for religious or spiritual reasons. By the 1800s, “anorexia nervosa” evolved to signify a deliberate avoidance of food.
This avoidance was due to psychological factors rather than spiritual motives. Today, it represents a complex eating disorder, where the ‘nervosa’ emphasises the underlying emotional and mental challenges.
How long does it take to recover from anorexia?
How long it takes to recover from anorexia depends on several factors, such as:
- Your specific issues with disordered eating
- Your personal and family history
- Accessibility to social support
- Accessibility to professional support
- Your willingness to engage in therapy
While some may find progress within months, others might need years.
During recovery, you may be expected to follow through with a personalised therapeutic plan. Here, your Therapist may use approaches such as:
- Cognitive behavioural therapy
- Dialectical behaviour therapy
- Interpersonal psychotherapy (IPT)
- Family-based treatment (FBT)
- Acceptance and commitment therapy (ACT)
- Cognitive remediation therapy (CRT)
Consistency is another important aspect that could help determine the progress of recovery. For example, someone who attends therapy regularly – ideally once every week – may see progress much faster than someone who attends therapy only once a month.
That being said, everyone has different types of commitments – and how soon you recover is not as important as how well you recover!
Regardless of how frequently you can attend therapy, give it enough time to actually affect how you eat and think about yourself.
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