Anorexia nervosa

Anorexia nervosa (BSL, audio, easy read)

Anorexia nervosa is an eating disorder. It's a serious mental health condition and it can be life-threatening.

It can affect people of any ethnicity and background, and at any age. Most often, though, it starts in the teens and early adulthood.

Some people with anorexia nervosa don't realise how serious their condition is, and that can make it harder for them to ask for help.

People with the condition are very concerned about their weight, their body shape and the amount of calories they eat and drink. They may limit what they eat and drink, and build up lots of rules around it. They may also exercise excessively.

Some also try other ways to control their weight, such as using laxatives or making themselves sick after eating.

Anorexia nervosa can cause many different symptoms, though most people won't have all of them.

Symptoms include:

• if you're under 18, your weight and height may be lower than the healthy range expected for your age
• if you're an adult, you may have an unusually low body mass index (BMI) or lose weight rapidly over a short time
• severely restricting food, drink and calories, so that your body doesn't get the nutrition it needs
• thinking about food a lot
• being very careful about what you eat, such as avoiding any foods you see as fattening or unhealthy
• making yourself sick after food, or using drugs like laxatives or weight loss medicine
• believing you're overweight when you're a healthy weight or underweight
• avoiding looking in mirrors or wearing baggy clothes
• constantly checking your weight and comparing yourself to others
• if you get periods and you have anorexia nervosa, your periods may stop
• doing an excessive amount of exercise
• physical changes, like feeling lightheaded or dizzy, hair loss or dry skin
• feeling tired and cold
• changes to your bone density, which make your bones more fragile and more likely to break
• difficulty concentrating, which affects your work or study
• changes to the way you think, which may include making very strict rules for yourself
• compulsive checking of ingredient lists and nutrition labels
• having rigid food rules and beliefs
• criticising others' food choices
• fixation on eating foods that are considered healthy or clean

You can never tell how unwell a person is just from their weight or BMI.

In children with anorexia nervosa, puberty and the growth spurt that comes with it may be delayed. They may also gain less weight than you'd expect for someone going through puberty.

Ask to see a doctor urgently if you think you have an eating disorder like anorexia nervosa, or if you are having symptoms like these:

• rapid weight loss
• very low weight
• collapsing or fainting
• dizziness
• tiredness or fatigue
• weakness
• dehydration
• muscle spasms
• pins and needles
• irregular heartbeat (arrhythmia)
• chest pain
• high levels of distress, like feeling really upset, agitated and uncomfortable

If you feel it would help, you can take a friend or family member with you to the appointment.

If someone close to you is showing signs of anorexia nervosa, you can offer help and support.

You could try talking to them about how they feel, and encourage them to think about getting help. Try not to put pressure on them or be critical of them, as this could make things worse. You could also offer to go with them to see their doctor.

Anorexia nervosa can often make people think they are making positive changes, or that they are not as ill as they are. They may not be able to see the harmful effects of the condition. So this can be a hard conversation to have with someone you love.

If you'd like advice on how to help, speak to a healthcare professional for information on:

• how to help the person recognise that they have a problem
• the treatments available
• how you can support them during their treatment

To diagnose anorexia nervosa, your doctor will probably start by asking about your weight and eating habits. For example, they might:

• ask if you've lost a lot of weight recently or quite quickly
• ask how you feel about your weight, and if you're worried about it
• ask if you make yourself sick regularly
• check if you have periods, whether they've stopped and, if so, for how long
• check your weight (if this feels frightening, you can ask not to be told your weight)
• check your pulse and blood pressure
• do a blood test

It's important to answer these questions honestly. Your doctor isn't trying to judge you. They just need to assess your symptoms accurately.

BEAT has more information on planning an appointment, how to talk to your doctor and what will happen at an appointment.

If your doctor thinks you may have anorexia nervosa, they'll refer you to a specialist in eating disorders for a more detailed assessment.

If you're not referred to a specialist service, there is still support available to you through services like:

• BEAT
• SupportED

You can recover from anorexia nervosa, but it may take time, and recovery looks different for everyone.

Effective treatments exist. Recovery usually means working with a mental health team, and it will include dietetic support and talking therapies. Some people also need extra support for their physical health, or other treatments.

Start treatment as early as you can, because this lowers the risk of serious complications.

Treatment for anorexia nervosa is slightly different for adults and for those under 18 years old.

You may be offered cognitive behavioural therapy (CBT) for anorexia nervosa, either one to one or as part of a group. CBT starts from the idea that your thoughts, feelings and behaviour are linked, and that each one affects the others.

Family Based Treatment (FBT) is an approach to anorexia nervosa that brings the whole family into the work of helping a child or young person with an eating disorder. Parents and carers aren't just on the sidelines. They are a key part of the solution, and they are members of the treatment team.

Interpersonal psychotherapy, used in the treatment of anorexia nervosa, looks at how your relationships, your feelings and the way you eat are linked.

When a child or young person has anorexia nervosa, Family Based Treatment (FBT) brings the whole family into solving the eating disorder. Parents and carers are an essential part of the solution during FBT, and they are members of the treatment team. CBT may also be used.

SIGN guidelines for eating disorders

Anorexia nervosa can cause other physical health problems.

Some people are at higher risk of these problems, which means a doctor should check on them regularly. This includes people who:

• have a very low weight
• lose weight quickly
• are making themselves sick several times a day
• are regularly using laxatives

People with anorexia nervosa have a higher risk of:

• health problems caused by malnutrition
• an imbalance of vitamins and minerals
• problems with the heart and blood vessels, including poor circulation, an irregular heartbeat, low blood pressure, heart valve disease, heart failure, and swollen ankles, feet and legs (oedema)
• a weakened immune system or anaemia
• low blood sugar levels (hypoglycaemia)
• kidney, liver or bowel problems
• problems with muscles and bones, including feeling tired and weak, osteoporosis (fragile bones), and problems with physical development in children and young adults
• problems with the brain and nerves, including difficulties with concentration and memory
• loss of sex drive (libido) and impotency in men
• dental problems, like tooth decay caused by regular vomiting

If you feel unwell with any of these symptoms, you should contact a doctor.

Refeeding syndrome can happen when someone who is malnourished starts eating again. If food is brought in too quickly, it can cause serious complications because of an imbalance in vitamins and minerals.

If you're significantly malnourished and about to start eating again, speak to a doctor first. They can help you bring food back in safely.

Anorexia nervosa can make your menstrual cycles (periods) irregular, or stop them altogether. As you recover and reach a healthier weight, your period should return.

If you aren't planning a pregnancy, keep using birth control, even if your periods are irregular or have stopped.

If you have anorexia nervosa and are trying to become pregnant, talk about this with your doctor and care team.

Anorexia nervosa during pregnancy can raise the risk of complications, like:

• miscarriage
• giving birth early (premature birth)
• having a baby with a low birth weight

You're also likely to need extra care and support during pregnancy if you have had anorexia nervosa in the past and recovered from it. Discuss this with your midwife.