Anorexia nervosa

This content mentions body image or generally discusses weight, eating disorders, anxiety and depression, which some people may find triggering.

Summary

What are the symptoms of anorexia?
What causes anorexia?
What help is available?
Ways you can look after yourself

Anorexia nervosa (commonly referred to as anorexia) is an eating disorder and a serious mental health problem. Someone with anorexia often has an intense fear of gaining weight and may have a distorted view of their body, thinking they’re fat even when they’re underweight.

People often think anorexia is about dieting, but it’s more complicated than that. It’s linked to low self-esteem, negative body image and many other factors.

Anyone can be affected by anorexia. While young women more commonly report it, anorexia is increasingly being reported by men and boys, women over the age of 40, and children as young as seven.

The idea of recovery might feel difficult or scary if you're afraid of putting on weight or worried about losing control. You might not feel ready to think about it yet. Just remember that it's possible to feel better, even if it takes a while to get there.

What are the symptoms of anorexia?

If you have anorexia, you may feel:

afraid of putting on weight or being fat
preoccupied with your weight
that food dominates your thoughts
as though your body is bigger or a different shape than it really is
anxious, especially around mealtimes
lacking in confidence and self-esteem
irritable and moody
that you have very high standards for yourself or you are a perfectionist

You may also underestimate or deny that you have a problem, even after you’ve been diagnosed.

The physical signs of anorexia include:

weight loss
lack of sexual interest
difficulty sleeping
dizziness
hair loss
constipation, bloating and stomach pains
feeling cold and weak
soft downy hair (lanugo) growing all over your body
difficulty concentrating
low blood pressure
periods stopping or becoming irregular

Anorexia can affect your behaviour. You might:

reduce your food intake or stop eating altogether
spend a lot of time counting calories
avoid food you think is fattening
skip meals
hide food or throw it away
cut food into tiny pieces to make it less obvious you haven’t eaten much or to make it easier to swallow
develop rules and rituals around eating, such as listing ‘good’ and ‘bad’ foods
eat very slowly
exercise a lot
take pills that claim to reduce your appetite or speed up your metabolism
make yourself sick or use laxatives
withdraw from other people and shut yourself off from the world

With other people, you may lie about what you’ve eaten, make excuses about why you’re not eating or pretend you’ve eaten earlier. You might also lie about how much weight you’ve lost.

What causes anorexia?

There is no single cause of anorexia. It usually develops because of a combination of factors.

Common traits

People with anorexia often have common traits, including:

low self-esteem, feeling worthless or like you’re not good enough. Losing weight can start to feel like a sense of achievement or a way to feel a sense of worth
perfectionism
having other mental health conditions, particularly depression, self-harm and anxiety
finding it hard to handle stress and cope with life
obsessive or compulsive behaviours (read our page on obsessive-compulsive disorder)

Social and cultural pressure

Society places a lot of importance on body image, meaning we’re constantly told that how we look reflects our worth. This can leave us feeling ashamed if we don’t fit the model of a ‘good body’.

While these pressures don’t cause eating disorders, they can make us feel we’re not good enough or negatively affect our self-esteem. This can trigger an eating disorder in people already vulnerable to developing one.

Biological and genetic factors

Research shows there may be genetic links to anorexia. The brain chemicals that control our hunger, appetite and digestion can also make us more likely to develop anorexia. If we have too much or too little of these brain chemicals or are particularly sensitive to them, our appetite and mood can be affected.

What help is available?

Living with anorexia can be incredibly difficult, but so too can the idea of recovery. If anorexia has become a big part of your identity, you might wonder who you'll be without it. You might be afraid of not being in control of your food or of how your body might change. It can take time to feel ready to try to recover. Think about what recovery might look like to you and what the benefits could be. Change is possible, even if it doesn't feel like it right now.

If you think you have anorexia, start by talking to your GP. They may not be an expert in treating eating disorders, but they will be able to assess any physical symptoms and then refer you to specialist eating disorder services.

Talking therapies

Talking therapies can help you identify the feelings and fears that triggered your anorexia and help you develop a healthier attitude towards food and your body. You may be offered:

Cognitive analytical therapy (CAT). This looks at past experiences and events to help you understand why you think, feel and behave the way you do now. Your therapist will then help you develop new tools to cope in a healthier way
Cognitive behavioural therapy (CBT). This focuses on identifying and changing the thoughts and beliefs that may trigger your anorexia. Your therapist will help you understand and change disordered thoughts such as ‘everyone thinks I am fat’. You may set homework and goals around challenging any unhealthy rules you have around food.

Support for children and young people

The ‘Maudsley Approach’ is a type of therapy to help children and young people with anorexia. It involves parents taking an active role in helping to get their child’s weight to a normal level, giving control of eating choices back to the child and then encouraging them to develop healthy independence.

Medication

You may be offered antidepressants alongside self-help or therapy to manage other conditions such as depression, anxiety or obsessive-compulsive disorder (OCD). However, antidepressants shouldn’t be the only treatment you’re offered.

Inpatient treatment

Most people with anorexia won’t need to go to hospital. However, if your weight is very low, you may be admitted. Your treatment could involve counselling, group and family therapy, and working with a dietician and mental health team.

Ways you can look after yourself

It’s difficult to recover from an eating disorder on your own, but there are things you can try alongside treatment and support. Beat has many tips for recovery, and Mind has ideas for self-care, including managing relapses, changing unhealthy routines and being careful online.

You may find that support groups are useful. It can be comforting to talk to others with the same feelings and experiences. You could join Beat’s online support group for people with anorexia.