People with anorexia nervosa don’t eat enough, usually because they feel that their problems are caused by what they look like.

Anorexia Nervosa is an eating disorder characterised by restrictive eating and an intense fear of gaining weight. While anorexia is often recognised physically through excessive weight loss, it is a serious mental health problem.^1,2

Someone with anorexia often has an intense fear of gaining weight and for many people they judge themselves and their worth based on their weight.³

Anyone can be affected by anorexia. While statistics show that anorexia is more commonly reported by young females, anorexia is increasingly being reported by men and boys, women over the age of 40, and in children as young as seven.⁴

What causes anorexia nervosa?

There is no single cause of anorexia and everyone’s reasons or triggers can be very different. It is usually understood as being due to a combination of factors.⁵

Psychological factors

Low self-esteem has been commonly associated as a trigger for the onset of anorexia.⁶ Many people with anorexia report feeling worthless and not good enough. Losing weight can start to feel like a sense of achievement and can become a way for some people to feel a sense of worth.

Certain personality traits such as perfectionism have also been found to make a person more likely to be affected by anorexia.⁷ Other psychological factors which are associated with anorexia include:⁸

• other mental health conditions, particularly depression, self-harm and anxiety
• finding it hard to handle stress and cope with life
• having feelings of obsession and compulsion.

Social factors

We live in a society where body image is highly important. This means we are constantly being told that how we look reflects our worth which can leave us feeling increasingly ashamed of our bodies if they do not fit the model of what is a ‘good body’.

This can have an impact on our body-esteem and how we feel about ourselves. While these cultural and social pressures do not cause eating disorders, they can make those particularly vulnerable to developing an eating disorder feel more pressure to look a certain way and they can trigger an eating disorder.⁹

Biological factors

New research is looking into the genetic links that may underpin anorexia.¹⁰ There is also increasing work focusing on exploring the neurochemical and neurological make-up that may help us understand why some people develop anorexia and why some do not.¹¹

Signs and symptoms of anorexia

It can be difficult to tell if you, someone you know or a friend has anorexia nervosa. Someone who has lost a lot of weight may have another type of health condition. However, particular signs that indicate that someone may have anorexia include are:¹²

Behavioural signs

• Fear of fatness or pursuit of thinness.
• Pre-occupation with body weight.
• Distorted perception of body shape or weight, for example the person thinks they are overweight when actually they are underweight.
• May underestimate the seriousness of the problem even after diagnosis.
• May tell lies about eating or what they have eaten, give excuses about why they are not eating, pretend they have eaten earlier.
• Not being truthful about how much weight they have lost.
• Finding it difficult to think about anything other than food.
• Strict dieting.
• Counting the calories in food excessively.
• Avoiding food they think is fattening.
• Eating only low-calorie food.
• Missing meals (restricting).
• Avoiding eating with other people.
• Hiding food.
• Cutting food into tiny pieces – to make it less obvious they have eaten little and to make food easier to swallow.
• Obsessive behaviour and rituals around eating.
• Excessive exercising.
• Social withdrawal and isolation, shutting yourself off from the world.

Physical signs

• Severe weight loss.
• Lack of sexual interest or potency.
• Difficulty sleeping and tiredness.
• Feeling dizzy.
• Stomach pains.
• Constipation and bloating. 
• Feeling cold or having a low body temperature. 
• Growth of downy (soft and fine) hair all over your body (called Lanugo).
• Getting irritable and moody.
• Difficulty concentrating.
• Low blood pressure.

What treatments are available?

Talking therapies

Talking therapies can last up to 12 months or more depending on how severe and persistent someone’s anorexia is. The aim of talking therapies is to help identify the feelings and fears that cause one to stop eating and to help develop a healthier attitude towards food and one’s body.¹³

• Cognitive analytical therapy (CAT) – this is based on the theory that the unhealthy patterns which trigger anorexia, are usually developed during childhood. It involves three stages: reformulation (looking at past events that may provide a reason for unhealthy patterns), recognition (helping people see how these patterns contribute to anorexia) and revision (identification of changes which can break these unhealthy patterns).¹⁴
• Cognitive behavioural therapy (CBT) – focuses on identifying and altering dysfunctional thought patterns, attitudes and beliefs which may trigger and perpetuate the person’s restrictive eating. The therapist helps the individual understand, identify and change eating disordered thoughts such as “everyone thinks I am fat”. A therapist can work with the individual with anorexia through specific behavioural interventions, such as promoting healthy eating behaviours through goal setting etc.¹⁵

Family therapy

One type of family therapy which is most often used with young people with anorexia is called ‘The Maudsley Approach.’ It is an intensive outpatient treatment programme where parents play an active and positive role in order to restore their child’s weight to normal healthy levels, give control of eating choices back to their child and encourages normal adolescent development.¹⁶

Inpatient treatment

Most people with anorexia do not need to have inpatient treatment, but for some it may be needed to manage poor physical health. The decision to start inpatient treatment will usually be made alongside someone’s therapist and GP and the type of treatment will be decided to suit the person’s needs.