Anorexia nervosa

Anorexia nervosa (anorexia) is an eating disorder and a serious mental illness.

Someone with anorexia may:

• restrict how much they eat
• do too much exercise
• be scared of gaining weight
• believe that they have a larger body when they are actually underweight

Eating disorders are not a choice.

Types of anorexia nervosa

There are 2 types of anorexia:

1. restricting type
2. binge eating and purging type

Restricting type

People with restricting anorexia limit the amount of food they eat. They may also exercise too much.

Food restriction can mean:

• counting calories — often having less calories each day than is healthy
• missing meals or lying about having already eaten to family and friends
• limiting or avoiding certain food groups, such as carbohydrates and fats
• following strict rules, such as only eating foods of a certain colour or only raw food

These behaviours may be accompanied by too much exercise.

Binge eating/purging type

People with binge eating/purging anorexia restrict the food they eat and also purge.

Purging behaviours are when you:

• make yourself vomit (be sick)
• misuse laxatives or enemas
• misuse diuretics

Purging behaviours often happen after eating.

Atypical anorexia nervosa

Atypical anorexia nervosa is when you have the symptoms of anorexia, but your body mass index (BMI) is normal or above.

It can cause similar, or worse physical and mental health issues compared to typical anorexia.

Who gets anorexia nervosa?

Anyone can get anorexia, but it's most often diagnosed in females. This may be because it's under diagnosed in males.

Trans and gender diverse people have unique risk factors that make them more likely to develop eating disorders.

About 1 in 3 females with anorexia have autism.

Eating disorders often start between the ages of 12 and 25 years.

There are many signs of anorexia nervosa. Limiting how much you eat can cause a large amount of weight loss in a short time.

The most obvious signs of anorexia are:

• losing weight quickly
• controlling and restricting food intake
• being secretive about food and eating
• excessive exercise

Physical signs of anorexia nervosa

Some physical signs of anorexia are:

• feeling cold even when it's warm
• tooth decay
• feeling faint or tired
• bloating or nausea (feeling sick)
• dry hair or skin and brittle nails
• lanugo (fine hair on your face and body)
• loss of menstruation (your period) in females
• lower libido (sex drive)

Psychological signs of anorexia nervosa

Some psychological signs of anorexia are:

• depression and anxiety
• being unhappy with your body image
• having a distorted view of your own shape and body weight
• a fear of gaining weight
• poor concentration
• low self-esteem and perfectionism
• self-harm or thinking about suicide

Behavioural signs of anorexia nervosa

Some behavioural signs of anorexia around food are:

• a rigid diet — counting calories (often not getting enough calories each day) and avoiding foods
• avoiding eating with other people or lying about eating
• binge eating
• eating in secret
• being anxious or secretive at mealtimes
• obsessive rituals around food
• preoccupation with cooking, recipes and nutrition — can cook elaborate meals for other people but they don't eat

Other behavioural signs of anorexia are:

• wearing baggy clothes
• misuse of laxatives and diet pills
• wanting to be alone
• too much exercise — being stressed when unable to exercise
• frequently weighing or measuring your body
• using the toilet a lot

The causes of anorexia nervosa are not fully understood.

There are some things that can increase your chance of getting anorexia:

• Genetic causes — anorexia nervosa can run in families.
• Physical causes — such as the way your brain works, or the start of puberty.
• Psychological causes — such as anxiety, stressful life events and bullying.
• Cultural causes — society can promote ideals of body shape such as females being thin and males being muscular.

Anorexia can be a way of controlling areas of your life that feel out of control. Your body image can define your sense of self-worth.

Your doctor will examine you and ask you questions about your health and eating habits. They may weigh you and check your heart rate and blood pressure.

Your doctor may arrange for you to have some blood tests. This is to check your physical health.

If your doctor thinks that you have anorexia they may refer you to an eating disorder specialist.

Treatment for anorexia is different for each person. It will depend on many things, including your:

• age
• symptoms
• support systems
• where you live

Your treatment will likely involve a team of different healthcare professionals. This team can include a:

• psychologist or psychiatrist
• dietitian
• social worker
• mental health nurse
• other medical specialists such as an endocrinologist or gastroenterologist
• community support organisations

Recovery is often long and challenging. But with the right team supporting you and a lot of commitment, you can recover.

You can read more about how to talk about your mental health concerns.

Psychological support

Cognitive behavioural therapy enhanced for eating disorders (CBT‐E) is usually the first treatment suggested for adults. This is often given over 40 weekly sessions.

Family‐based therapy is usually the first treatment suggested for children and adolescents. This may be for the whole family or just the parents.

A registered dietitian can offer nutritional counselling and meal planning advice.

Your support team will help you learn how to get to and keep a healthy weight.

Other treatments

There are no medicines recommended for the treatment of anorexia.

You may be given medicines to treat other problems, such as depression.

If you have life-threatening medical complications, you may need to spend time in hospital.

Prevention programs for anorexia are available. Programs that target people most likely to develop anorexia and those who have some symptoms show the most promise.

These programs may focus on:

• healthy lifestyle
• media literacy
• self-esteem
• mindfulness
• cognitive dissonance

You can ask your doctor for more information about prevention programs.

For more support and information about anorexia and eating disorders, there are organisations that can help.

• If you think you might have anorexia you can call the Butterfly National Helpline on 1800 33 4673 for help and support.
• Visit the National Eating Disorders Collaboration website to learn about evidence-informed prevention and treatment of anorexia, and eating disorder prevention programs.
• Eating Disorders Families Australia (EDFA) supports the families and carers of people with an eating disorder. You can call them on 1300 195 626.
• The InsideOut eClinic includes SupportED a free, online clinic for carers.

Other organisations offer general mental health resources and support.

• You can call Medicare Mental Health on 1800 595 212 for advice and to get connected to local mental health services. Check the operating times here.
• If you are thinking about suicide, you can call Lifeline on 13 11 14 or chat online.

Languages other than English

• Embrace Multicultural Mental Health has information about eating disorders in multpile community languages.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.