Anorexia nervosa is an eating disorder in which people keep their body weight as low as possible. People with anorexia usually do this by restricting the amount of food they eat. Additionally they may use other behaviours like vomiting after meals, exercising excessively or taking laxatives or diet pills.
Anorexia develops out of an anxiety about body shape and weight stemming from a fear of being fat or a desire to be thin. Whilst there is no single reason why someone will develop anorexia, there is always an underlying emotional cause. Anorexia may help someone to feel in control, to feel successful or strong, it may help them avoid or escape challenging emotions or may help communicate a message to others about how they are feeling. Many people with anorexia struggle to see or believe that they are underweight and it can be a long time before someone decides to seek help.
People with anorexia often go to great lengths to hide their behaviour from family and friends by lying about what they have eaten, or by pretending to have eaten earlier.
Signs that someone may have anorexia or another eating disorder include:
People with anorexia often don’t seek help, perhaps because they’re afraid of changing their eating or because they don’t recognise they have a problem. Many people have successfully hidden their condition for a long time – sometimes years.
The most important first step is for someone with anorexia to realise that they need help and want to get better.
If you suspect someone you know has anorexia, you should try to talk to them about your worries and encourage them to seek help.
This can be a very difficult conversation because they may be defensive and refuse to accept they have a problem. But it’s important not to criticise or pressure them as this can make things worse.
Cognitive behavioural therapy and supportive psychotherapy are the two most commonly recommended treatments for adults with anorexia nervosa. For children with anorexia, family treatment is almost always recommended, either in isolation or in combination with individual therapy.
CBT is one of the current leading treatments for anorexia (NICE Guidelines, 2004). Our CBT therapists have extensive experience in providing high quality CBT to individuals with all eating and body image disorders. CBT focuses on your thinking (cognitions), your behaviours (what you do in response to certain thoughts), and your emotions (how you feel in response to certain thoughts). People can often recognise patterns in their thinking (e.g. I am not good enough, people dont like me, I need to be thinner to be successful). These thoughts result in familiar emotions and behaviours that often involve manipulation of food or eating. CBT helps individuals to recognise their unhelpful or negative thinking, see the patterns in their behaviours and develop healthy strategies and skills to challenge or cope with their unhelpful thoughts. CBT is a structured skills based therapy that is most suitable for people who want to be guided by their therapist to find new ways of coping.
Family Based Treatment is well evidenced as a treatment in adolescents and children with anorexia. FBT is a treatment that involves utilising the whole family to help the adolescent overcome their eating difficulties. FBT has three specific phases. The first phase focuses on empowering the parents to assist in the re-feeding of the child. Family meals are undertaken (with the therapist initially). The second phase focuses on the relationships that exist between family members and aims to help the family to negotiate new, more adaptive relationships. In the third phase the focus is on maintaining healthy adult or adolescent relationships between family members in which the eating disorder does not form the basis of the relationship.
Specialist Supportive Psychotherapy has also been shown to be an effective treatment for anorexia nervosa. This treatment is sometimes referred to as Specialist Supportive Clinical Management (SSCM). Supportive Psychotherapy combines features of clinical management (ensuring your medical safety) with supportive psychotherapy and dietetic advice. Supportive psychotherapy allows you to explore and talk freely about issues that you feel are relevant to your current mood or eating patterns. Together with your therapist you can then be supported to find solutions to these difficulties so that rigid control over your weight and eating is no longer used as a solution. Your therapist will use supportive encouragement, psychoeducation, gentle exploration and advice to help you to set and reach your own eating and life goals.
Each of these treatments are known to be effective in treating anorexia nervosa. Your therapist will help you to determine which of these treatments is most appropriate for you during your initial assessment session.
Beating Your Eating Disorder: A Cognitive-Behavioral Self-Help Guide for Adult Sufferers and their Carers
By Glenn Waller, Victoria Mountford, Rachel Lawson, Emma Gray, Helen Cordery, Hendrik Hinrichsen
Overcoming Anorexia Nervosa, A self-help guide using Cognitive Behavioural Techniques
By Christopher Freeman
Anorexia nervosa, a survival guide for families, friends and sufferers
By Janet Treasure