Specialist Treatment for Eating Disorders at The London Centre

Anorexia Nervosa

what is anorexia?

Anorexia nervosa (AN) is an eating disorder in which people maintain a significantly low weight by limiting their nutritional intake or engaging in behaviours such as excessive exercise. Those with anorexia will typically have a fear of weight gain or becoming fat, and a distorted view of their condition, for example, seeing themselves as larger than they are or believing there is no problem with their low weight (despite the significant health risks). Sometimes people with anorexia may binge or purge (anorexia nervosa - binge/purge subtype) just as in bulimia nervosa.

 

 

atypical anorexia and orthorexia

Atypical anorexia is a diagnosis recognised in DSM 5 (a diagnostic manual) where people present with all the features of anorexia nervosa (restrictive eating, fear of weight gain), however do not present as significantly underweight. These people may have lost a considerable amount of weight but still be within a healthy weight range, or they may have had their weight increased within a different treatment setting, for example an inpatient setting, but still experience all of the cognitive, psychological and emotional features of anorexia. It is very important that these people are still recognised as having anorexia, and that not too much importance is placed on a person’s weight when giving a diagnosis of anorexia. Treatment for atypical anorexia should be exactly the same as treatment for anorexia. There has also recently been recognition of a related condition called orthoerxia, in which a focus on healthy eating can become obsessive and damaging to health. There is more information about this here.

 

 

Helping someone with anorexia

Whilst there is no single reason why someone will develop anorexia, there is normally an underlying emotional cause. Anorexia may help someone to feel in control, to feel successful or strong, to avoid or escape challenging emotions, or to communicate a message to others about how they are feeling. It is important that treatment addresses this.

People with anorexia often don’t seek help; perhaps they’re afraid of changing their eating or 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, talk to them about your worries and encourage them to seek help. This can be a very difficult conversation because they may not accept they have a problem. But it’s important not to criticise or pressurise as this can make things worse.

 

 

Treatment for anorexia

For adults with anorexia, NICE Guidelines recommend enhanced Cognitive Behavioural Therapy (CBT-E), Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA), or Specialist Supportive Clinical Management (SSCM). For children and adolescents with anorexia, Family-Based Treatment (FBT) is almost always recommended, either in isolation or in combination with individual therapy. However, other treatments might be useful if these are not sufficient or acceptable - these can be discussed further at assessment.