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Anorexia

 

 

 

Anorexia nervosa is an eating disorder. A person with anorexia nervosa deliberately loses weight and often finds that food dominates their life. The weight loss may become severe and life-threatening. Treatment includes talking treatments such as cognitive behavioural therapy (CBT), sometimes medication, and self-help measures.

 

 

What is anorexia nervosa?

Anorexia nervosa (just called anorexia from now on) is an eating disorder. It means loss of appetite due to your nerves. Anorexia is a serious condition which affects all sorts of people. Anorexia is very common - about 1 in 20 teenagers has it. However, it affects people of all ages and has become more common in boys and men in recent years.

People with anorexia often find that they do not allow themselves to feel full after eating. This means that they restrict the amount they eat and drink. People with anorexia are underweight. Sometimes, the weight becomes so low that it is dangerous to health.

 

 

 

How do I know if I have an eating disorder?

If you answer yes to two or more of these questions then you may have an eating disorder and you should see your doctor:

  • Do you make yourself sick because you are uncomfortably full?
  • Do you worry that you've lost control over how much you eat?
  • Have you recently lost more than 6 kg (about one stone) in the past three months?
  • Do you believe you're fat when others think you are thin?
  • Would you say that food dominates your life?

 

 

What are the symptoms of anorexia nervosa?

Deliberate weight loss

This is the main symptom. You lose weight by avoiding fattening foods or even any foods. People with anorexia limit the amount they eat and drink, in order to control how their body looks. You may often pretend to other people that you are eating far more than you actually are. You may be using other ways of staying thin such as exercising too much. You may also have made yourself vomit, take laxatives, or even take appetite suppressant medicines or diuretics (water tablets).

People with anorexia typically weigh 15% or more below the expected weight for their age, sex and height. The body mass index (BMI) is calculated by your weight (in kilograms) divided by the square of your height (in metres). A normal BMI for an adult is 20-25. Above that you are overweight, and below that you are underweight. Adults with anorexia have a BMI below 17.5.

With anorexia, you feel very in control of your bodyweight and shape. However, with time, anorexia can take control of you. After some time it can become very difficult to make healthy, normal choices about the amount and types of food you eat.

A wrong idea of body size

People with anorexia think that they are fat when they are actually very thin. Although other people see you as thin or underweight, it is very difficult for you to see this. You are likely to have a severe dread (like a phobia) of gaining weight. People with anorexia will do their utmost to avoid putting on weight.

Other features

It is common for people with anorexia to:

  • Vomit secretly after eating.
  • Try hard to hide their thinness - for example, by wearing baggy clothes.
  • Tend not to be truthful about how much they eat and everything to do with food.
  • Like food and feel hungry. However, it is the consequences of eating that frighten them.
  • anorexia is a mental illness. many people do not feel like they may have an eating disorder because theyre not thin enough but this is not true.

People with anorexia may also become obsessed with what other people are eating, and often try to feed other people high calorie foods while not eating themselves.
 
People with anorexia often restrict themselves to certain types of food. Eating food may even become like a ritual. For example, each time you eat, you have to cut your food into very small pieces. You may think frequently about your weight and even weigh yourself most days or even several times a day. It is also common to feel cold most of the time and to have irregular sleeping patterns. You might also find yourself having poor concentration.

 

Many people with eating disorders may well feel like there is a 'voice' inside their head.

 

 

 

 

What are the health risks with anorexia nervosa?

Health risks are caused by undereating (starvation) and by the methods used to get rid of eaten food (vomiting, excess laxatives, etc). Problems that may occur include the following:

Irregular periods

Many people with anorexia have irregular periods, as hormone levels can be affected by poor diet. Your periods may even stop altogether or you may find that your periods have never started, especially if you started having eating problems when you were younger. Some people with anorexia are even infertile.

Chemical imbalances in the body

These are caused either by repeated vomiting or by excess use of laxatives - for example, a low potassium level which may cause tiredness, weakness, abnormal heart rhythms, kidney damage and convulsions. Low calcium levels can lead to tetany (muscle spasms).

Thinning of the bones (osteoporosis)

This is caused by a lack of calcium and vitamin D and can lead to easily fractured bones. In addition, the risk of getting osteoporosis increases if your periods have stopped. This is because oestrogen in your body protects your bones from osteoporosis and the levels of oestrogen in your body reduce when your periods stop.

Bowel problems

These may occur if you take a lot of laxatives. Laxatives can damage the bowel muscle and nerve endings. This may eventually result in permanent constipation and also sometimes abdominal pains.

Swelling of hands, feet and face

This is usually due to fluid disturbances in the body.

Teeth problems

These can be caused by the acid from the stomach rotting away the enamel with repeated vomiting.

Anaemia

Having a diet low in iron can lead to anaemia. This can make you feel weaker and more tired than normal. Dizzy spells and feeling faint can also occur.

Depression

It is common to feel low when you have anorexia. Some people develop clinical depression, which can respond well to treatment. It is important to talk to your doctor about any symptoms of depression you may have. Many people find they become more moody or irritable.

Hair and skin problems

You may find you have downy hair on your body and also the hair on your head becomes thinner. Many people with anorexia also have dry, rough skin.

 

 

 

 

What is the cause of anorexia nervosa?

The exact cause is not fully understood. Part of the cause is a fear of getting fat but it is not just as simple as that. Different causes possibly work together to bring on the condition. These may include the following:

  • The pressure from society and the media to be thin is thought to play a part. This is probably why anorexia is much more common in westernised countries.
  • Personality and family environment probably play a role too. People with anorexia often have poor self-esteem (not much self-confidence) and commonly feel that they have to be perfectionists. Often there are disturbed family relationships. All sorts of emotions, feelings and attitudes may contribute to causing anorexia.
  • There may be some genetic factor. We know this from studies of families with identical twins. If one twin has anorexia then the other has a 1 in 2 chance of getting it. This tells us that the condition may have a genetic part. However, because not every twin gets it, there are other factors too.

 

 

Are any tests needed?

Although there is no test to diagnose anorexia, your doctor may wish to do some tests. These may include blood tests to check for complications of anorexia - for example, anaemia, potassium levels, kidney or liver problems or a low glucose level. An ECG hear tracing (electrocardiography) may be advised to check for an irregular heart rhythm.

 

 

 

What is the treatment for anorexia nervosa?

The aim of treatment is to:

  • Reduce risk of harm (and death) which can be caused by anorexia.
  • Encourage weight gain and healthy eating.
  • Reduce other related symptoms and problems.
  • Help people become both physically and mentally stronger.

You are likely to be referred to a specialist mental health team which includes psychiatrists, psychologists, nurses, dietitians and other professionals. If you have more severe anorexia, you may be referred to a specialist eating disorder unit.

The sort of treatments that may be offered include the following:

Help with eating

Having regular meals is better. Even if you only eat small meals it is beneficial to the body to eat at least three times a day. You should try to be honest (with yourself and other people) about the amount of food you are actually eating. You should reduce the number of times you weigh yourself; try to weigh yourself only once a week. It may be useful to keep an eating diary to write down all the food that you eat.

Your daily intake will have to be GRADUALLY increased with the help of those around you. usually (depending on how severe the weight loss is) it is reommended a weight gain of 0.5-1kg a week with a meal plan of 2500-3500 calories a day.

Psychological (talking) treatments

For example, cognitive behavioural therapy (CBT), cognitive analytic therapy (CAT), interpersonal psychotherapy (IPT) and focal psychodynamic therapy. Talking treatments help to look at the reasons why you may have developed anorexia, and aim to change any false beliefs that you may have about your weight and body, and to help show you how to identify and deal with emotional issues. Talking treatments take time and usually require regular sessions over several months. Treatment may also involve other members of your family going to meetings to discuss any family issues.

Antidepressant medication

This may be advised in addition to talking treatments if you also develop depression. These are not always recommended if you are younger than 18 years old.

Treatment of any physical or teeth problems that may occur

This may include taking potassium supplements, having dental care and trying not to use laxatives or water tablets. You may be recommend to take hormones (for example, the oral contraceptive pill) to increase levels of oestrogen in your body to help strengthen your bones.

Self-help measures may be of benefit

There are a number of self-help books and guides available. These provide methods on how to cope with and overcome anorexia. (www.Beat.com - the Eating Disorders Association - may be able to suggest current titles.) They are not suitable for everyone, particularly if your anorexia is severe.

 

try not to comment on the eating patterns of someone with an eating disorder, amd do not talk about your own dieting.

NEVER tell someone to 'just eat'. this will get you no where as a real fear with foods occurs and they cant just snap out of it.


 
Some people with more severe anorexia may need to have a short stay in hospital.

 

 

 

What is the outlook (prognosis)?

With treatment, anorexia can take weeks or even many months to improve. It can take several years for people with anorexia to become completely better. Many people find they still have issues with food, even after treatment, but they are more in control and can lead happier, more fulfilled lives.

Unfortunately, some people with anorexia die from causes related to anorexia. Causes of death include infections, dehydration, blood chemical imbalances (such as low potassium levels) and even suicide.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bulimia

 

People with bulimia nervosa have episodes of binge eating. This is followed by deliberately making themselves sick (self-induced vomiting) or other measures to counteract the excessive food intake. Treatments include talking therapies, and sometimes medicines and self-help measures. Many people with bulimia get better with treatment.

What is bulimia nervosa?

Bulimia nervosa (often just called bulimia) is a condition where you think a lot about your body weight and shape. It affects your ability to have a 'normal' eating pattern. Bulimia is one of the conditions that form the group of eating disorders that includes anorexia nervosa. There are important differences between these two conditions. For example, in anorexia nervosa you are very underweight, whereas in bulimia nervosa, you are most likely to be normal weight or even overweight.

Who gets bulimia nervosa?

Bulimia mainly affects women aged 16-40. It most commonly starts around the age of 19 years. It affects around 1 in 100 women in the UK. Bulimia sometimes develops in men and children. Women are ten times more likely than men to develop bulimia. However, bulimia is becoming more common in boys and men. Bulimia is more common than anorexia nervosa.

There may be some genetic factor, as the risk of developing bulimia in close relatives of people with bulimia is four times greater than in the general population.

What are the symptoms of bulimia nervosa?

Bingeing and purging are the main symptoms and are usually done in secret.

  • Bingeing means that you have repeated episodes of eating large amounts of foods and/or drinks. For example, you may eat a whole large tub of ice cream or two packets of biscuits even if you are not hungry. You feel out of control and unable to stop eating. Binge eating is often done very quickly until you feel physically uncomfortable. This happens not just on one occasion, but regularly. Eating patterns typically become chaotic.

  • Purging means that you try and counteract the 'fattening' effects of the food from the bingeing. Making yourself sick (self-induced vomiting) after a bout of bingeing is the most well-known, but not all people with bulimia do this. Other purging methods include taking lots of laxatives, extreme exercise, extreme dieting or even periods of complete starvation, taking 'water' tablets (diuretics) or taking other medicines such as amfetamines.

The reasons why you binge eat and then purge may not be easy to explain. Part of the problem may be due to a fear of getting fat, although it is often not just as simple as that. All sorts of emotions, feelings and attitudes may contribute. The physical act of bingeing and purging may be a way of dealing with your emotions in some way.

What are the physical problems caused by bulimia?

These are caused by the unusual eating habits and the methods used to purge the body of food (such as being sick (vomiting) or the excessive use of laxatives). Physical problems do not always develop. They are more likely if you binge and purge often. One or more of the following may develop:

Irregular periods

Many people have irregular periods as hormone levels can be affected by poor diet. Periods may even stop altogether or you may find that your periods have never started, especially if you started having eating problems when you were younger.

Chemical imbalances in the body

These are caused by either repeated vomiting or excess use of laxatives. For example, a low potassium level which may cause tiredness, weakness, abnormal heart rhythms, kidney damage and convulsions. Low calcium levels can lead to muscle spasms (tetany).

Bowel problems

These may occur if you take a lot of laxatives. Laxatives can damage the bowel muscle and nerve endings. This may eventually result in permanent constipation and also sometimes abdominal pains.

Swelling of hands, feet and face

This is usually due to fluid disturbances in the body. The saliva glands in the face can sometimes swell due to the frequent vomiting.

Teeth problems

These can be caused by the acid from the stomach rotting away the enamel as a result of repeated vomiting.

Depression

It is fairly common to feel low when you have bulimia. Some people even become depressed, which can respond well to treatment. It is important to talk about any symptoms of depression you may have. Many people find they become more moody or irritable.

Psychological problems

These are very common and include feelings of guilt and disgust after bingeing and purging. Poor self-esteem, and mood swings, are common.

What causes bulimia nervosa?

The exact cause is not clear. Some people blame the media and the fashion industry which portray the idea that it is fashionable to be slim. This can put pressure on some people to try to be slim which can then lead to an eating disorder.

There may be some genetic factor to developing bulimia, which is triggered by stressful or traumatic life experiences. For example, some people with bulimia have had a childhood where there were frequent family problems with arguments and criticism at home. Some people with bulimia have been abused as a child.

Sometimes bulimia is also associated with some other psychological problem. (That is, the bulimia is sometimes just a part of a broader mental health problem.) For example, there is a higher than average rate of bulimia in people with anxiety disorders, obsessive-compulsive disorder, depression, post-traumatic stress disorder and some personality disorders.

A chemical called serotonin found in some  parts of the brain is thought to have something to do with bulimia. In some way one or more of the above factors, or even other unknown factors, may lead to a low level of serotonin.

Are there any tests done for bulimia?

Although there is not an actual test to diagnose bulimia, your doctor may wish to undertake some blood tests. These are usually done to check your kidney function and potassium levels.

 

What are the treatments for bulimia nervosa?

The aim of treatment is to:

  • Reduce risk of harm which can be caused by bulimia.
  • Encourage healthy eating.
  • Reduce other related symptoms and problems.
  • Help people become both physically and mentally stronger.

Most people with bulimia who see their GP will be referred to a specialist eating disorder unit. Members of the team may include psychiatrists, psychologists, nurses, dietitians and other professionals.

The sort of treatments that may be offered include the following:

Help with eating

It is best if you have regular meals; even if you only eat small meals. It is beneficial to the body to eat at least three times a day. You should try to be honest (with yourself and other people) about the amount of food you are actually eating. You should reduce the number of times you weigh yourself; try only to weigh yourself once a week. It may be useful to keep an eating diary in order to write down all the food that you eat.

Psychological ('talking') treatments

Cognitive behavioural therapy (CBT) is the most commonly used psychological treatment for bulimia. It helps you to look at the reasons why you developed bulimia, aims to change any false beliefs that you have about your weight and body, and it helps to show you how to deal with emotional issues. Talking treatments take time and usually require regular sessions over several months.

However, CBT does not suit everyone. About a third of people drop out before finishing the course. Other forms of psychological therapies, either in groups, on an individual basis or using computer-based packages may also be used.

Medication

A medicine may be advised by your doctor. The most commonly used medicines are selective serotonin reuptake inhibitor (SSRI) antidepressants. These are used to treat depression but, in higher doses, one called fluoxetine can reduce the urge for bingeing or purging. These are not usually recommended if you are younger than 18 years old.

Self-help measures

There are a number of self-help books and manuals available. These provide strategies in how to cope with, and overcome, bulimia. Some people find these very helpful and prefer them to 'formal' treatment. It is certainly worth trying a self-help manual if there is a waiting list or difficulty in getting psychological treatment.

Treatment of any physical or teeth problems that may occur

This may include taking potassium supplements, dental care and help with cutting down use of laxatives.

 

 

What is the outlook (prognosis)?

Bulimia is the sort of condition that is difficult to cure fully 'once and for all'. Many people improve with treatment, but bad spells (relapses) may recur from time to time in some cases. Many people find they still have issues with food, even after treatment, but they are more in control and can lead happier, more fulfilled lives.

Studies suggest that 10 years after a diagnosis of bulimia about 5 in 10 people are well, about 2 in 10 people still have bulimia, and about 3 in 10 people are somewhere in the middle. However, the recent study about CBT treatment (see the end of the leaflet) suggests that with good-quality CBT, the outlook is probably even better than these 'overall' figures. It is very unusual to die from bulimia.