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Anorexia nervosa: information, advice and support

Worried a friend or family member may be suffering with anorexia? Find out more about this eating disorder, plus how to offer help and support.

Anorexia nervosa: information, advice and support
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If you’re concerned that a friend or family member is displaying signs of anorexia nervosa (commonly referred to as anorexia), it can be a highly distressing time. You’re also not alone: according to eating disorder charity Beat, approximately 1.25 million people in the UK are living with an eating disorder, with a 2015 study by Hay et al finding that anorexia accounts for eight per cent of all cases.

It’s true that anorexia can be devastating – it has the highest mortality rate of any psychiatric disorder, often arising from medical complications associated with the illness. But it’s also true that there is hope: according to Beat, while 20 per cent of patients remain chronically ill, some 47 per cent do go on to make a full recovery.

We speak to Lynn Crilly, a mental health counsellor and author of Hope With Eating Disorders, to find out more about the illness and how to offer practical and emotional support:

What is anorexia?

While a person with anorexia often has a fixation with losing weight and controlling their food intake, as well as having a distorted body image, the illness’s roots often run far deeper than simply a desire to be thin.

‘Anorexia is a severe mental illness that has both mental and physical symptoms,’ explains Crilly. ‘Yes, it’s a severe restriction of food over a period of time, but obviously it’s a lot more than that. It can stem from low self-esteem, environmental factors such as bullying, childhood trauma or genetic vulnerability.

Anorexia is a severe mental illness that has both mental and physical symptoms.

'While sometimes eating disorders, particularly anorexia, can start off fairly innocently, with the person liking the way weight loss makes them feel, it can quickly become an obsession. Many people with anorexia also suffer with obsessive compulsive disorder – in fact, the two illnesses are often intrinsically linked. The very nature of anorexia is an obsessive compulsive behaviour, after all. But at its worst, it can be quite devastating, which is why early intervention is key.’

Rigidly restricting food intake can often give sufferers a sense of control, which they may feel is lacking in other areas of their life. Many sufferers report that this this gives them a feeling of calm and peace, which may explain why they are often reluctant to seek help.

Anorexia nervosa: information, advice and support
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Who is affected by anorexia?

While typically, anorexia – as with other eating disorders – develops during adolescence, this is not always the case. According to Beat, cases have been reported in children as young as eight and some research reports of the illness developing in people in their 70s.

While sufferers can often display some similar characteristics, including perfectionism, Crilly reveals there is no such thing as a ‘typical’ anorexia sufferer.

‘I predominantly work with people under the age of 25, but anyone, regardless of their age, gender, race, sexuality or social background, can be affected – I’ve worked with people from all walks of life,’ she says. ‘It’s becoming more and more common in men and boys, too.’



Anorexia signs and symptoms

If you are worried about a friend or family member, there are some signs you can look out for, some of which are physical, others behavioural and psychological. These include:

Anorexia physical signs

  • Weight loss
  • Irregular periods (or periods stopping)
  • Tiredness
  • Feeling cold (especially fingertips, toes and nose)
  • Thinning hair
  • Growing a fine layer of hair over their body (lanugo)
  • Stomach problems, including constipation and bloating
  • Swelling in hands and feet (oedema)

    Anorexia behavioural and psychological signs

    • A change in personality
    • Becoming withdrawn
    • Seeming preoccupied
    • Becoming secretive
    • Denying they have a problem
    • Concealing their weight loss
    • Saying they’ve already eaten, or will eat later, at mealtimes
    • Missing meals
    • Walking and exercising more regularly

      ‘I think the biggest sign for me is the change in personality and behaviour,’ reveals Crilly, whose own daughter suffered with an eating disorder in the past. ‘If they’re just not themselves or they become secretive, withdrawn or preoccupied. They just sort of lose their zest for life – they become haunted.’



      Long-term effects of anorexia

      Anorexia can have very serious physical consequences, due to malnutrition and very low body weight. ‘Osteoporosis can be a huge problem for anorexia sufferers,’ says Crilly.

      ‘It can obviously play havoc with your hormones and periods, too. Then there’s the long-term effect that it has on your life – the life you’re missing out on because of the illness.

      'And then obviously there’s the strain on the heart and organs, as well, which in severe cases can lead to heart and/or organ failure. Anorexia has the biggest mortality rate of all the mental illnesses, sadly.’



      How to support a loved one with anorexia

      While realising that a loved one has an eating disorder is scary, there is plenty you can do to help and support them, and lots of places you can seek guidance and advice, so never give up hope.

      ‘I think the first thing to do is to educate yourself,’ advises Crilly. ‘First, learn as much as you can about the nature of anorexia. Then you can approach them gently, in the right environment and somewhere they feel safe. Always ensure you take a non-judgemental approach.

      While realising that a loved one has an eating disorder is scary, there is plenty you can do to help and support them.

      'Some sufferers are very relieved to actually be able to talk to someone about it; others tend to be more secretive and are not ready to open up. But regardless, always let them know you’re there for them, and encourage them to seek professional help.’



      The difficulty with anorexia diagnosis

      While the first steps should always be to try to persuade the sufferer to visit their GP, Crilly admits that diagnosis procedures can often be frustrating. ‘A lot of the diagnosis process is to do with BMI, which is wrong, because obviously everyone is different,' she says.

      'It can be difficult for a lot of people whose weight isn’t perceived as being “low enough”, but this doesn’t mean to say they don’t have an eating disorder. This is where I think intervention is sometimes let down, because people aren’t offered the help they need straight away, because they don’t fit a certain criteria, and then the illness can manifest into something worse.’

      There has been much publicity over the past few years surrounding this problem, with mental health campaigner and author Hope Virgo’s campaign, Dump the scales, calling on a change in procedure surrounding early diagnosis.



      Anorexia treatment and therapy options

      Treatment and therapy options for anorexia can mostly be performed as outpatient services, although hospital admission can become necessary.

      Talking therapies, such as cognitive behavioural therapy (CBT), psychotherapy and neurolinguistic processing (NLP) can all be very helpful, as can family therapy sessions. Crilly says that patience is key, and it’s vital to help the sufferer get to the root of the issue.

      ‘If you treat the mind, the mind will treat the body,’ she says. ‘Anorexia Nervosa is a mental illness, so it is paramount for long-term recovery that the mind and body recover together.'

      Crilly also says you must keep persevering and explore other options if a certain approach doesn’t seem to be working. ‘One thing I would say is that if a certain treatment is not working, don’t wait,’ she implores. ‘Don’t be afraid to challenge, ask questions and find out more, because there are so many different types of therapies and treatments out there – it’s not “one size fits all”.’



      The importance of support for carers

      Caring for a person with anorexia can become all-encompassing, so it’s vital to look after your own mental health, too.

      ‘This is so important,’ reiterates Crilly. ‘You really need to protect your own mental health and practise self care. Even if it’s just going out with a friend for a coffee – remove yourself from the environment often, just so that you can recharge your batteries. Never feel guilty about this – not a lot is going to change in the time it takes you to go out for coffee, or watch a film, or read a magazine. So just take some time out for you.’

      Family dynamics often become strained, too, so Crilly advises spending time together, outside of talking about the illness.

      An eating disorder can be a monumental challenge for a family, but it’s important never to blame the sufferer.

      ‘As a family, it’s really important that you still do stuff together, outside of the eating disorder. Spend time together, have eating disorder-free talking time, even just sit down and watch a film together. I think carers suffer just as much as the person with the illness and siblings tend to get sidelined, so time together is so important.’

      The sad fact is that an eating disorder can be a monumental challenge for a family, but it’s important never to blame the sufferer – they are not choosing to be unwell. And remember, there is always hope.

      ‘As a family, it’s so important that you all recover together,’ says Crilly. ‘And never accept that this is as good as it gets, because it can always get better.’



      Further help and support for anorexia

      There are lots of places you can find additional help, advice and support for people suffering from anorexia:

      • Beat – the UK’s eating disorder charity offers support and advice to sufferers and their loved ones. Beat also runs three helplines: Helpline 0808 801 9677; Youthline 0808 801 0711; Studentline 0808 801 0811.
      • Sane – this leading UK mental health charity runs a daily helpline, which you can call for support and advice: Saneline 0300 304 7000, 4.30pm-10.30pm daily.
      • Young Minds – the UK’s leading charity fighting for children’s and young people’s mental health: Parents’ Helpline 0808 802 5544, 9.30am-4pm, Monday to Friday; YoungMinds Crisis Messenger offers urgent help for young people under 25 – text YM to 85258, available 24/7.
      • Anorexia & Bulimia Care (ABC) – this national UK eating disorders organisation provides emotional support and practical guidance: Helpline 03000 11 12 13, 9.30am-5.30pm Monday to Friday.


        Last updated: 26-11-19

        Dr Juliet McGrattan Dr Juliet McGrattan spent 16 years working as an NHS GP.
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