Anorexia Nervosa

Condition Basics

What is anorexia?

Anorexia is a type of eating disorder. People who have it have an intense fear of gaining weight. They strictly limit the amount of food they eat and can become so thin that it becomes a danger to them.

Anorexia is both a physical and emotional problem. It almost always begins with a strict weight-loss diet. Over time, strictly limiting foods leads to malnutrition and unhealthy weight loss.

It usually starts in the teen years. And it's much more common in females than in males. The earlier the problem is treated, the better the chances are that someone with anorexia can recover. If not treated, it can lead to serious health problems and starvation.

What causes it?

Experts don't really know what causes anorexia. But it may be due to a mix of genetics, family behaviours, social factors, and personality traits. For example, you may be more likely to have anorexia if someone in your family has it or if you do a sport that stresses body size, like gymnastics.

What are the symptoms?

People who have anorexia weigh much less than is healthy or normal. They think they are overweight even when they are very thin. Their lives become focused on controlling their weight. They may obsess about food, weight, and dieting. And they may strictly limit how much they eat.

How is it diagnosed?

There is no single test that can diagnose anorexia. But anorexia has a visible effect on your health and eating habits. If anorexia is suspected, your doctor will compare your weight with the expected weight for someone of your height and age. He or she will also check for signs of malnutrition or starvation.

How is anorexia treated?

Because anorexia is a physical and emotional problem, you may work with a doctor, a dietitian, and a counsellor. Treatment can help you get back to a healthy weight, learn good eating habits, and learn to feel better about yourself. If your weight has dropped too low, you'll need treatment in a hospital.

What should you do if you think someone has an eating disorder?

If you think your child has an eating disorder:

• Talk to them. Tell your child why you're worried. Let them know you care.
• Make an appointment for you and your child to meet with a doctor or a counsellor.

If you're worried about someone you know:

• Tell someone who can make a difference, like a parent, a teacher, a counsellor, or a doctor. A person with an eating disorder may say that they are okay and don't need help. You can help by encouraging them to talk to someone they trust.

What Increases Your Risk

Experts don't know for sure what causes someone to have an eating disorder such as anorexia, bulimia, or binge eating. But certain things put a person at greater risk for getting an eating disorder. Some of these things include:

• Having a family history of an eating disorder.
• Struggling with depression, anxiety, low self-esteem, or obsessive behaviours.
• Feeling a need to be perfect.
• Feeling social or cultural pressure about thinness or weight.
• Having a poor body image.
• Taking part in sports or activities that encourage thinness. Modelling and dance are examples.
• Having a history of physical or sexual abuse.

Having risk factors for it doesn't mean a person will get an eating disorder. But knowing some of the things that can add to the risk may help to see a problem early when it is easier to treat.

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Prevention

There is no known way to prevent an eating disorder. But knowing the early signs and seeking treatment right away can help prevent problems caused by an eating disorder. Early treatment may be the best way to prevent it from getting worse.

Symptoms

People who have anorexia often strongly deny that they have a problem. It's most often up to their loved ones to get help for them. If you're worried about someone, you can look for certain signs.

People who have anorexia:

• Weigh much less than is healthy or normal.
• Are very afraid of gaining weight.
• Refuse to stay at a normal weight.
• Think they are overweight even when they are very thin.
• Deny the seriousness of their low body weight.
• Base their self-esteem on how they view their body weight and shape.

Their lives become focused on controlling their weight. They may:

• Obsess about food, weight, and dieting.
• Strictly limit how much they eat.
• Have special ways of eating food or making it look like they've eaten when they haven't.
• Exercise a lot, even when they are sick.
• Vomit or use laxatives or water pills (diuretics) to avoid weight gain.

What Happens

Anorexia almost always begins with a strict weight-loss diet. Over time, strictly limiting foods leads to weight loss that isn't healthy and malnutrition.

As malnutrition sets in, the brain and metabolism change. This limits the appetite and how your body uses food. It also limits your ability to think clearly and make good decisions. As the illness gets worse, behaviours that aren't rational begin. You might make rules about food or make yourself vomit out of fear of gaining weight.

Starvation and malnourishment from anorexia can cause other problems. These include osteoporosis or an irregular heartbeat. Often other mental health conditions occur along with anorexia, such as depression.

After anorexia starts, a return to normal eating is very hard without help. Early treatment offers the best chance to recover. Some people will need treatment at an inpatient clinic. People who have anorexia tend to strongly deny that they have a problem. So most often, their loved ones have to get help for them.

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When to Call a Doctor

Call 911 or other emergency services immediately if:

• You have severe anorexia, and starvation has become life-threatening.
• You or someone you know is thinking seriously of suicide or has recently tried suicide. Serious signs include these thoughts:
  • You have decided on how to kill yourself, such as with a weapon or medicines.
  • You have set a time and place to do it.
  • You think there is no other way to solve the problem or end the pain.
• You feel you cannot stop from hurting yourself or someone else.

Where to get help 24 hours a day, 7 days a week

If you or someone you know talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away.

• Call or text Canada's suicide and crisis hotline at 988.
• Call Talk Suicide Canada: 1-833-456-4566 or text 45645 (4 p.m. to midnight ET).
• Kids or teens can call Kids Help Phone: 1-800-668-6868 or text CONNECT to 686868.
• Go to the Talk Suicide Canada website at https://talksuicide.ca or the Kids Help Phone website at https://kidshelpphone.ca for more information.

Consider saving these numbers in your phone.

Call your doctor now if you have been diagnosed with anorexia nervosa and:

• Are not able to pass urine.
• Have a pounding heartbeat, skipping heartbeats, or a slower-than-normal heart rate.
• Have been fainting.
• Have severe belly pain; are vomiting up blood; or have black, sticky (tarry) stools. These signs may mean that there is bleeding in the digestive tract.
• Have severe pain anywhere in your body, such as the joints or torso.

Call your doctor if you:

• Have signs of anorexia, including rapid weight loss, eating very little, and being overly concerned about weight and appearance.
• Have lost a lot of weight and can't stop losing weight.
• Fear gaining even a small amount of weight, and this interferes with eating healthy meals.
• Notice that you are secretive or lie about your eating habits.
• See yourself as fat and feel that you must diet, even when other people say you look too thin.
• Have been making yourself vomit or are abusing laxatives or diuretics (bulimia).
• Are not having menstrual periods when you should.
• Feel the need to exercise a lot, and don't give yourself healing or rest time when you are injured or exhausted.
• Have been diagnosed with anorexia and feel dizzy.

Watchful waiting

Watchful waiting is a wait-and-see approach. It's not a safe way to handle a possible eating disorder.

Getting early treatment improves your chances of overcoming anorexia.

Exams and Tests

There is no single test that can diagnose anorexia. But this illness has a visible effect on your health and eating habits. If your doctor thinks that you may have anorexia, he or she will compare your weight with the expected weight for someone of your height and age. He or she will also check you for signs of malnutrition or starvation.

Common exams and tests for anorexia include:

• A medical history of your physical and emotional health.
• A physical exam. This may include checking your heart, lungs, blood pressure, weight, mouth, skin, and hair for problems from malnutrition.
• Screening questions about your eating habits.
• A mental health assessment, to check for depression or anxiety.
• Blood tests, to check for signs of malnutrition.
• X-rays. They can show if your bones have been weakened by malnutrition.

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Treatment Overview

All people who have anorexia need treatment. Treatment can help you get back to and stay at a healthy weight.

Because anorexia is both a physical and an emotional problem, you may work with:

• A doctor. They will treat the medical conditions that have been caused by anorexia, such as osteoporosis, heart problems, or depression.
• A registered dietitian. They will help you learn healthy ways to eat and to understand what good nutrition is.
• A mental health professional. They will help you cope with the emotional reasons behind anorexia.

If your weight has dropped too low, you will need to be treated in a hospital.

There are no medicines to treat anorexia. But an antidepressant medicine may help if you also have depression, an anxiety disorder, or obsessive-compulsive disorder.

Anorexia can take a long time to overcome. Many people have ups and downs. Try to think of treatment as an ongoing process.

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Self-Care

Here are some things you can do to take care of yourself during recovery from an eating disorder.

Stick to your treatment plan.

Go to any counselling sessions you have. If you can't go, or don't think the sessions are helping, talk to your counsellor about it. And take any medicines you've been prescribed exactly as directed.

Work on healthy eating habits.

Listen to what counsellors and nutrition experts say about healthy eating. Learn about what makes a healthy and balanced diet, and then make a plan for your own healthy eating.

Learn healthy ways to deal with stress.

Managing stress is important in recovery. Find what works for you. You could try things like journaling, volunteering, reading, or meditating.

Take it easy on yourself.

Focus on your good qualities. Don't blame yourself for your disorder. And remember that recovery takes time, and that you can make progress one goal at a time.

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