Eating Disorder Recovery

Anorexia

What is Anorexia?

Anorexia nervosa is an eating disorder characterised by an intense fear of weight gain. People with anorexia may follow very strict rules with their diet, significantly under-eat and engage in a high level of exercise. This results in rapid weight loss and/or a significantly low body weight that is dangerous to health.

Some people with anorexia will also binge and purge (e.g., vomiting, laxatives). These binges may be objectively large or they may be subjective, where the person has a sense of having lost control of their eating but the total amount of food eaten would not be considered by others as excessive. A key difference with bulimia, is that the person’s body weight remains extremely low. 

Most people with anorexia will have very poor body image and perceive themselves to be fat when in fact they are very thin. Others may be aware that they are underweight but feel that their eating disorder is not as serious as others, or believe that their health will not be seriously affected.

Some people may have been unwell with anorexia for a very long time and are fully aware that their current weight is too low, but need support to tackle the overwhelming anxiety about restoring weight.

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Follow strict rules about what you can and can’t eat?

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Count calories, avoid food groups or delay eating for long periods?

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Feel you are fat or overweight even though your weight is lower than before or people have shared worries about your weight?

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Exercise even when you are feeling exhausted, overwhelmed, and/or injured?

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Feel extremely guilty or ashamed if you have broken a food rule?

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Feel terrified of gaining weight?

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Tell others you have eaten when you haven’t?

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Vomit or take laxatives when you feel you have eaten too much?

Causes of Anorexia

The causes of anorexia are hugely varied and will be specific to the person. We recommend a specialist assessment to build an understanding of what led to the development of anorexia and what is keeping the problem going. 

We know that there are several factors that can make someone more vulnerable to developing anorexia. These include biological factors (e.g., having someone in your family with an eating disorder, recent dieting or weight loss caused by being in an energy deficit), psychological factors (e.g., high levels of anxiety, perfectionism, self-criticism and poor body image), and social factors (e.g., cultural messages about thin bodies and weight stigma, previous trauma, isolation and bullying). 

Often people talk about aspects of the eating disorder that feel positive. These can vary from person to person but themes include:

  • Feeling that anorexia gives you something your good at and can succeed at.

  • A powerful way to cope with and numb yourself from highly distressing emotions.

  • A familiar and comforting pattern when other aspects of life feel out of control.

  • A way of communicating to others that you are struggling without having to voice this out-loud. 

It is important to acknowledge what purpose anorexia is serving in someone’s life. This will help us to understand what the core need is, so that we can address this (e.g., low self-esteem, emotion regulation) and the person can discover long-term and sustainable ways of coping. 

Treatment for Anorexia

After an initial assessment, your psychologist will put together a joint understanding of what has caused and maintained your anorexia. They will then discuss with you the best treatment approach.

There are three main treatment approaches for adults with anorexia recommended by the NICE guidelines: Cognitive Behavioural Therapy for eating disorders (e.g., CBT-E); the Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA); and Specialist Supportive Clinical Management (SSCM).

The different approaches will focus on and explore different areas. For example, CBT-E includes tackling the fear that regular eating will cause uncontrollable weight gain through talking, using food diaries (self-monitoring) and weight monitoring. MANTRA may focus more on your sense of identity and values and SSCM is a more goal-based, flexible approach depending on what the person would like to work towards.

All the approaches will focus on the importance of nutritional rehabilitation and stabilising weight, as we know that it is hugely important to tackle the biological factors that drive worries about weight, shape, and eating as well as protecting your physical health. 

Usually 20-40 sessions are needed to successfully treat anorexia, the specific number of sessions needed will be discussed after the assessment session. Generally speaking, the process of restoring weight can take a long time and we would always recommend working towards a healthy weight range before ending treatment as the evidence tells us this is key to long-term recovery. 

If you’re interested in learning more about our therapy services for anorexia, we invite you to book a 15-minute consultation to find out if we are a good fit.