Anorexia Nervosa

Anorexia nervosa is a serious illness characterised by extreme weight loss caused by behaviours of dieting/food restriction and/or excessive exercise to the point of self-starvation, which may result in death. Due to the irrational fear of weight gain an individual develops inappropriate eating habits or rituals and compensatory behaviours in an effort to “burn off” calories. Sufferers may display an obsession with having a thin body and often have a distorted body self-perception; seeing themselves as fat when they are clearly underweight.

Individuals with anorexia tend to experience extreme anxiety and fear around food and eating, which to others will seem irrational or even bizarre. In a seemingly paradoxical way the more the individual tends to lose weight and engage in food avoidance the more extreme their fears and behaviours tend to become.

Anorexia is not a choice nor is it something that one can “snap out of”. Sufferers experience not just anxiety but extreme feelings of guilt, panic, hopelessness and distress that are very frightening to them and those around them. A defining characteristic of the disorder is the individual’s denial of the problem and ambivalence to engage in treatment.

Anorexia occurs in approximately 0.5% of females and in only 0.05% of males, with the average age of onset in early to mid adolescence. However, younger and older adults may also present for treatment.

The factors contributing to the development of anorexia are complex and include a strong genetic component. These genes tend to get switched on through environmental influences such as dieting behaviour or extreme exercising, particularly after puberty. Personality traits of perfectionism and fear of failure, low self esteem, emotion avoidance and obsessionality are very common in individuals with anorexia.

Anorexia nervosa is the third most common chronic disorder affecting adolescent girls, with the highest mortality rate of all psychiatric disorders. Statistically about 40 – 50% of people with anorexia will make a full and complete recovery, a further 30% partial recovery and approximately 20% have a chronic course of illness.

There is a strong statistical association between duration of illness and chances of recovery. Adolescents with an illness duration of up to 3 years have an especially good chance of full recovery when treated with Family Based Treatment (FBT). After an illness duration of 6 years and more, the chances of full clinical recovery, at least statistically, decrease significantly. However, there have been reports of individual cases who have achieved close to full, or at least partial recovery after many years of illness. It is important to always remain recovery oriented and develop realistic and achievable treatment goals that are meaningful for each individual.