Anorexia Nervosa

What is Anorexia Nervosa?

BEAT – the leading Eating Disorder Charity defines Anorexia Nervosa as follows:

Anorexia (or anorexia nervosa) is a serious mental illness where people keep their body weight low by dieting, vomiting, using laxatives or excessively exercising. The way people with anorexia see themselves is often at odds with how they are seen by others and they will usually challenge the idea that they should gain weight. For example, they often have a distorted image of themselves, thinking that they’re fat when they’re not. People affected by anorexia often go to great attempts to hide their behaviour from family and friends.

Often people with anorexia have low confidence and poor self esteem. They can see their weight loss as a positive achievement that can help increase their confidence. It can also contribute to a feeling of gaining control over body weight and shape.

As with other eating disorders, anorexia can be associated with depression, low self-esteem, alcohol misuse and self-harm.

Anorexia is a serious condition that can cause severe physical problems because of the effects of starvation on the body. This can lead to loss of muscle strength and reduced bone strength in women and girls; in older girls and women their periods often stop. Men can suffer from a lack of interest in sex or impotency.

The illness can affect people’s relationship with family and friends, causing them to withdraw; it can also have an impact on how they perform in education or at work. The seriousness of the physical and emotional consequences of the condition is often not acknowledged or recognised and people with anorexia often do not seek help. Anorexia in children and young people is similar to that in adults in terms of its psychological characteristics. But children and young people might, in addition to being of low weight, also be smaller than other people their age, and slower to develop. 


Early warning signs of Anorexia Nervosa:

  • Significant weight loss
  • Distorted body image
  • Intense fear/anxiety about gaining weight
  • Preoccupation with weight, calories, food, etc.
  • Feelings of guilt after eating
  • Denial of low weight
  • High levels of anxiety and/or depression
  • Low self-esteem
  • Self-injury
  • Withdrawal from friends and activities
  • Excuses for not eating/denial of hunger
  • Food rituals
  • Intense, dramatic mood swings
  • Pale appearance/yellowish skin-tone
  • Thin, dull, and dry hair, skin, and nails
  • Cold intolerance/hypothermia
  • Fatigue/fainting
  • Abuse of laxatives, diet pills, or diuretics
  • Excessive and compulsive exercise

Physical health complications include:

  • Amenorrhea (cessation of menstrual cycle)
  • Abnormally slow and/or irregular heartbeat
  • Low blood pressure
  • Anemia
  • Poor circulation in hands and feet
  • Muscle loss and weakness (including the heart)
  • Dehydration/kidney failure
  • Edema/swelling
  • Memory loss/disorientation
  • Chronic constipation
  • Growth of lanugo hair (downy hair on the face and body)
  • Bone density loss/Osteoporosis

Treatment recommendations for Anorexia Nervosa

 NICE Guidelines, (2004, p 8) recommend:

The delivery of psychological interventions should be accompanied by regular monitoring of a patient’s physical state, including weight and specific indicators of increased physical risk”

CAT, IPT, CBT, focal psychodynamic therapy and family interventions focused explicitly on eating disorders

Patient, and where appropriate, carer preference should be taken into account in deciding which psychological treatment is to be offered. Aims of psychological treatment should be to reduce risk, encourage weight gain, and healthy eating, to reduce other symptoms related to an eating disorder, and facilitate psychological and physical recovery”


Therapy for Anorexia Nervosa & What to Expect

Nine Wellbeing have therapists and psychologists who have worked in specialist eating disorder settings for many years. If you have a diagnosis of Anorexia Nervosa, your GP , or other designated medical professional WILL have to be involved in your therapy treatment plan, to manage the physical health complications associated with your diagnosis. No therapy will be offered without this agreement being in place.  Whilst this may sound daunting, it does not mean that your GP will know anything about what you discuss in therapy, the content of your sessions will remain confidential between you and your therapist

You will be offered an initial consultation which will look at your symptoms, and what is troubling you most at the moment. We will also consider your motivation levels and whether you are ready to make changes at this stage. Often, the idea of increasing food intake is terrifying. We understand this, and it may be that your treatment focuses on other areas of your life to begin with, to help you to improve your confidence and self esteem.

Sometimes, an eating disorder can develop due an earlier traumatic experience. You may or may not link the development of your eating disorder feelings and behaviours with this experience. By treating the trauma, it is possible that the current eating difficulties begin to resolve.

Therefore, what you can expect from your therapy is that you will not be discussing food and weight at each of your sessions.  Neither will you be weighed during your sessions, However, if your weight is at a critically low point (this will be discussed with you at consultation), then it may be that therapy is not the right course of action at this time. Furthermore, if your weight is very low, or falling rapidly, this cannot be ignored, and we will make an agreement about how your weight is reported back to therapy, to ensure that all the associated physical health risks can be taken care of by your GP or other health professional.

The NICE approved psychological therapies that are available to help you with your Eating Disorder include:

Cognitive Behaviour Therapy – adapted for Eating Disorders
Eye Movement Desensitisation and Reprocessing (EMDR) for trauma and phobias
Motivational Therapy
Dialectical Behaviour Therapy (DBT)
Cognitive Analytic Therapy (CAT)

I would like to get help for my eating disorder, what shall I do?

First and foremost, contact your GP.  You may live in an area where you can receive free care from an NHS specialist eating disorder service.

B-EAT is a leading eating disorder charity. Please consult their pages for more information and sources of support.

If you are in the North West area, and you are looking for private therapy, then please contact Nine Wellbeing to find out more, and we will be very happy to answer your questions:


Please note that if you are making contact about someone you are concerned about, we will try to answer any queries, but should your loved one engage in therapy with us, unless they are at an immediate risk of serious harm, or we believe that they lack capacity to make treatment decisions, the content of their therapy sessions will remain confidential, We understand that this can be very stressful and frustrating for loved ones and carers, but please be assured that if we thought there were immediate risks, we would be liaising with their GP or their named contact.