Anorexia nervosa, or anorexia for short, is an eating disorder that can have fatal consequences. People with anorexia eat very limited amounts of food, which leads to starvation. Eventually they may become dangerously thin and malnourished, yet still feel fat. People with anorexia are often so malnourished that they have to be admitted to hospital. Even then, they deny that anything is wrong.

To prevent weight gain or to keep losing weight, people with anorexia usually severely restrict the amount of food they eat. They may control their calorie intake by vomiting after meals or by misusing laxatives, diet aids, diuretics or enemas. They may also try to lose weight by exercising excessively. However much weight is lost, the person remains afraid of gaining weight.

Anorexia is in fact about something other than food. It is an extremely unhealthy and sometimes life-threatening way of coping with emotional problems. When you have anorexia, you often equate thinness with self-worth.

How is anorexia diagnosed?

The doctor takes a detailed medical history and carries out a physical examination. During diagnosis and treatment in Switzerland, a neurological examination is also performed. In children and adolescents, the doctor checks whether development is appropriate for their age.

Depending on the severity of the symptoms, further tests are carried out. These include:

  • Abdominal ultrasound
  • Laboratory tests: for example, electrolytes, kidney and liver values and urine tests. Anorexia increases the risk of osteoporosis, so a bone density measurement may also be needed. Clinical psychologists or psychotherapists may also be involved in the diagnosis.

Symptoms of anorexia

Our society holds the distorted belief that a person has to look emaciated to be struggling with anorexia. The truth is that you cannot tell by looking at someone whether they have anorexia; certain warning signs, however, may point to a possible problem.

Physical effects of anorexia

Anorexia nervosa leads to severe malnutrition, which can be identified by many signs besides weight loss, such as the following:

  • Loss of, or fluctuations in, body fat and muscle.
  • Yellowing and dryness of the skin.
  • Growth of fine hair all over the body.
  • Loss or disruption of the menstrual cycle (amenorrhoea).
  • Constipation.
  • Abdominal pain and gastrointestinal problems.
  • A weakened immune system.
  • Difficulty regulating body temperature or tolerating cold.
  • Lethargy and low energy.
  • Dental erosion.

Behavioural and emotional signs of anorexia

People struggling with anorexia show certain behavioural and emotional warning signs that point to undernourishment and psychological distress. These include:

  • Expressing an intense fear of gaining weight or becoming fat.
  • A focus on body weight, size, shape and appearance that causes marked distress.
  • Hyperfocus on food, including its nutritional value and its effect on the body.
  • Ritualised eating patterns, such as taking very small or very large bites, pushing food around the plate, eating foods in groups, cutting out certain foods, holding food in the cheeks, etc.
  • A distorted body image.
  • Excessive exercise, even in bad weather, that interferes with work, study or social life or leads to injury.
  • Refusing to eat or to be seen eating, and avoiding meals in social situations.
  • A pattern of refusing food, perhaps claiming to have “already eaten” and/or to be “not hungry”.
  • Mood swings and increased emotional dysregulation.
  • Difficulty thinking clearly and concentrating.

Prevention

There is no guaranteed way to prevent anorexia nervosa. Primary care doctors (paediatricians, family doctors and general practitioners) may be well placed to spot early signs of anorexia and prevent the full-blown illness from developing. For example, they can ask about eating habits and satisfaction with appearance during routine appointments.

If you notice that a family member or friend has low self-esteem, follows strict diets and is dissatisfied with their appearance, talk to them about these concerns. Although you may be unable to prevent an eating disorder from developing, you can talk about healthier behaviour or treatment options.