Anorexia Nervosa

The term ‘Anorexia Nervosa’ can be translated as ‘loss of appetite for nervous reasons’. Anorexia has two subtypes—restricting type and binge-eating/purging type.

Bulimia also has two subtypes—purging and non-purging. Anorexics have a terror of gaining weight and will actively restrict their calorie intake to prevent weight gain. An anorexic will typically possess a very distorted, or dysmorphic, perception of their weight and body shape, thinking they are overweight even when clinically anorexic and possibly close to death. Behavioural symptoms of anorexia nervosa are quite diverse.

The anorexic may have so little energy that she spends all her time in bed or sitting in a chair. Alternatively, the anorexic may appear restless and very active and engage in over-exercise as a way of getting rid of unwanted calories. Mood swings and lack of interest in sex will be apparent. Laxative abuse is very common and some anorexics may purge (vomit) after every occasion that food passes their lips or on occasions when they believe they have eaten too much. Most anorexics will claim allergies to various foodstuffs and will eat very few, or no, carbohydrates and avoid eating in front of others.

There will be a lot of secrecy around food and extreme anger or rage when confronted by concerned others. In term of clothing, a sign of anorexia is the increased use of baggy clothes to conceal how thin the body has become. An anorexic will become progressively more starved and hence their cognitions will become more dominated by a preoccupation with food. Successful restricting will be a source of great pride and, as time goes by, the brain will become ever more starved of the essential vitamins, proteins and minerals needed for normal cognitive functioning. This means that an anorexic’s cognition will become progressively more distorted and their perception of reality ever more skewed.

Anorexia carries with it a significant risk of mortality and numerous health deficits. Notable deficits include: cardiac arrhythmia; the growth of fine, downy hair on arms and face (laguno); light-headedness; dizziness; constipation; impaired blood circulation; damage to the stomach caused by laxative abuse; delayed puberty; loss of periods (amenorrhea); feeling cold all the time; weak bones; infertility; and osteoporosis.

Anorexia is, at heart, not really about food. It is about using an obsessive relationship with food to control and repress difficult and painful feelings. By focusing on food and body weight, the uncomfortable feelings can be avoided for a while. In the long run, of course, the isolation and pain of anorexia will make the core problems worse and the anorexia may prove fatal to the sufferer.

Acute care: At Start2Stop, we are unable to treat anorexics who are in the acute phase of anorexia. Anorexics in the acute phase will typically require admission to a psychiatric hospital for re-feeding, nursing, medical input and psychiatric support.

Post-acute care: Once weight has been picked up, best practice is for an anorexic to commit to going through an extended period of residential rehab, where they can engage in a psychological programme and be supported and contained around their meal structures. This is the post-acute phase.

Post-post-acute care: Start2Stop is ideally placed to help a recovering anorexic who has stabilised on their weight and is either out of the anorexic spectrum (a BMI of 18 or more), or whose BMI is at least 17. At this point in the recovery process, the anorexic will be working with a registered dietician or nutritionist around a structured and balanced meal plan, will have worked through underlying emotional distress and traumas, will probably be active within an appropriate 12-Step fellowship, and will have developed a generally more healthy relationship with her body and food. These gains will probably have been made in various residential settings over an extended period of time.

Our job at Start2Stop is to help with the return home, an especially difficult time for a recovering anorexic as family systems are often very triggering. Our dedicated eating disorder therapists will work with you and your clinical team (dietician, nutritionist, GP, psychiatrist) to ensure that relapse is avoided.

We will follow through on the continuing care plan formulated by referring institutions, and our holistic and healing group process will provide a sensitive and understanding space where you will feel held and supported. Start2Stop can offer outpatient help, Daycare at The Mews House, or safe and contained residential accommodation at The Mews House, where dietetic input, meal supervision and emotional support is always on-hand.

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