Anorexia is both an eating disorder and a mental illness. It’s the third-highest chronic illness among adolescents.
A life-threatening disease, research shows that the mortality rate associated with anorexia is 12x higher than the death rate of all other causes of death for women between ages 15-24 years old.
Anorexia entails an obsessive desire to control and lose weight. This desire leads to dangerous behaviors like severe restriction, obsessive calorie-counting, compulsive exercise, purging, and lying about food intake.
Anorexia often develops during adolescence or young adulthood. However, people can develop this condition at any point during their lives. While it’s more common amongst women, men are not immune to eating disorders. In fact, the stigma of males seeking help can be so damaging that many men do not receive any support.
Anorexia can be a progressive condition, meaning it often worsens in severity over time. Without treatment, it can lead to numerous mental and physical health consequences. Subsequently, it may be fatal.
Side Effects of Anorexia
Anorexia includes an excessive preoccupation with food, weight, and controlling these two variables. As a result, many people will deny hunger, eat only specified ‘safe’ foods, and adopt other rigid dietary patterns.
The common side effects of anorexia include:
- Failure to make expected developmental milestones
- Insomnia or other sleep-related problems
- Dizziness or fainting
- Bluish discoloration on the skin or fingertips
- Thin, brittle hair
- Soft fuzzy hair that coats the body
- Gastrointestinal problems
- Low blood pressure
Anorexia often coincides with emotional side effects, which may include:
- Withdrawing from friends and family
- Problems at work or school
- Flat affect (presenting as having limited or no emotions)
- Pronounced fear of weight gain or body changes
- Increased irritability.
Many people struggling with anorexia also meet the criteria for other mental health conditions. Therefore, symptoms may occasionally overlap. These conditions can include:
- Major depressive disorder
- Obsessive-compulsive disorder (OCD)
- Posttraumatic stress disorder (PTSD)
- Personality disorders
- Substance use disorders
- Bipolar disorder
A qualified mental health professional can adequately screen for anorexia. They will conduct a comprehensive questionnaire that discusses specific thoughts and behaviors. This information helps determine an appropriate diagnosis. It can also classify the disorder as mild, moderate, or severe, providing invaluable information for locating the best treatment.
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What Causes Anorexia?
Just like any mental illness, there isn’t a specific origin for anorexia. Instead, it’s beneficial to examine the potential risk factors.
Many individuals with this disorder report histories of trauma or dysfunctional family dynamics. Trauma can profoundly impact someone’s self-esteem and cognitive development.
Sexual trauma can trigger immense shame, which may lead to anorexic behaviors.
It’s no secret that we live in a society that covets thinness and themes of self-control. For some people, anorexia starts with a simple diet. Someone may want to lose some weight or get healthier. But if the process itself can become compulsive, it can spiral out quickly.
Parents model healthy eating for their children. But what happens if the parent struggles with an eating disorder? The child may adopt their habits, often unconsciously, because it feels so familiar to them.
Likewise, a struggling parent may project their insecurities onto their child (especially if the child gains weight), which may reinforce restricting or dieting behaviors.
Perfectionism and Control
From a psychological perspective, anorexia often stems from an innate desire for control. Therefore, controlling food and weight may seem like a viable way to restore a sense of power.
How Can I Tell If Someone I Love Has Anorexia?
Weight loss alone can’t indicate if someone has anorexia. Many factors can cause weight loss, including stress, medical issues, and increased physical activity.
Anorexia isn’t just about weight loss. It’s about the thoughts, feelings, and patterns related to weight loss. The following warning signs may indicate someone is struggling:
- They frequently complain or seemingly obsess over their weight.
- They cook for others, but you don’t see them eating the same food.
- They become upset or agitated if they can’t exercise.
- They become reactive if they need to change restaurants or a menu item is unavailable.
- They present as more guided or withdrawn from you.
- They wear baggy clothing often, even when it’s warm outside.
- They use the restroom immediately after eating.
- They cut their food into tiny pieces or eat their food very slowly.
- They frequently have reasons why they don’t want to eat with you.
- They make jokes about feeling too fat.
- They have lost a lot of weight and appear bony, gaunt, or frail.
Keep in mind that none of these warning signs inherently indicate a problem. But a cluster of symptoms might mean that your loved one is struggling.
Only a qualified professional can make the diagnosis of anorexia.
How Can I Support Someone Struggling?
Eating disorders can be sensitive, unnerving issues. As a loved one, you may feel nervous about saying or doing the wrong thing. These fears are normal, but it’s still important to work through them to offer support.
Practice In Advance
It isn’t easy to share your feelings with someone. This is especially true if you don’t have the best relationship or worry about their reaction.
That’s why practicing can be so beneficial. It gives you time to think about what you want to say. You may even want to rehearse with another trusted friend. That way, they can provide you with feedback.
Finally, you might write down your feelings and read from the letter directly. This strategy avoids needing to say what you want to say on the spot.
Pick a Safe Time to Share Your Concerns
Choose a time where you don’t have time constraints or apparent distractions. Ideally, this time should be fairly neutral. Avoid the discussion during or after mealtime. Ensure that you two are alone- it’s not fair to have other people around during this private discussion.
When you express yourself, be careful to avoid making assumptions, criticizing, or lecturing your loved one. These statements can come across as accusatory, and they may shut down or withdraw from you.
Instead, focus on being objective. Point out concrete situations, and be sure to provide concrete examples as to why you have concerns. Don’t tell your loved one what they should do- instead, your goal is to convey your worry and love.
Let them know that you love and care about them. Reinforce that you are here to help them and that you hope they are willing to hear your feedback.
Expect Pushback and Resistance
Denial and shame underlie many eating disorders, so don’t be surprised if your loved one minimizes or outright denies the behavior. This pattern isn’t usually malicious. It comes from an evolutionary need to self-protect. Nobody likes being exposed, even if they’re aware of the issue.
If this happens, try to be patient and supportive. Remain empathic, even if they start becoming combative. Don’t try to focus on changing their mind. If you start lecturing, it’s easy for the other person to become angry or tune you out altogether.
Remember that change is scary, and the idea of letting go of an eating disorder can feel terrifying.
Don’t make idle threats right now.
Change is slow, and they’re already probably feeling guilty and embarrassed by your feedback. Besides, ultimatums are only useful if you plan to implement them immediately. Otherwise, your message comes across as inconsistent and even untrustworthy.
Avoid Giving Advice
You may feel tempted to talk about ways to eat more or practice self-compassion. Even if your intentions are good, they might come across as invalidating.
Anorexia is complex and insidious.
It’s not as simple as not wanting to eat. If the solution were truly that easy, anyone could recover.
Avoid Making Any Statements About Their Appearance
No matter how you think your loved one looks, keep those thoughts to yourself. People with anorexia are already consumed with their physical appearance. A comment about how they “aren’t fat” may reinforce their desire to continue with the same behavior.
Offer Treatment Options
If your loved one is receptive to change, it’s worth discussing potential treatment. This, of course, will depend on the severity of their condition.
As a loved one, it may be worthwhile to research some options and/or how to find the right provider before your discussion. This will ensure that you’re prepared to help them immediately. It’s not uncommon for people to change their minds, so you want to be ready to act as soon as you can.
What Does Recovery Look Like?
Recovery from anorexia isn’t a straightforward process. Even experts often disagree about the best ways to treat this condition. That said, here are some treatment considerations.
Some people require inpatient hospitalization. This period is short-term and intended to provide acute stabilization. This is the highest level of care, and it may require vital monitoring, intravenous fluids, and tube feeding.
Hospitalization may be required in the event of severe malnourishment or risk for developing refeeding syndrome. Some people stay in the hospital after a medical event, like a heart attack, fainting, or bleeding from vomiting. These medical conditions often mandate the need for ongoing supervision.
Inpatient hospitalization provides 24/7 monitoring. The treatment team consists of numerous healthcare professionals, including:
- Registered nurses
- Licensed therapists
- Registered dietitians
- Case managers
In some cases, the individual may also need to meet with specialists, such as cardiologists or gastroenterologists. Treatment usually lasts until the individual’s vitals are stabilized, and they can eat again independently. Afterward, most clients transfer to a residential or partial hospitalization level of care.
Residential treatment, often known as rehab, consists of daily clinical services, housing, and a supportive community. This treatment is ideal for people struggling with moderate or severe anorexia. It provides a safe place to work on recovery without the usual distractions from home.
The length of residential care varies anywhere from one month to several months. Treatment consists of a mix of group, individual, and family therapies. The average day typically focuses on concepts related to:
- Education about eating disorders and their progression
- Healthy coping skills for stress management
- Meal planning and eating enough food throughout the day
- Building a healthy relationship with exercise
- Trauma and other co-occurring mental health issues
- Medication management
- Self-esteem and self-empowerment
- Peer support
Partial Hospitalization/Outpatient Treatment
After residential treatment, clients often transition into programs known as:
- Partial hospitalization treatment
- Intensive outpatient treatment
- Outpatient treatment
These treatments have similar goals as residential treatment, but clients do not live at the facility. They also usually work or go to school while receiving care. Some people start right at this level. Others may transition into it after completing a residential program.
These programs offer various services, such as psychotherapy, group therapy, holistic approaches (acupuncture, equine therapy, art therapy), nutrition, and alumni support.
Does Someone Recover Fully From Anorexia?
Many clients (and health professionals) struggle to pinpoint an exact definition for recovery.
Some people believe it’s entirely possible to recover from anorexia in the sense that the individual is free from all anorexia symptoms. In this case, full recovery is undoubtedly a viable goal. However, it doesn’t always appear to be a rational one. In some cases, it may set people up for having unrealistic expectations.
Others argue that recovery is more an active process and that someone must continuously be aware of their triggers and manage them. Theoretically, the person may always be “in recovery.”
Furthermore, many people recognize that anorexia recovery may be subjective. For instance, some people may always have safe foods. Others might still struggle with their body image despite weight restoration.
It’s crucial to find a definition that works for you. Recovery can be a complicated concept, and this concept can change over time. That’s why seeking support and taking care of yourself is so important.
All eating disorders are serious mental illnesses. Anorexia can be a life-threatening condition. If you or someone you love is struggling, reach out for support. Help is available, and you deserve a fulfilling and healthy recovery.