Understanding Anorexia Nervosa
All eating disorders are serious but amongst all, anorexia nervosa is the most severe as it can be life-threatening in the short-term.
For a person with anorexia nervosa, treatment and recovery can take many years. This is not only due to the lack of services and access to treatment but also because of its nature. So, if you are recovering from anorexia nervosa or providing treatment/ support to someone, it is important to be understanding, practice empathy and be patient.
10 things you need to know about anorexia nervosa
To better understand anorexia nervosa and its treatment, I would recommend you to read National Eating Disorders Collaboration’s article here, which is also available as a downloadable PDF fact sheet.
Going through the information and understanding it will take time. However, here are ten points which I believe are key in understanding anorexia nervosa, knowing what to expect from treatment and in being realistic about recovery.
1. Anorexia nervosa has three significant facets.
They are restriction of energy intake, fear of gaining weight and body image disturbance. These contribute to persistent behaviours and low weight. The more underweight a person is, the more severe the condition.
2. A person within or above a normal BMI range could have anorexia nervosa.
This means we are to be concerned when someone shows signs of disordered eating behaviours. Just because someone is not underweight, it does not mean they are well nutritionally and psychologically. If a person meets all diagnosis criteria but does not present as underweight, a diagnosis of atypical anorexia nervosa (under OSFED) is appropriate and will warrant treatment.
3. A person may binge-eat or purge but has anorexia nervosa.
If a person has binge eating or purging behaviours, it does not equate to a diagnosis of bulimia nervosa or binge eating disorder. Anorexia nervosa has two subtypes: restricting and binge-purge.
In order to access suitable treatment options, it is important to differentiate and have the right diagnosis. But do note, it is possible for the eating disorder to change over time and be more dominant in how it affects a person. If this happens, treatment can be adjusted to suit a person’s needs.
4. If not treated, anorexia nervosa can lead to permanent complications or death.
As often advised, ‘never watch and wait’. Early intervention is key to prevent entrenchment of an eating disorder and serious complications such as early osteoporosis and death.
5. Lack of recognition of the seriousness of low weight is common.
Lack of recognition and ambivalence is common. Be empathetic and understanding. Learn to see from their perspective. Before being able to see another perspective, they need to know that someone recognises their experience as legitimate and important.
6. Treatment and management are different when in hospital vs community.
The treatment focus will change depending on whether a person is in a life-threatening situation and requires hospital admission. To prevent falling through the cracks with therapy, when being discharged, it is vital to be linked with appropriate eating disorder clinicians through the outpatients clinic or in the community.
7. Restoring nutritional status and weight is an important early step.
Starvation itself can cause changes to our physical body, emotions, thinking, social behaviours and attitudes/behaviours relating to food. Without restoring a person’s nutritional status, attending therapy sessions and making progress is almost impossible.
8. Nutrition and exercise management has to be planned in line with treatment.
Food and activity behaviours can stall progress. Because behaviours and thoughts are intertwined, having a nutrition and exercise plan is an essential part of all stages in recovery.
9. Fully recovery can take a few years.
How quickly can someone recover from anorexia nervosa? Research statistics provide us different information but from one study, an average of 20 months is required for full recovery. Many factors come into play but family relationships are found to play a significant role.
10. Key factors to consider during treatment and recovery from anorexia nervosa:
How can we ensure full recovery and reduced risk of relapses? It appears that addressing compulsive exercise and improving family and social relationships can help.
Final note
If you are supporting someone in their recovery from anorexia nervosa, remember to take your time in understanding the condition, get the professional help you need and make sure you yourself are well supported.
If you are recovering from anorexia nervosa, be gentle with yourself and understand that ambivalence and working through it is part of the journey.