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Focus on.... Anorexia Nervosa

Focus on.... Anorexia Nervosa

The term ‘anorexia nervosa’ is itself misleading and generally considered a misnomer.
‘Anorexia’ implies the individual has lost all interest in food, never hungry and has no appetite. Yet, this is rarely the case. The opposite is more accurate of anorexia. 

The person experiencing anorexia is not only very interested in food and frequently very hungry, but as weight continues to decrease and the person reaches low-weight stages AN, his/her preoccupation and obsession with food becomes overwhelming. 

Nevertheless, the person will do everything in their power to deny and ignore these feelings & sensations & not permit him/herself to eat. This is a particularly important characteristic of AN, along with the individual’s attempt to strictly control food and eating, with great time & effort.
The question of ‘what is Anorexia Nervosa?’ is a difficult one to answer given particularly complex & multidimensional nature of the illness. 

A large spectrum of physical, psychological, social, emotional, behavioural and cognitive features have been documented. 

However, it may be argued that the list of defining features of AN are not complete and it must be remembered that AN is a complex illness with many consequences and implications. This is ighlighted by point that not all individuals experience exactly the same symptoms/implications in degree or severity. 

AN and all Eating Disorders are very much an individual experience with individual signs, symptoms, problems, difficulties, impairments etc. We can gain a general picture of the AN experience but we must remember that the experience is very much an individual one.

A number of signs and symptoms to look out for with AN & include:

• Food abstinence, semi-starvation, restricted dietary/food intake – person deliberately and consciously works to restrict food consumption. Calorie intake is drastically cut.
• Typically forbids all foods considered fattening or high in fat.
• May allow self to eat bulky, low calorie, low-fat foods e.g. cottage cheese, carrots or crisp-bread.
• Often diet becomes so restricted they eat only 1 or 2 types of food.
• Food intake - often become quite eccentric in its constituent foods. E.g., yellow pigmentation of the skin is witnessed in some individuals due to eating large amounts of carrots but little else (carotenosis).
• Delusional disturbances in body image. Unable to see themselves as they really are and deny extreme thinness/lightness (if present).
• Abuse of strenuous and/or compulsive exercise, laxatives, diuretics to control weight & bodily functions.
• Dry, chapped skin.
• Hyperactivity & periods of feeling ‘high’ (due to lack of food).
• Heart arrhythmias.
• Low blood pressure.
• Muscle weakness & atrophy.
• Lanugo (increased hair growth on face & body).
• Loss of periods (amenorrhoea).
• Bradycardia (slow pulse rate).
• Acrocyanosis (blueness to hands, feet & other extremities).
• Extremely low self-esteem.
• Socially anxious.
• Excessively dependant.
• Social withdrawal & isolation.
• Hair loss.
• Malnutrition
• Sleep disturbances.
• Conflict avoidant.
• Stealing.
• Electrolyte disturbances.
• Zinc deficiency.
• Dehydration.
• Osteopenia/osteoporosis.
• Cognitive impairments, e.g. memory, concentration, decision-making, problem-solving, black-&-white thinking.
• Self-harm.
• Feelings of being out of control.
• Chronic depression.
• Suicidal ideation.
• Neutropenia.
• Perfectionism.
• Acute dilation of stomach.
• Lack of self-worth, self-loathing, self-doubting.
• Feelings of despair, loneliness & desperation.
• Obsessive compulsive behaviours are common.
• Rituals & routines pervade almost every aspect of life - food, relationships, work, body shape, chores, daily activities etc.
• Psychiatric co-morbidity.
• Bloating & gastrointestinal symptoms.
• Seizures.
• Oedema.
Cardiac problems.
• Anaemia.
• Myopathy.
• Death.

The individual finds an outlet via their body: distress and pain mirrored in his/her extreme control of body. This is not for beauty or vanity’s sake, but because s/he has no other way of coping with such distress. 

The body becomes a canvas for which such distressing emotional and psychological thoughts & feelings are represented. 

Bruch (1978) suggests: ‘Anorexia is often considered to be a disorder of eating. In the most precise sense, this is incorrect....the pursuit of thinness becomes necessary for the individual to feel a sense of control.’

As with all types of ED, AN is a complex, multidimensional illness that has complications that can affect all areas of life – physical, psychological, emotional, social, sexual, behavioural, occupational. 

Someone experiencing AN can become easily trapped in cycle which only serves to perpetuate this AN behaviour. This is why is can be really important to access some help and support with interrupting this vicious cycle so that you can take control of this trap rather than you being trapped by this cycle.

(Alexandra O'Brien, Talking EDs (Glasgow & West Eating Disorder Support Service), 'Understanding Eating Disorders: Basics and Beyond (2012; 2019)

#anorexia #anorexianervosa #eatingdisorders #disorderedeating #restriction #eating #overeating #bodyimage #lowmood #selfesteem #support #therapy #counselling #Glasgow #Scotland


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