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Anorexia Nervosa

Many clients enquire about therapy because they have concerns about their eating.  I have previously worked for many years within an NHS Specialist Eating Disorder service. Therefore, if you or someone you care about is worried about their eating, I hope that you find these  ‘Eating and Body Distress’ articles helpful. You may also be interested in the teaching sessions on Eating Disorders and Body Distress at Nine Teaching.



What is Anorexia Nervosa?


BEAT - the leading Eating Disorder Charity defines Anorexia Nervosa as follows:


Anorexia (or anorexia nervosa) is a serious mental illness where people keep their body weight low by dieting, vomiting, using laxatives or excessively exercising. The way people with anorexia see themselves is often at odds with how they are seen by others and they will usually challenge the idea that they should gain weight. For example, they often have a distorted image of themselves, thinking that they're fat when they're not. People affected by anorexia often go to great attempts to hide their behaviour from family and friends.


Often people with anorexia have low confidence and poor self esteem. They can see their weight loss as a positive achievement that can help increase their confidence. It can also contribute to a feeling of gaining control over body weight and shape.


As with other eating disorders, anorexia can be associated with depression, low self-esteem, alcohol misuse and self-harm.


Anorexia is a serious condition that can cause severe physical problems because of the effects of starvation on the body. This can lead to loss of muscle strength and reduced bone strength in women and girls; in older girls and women their periods often stop. Men can suffer from a lack of interest in sex or impotency.


The illness can affect people’s relationship with family and friends, causing them to withdraw; it can also have an impact on how they perform in education or at work. The seriousness of the physical and emotional consequences of the condition is often not acknowledged or recognised and people with anorexia often do not seek help. Anorexia in children and young people is similar to that in adults in terms of its psychological characteristics. But children and young people might, in addition to being of low weight, also be smaller than other people their age, and slower to develop. 




Early warning signs of Anorexia Nervosa


Significant weight loss

Distorted body image

Intense fear/anxiety about gaining weight

Preoccupation with weight, calories, food, etc.

Feelings of guilt after eating

Denial of low weight

High levels of anxiety and/or depression

Low self-esteem


Withdrawal from friends and activities

Excuses for not eating/denial of hunger

Food rituals

Intense, dramatic mood swings

Pale appearance/yellowish skin-tone

Thin, dull, and dry hair, skin, and nails

Cold intolerance/hypothermia


Abuse of laxatives, diet pills, or diuretics

Excessive and compulsive exercise


Physical health complications include


Amenorrhea (cessation of menstrual cycle)

Abnormally slow and/or irregular heartbeat

Low blood pressure


Poor circulation in hands and feet

Muscle loss and weakness (including the heart)

Dehydration/kidney failure


Memory loss/disorientation

Chronic constipation

Growth of lanugo hair (downy hair on the face and body)

Bone density loss/Osteoporosis




Treatment recommendations for Anorexia Nervosa



 NICE Guidelines, (2004, p 8) recommend:


“The delivery of psychological interventions should be accompanied by regular monitoring of a patient’s physical state, including weight and specific indicators of increased physical risk”



Patient, and where appropriate, carer preference should be taken into account in deciding which psychological treatment is to be offered. Aims of psychological treatment should be to reduce risk, encourage weight gain, and healthy eating, to reduce other symptoms related to an eating disorder, and facilitate psychological and physical recovery”



I would like to get help for my eating disorder, what shall I do?


First and foremost, contact your GP.  You may live in an area where you can receive free care from an NHS specialist eating disorder service.


B-EAT is a leading eating disorder charity. Please consult their pages for more information and sources of support.


If you are in the North West area, and you are looking for private therapy, then please contact Nicola at Nine Wellbeing to find out more, and we will be very happy to answer your questions:


However, if you are seeking therapy and you meet the diagnostic criteria for Anorexia-Nervosa  we will only agree to undertake therapeutic work with you if you are also under the care of a medical practitioner and if there is regular monitoring of your weight. Anorexia-Nervosa is a very serious medical condition, which requires a combination of medical and psychological intervention.


Please note that if you are making contact about someone you are concerned about, we will try to answer any queries, but should your loved one engage in therapy with us, unless they are at an immediate risk of serious harm, or we believe that they lack capacity to make treatment decisions, the content of their therapy sessions will remain confidential, We understand that this can be very stressful and frustrating for loved ones and carers, but please be assured that if we thought there were immediate risks, we would be liaising with their GP or their named contact.

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