It is not always clear why someone develops anorexia, and the specific causes are different for different people. Worries about body image can often play a role, but while anorexia can seem like it’s all about food and body size on the surface, the root causes are usually linked to how the person feels about themselves and what they’re going through in their lives.

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The behaviours around eating that other people can see are often just the external expression of an internal struggle. Mental health difficulties like anxiety and low self-esteem, a family history of eating disorders, addiction, or traumatic experiences like sexual abuse are all associated with developing anorexia.

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To better understand how anorexia affects a person, it can be helpful to think of it as a coping mechanism. Like any eating disorder, anorexia causes a person to control food and their body to manage distress and feel in control when something else in their life is making them feel out of control or unsafe. Understanding this makes it easier to understand how scary it can be to stop engaging in eating disorder behaviours. 

 

Not everyone who experiences anorexia will have the exact same profile of symptoms and different symptoms can emerge as the condition develops over time. The behaviours associated with anorexia can cause you to experience physical symptoms in your body and can lead to physical health complications over time.

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Because some symptoms of anorexia don’t develop straight away, it’s important to keep in mind that you should still reach out for help and support, even if you aren’t experiencing physical symptoms or complications.

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Like all eating disorders, anorexia begins in the mind, affecting how you think and feel. Mental distress and inner turmoil significantly impact on wellbeing and they do not have to be accompanied by physical complications to justify care and support.

Below is a list of common signs and symptoms of anorexia.

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This list doesn’t capture all the signs and symptoms associated with anorexia, as each individual’s experience with anorexia is different.

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Your behaviour when dealing with anorexia

 

•     Missing meals and limiting what you eat and how often you eat

•     Weighing yourself all the time

•     Not being truthful about when you’ve eaten and what your weight is

•     Exercising too much

•     Purging food by vomiting or using medications such as laxatives or diuretics to make you need to go to the toilet

•     Obsessively thinking about food and how much you’ve eaten

•     Avoiding meals with other people

•     Keeping strict rituals around the meals you eat

•     Secretly getting rid of food

•     Having a fear of gaining weight

•     Seeing your weight loss as a good thing

•     Not recognising the seriousness of your weight loss

 

Psychological symptoms of anorexia

 

•     Low self-esteem

•     Feeling irritable and having mood swings

•     Feelings of guilt or shame

•     Being preoccupied with food and calories

•     Anxiety and low mood

•     You might withdraw from friends and family and end up socially isolated

•     Struggling with your body image and believing your body looks different to how others might see it

•     Depression may set in and you might develop obsessive and/or compulsive thoughts and behaviour

•     Marked change in personality

 

Physical symptoms of anorexia

 

•     Your weight is lower than what is considered healthy for your age and height

•     Being overly active and spending too much time exercising

•     Feeling tired after minimal effort

•     Feeling dizzy or having brain fog

•     Poor circulation, causing you to feel cold

•     Your tummy is bloated and retaining fluid

•     You might also have constipation and abdominal pain

•     Your hair is dry and thinning while your skin is dry and off colour

•     Fine, downy hair may start growing on your face and body because your system is trying to keep warm

•     If you get periods, these can change, become irregular, or stop entirely

•     Loss of interest in sex

 

Complications of anorexia

 

Anorexia can lead to malnutrition if the person is starving themselves or trying to eat as little as possible. This causes your body to slow down bodily processes because it doesn’t have enough energy to fuel them. Experiencing physical complications can be frightening, but many of these issues can be reversed and improved with appropriate treatment. Some of the complications that can arise with anorexia include:

 

  

Malnutrition

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•     Weak or tired muscles and problems with the bones in the body

•     Fertility issues

•     Heart problems

•     Stomach or digestive problems like acid reflux and stomach pain, diarrhoea, bloating, and constipation

•     Skin problems

•     Hair loss

•     Issues with the brain and your nerves, for example, having trouble focusing or forgetting things

•     Dehydration and kidney or bowel issues

•     Having problems sleeping

•     Anaemia (low levels of red blood cells, causing you to feel weak or tired)

•     Bloated stomach and fluid retention

•     A weakened immune system makes it harder to fight off sickness

•     In extreme cases, anorexia can cause death due to heart failure

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How Does CBT Work?

 

CBT use psychological approaches which are based on scientific, clinically proven research, and has been shown to be effective for problems associated with eating disorders. CBT begins with an assessment using diagnostic tests, and a semi-structured interview.

 

A client is given a clear-cut diagnosis and an individualised treatment plan.

 

The first part of the treatment is aimed at symptom relief for specific problems targeted for change using a series of behavioural techniques, relaxation and imagery.

 

The second part of the treatment teaches clients the relationship between thoughts – mood – and behaviour. Clients learn first to identify negative automatic thoughts and challenge those replacing thinking distortions with more balanced alternatives.

 

The third part of the treatment works with attitudes, and core beliefs using schema-focused therapy, mindfulness, and standard CBT core belief work. This part of the treatment mitigates relapse and looks at the meaning beliefs have and how to modify them.

 

Types of eating disorders

 

Eating disorders include a range of conditions that can affect someone physically, psychologically and socially. The most common eating disorders are:

 

    Anorexia Nervosa 

When someone tries to keep their weight as low as possible, for example by starving themselves or exercising excessively.

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    Bulimia 

When someone tries to control their weight by binge eating and then deliberately being sick or using laxatives (medication to help empty their bowels) binge eating – when someone feels compelled to overeat.

 

Some people, particularly young people, may be diagnosed with an eating disorder not otherwise specified (EDNOS). This means you have some, but not all, of the typical signs of eating disorders such as anorexia or bulimia.

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How to get help for an eating disorder

 

“The earlier you can get access to support, the better your chance of recovery.

 

Admitting you have an eating disorder and asking for help is a big step, which can be very difficult for some people.

 

If you think you have an eating disorder, see your GP. They can refer you to a specialist who will be responsible for your care. Most people are offered therapy as part of a support package.

 

You can also look for a private therapist counsellor or psychologist. But counselling for eating disorders is complex so make sure the therapist has specialist experience and training. 

 

How therapy can help

 

“It gives you a safe space to explore your feelings and understand the underlying causes of your eating disorder.

 

“For some people, their eating habits are the only things they feel they have control over.

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Talking therapy and family therapy

 

Talking therapy is usually a part of treatment for anorexia. Some people will take part in individual talking therapy, or group therapy, while others (especially young people) might do family-based treatment with members of their family. The aim of talking therapy is to help you understand the root causes of your eating disorder, and to work towards feeling more comfortable with food.

 

A form of Cognitive behavioural therapy (CBT) called CBT is often used to support recovery from anorexia. CBT has been enhanced in certain areas, and particular strategies have been added to specifically address eating disorders and their core symptoms. CBT looks at the ways that our thoughts affect our behaviours and feelings. Through CBT, you can develop strategies to help you build self-awareness and identify triggers, create helpful routines, and manage compulsive thoughts and unhelpful behaviours. All of these are important steps towards a future free from anorexia.

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Long-term risks of ongoing anorexia nervosa

 

Untreated and ongoing anorexia nervosa can cause problems including:

 

•     weakened bones (osteoporosis)

•     slowed growth (in young people)

•     infertility

•     gastrointestinal issues

•     problems with concentration and thinking

•     problems with decision-making

•     social, emotional and educational problems.

 

Causes

 

The exact cause of eating disorders is unknown. As with other mental illnesses, there may be many causes, such as:

 

 Genetics and biology.

 

Certain people may have genes that increase their risk of developing eating disorders. Biological factors, such as changes in brain chemicals, may play a role in eating disorders.

   

Psychological and emotional health.

 

People with eating disorders may have psychological and emotional problems that contribute to the disorder. They may have low self-esteem, perfectionism, impulsive behaviour and troubled relationships.

 

Risk factors

 

Teenage girls and young women are more likely than teenage boys and young men to have anorexia or bulimia, but males can have eating disorders, too. Although eating disorders can occur across a broad age range, they often develop in the teens and early 20s.

 

Certain factors may increase the risk of developing an eating disorder, including:

 

Family history

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Eating disorders are significantly more likely to occur in people who have parents or siblings who've had an eating disorder.

   

Other mental health disorders. People with an eating disorder often have a history of anxiety disorder, depression or obsessive-compulsive disorder.

   

Dieting and starvation

 

 Dieting is a risk factor for developing an eating disorder. Starvation affects the brain and influences mood changes, rigidity in thinking, anxiety and reduction in appetite. There is strong evidence that many of the symptoms of an eating disorder are actually symptoms of starvation. Starvation and weight loss may change the way the brain works in vulnerable individuals, which may perpetuate restrictive eating behaviours and make it difficult to return to normal eating habits.

   

Stress

 

Whether it's heading off to college, moving, landing a new job, or a family or relationship issue, change can bring stress, which may increase your risk of an eating disorder.

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Complications

 

Eating disorders cause a wide variety of complications, some of them life-threatening. The more severe or long-lasting the eating disorder, the more likely you are to experience serious complications, such as:

 

•     Serious health problems

•     Depression and anxiety

•     Suicidal thoughts or behaviour

•     Problems with growth and development

•     Social and relationship problems

•     Substance use disorders

•     Work and school issues

•     Death

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Your behaviour when dealing with anorexia

 

•     Missing meals and limiting what you eat and how often you eat

•     Weighing yourself all the time

•     Not being truthful about when you’ve eaten and what your weight is

•     Exercising too much

•     Purging food by vomiting or using medications such as laxatives or diuretics to make you need to go to the toilet

•     Obsessively thinking about food and how much you’ve eaten

•     Avoiding meals with other people

•     Keeping strict rituals around the meals you eat

•     Secretly getting rid of food

•     Having a fear of gaining weight

•     Seeing your weight loss as a good thing

•     Not recognising the seriousness of your weight loss

​

Psychological symptoms of anorexia

 

•     Low self-esteem

•     Feeling irritable and having mood swings

•     Feelings of guilt or shame

•     Being preoccupied with food and calories

•     Anxiety and low mood

•     You might withdraw from friends and family and end up socially isolated

•     Struggling with your body image and believing your body looks different to how others might see it

•     Depression may set in and you might develop obsessive and/or compulsive thoughts and behaviour

•     Marked change in personality

 

Physical symptoms of anorexia

 

•     Your weight is lower than what is considered healthy for your age and height

•     Being overly active and spending too much time exercising

•     Feeling tired after minimal effort

•     Feeling dizzy or having brain fog

•     Poor circulation, causing you to feel cold

•     Your tummy is bloated and retaining fluid

•     You might also have constipation and abdominal pain

•     Your hair is dry and thinning while your skin is dry and off colour

•     Fine, downy hair may start growing on your face and body because your system is trying to keep warm

•     If you get periods, these can change, become irregular, or stop entirely

•     Loss of interest in sex

​

Complications of anorexia

 

Anorexia can lead to malnutrition if the person is starving themselves or trying to eat as little as possible. This causes your body to slow down bodily processes because it doesn’t have enough energy to fuel them. Experiencing physical complications can be frightening, but many of these issues can be reversed and improved with appropriate treatment. Some of the complications that can arise with anorexia include:

 

•     Malnutrition

•     Weak or tired muscles and problems with the bones in the body

•     Fertility issues

•     Heart problems

•     Stomach or digestive problems like acid reflux and stomach pain, diarrhoea, bloating, and constipation

•     Skin problems

•     Hair loss

•     Issues with the brain and your nerves, for example, having trouble focusing or forgetting things

•     Dehydration and kidney or bowel issues

•     Having problems sleeping

•     Anaemia (low levels of red blood cells, causing you to feel weak or tired)

•     Bloated stomach and fluid retention

•     A weakened immune system makes it harder to fight off sickness

•     In extreme cases, anorexia can cause death due to heart failure

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How do I begin recovery from an eating disorder?

 

The inner voices of anorexia and bulimia whisper that you’ll never be happy until you lose weight, and that your worth is measured by how you look. But the truth is that happiness and self-esteem come from loving yourself for who you truly are—and that’s only possible with recovery.

 

The road to recovery from an eating disorder starts with admitting you have a problem. This admission can be tough, especially if you're still clinging to the belief—even in the back of your mind—that weight loss is the key to your happiness, confidence, and success. Even when you finally understand this isn't true, old habits are still hard to break.

 

The good news is that the behaviours you've learned can also be unlearned. Just as anyone can develop an eating disorder, so too, anyone can get better. However, overcoming an eating disorder is about more than giving up unhealthy eating behaviours. It's also about learning new ways to cope with emotional pain and rediscovering who you are beyond your eating habits, weight, and body image.

 

True recovery from an eating disorder involves learning to:

 

•     Listen to your feelings.

•     Listen to your body.

•     Accept yourself.

•     Love yourself.

 

This may seem like a lot to tackle, but just remember that you’re not alone. Help is out there and recovery is within your reach. With the right support and guidance, you can break free from your eating disorder’s destructive pattern, regain your health, and find joy in life again.

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