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Anorexia nervosa is an eating disorder where a person keeps their body weight as low as possible by dieting, vomiting, using laxatives or excessively exercising.

People with anorexia usually do this by restricting the amount of food they eat, making themselves vomit, and exercising excessively. 

Anorexia most commonly affects girls and women, although it has become more common in boys and men in recent years. On average, the condition first develops at around the age of 16 to 17.

Anorexia often develops out of an anxiety about body shape and weight that originates from a fear of being fat or a desire to be thin. 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. Many people with anorexia 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.

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.

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. The illness can also 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.

Anorexia - Signs and symptoms

People with anorexia often go to great lengths to hide their behaviour from family and friends by lying about what they've eaten or pretending to have eaten earlier.
Signs that someone may have anorexia or another eating disorder include:

• missing meals, eating very little, or avoiding eating any fatty foods
• obsessively counting calories in food 
• leaving the table immediately after eating so they can vomit
• taking appetite suppressants, laxatives, or diuretics (a type of medication that helps remove fluid from the body)
• repeatedly weighing themselves or checking their body in the mirror
• physical problems, such as feeling lightheaded or dizzy, hair loss, or dry skin

Anorexia can also be associated with other psychological problems, such as depression, anxiety, low self-esteem, alcohol misuse, and self-harm.

Anorexia - Complications

If anorexia nervosa isn't treated, it can lead to a number of serious health problems. In some cases, the condition can even be fatal.

Anorexia - Other health problems
Long-term anorexia can lead to severe complications and health problems, often as a result of malnutrition. Some complications may improve as the condition is treated, but others can be permanent.

Health problems associated with anorexia include:

• problems with muscles and bones – including weakness, fragile bones (osteoporosis) and problems with physical development in children and young adults
• sexual problems – including absent periods and infertility in women, and loss of sex drive and erectile dysfunction in men
• problems with the heart and blood vessels – including poor circulation, an irregular heartbeat, low blood pressure, heart valve disease, heart failure and swelling in the feet, hands or face (oedema)
• problems with the brain and nerves – including fits (seizures) and difficulties with concentration and memory
• other problems – kidney damage, liver damage, anaemia and low blood sugar (hypoglycaemia)

Some people with anorexia develop another eating disorder called bulimia nervosa. This is where a person binge eats and then immediately makes themselves sick, or uses laxatives to rid their body of the food.

Anorexia - Pregnancy complications
If you have anorexia and are pregnant, you'll need to be closely monitored during pregnancy and after you've given birth.

Anorexia during pregnancy can increase the risk of problems such as:

• miscarriage
• giving birth early (premature birth)
• having a baby with a low birth weight
• needing a caesarean section

For expectant mothers extra care and support is likely to be needed during pregnancy, even in cases where the mother has fully recovered from anorexia that has happened in the past.

Anorexia - NHS Treatment

Typically, within the NHS, a physical, psychological and social needs assessment will first need to be carried out by a GP or an eating disorders specialist. This will help them work out a suitable care plan.

In most cases, treatment will involve a combination of psychological therapy and individually tailored advice on eating and nutrition to help gain weight safely.

A range of different healthcare professionals will usually be involved, such as GPs, psychiatrists, specialist nurses and dietitians.

Most people are able to be treated on an outpatient basis, which means that patients can go home between appointments. More serious cases are treated in hospital or specialist eating disorder clinics.

You should expect that most of your treatment will be as an outpatient and any psychological treatment should last for at least six months. If a patient is thought to be at serious risk they might be recommended for inpatient or day patient treatment.

Psychological treatments such as cognitive analytic therapy (CAT), cognitive behaviour therapy (CBT), interpersonal therapy (IPT), focal psychodynamic therapy and family therapy are some of the treatments that you might be referred to by the NHS following diagnosis with anorexia. The aim is to help psychological recovery.

It is to be expected that aspects of your physical health should be monitored at the same time. There might also be access to a specialist to give you advice about diet and food but this shouldn’t be the only treatment you’re offered. Medication for anorexia may be prescribed as a part of an individual's treatment plan.

Prescribed medication might cause side effects, and doctors should alert patients to possible side effects and make a note of them on your medical records.

Inpatient treatment is usually only offered to patients with anorexia if your physical health is very poor or your team think that you might be at risk of harming yourself in some way.

For patients in outpatient treatment who have either not improved, or who are getting worse, inpatient care may then be recommended. Inpatient treatment is likely to be located further away from home than outpatient treatment but it should be within reasonable travelling distance.

Anorexia - Outlook
The NHS consider that it can take several years of treatment to fully recover from anorexia, and relapses are common. For example, a woman may relapse if she tries to lose weight gained during pregnancy (but see next section regarding Appetite loss when crash dieting).

Around half of people with anorexia will continue to have some level of eating problem despite treatment.

If anorexia remains unsuccessfully treated for a long time, a number of other serious problems can develop. These can include fragile bones (osteoporosis), infertility, an irregular heartbeat, and other heart problems.

Despite being an uncommon condition, anorexia is one of the leading causes of mental health-related deaths. This can be because of the effects of malnutrition or as a result of suicide.

When a person is deprived of food, either by choice, or by food simply not being available to them, there are two dominant effects, one of which is not widely appreciated:

Weight loss

The person begins to lose weight, and can continue to lose weight, leading, in extreme cases, leading to death as a result of extreme weight loss.

Appetite loss

The person loses their appetite for food. Yes, you read that right - the person loses their appetite for food ! Such that it actually becomes very difficult for the person to eat because they simply really aren't hungry. They genuinely do not feel hungry and consequently eating food becomes really difficult for them to do.

This effect is not an easy thing for many people to appreciate. However, you can see this happening for yourself, in the TV news reports that feature obviously underfed and under nourished young children, say in Africa, that are happily running around and surviving on very small amounts of not very good quality food.

Those people who have self imposed a very strict low calorie diet on themslves in order to lose a few pounds of weight might also appreciate that, whilst a low calorie 'starvation' diet might be very difficult to do for, say, the first week - after that first week 'sticking to that diet' just gets easier and easier - because of the loss of appetite that accompanies extreme food deprivation. Prisoners and protesters who refuse food and go on hunger strike pretty quickly get used to their new (poor/low) diet regime - 3 weeks into their hunger strike they really have no strong desire for food and eating food would actually be a real challenge and hard work for them to do.

The NHS recognises that people with anorexia need  some form of psychological treatment, to help psychological recovery, for example, cognitive analytic therapy (CAT), cognitive behaviour therapy (CBT), interpersonal therapy (IPT), focal psychodynamic therapy and family therapy are just some of a range of NHS treatments that might be available following diagnosis with anorexia. Many of these treatments are directed towards talking to the anorexic in order to find out 'why they are like they are', in the hope that this will help. In some cases this can be helpful, but is unlikely to change their behaviour. In some cases the Anorexic already knows anyway, and again, that knowledge doesn't lead to behaviour change.

It becomes easy to see, for example, that a young 12 year old girl might receive a few undeserved and thoughtless comments on her weight or body shape by some stupid thoughtless boys (or girls), and as a result she might put herself on a starvation diet. In so doing she then loses her appetite and progressively eats less and less - because she has, by now, lost her appetite. It is not that she is refusing to eat - it is because she now doesn't feel that she wants to eat. Talking about the incident with the thoughtless boys on the bus with a therapist will not be particularly helpful to her, because she knows that she doesn't feel hungry, she doesn't experience hunger pangs, and all she knows is that she simply doesn't want to eat and no longer enjoys food.

In many cases it simply isn't acknowledged that she might have put herself on a short 'quick fix' starvation diet at some point, for some reason, and her body's standard physiological response, of losing appetite, has created her current predicament of 'Anorexia' - and the girl herself may well not realise that it was her initial starvation diet, of having a restricted food intake, that has caused her loss of appetite and loss of a desire for food.

It is also easy to see how such a person, who is no longer feeling hunger pangs, might well try and dismiss a problem that others (e.g. concerned parents or therapists) can see, of not eating and of extreme weight loss, as 'not being a problem because they need to lose weight anyway' - and they might well say this in an attempt to deflect and avoid any such well intentioned 'criticism' from concerned parents and therapists.

To summarise, anorexia can often occur due to lack of appetite simply as a result of going without food for a while, which may occur, for example, as a result of:

• Crash dieting, maybe as a reaction against criticism, or even merely to lose weight that was gained during pregnancy.
• Simply not eating for a while due to lack of appetite as a result of, say, reactive depression arising as a result of one of life's negative events, such as grief or trauma.

Whilst it is possible that the issues that initially contributed to 'going without food for a while' may still exist it is quite possible that they now no longer apply and the real problem is loss of appetite as a result of food deprivation.

Hypnosis and Hypnotherapy

The primary goal with anorexia should be simply to get the anorexic eating again, and putting on weight. When this is achieved the appetite should eventually, and naturally, return such that they can return to a normal, natural, eating style.

Hypnosis and suggestion therapy can be used to administer therapeutic suggestions, whilst in Hypnosis, in the style of "you will feel a sense of pride and pleasure in always finishing your food and leaving nothing on your plate".

The therapy is, in effect, the very opposite of suggestion Hypnotherapy for weight loss, where the client who wishes to lose weight would instead be given therapeutic suggestions of the style "you will feel a sense of pride and pleasure in enjoying smaller portion sizes and always leaving some food on your plate".

Any thoughts that there might be regarding negative body image, or body dysmorphia, can also be addressed and countered using suggestion hypnotherapy.

Hypnosis and Hypnotherapy treatment can work well as an alternative to NHS psychological treatment and in combination with a NHS treatment plan, however note that some people will choose not to involve the NHS in their treatment because Anorexia is considered by the NHS to be a serious mental health condition and their Anorexia episode and treatment is then recorded and noted in their medical history in their NHS medical notes. These notes will stay with them for the rest of their life, and may, longer term, have an affect on things like life insurance and employability.

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Acknowledgements

http://www.nhs.uk/Conditions/Anxiety/Pages/Introduction.aspx

http://evidencebasedpsychotherapy.com/therapist-directory/name/peter-back/

http://www.nhs.uk/conditions/Eating-disorders/Pages/Introduction.aspx

https://www.b-eat.co.uk/

https://www.b-eat.co.uk/assets/000/000/383/Beat_EOSG_survey_results_original.pdf?1427212028

https://www.nice.org.uk/guidance/ng69

https://www.psychiatry.org/psychiatrists/practice/dsm

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