anorexia nervosa uk

Overview - Anorexia nervosa

Anorexia nervosa (often called anorexia) is an eating disorder and serious mental health condition.

People who have anorexia try to keep their weight as low as possible. They may do this in different ways, such as not eating enough food, exercising too much, taking laxatives or making themselves sick (vomit). This can make them very ill because they start to starve.

They often have a distorted image of their bodies, thinking they're fat even when they're underweight.

Men and women of any age can get anorexia, but it's most common in young women and typically starts in the mid-teens.

Signs and symptoms of anorexia

Signs and symptoms of anorexia include:

• if you're under 18, your weight and height being lower than the minimum expected for your age
• if you're an adult, having an unusually low body mass index (BMI)
• missing meals or eating very little
• thinking about food a lot and being very careful about what you eat, such as avoiding eating any foods you see as fattening
• believing you're fat when you're a healthy weight or underweight
• your periods stopping (in women who have not reached menopause) or not starting (in younger women and girls)
• physical problems, such as feeling lightheaded or dizzy , hair loss or dry skin

Some people with anorexia may also make themselves sick or do an extreme amount of exercise. Some use medicines to reduce their hunger (appetite suppressants), help them poo (laxatives) or make them pee (diuretics) to try to stop themselves gaining weight from any food they do eat.

Getting help for anorexia

Getting help and support as soon as possible gives you the best chance of recovering from anorexia.

If you think you may have anorexia, even if you're not sure, see a GP as soon as you can.

They will ask you questions about your eating habits and how you're feeling. They will probably weigh you, and check your heart rate, blood pressure and temperature.

They may also want to do some blood tests and to check your overall physical health.

If they think you may have anorexia, or another eating disorder, they should refer you to an eating disorder specialist or team of specialists.

It can be very hard to admit you have a problem and to ask for help. It may make things easier if you bring a friend or loved one with you to your appointment.

You can also talk in confidence to an adviser from eating disorders charity Beat by calling its helpline on 0808 801 0677.

Getting help for someone else

If you're concerned that a family member or friend may have anorexia, let them know you're worried about them and encourage them to see a GP. You could offer to go along with them.

Read more about advice for parents on eating disorders and how to help someone with an eating disorder .

Treatment for anorexia

You can recover from anorexia, but it may take time and recovery will be different for everyone.

Your treatment plan will be tailored to you and should consider any other support you might need, such as for depression or anxiety.

If you're over 18, you should be offered a type of talking therapy to help you manage your feelings about food and eating so that you are able to eat enough to be healthy.

Talking therapies that are commonly used to treat anorexia in adults include:

• cognitive behavioural therapy (CBT)
• Maudsley anorexia nervosa treatment for adults (MANTRA)
• specialist supportive clinical management (SSCM)

If you're under 18, you should be offered family therapy. You may also be offered another type of talking therapy, such as CBT or adolescent-focused psychotherapy.

Find out how to get mental health support for children and young people.

Health risks of anorexia

Long-term anorexia can lead to severe health problems associated with not getting the right nutrients (malnutrition) . But these will usually begin to get better once your food intake starts improving.

Possible complications include:

• problems with muscles and bones – including feeling tired and weak, osteoporosis , and problems with physical development in children and young adults
• fertility problems
• loss of sex drive
• problems with the heart and blood vessels – including poor circulation, an irregular heartbeat, low blood pressure , heart valve disease, heart failure , and swollen ankles, feet and legs (oedema)
• problems with the brain and nerves – including difficulties with concentration and memory or, less often, fits (seizures)
• kidney or bowel problems
• having a weakened immune system or anaemia

Anorexia can also put your life at risk. It's one of the leading causes of deaths related to mental health problems. Deaths from anorexia may be due to physical complications or suicide.

Causes of anorexia

We do not know exactly what causes anorexia and other eating disorders. You may be more likely to get an eating disorder if:

• you or a member of your family has a history of eating disorders, depression, or alcohol or drug addiction
• you have been criticised for your eating habits, body shape or weight
• you're overly concerned with being slim, particularly if you also feel pressure from society or your job – for example, ballet dancers, jockeys, models or athletes
• you have anxiety, low self-esteem, an obsessive personality or are a perfectionist
• you have been emotionally, physically or sexually abused

Video: Anorexia – Katie's story

In this video, Katie shares her experiences of life with anorexia and explains how she recovered.

Page last reviewed: 18 January 2024 Next review due: 18 January 2027

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This content mentions body image or generally discusses weight, eating disorders, anxiety and depression, which some people may find triggering.

What are the symptoms of anorexia?

What causes anorexia, what help is available, ways you can look after yourself.

Anorexia nervosa (commonly referred to as anorexia) is an eating disorder and a serious mental health problem. Someone with anorexia often has an intense fear of gaining weight and may have a distorted view of their body, thinking they’re fat even when they’re underweight.

People often think anorexia is about dieting, but it’s more complicated than that. It’s linked to low self-esteem, negative body image and many other factors.

Anyone can be affected by anorexia. While young women more commonly report it, anorexia is increasingly being reported by men and boys, women over the age of 40, and children as young as seven.

The idea of recovery might feel difficult or scary if you're afraid of putting on weight or worried about losing control. You might not feel ready to think about it yet. Just remember that it's possible to feel better, even if it takes a while to get there.

If you have anorexia, you may feel:

• afraid of putting on weight or being fat
• preoccupied with your weight
• that food dominates your thoughts
• as though your body is bigger or a different shape than it really is
• anxious, especially around mealtimes
• lacking in confidence and self-esteem
• irritable and moody
• that you have very high standards for yourself or you are a perfectionist

You may also underestimate or deny that you have a problem, even after you’ve been diagnosed.

The physical signs of anorexia include:

• weight loss
• lack of sexual interest
• difficulty sleeping
• constipation, bloating and stomach pains
• feeling cold and weak
• soft downy hair (lanugo) growing all over your body
• difficulty concentrating
• low blood pressure
• periods stopping or becoming irregular

Anorexia can affect your behaviour. You might:

• reduce your food intake or stop eating altogether
• spend a lot of time counting calories
• avoid food you think is fattening
• hide food or throw it away
• cut food into tiny pieces to make it less obvious you haven’t eaten much or to make it easier to swallow
• develop rules and rituals around eating, such as listing ‘good’ and ‘bad’ foods
• eat very slowly
• exercise a lot
• take pills that claim to reduce your appetite or speed up your metabolism
• make yourself sick or use laxatives
• withdraw from other people and shut yourself off from the world

With other people, you may lie about what you’ve eaten, make excuses about why you’re not eating or pretend you’ve eaten earlier. You might also lie about how much weight you’ve lost.

There is no single cause of anorexia. It usually develops because of a combination of factors.

Common traits

People with anorexia often have common traits, including:

• low self-esteem, feeling worthless or like you’re not good enough. Losing weight can start to feel like a sense of achievement or a way to feel a sense of worth
• perfectionism
• having other mental health conditions, particularly depression , self-harm and anxiety
• finding it hard to handle stress and cope with life
• obsessive or compulsive behaviours (read our page on obsessive-compulsive disorder )

Social and cultural pressure

Society places a lot of importance on body image , meaning we’re constantly told that how we look reflects our worth. This can leave us feeling ashamed if we don’t fit the model of a ‘good body’.

While these pressures don’t cause eating disorders, they can make us feel we’re not good enough or negatively affect our self-esteem. This can trigger an eating disorder in people already vulnerable to developing one.

Biological and genetic factors

Research shows there may be genetic links to anorexia. The brain chemicals that control our hunger, appetite and digestion can also make us more likely to develop anorexia. If we have too much or too little of these brain chemicals or are particularly sensitive to them, our appetite and mood can be affected.

Living with anorexia can be incredibly difficult, but so too can the idea of recovery. If anorexia has become a big part of your identity, you might wonder who you'll be without it. You might be afraid of not being in control of your food or of how your body might change. It can take time to feel ready to try to recover. Think about what recovery might look like to you and what the benefits could be. Change is possible, even if it doesn't feel like it right now.

If you think you have anorexia, start by talking to your GP . They may not be an expert in treating eating disorders, but they will be able to assess any physical symptoms and then refer you to specialist eating disorder services.

Talking therapies

Talking therapies can help you identify the feelings and fears that triggered your anorexia and help you develop a healthier attitude towards food and your body. You may be offered:

• Cognitive analytical therapy (CAT). This looks at past experiences and events to help you understand why you think, feel and behave the way you do now. Your therapist will then help you develop new tools to cope in a healthier way
• Cognitive behavioural therapy (CBT) . This focuses on identifying and changing the thoughts and beliefs that may trigger your anorexia. Your therapist will help you understand and change disordered thoughts such as ‘everyone thinks I am fat’. You may set homework and goals around challenging any unhealthy rules you have around food.

Support for children and young people

The ‘Maudsley Approach’ is a type of therapy to help children and young people with anorexia. It involves parents taking an active role in helping to get their child’s weight to a normal level, giving control of eating choices back to the child and then encouraging them to develop healthy independence.

You may be offered antidepressants alongside self-help or therapy to manage other conditions such as depression , anxiety or obsessive-compulsive disorder (OCD) . However, antidepressants shouldn’t be the only treatment you’re offered.

Inpatient treatment

Most people with anorexia won’t need to go to hospital. However, if your weight is very low, you may be admitted. Your treatment could involve counselling, group and family therapy, and working with a dietician and mental health team.

It’s difficult to recover from an eating disorder on your own, but there are things you can try alongside treatment and support. Beat has many tips for recovery , and Mind has ideas for self-care , including managing relapses, changing unhealthy routines and being careful online.

You may find that support groups are useful. It can be comforting to talk to others with the same feelings and experiences. You could join Beat’s online support group for people with anorexia .

Anorexia - Young Minds

Anorexia nervosa - NHS

Beat - The UK's Eating Disorder Charity

What is an eating disorder? (rethink.org)

What is an eating problem? | Mind

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Anorexia Nervosa is a mental health condition; not just the desire to be slim. Early treatment with someone who understands it is crucial. If you are a carer or student please also read our article Phases of Restrictive Eating Disorders & other documents for carers - also on our information pages.

A brief overview by Deanne Jade, Director NCFED . For a more thorough understanding of anorexia nervosa, the reader is directed to professional texts in our book section. To understand anorexia, we first have to understand what an “eating disorder” means and where anorexia fits. Eating disorders are characterised by excessive concerns about shape and weight, leading to some harmful weight-control behaviours. People with eating distress attach great importance to how they feel about their weight and shape and their body image is poor. Eating disorders are not aspects of other mental health conditions like depression, although most sufferers are miserable and obsessed. The question “do I / does my child have an eating disorder?” is often asked by people who come to our practice. Even the label “eating disorder” is contentious because this implies that there is something we call “normal eating” which is gender and culture-specific. In 21 st  century Britain, many people are dieting, struggling to lose weight, overeating, eating for comfort, avoiding carbs or eating very little because they are stressed or depressed. This article contains information under the following headings which you can scroll through. If you think that we might add anything useful please let us know. Books which are useful for anorexia are listed in the book area of our website. Information which may help carers is in the information section of the website, including what to look for in a therapist .  

Here are  some  of the features of anorexia Weight loss, or failure to thrive and develop normally in young people. Intense fear of eating or eating certain foods which are viewed as dangerous. Eating habits may become bizarre, there is more food-souping and an increase in the desire to spice up food which is a way of managing hunger. There is a gross disturbance in how the body is experienced. Irrationally, the thinner an anorexic becomes the fatter they can “feel”. There is no target weight, the aspirations of someone with anorexia is “weighing less” and any small increase in eating or weight is experienced catastrophically. These experiences are irrational and there is no point in arguing against them. Can’t you see how thin you are! You have lost enough weight can’t you see that. Have you looked at yourself you look terrible! Mood changes set in- usually  depression, anxiety and withdrawal from wanting to do things with friends. There may be an increase in odd rituals like eating foods in a certain order. I have three boiled sweets on the go at any one time. I suck one for a minute each day then put it back on the shelf. Obsessive interest in food and the qualities and calorie values of food. This interest extends to wanting to cook or provide food for others without needing to eat it themselves. Contrary to what many people think, people with anorexia are very hungry although they will deny it. They will make great efforts to find ways of managing their hunger such as chewing gum. In chronic cases appetite can disappear. Restlessness and poor sleep. Strenuous exercise is a feature of anorexia and is most probably a means of reducing anxiety or keeping warm rather than burning calories. People with anorexia predictably hear a Voice which emerges during the initial period of weight loss. This voice is real and concrete, persuades, encourages, berates and threatens. It varies from one person to the other, it can be a hiss or a growl and is louder than anyone in the real world. Laura Freeman in her book The Reading Cure describes the Voice like this The monstrous voice I had battled with for years… spitting against the filthiness of eating, the shame of appetite; those bullies and demons came roaring back…. Anorexia has so often seemed to me something demonic, something foul squatting on my chest like the demon in Henry Fuseli’s Nightmare, or a raging Jabberwock.   A predictable anorexic mindset (reinforced by the Voice) which again is full of irrational ideas about food. Examples of typical anorexic thinking: If I were to start eating again, I will never stop If I eat a piece of toast, I will gain 3 lbs I was unhappy when I ate bread and I would be unhappy if I were to eat it again. I don’t need food in the same way that others do I would not want to eat like you Some of these features are not anorexia; they are simply the result of low weight, starvation and its effects on the body and brain. They resolve if a person eats a more nutritious diet and is weight restored -although telling people with anorexia that they will feel better if they were to eat more is unhelpful and they will not believe you.

• The culture; which places unremitting pressures on women particularly to attain an ideal appearance that is impossible. This will impact on people who have a high need for approval and poor self-confidence.
• Genes  – anorexia runs in families and if one  identical  twin becomes anorexic the other is likely to do so.
• Core personality  which requires further explanation. The future anorexic is sensitive, perfectionistic and anxious. He or she probably has an over-developed need for approval for diverse reasons. Some theorists propose that perfectionism leads to a stress disorder or alternatively a history of trauma if the person fails consistently.Anxiety is common before the illness sets in and can be an early symptom before a person turns to food restriction. Anxiety can show up in obsessive compulsive symptoms in childhood and OCD may persist after recovery. Writing in The Reading Cure, Laura Freeman describes how she must continue walking for hours around the streets of London, rain or shine. She seems unable to sit at home and have a lazy day off. Anxiety might also (arguably) be a symptom of coping problems in someone with mild autistic presentation. For a nice description of autistic anxiety, read  The Curious Incident of The Dog in the Night-Time. I would spend hours arranging my china horses just so in my bedroom. I had to check everything; is my bed properly made, did I close the window, are my shoes lined up? Cited in Fairburn, Binge Eating : Detailed investigation of the inner world of the eating disorder patient is an omnipresent fear of seeming weak inadequate and average, inability to take pleasure in leisure activities, a reluctance to confront risks and novelty; to engage in uninhibited spontaneous action or to assert feelings, and the experiencing of impulses and desires as wasteful distractions to achieving higher moral objectives;…. to have been compliant and conscientious as children, tend to be solitary and have had difficulty mixing with other children. They are competitive and set themselves high standards.

Michael Strober UCLA, expert in personality writes:  She or he is high risk averse, with maturity fears, high levels of persistence to tasks in hand, is aversive to change and uncertainty, and has ascetic drives – where asceticism is a motivation to be free from the demands of the body. A relatively high proportion of patients do not nor ever had, a close sexual relationship and appear to have an abnormal developmental trajectory; stuck in an early phase.

• Poor central coherence” which is how the brain processes, organises and prioritises flows of information and which make it hard for a person to shift attention and see all sides of an issue. Anorexic patients often do have problems with self -organisation, prioritising, seeing the big picture and being unable to distract themselves from unfavourable thoughts. Note: Poor central coherence is a feature of Autism.
• Appearance teasing or weight comments, both among peers and at home. Women are particularly affected by dieting behaviour of mothers and appearance comments made by fathers.
• Experiences which have rendered an individual unable to recognise and deal with emotions especially bad emotions such as anger or disappointment. This could be due to methods of upbringing where it feels forbidden to express emotions or, if one has a bad feeling one is charged to deal with it alone. It is interesting to note that most people with anorexia have difficulty expressing and managing a wide range of emotions. In his work with adolescents, Daniel Goleman, expert in Emotional Intelligence, notice that young people who were unable to recognise their own bad feelings were more likely to develop eating disorder behaviours.
• Physical or sexual abuse is not a common risk factor for anorexia.
• Psychoanalysts have many different ideas about what “causes” anorexia. For example, one school of thought proposes Em Farrell that anorexia emerges in a person who has met disapproval for trying to be themselves; that they exist simply to be a mirror and possession of their parent. They will grow up being unable to take proper care of themselves and anorexia is a response.
• In her book  The Golden Cage , Hilde Bruch suggests that anorexia is caused by faulty parenting. By responding inappropriately to a child’s need for care-taking, a child will grow unable to meet their own needs properly and will lack a robust sense of their own identity.
• An early expert in anorexia, Professor Hubert Lacey, suggested that emotional conflicts early in childhood would require a retreat to childhood to avoid the need to become a sexually mature adult. Alternatively, Professors Arthur Crisp and Bryan Lask, believed that anorexia is present “from birth” and that it would be unleashed by adverse circumstances at times of stress or change.

There are many different explanations of anorexia and I will mention a few of these briefly with references if you wish to learn more. There are thousands of books written by professionals and hundreds of personal accounts written by sufferers which explain the horrific experiences of anorexia but do not quite explain what having anorexia means. Some  of the explanations of anorexia include;

• It is a “monomania” not unlike the mindset of someone who climbs mountains despite injury and risk of death; who becomes obsessed with their quest to go further and higher and who will sacrifice family life and their own personal health to meet the demands of their obsession?
• It is a “cry for help” in someone who lacks the capacity to express their unhappiness in words.
• It is a form of schizophrenia. The anorexic Voice would lead some people to assume that anorexia is a psychosis. Anorexia is regarded as a “compartmentalised psychosis” which creates a compulsion to avoid treatment or only to accept treatment which they know will not succeed.
• It is a gendered / culturally derived condition. Feminist writers such as Susie Orbach and Naomi Woolfe write about anorexia as a form of hunger strike, a way of managing pressures imposed on women to be successful and at the same time conform to a slim and submissive female stereotype. Feminist writers regard these pressures as being designed in a patriarchal society as a means of keeping women “in their place”. This does not explain anorexia in males.

All explanations of anorexia are thought-provoking and should be read by carers and professionals alike to help make their own sense of this condition. While experts differ in their understanding of anorexia and quarrel about which treatment is best, they all agree that what begins as an attempt just to feel better by losing a little weight becomes a very stuck condition which is resistant to help.

The answer is “mostly girls, dieters, and mostly in early adolescence” although there are many male hidden sufferers in the sports and fitness industries in particular.  We look at male anorexia later in this article. Anorexia appears in young children and also in the aged in nursing homes where is it invariably not recognised. (Anorexia Tardive). Anorexia can appear at any time of change such as after having a child or suffering divorce. If anorexia appears in adult life, it is possible that there was an earlier episode. I do not like to talk about typical patients because everyone is different. However many people with anorexia are sensitive, risk averse, compliant in early life with a desire for people to think well of them. People who develop anorexia are likely to be introverted and inhibited; perhaps feeling that they do not deserve to share their opinions with others. It is said that they have maturity fears and lean toward an ascetic personality style which expresses itself in a desire for purity and simplicity. They do not like mess and uncertainty.

There are arguments for and against. Accounts of behaviour that look like anorexia go back a long way. There are stories of starving religious ascetics – or “fasting saints” as far back as the 11th century and an analysis of their stories by a psychologist,  Lorraine Bell , identifies them as anorexics, some self-harming. In the 19th century, people flocked to the bedside of Sarah Jones,  The Wonderful Child  in Wales, who lived without seeming to eat any food at all. We cannot know about the prevalence of anorexia in Third World countries where there is barely enough food for survival. There may well be cases of anorexia among local populations which are explained away as something else. The 21 st  century has seen an unparalleled media onslaught especially via social media, of pressures to attain unrealistic body size and shape. There can be little doubt of the effects on insecurity, both on females and on males and the prevalence of eating and fitness plans designed to take control of weight and shape. We are concerned about an apparent general explosion in poor mental health among young people and rates of eating disorders appear to be increasing overall. However, it would be misleading to suggest that anorexia is simply a slimming illness, which it is not. Pro-anorexia websites and the use of Instagram and other Apps do perpetuate dangerous eating and weight control practices. Some of the advice which is proffered both by these sites and by blogs written by untrained egotists exert a dangerous influence on people who are vulnerable emotionally, who lack self -confidence and who are too young or misguided to rationally assess the material they read. People with anorexia need guidance on how to manage social media if they have any interest in recovery.

The Sufferer Starvation and malnutrition affect every system in the body, metabolic, digestive, skeletal, endocrine, neurological, and circulatory. Mental, mood, thinking and the ability to make decisions is impaired. Because of changes in the chemicals of mood which are nutrition dependent, there is a heightened risk of suicidal thoughts. The most immediate effect of starvation is on sex hormones and bone density. Adolescence is a period in which new bone is laid down and so the effects of starvation will affect bone density for life. Any person wishing to know the full extent of the effects of anorexia might read  Sick Enough  (see the books section on our website). You may email us for a handout we give to sufferers detailing the main effects of low body weight. The Family Anorexia causes collateral damage to families. Some carers in early stages deny that anything is wrong, even when their child’s behaviour gives rise to concern among schoolmates or people who may not have seen the child for a while. Perhaps the anorexic is expert at hiding how much weight he or she has really lost, or it may be due to a family tendency to shy away from drama and problems. Parents may be worried in case their child falls behind with their schoolwork or loses their place on a team. If the child appears to be keeping up, they do not want to rock the boat. Anorexia brings out the worst in family members. They say it is like having a person with cancer but what differs is that this seems “self-inflicted”. There may be arguments about what to do, how to deal with eating refusal, deception and rebellion. Anorexia thrives in an environment which is full of discord. Everything is affected, holidays, meals out and festivities. Some members of the family, such as the siblings, find their needs are ignored. A family which comes to terms that their loved one has a severe and possibly enduring mental-health issue, experiences a sense of bereavement. They have lost the life which they expected their loved one to have, such as completing an education, having relationships and families of their own. They are conflicted about needing to take care of someone who they believe should be taking care of themselves and is not doing so. We know that the effects of anorexia on families can make the illness worse. For this reason, a care plan will ideally include key members of the family to help them manage themselves and help their loved one fight the illness better.

Anorexia is a progressive condition with many phases. The weight-loss phase is called acute anorexia. When weight is first lost, the anorexic may get admiring comments which reinforces their feelings of success and they may appear much happier for a while. They feel in control but soon discover that the anorexia goes out of control and they are unable to stop themselves from losing weight. There is no “enough”. What sets in is a more profound process that we do not even now fully understand, of fearing food inside, of feeling horrible when it is inside you, of only feeling safe when you are empty” (Christopher Dare)   The year after our marriage I began calorie counting, cutting out some foods missing out meals and began speed walking. My weight then dropped to 7 stones, I felt utterly miserable with life but boosted by my weight loss and the control I had over refusing food. I worked as a Doctor’s receptionist at the time and a colleague, an older lady noticed what was happening and nurtured me out of the cycle I was in. To my delight I became pregnant…… But then: My husband spent a lot of time away from home and began working 7 days a week as well. I began eating less and less, was extremely physically active during the day, going to the gym 3 evenings a week and then discovered laxatives. I felt fantastic; I could go all day with just eating an apple or a grapefruit and drinking lots of coffee. A customer asked me if I was competing in the thinnest woman in the world competition. My weight got down to 5 stones 9 lbs.      The chronic phase is where weight is maintained and there may be small ups and downs. Some people are very impaired and may have had to give up their education and a career. Others have medical crises from time to time. I want to be well enough to go to university and I manage to eat a little more for a couple of days then I feel huge like an elephant and don’t carry on. They told me I am chronic so perhaps there is no point in trying to get well. High-functioning  chronic anorexic people manage to conduct a normal life with a very small food intake. Anorexic females may continue to menstruate and even have children. Recovery is possible only when the person reaches a  Turning Point,  where they decide that they do not wish to live like this anymore. There is no one way or guaranteed time for this Turning Point to show up. Some people decide to fight their anorexia because they have fallen in love, or have had the right therapist, or don’t wish to feel ill and cold all the time. My daughter was constantly pleading with me to put some weight on but it was a photograph of me at our work Christmas party that made me realise how thin I had become.  I found (a message) dated 2014 from my dad forwarding a message from the NCFED about ‘how to find an eating disorder therapist’ .  At that time I was deep in my eating disorder; I was terrified to eat more and denied that I had a problem, but a small part of me knew I couldn’t go on driving myself crazy thinking about food 24/7. So, I reluctantly gave in and started to see a therapist, which turned out to be a big turning point in my relationship with food.   Not all anorexics recover. Prognosis depends on speed and extent of weight loss, having a supportive family who are taught to say and do the right things; age of onset and duration of illness. People who get anorexia at a young age have a good chance of recovery. The best predictor of successful treatment is getting help QUICKLY, not waiting until someone is “thin enough”. We cannot stress this more firmly. The battle to recover from anorexia, once a Turning Point is reached is harder than remaining anorexic.

Inpatient vs Outpatient

Outpatient treatment is preferred. The benefits are being in a service with people supposedly with understanding of eating distress. In a specialist service, aspects of eating disorder presentation (being competitive) emerge in dedicated settings to make the problem even worse. Why do I need to eat? There are people here that are thinner than me. I cannot be all that ill (Lily BMI 13). If I am not thinner than others, they will think I am fat (and weak). Or they learn to eat for the wrong reasons: I decided to eat and eat so that they would let me out and I could go back to being how I was before.

Treatment must do all the following

1  Address motivation  and ambivalence to change.

2  Engage with the sufferer .  Engagement with a therapist is an important missing piece. The anorexic person comes to therapy with intrinsic mistrust of other people and ideas that everyone is interested in making them fat and out of control. The firs thing most anorexics do is scope out their therapist. She wants to make me fat like her. I wouldn’t want to look like that. She is thin, I bet she is anorexic too (so why should I change?) It is crucial for a therapist to be aware of their own issues and show eating disorder expertise by reflecting the hidden secrets of the anorexic mindset. We use hip-pocket patient understanding “ I expect you to have mixed feelings about change” and to show no anxiety about weight loss (even if we are worried). Engagement also means forging a connection with the family and other members of a treatment team. Many treatments fail because or poor communication.

3 Re-feeding to correct harms,  prevent emergencies and restore weight (not just make fat).

This must always be done under the guidance of a dietitian at all stages until a normal BMI is reached. In severely malnourished people there is risk of hypophosphatemia because of organs that have been damaged by starving. Medical emergencies can only be identified by a doctor who is trained to do specific investigations. In some cases, tube feeding will be given to people too ill and weak to make rational decisions for themselves. While this aspect of treatment is hated at the time, people are often grateful that they were given extra help. The powers of the Mental Health Act can be invoked if the person is at risk of death. This is a safe procedure and some patients prefer feeding through a nasal tube because they feel they cannot tolerate the required amounts orally. Complications are rare but can include pulmonary haemorrhage, empyema, oesophageal perforation and pneumonitis.  Fater 2005 . The experience is invasive, stressful, frightening and has the potential, especially if restraint is involved, to mirror the dynamics in someone who has previously experienced abuse or trauma. The resistance to the tube is interpreted as an expression of strong views, although in practice patients may tolerate the procedure well. There are guidelines for good practice with adults in such situations. Goldman, Birmingham and Smye in Handbook of Treatment for Eating Disorders Guilford Press 1997,  but there is no guidance for younger patients. Thankfully, there appears to be no obvious association between resistance to tube feeding and eventual outcome.

When asked to reflect on their experiences, young people in this study could be divided broadly into two camps, the first viewed the experience as horrible but necessary. Some patients even those viewing it as an ordeal were thankful and viewed it as a first step toward their recovery . Lask et al 2001, International Journal of Eating Disorders. Now looking back, I simply couldn’t see the wood for the trees, for I didn’t then, want a life. However now three years further on, I really know I can see tube feeding is the only last resort with the person’s best interests in mind. Without the help of the tube I know I wouldn’t be here now. Tube feeding can have unexpected outcomes which maintain the disorder. A patient can learn to give up eating altogether. But this is rare. Needing a tube is proof that I am worse than everyone else. That is a real  achievement. I let them feed me by tube at night. It means I don’t have to struggle to eat on my own. I don’t need to eat during the day.

4  Psychological strengthening

This helps with re-feeding and protects against relapse. Psychological strengthening is a huge task and is designed to make a person feel happier, effective, able to manage their feelings and deal with destructive anorexic thinking. It provides the message that therapy is not just about eating and weight, it is about helping the person flourish. Therapies that help with psychological strengthening include CeBT, CBT and Cognitive De-fusion, Flexibility Training, Compassion Focused Therapy, Assertion Training, Emotional Resilience Training and work on non-anorexic values. Positive Psychology Therapy works well for rebuilding damaged self-worth.

The success of these therapies depends on the skill and resilience of the therapist and their relationship with the anorexic person. Some patients with anorexia are autistic and find it hard to trust. Autism treatments include cognitive remediation to help re-wire the brain, and story work.  Trauma, if it exists may interfere with treatment. Traumatised people benefit from new wave therapies  such as EFT, EMDR and Sand Tray Therapy. Dialectical Behaviour Therapy is exclusively useful for anorexic patients with obstructive and dangerous behaviour patterns such as rage and self-harm.  NLP (Neuro-linguistic Programming) is a  powerful therapy that targets fixations, irrational unwanted thought and the Anorexic Voice. NLP can harness the power of the unconscious to change behaviour and get anorexic “outcomes” such as safety and pride, in more healthful ways.

5  Family work  is important for people of all ages but especially young people still in the care of their parents. It is designed to support and guide carers in helping their loved ones to take control over the disease from a no-blame position. Families benefit from linking with those in a similar situation and from having ongoing support via workshops and ongoing support from an eating disorder specialist. All carers benefit from learning the Animal Model developed by the Maudsley for how best to relate to someone with anorexia and how not to make the situation worse. A copy of the Animal Model document is available from NCFED by request. The Maudsley have a carer-aimed treatment model which teaches carers how to coach their loved one toward recovery. The model is flexible and can be self-taught using  Skills-Based Caring for a Loved One with an Eating Disorder by Janet Treasure and the Succeed DVD How to Care for Someone with an Eating Disorder.

6    Relapse Prevention Preventing lapses is an important part of this work. The illness can return at any time of stress or change such as marriage or having a child. Therapist and suffers will need to anticipate future problems and design a “what if” programme of care. Laura Freeman describes her relapse in vivid terms. That summer…. A very different sort of food writing began to appear in the newspapers and magazines that crossed my desk each morning…. This was clean eating, green eating, lean eating, food from a scrabble board:  kale and quinoa, chia and avocado, agave and baobab, goji and amaranth…. Eggs? You got no points for those.  ….. It was an absurd parlour game of substitutions, courgette spaghetti, cauliflower rice, coconut yoghurt, cashew cream, buckwheat porridge, almond milk, hazelnut milk, hemp milk, a lurid cheesecake of avocado flesh. What started on blogs and photo sharing websites spread to the newspapers, first on the lifestyle pages, first as a joke later in earnest; Then to the recipes pages, the health pages, the retail pages, every bookshop promised wellness with wheatgrass juice, glow, detox, nourish, delicious, good simple, meat-free gluten -free dairy-free sugar- free….The sire ns came roaring back.

  Some approaches which have a good track record with anorexia

CBT-E has a good evidence base to help free people from the intrusive horrible thoughts of anorexia and manage their emotions better.

The Maudsley offers the following programmes for anorexia and have a range of films available online to help people who have anorexia in the family.

FREED   – A rapid response programme for early cases of anorexia.

MANTRA  – a programme for adults which addresses the elements which maintain anorexia such as selective attention, ascetic values, fear of feelings and anorexic aspirations. Prof. Janet Treasure of the Eating Disorders Service of the Maudsley Hospital explains (I paraphrase);  The model works to understand the factors that may be linked to underlying personality qualities such as being an introvert, sensitive anxious and/or perfectionist. These personality traits can magnify as a result of starving causing the illness to progress and the person can develop beliefs that their illness helps them manage life better. The therapist explores their strengths and non -eating disorder life aspirations and informs a treatment plan which includes behavioural experiments to change some of these patterns and develop new skills. Hopefully this will change some of their rigid eating behaviours. We supplement this with a workbook A Cognitive Interpersonal Therapy Workbook for Treating Anorexia Nervosa (Schmidt 2018) which can be read alone or together with a therapist.

Family Based Therapy  is a system of treatment where parents take ownership of managing all meals and other behaviours of their loved ones, it is a huge commitment of time and energy with promising results. FBT therapists have specific training to deliver this programme in the community. You may find FBT trained therapists by doing the appropriate online searches and we advise doing your own research on this therapy first.

Addiction Clinics :   For those willing to consider anorexia as a form of addiction, 12-step or similar programmes might be helpful for adults. Psychological strengthening is a lengthy and potentially expensive undertaking. Not all people with anorexia get access to this kind of help. Most available short-term therapy for anorexia has little option other than to focus on symptoms such as eating and low weight.

Recovery is harder than staying ill for all the reasons which we have listed earlier. By reading recovery journals you will get a better idea of what kind of problems crop up. Example  Emma Woolf: An Apple a Day.  A recovering person needs to deal with unhelpful comments which can derail them: You look well. It’s nice to see you tucking in to a healthy meal. You were far too thin before…. Recovering anorexics experience predictable emotional changes against which they and their carers could be forewarned. Re-feeding releases a flood of emotions which have been blocked by starvation. The recovering anorexic may not feel happier for quite some time; they are angry, confused and overwhelmed by emotional experiences which they are unable to describe or manage. It is like being in the middle of a hurricane. Now I am fat  and  I have got all these awful feelings as well.

An eating disorder specialist can train carers to talk to their loved ones in helpful ways,  train sufferers how to deal with comments and help them stay motivated. This approach installs beliefs that current difficulties will, if mastered, bring better benefits than returning to active anorexia.

Sometimes anorexia evolves into another eating disorder such as orthorexia, bulimia nervosa or compulsive overeating. It is easier for a trained psychotherapist to treat overeating disorders which feel like a failure of control. Orthorexia is less accessible to therapy because it is not viewed as a problem unless it has serious effects on life and relationships with other people. It is a form of eating that helps a person with coping issues be in control by avoiding food groups like carbs or animal products. Orthorexic behaviour can become obsessive. They say that these foods make them ill or that they have a mission to save the planet. Research is clear: although many people with eating disorders claim to have food allergy or IBS, they probably do not. I am allergic to wheat because it makes me bloated.

Anorexia exists in children as young as 7 and children as young as 5 express fears of becoming fat. Doctors find it hard to identify anorexia at these early ages in children who might just express their fear of eating as having tummy pains. Children with anorexia need to access treatment very urgently because they have less body fat than adults and are therefore more at risk of medical emergencies and failure to grow. There is another eating disorder which occurs in even more children than have anorexia. This is called ARFID, Avoidant and Restrictive Feeding and Eating Disorders. Is the child so picky that they cannot thrive and grow? Do they have other emotional issues which makes them unable to eat?  Children with Arfid need to be taken to their GP in the first instance because only a GP can check their health status and see if they need professional help. Arfid in children can be associated with anxiety disorders and with autism. Children do not always grow out of their picky eating habits. If the picky eating is just a bad habit then it can be helpful to introduce a child to small new tastes and textures in pea size bites and rewarding them for their efforts.

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Anorexia Nervosa

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Anorexia nervosa is an eating disorder. A person with anorexia nervosa feels compelled to control and lose weight and often finds that food dominates their life.

In this article

What is anorexia nervosa, anorexia symptoms, anorexia nervosa health risks, what is the cause of anorexia nervosa, are any tests needed, what is the treatment for anorexia nervosa.

The weight loss may become severe and life-threatening. Treatment includes advice about eating, monitoring weight change, family therapy and talking treatments such as cognitive behavioural therapy (CBT) .

What is anorexia?

Anorexia nervosa (often just called anorexia) is an eating disorder. It is ten times as common in women as in men. It most often starts during teenage years. About 9 in 1,000 women develop features of anorexia at some point in their lives.

People with anorexia often find that they do not allow themselves to feel full after eating. This means that they restrict the amount they eat and drink. People with anorexia are underweight. Sometimes, the weight becomes so low that it is dangerous to health.

Anorexia Q&A

Is anorexia dangerous? Can men have anorexia? Can anorexia give you diarrhoea? How do you help someone with an eating disorder? All your questions answered.

Deliberate weight loss

This is the main symptom. People with anorexia lose weight by avoiding potentially fattening foods or sometimes any foods. If you have anorexia, you limit the amount you eat and drink, in order to control how your body looks. You may often pretend to other people that you are eating far more than you actually are. You may be using other ways of staying thin such as exercising too much. You may also have made yourself be sick (vomit), take laxatives, or even take appetite suppressant medicines or 'water' tablets (diuretics).

If you are a teenager and still growing, you may not lose weight but you may not be gaining it as you should. The result will be the same, ie you are under the normal weight for your age and height.

People with anorexia typically weigh 15% (or more) below the expected weight for their age, sex and height. Your body mass index (BMI) is calculated by your weight (in kilograms) divided by the square of your height (in metres). For example, if you weigh 66 kg and are 1.7 m tall then your BMI would be 66/(1.7 x 1.7) = 22.8. A normal BMI for an adult is 18.5-25. Above that you are overweight and below that you are underweight. Adults with anorexia have a BMI below 17.5. If you are under 18 years of age, normal weight is assessed by using special age-related BMI charts.

With anorexia, you want to feel very in control of your body weight and shape. However, with time, anorexia can take control of you. After some time it can become very difficult to make healthy, normal choices about the amount and types of food you eat.

An unrealistic image of own body size

People with anorexia think that they are fat when they are actually very thin. Although other people see you as thin or underweight, it is very difficult for you to see this if you have anorexia. You are likely to have a severe dread (like a phobia) of gaining weight. People with anorexia will do their utmost to avoid putting on weight.

Studies show that if you are anorexic, what you see when you look at yourself in the mirror is different to what other people see. If you were asked to draw, or match a computer image of what you think you look like, you may think you are bigger than you really are.

Other features with anorexia

It is common for people with anorexia to:

• Vomit secretly after eating.
• Try hard to hide their thinness - for example, by wearing baggy clothes, or putting heavy objects in their pockets when being weighed.
• Conceal how much they eat.
• Like food and feel hungry. However, it is the consequences of eating that frightens them.

People with anorexia may also become obsessed with what other people are eating.

People with anorexia often restrict themselves to certain types of food. Eating food may even become like a ritual. For example, each time you eat, you have to cut your food into very small pieces. You may think frequently about your weight and even weigh yourself most days or even several times a day.

Physical symptoms caused by low body weight or poor diet

These are many, but can include:

• Exhaustion.
• Dizziness or fainting.
• Feeling cold a lot of the time.
• Irregular sleeping patterns.
• Poor concentration.
• Others detailed in the 'health risks' section below.

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Do not let the voice of anorexia in your head convince you that you are losing weight to be healthy. Being underweight is extremely unhealthy and can damage your health and even lead to death. Health risks are caused by under-eating (starvation) and by the methods used to get rid of eaten food - being sick (vomiting), excess laxatives, etc. You literally starve your body organs (such as your muscles, brain and heart) of the energy they need to function. Problems that may occur include the following:

Irregular periods

Many women with anorexia have irregular periods , as hormone levels can be affected by poor diet. Their periods may even stop altogether or they may find that their periods have never started, especially if they started having eating problems when they were younger. Some women with anorexia may be unable to have a baby (be infertile ).

Chemical imbalances in the body

These are caused either by repeated vomiting or by excess use of laxatives. For example, a low potassium level which may cause tiredness, weakness, abnormal heart rhythm s, kidney damage and convulsions. Low calcium levels can lead to muscle spasms (tetany). Anorexia can also cause low sugar levels.

'Thinning' of the bones (osteoporosis)

Osteoporosis is caused by a lack of calcium and vitamin D and can lead to easily fractured bones. In addition, the risk of getting osteoporosis increases if you are a woman and your periods have stopped. This is because oestrogen in your body protects your bones from osteoporosis and the levels of oestrogen in your body reduce when your periods stop.

Bowel problems

Problems with guts are common for people with anorexia. You may feel full after eating, bloated or sick (nauseated). You may have indigestion and/or tummy (abdominal) pains. Constipation is common as you are not eating or drinking enough for your guts to work properly.

You can also run into trouble if you take a lot of laxatives. Laxatives can damage the bowel muscle and nerve endings. This may eventually result in permanent constipation and also sometimes abdominal pains.

Swelling of hands, feet and face

This is usually due to fluid disturbances in the body.

Teeth problems

These can be caused by the acid from the stomach rotting away the enamel with repeated vomiting.

Having a diet low in iron can lead to anaemia . This can make you feel weaker and more tired than normal. Dizzy spells and feeling faint can also occur.

It is common to feel low when you have anorexia. Some people develop clinical depression , which can respond well to treatment. It is important to talk with your doctor about any symptoms of depression you may have. Many people find they become more moody or irritable.

Heart problems

Anorexia can cause problems with the heart and circulation. Problems include leaking heart valves , low blood pressure, low heart rate and abnormal heart rhythms .

If you have anorexia, your body's defence system does not work as well and you are more likely to develop infections.

Hair and skin problems

You may find you have downy hair on your body and also the hair on your head becomes thinner. Many people with anorexia also have dry, rough skin.

The exact cause is not fully understood. Part of the cause is a fear of getting fat but it is not just as simple as that. Different causes possibly work together to bring on the condition. These may include the following:

Pressure from society

Pressure from the media and society to be thin is thought to play a part. This is probably why anorexia is much more common in westernised countries.

Personality and family environment

This probably plays a role too. People with anorexia often have poor self-esteem (not much self-confidence) and commonly feel that they have to be perfectionists. Often there are disturbed family relationships. All sorts of emotions, feelings and attitudes may contribute to causing anorexia. Traumatic events such as sexual abuse may make anorexia more likely, as do some dieting experiences.

Some studies of families with identical twins showed that if one twin has anorexia then the other has a 1 in 2 chance of getting it. However, not all studies have the same finding, so it is not known to what extent genetic factors are involved.

Brain changes have been found in people with anorexia. It is not known if these are the result of starvation, or if they are involved in the cause.

Although there is no test to diagnose anorexia, your doctor may wish to do some tests. These may include blood tests to check for complications of anorexia - for example, anaemia, low potassium levels, kidney or liver problems or a low blood sugar (glucose) level. A heart tracing (electrocardiogram, or ECG) may be advised to check for an irregular heart rhythm.

The aim of treatment is to:

• Reduce risk of harm (and death) which can be caused by anorexia.
• Encourage weight gain and healthy eating.
• Reduce other related symptoms and problems.
• Help people become both physically and mentally stronger.

If anorexia is suspected, you should be referred to a specialist eating disorders team, although unfortunately services in some parts of the UK are limited. This is a specialised mental health team which may include psychiatrists, psychologists, nurses, dieticians and other professionals. Usually this will involve outpatient appointments. Occasionally if you have very severe anorexia or medical complications, you may be admitted to a specialised eating disorder unit, or a medical ward in hospital. Medication is not usually necessary in treating anorexia.

The sorts of treatments that may be offered include the following:

Help with eating

It is best to have regular meals. Even if you only eat small meals it is beneficial to the body to eat at least three times a day. You should try to be honest (with yourself and other people) about the amount of food you are actually eating. You should reduce the number of times you weigh yourself; try to weigh yourself only once a week.

Your eating disorders specialist may suggest you keep an eating diary to write down all the food you eat. They will weigh you at regular intervals, and so you will be able to see the relationship between what you eat and the effect on your weight. They will be able to advise you on how much to eat, what your healthy target weight should be and how to safely reach it and over what time period.

Anorexia Focused Family Therapy

If you are under 18, it is likely that your parent(s) or carer(s) will be closely involved in this process. In the early stages of therapy, they will have more control over your eating choices. As you start to recover and become able to make rational and healthy decisions, more independence and control over what you eat is handed back to you. Sessions with your specialist will be regular and will include:

• Keeping an eating diary and advice surrounding food and eating.
• Weighing you regularly.
• Information about the ways in which anorexia damages your health.
• Help in motivating you to recover.
• Reassurance for you and your family that nobody is to blame for your anorexia. It is an illness and it is nobody's fault that you have it. It is not your fault or the fault of anyone in your family.

Psychological treatments

Examples of talking (psychological) treatments used are cognitive behavioural therapy (CBT) , Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), specialist supportive clinical management (SSCM) and focal psychodynamic therapy. Families are involved in therapy as much as possible, especially for young people with anorexia. Talking treatments help to look at the reasons why you may have developed anorexia. They aim to change any false beliefs that you may have about your weight and body, and to help show you how to identify and deal with emotional issues. Talking treatments take time and usually require regular sessions over several months. Treatment may also involve other members of your family going to meetings to discuss any family issues.

Treatment of any physical or teeth problems that may occur

This may include taking potassium supplements, having dental care and trying not to use laxatives or 'water' tablets (diuretics). Taking hormones may be recommended (for example, the oral contraceptive pill) to increase your body's oestrogen levels. Other tablets may be recommended to help strengthen your bones.

With treatment, anorexia can take many weeks or months to improve. It can take several years for people with anorexia to become completely better in some cases. Many people find they still have issues with food, even after treatment, but they are more in control and can lead happier, more fulfilled lives. About half of all people with anorexia (5 in 10) get completely better. About 3 in 10 improve so the anorexia has less impact on their lives, and 2 in 10 continue to live with an eating disorder.

Unfortunately, some people with anorexia die from causes related to anorexia. It is thought around 3 in every 100 people with anorexia die from it. Causes of death include infections, lack of fluid in the body ( dehydration ), blood chemical imbalances (such as low potassium levels) and even suicide.

Anorexia is a serious condition, so it is important to pick it up early and deal with it. If you or your family become aware there is a problem quickly, and your doctor refers you for specialist help quickly, you should have a better chance of making a full recovery.

Types of Eating Disorders

Bulimia Nervosa

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Further reading and references

Eating disorders ; NICE CKS, July 2019 (UK access only)

van Eeden AE, van Hoeken D, Hoek HW ; Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Curr Opin Psychiatry. 2021 Nov 134(6):515-524. doi: 10.1097/YCO.0000000000000739.

Dobrescu SR, Dinkler L, Gillberg C, et al ; Anorexia nervosa: 30-year outcome. Br J Psychiatry. 2020 Feb216(2):97-104. doi: 10.1192/bjp.2019.113.

Cost J, Krantz MJ, Mehler PS ; Medical complications of anorexia nervosa. Cleve Clin J Med. 2020 Jun87(6):361-366. doi: 10.3949/ccjm.87a.19084.

Neale J, Hudson LD ; Anorexia nervosa in adolescents. Br J Hosp Med (Lond). 2020 Jun 281(6):1-8. doi: 10.12968/hmed.2020.0099. Epub 2020 Jun 1.

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What does cognitive behavioural therapy involve?

What does the maudsley anorexia nervosa treatment for adults involve, what does specialist supportive clinical management involve, changing to a different therapy, diet advice, bone health.

If you have anorexia you should usually be offered a talking therapy. This kind of therapy helps you to understand the causes of your eating problems and learn new ways of thinking and behaving. You may be offered cognitive behavioural therapy (CBT), the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) or specialist supportive clinical management (SSCM). Treatment aims to help you feel comfortable around food, so you can eat enough to stay healthy. It is also likely to involve helping you reach a healthy weight.

If you have CBT you should be offered weekly therapy sessions for up to 40 weeks (9 to 10 months). For the first 2 or 3 weeks you should be offered 2 sessions a week. You will work with a practitioner (for example a therapist) to make a personal treatment plan and start making changes in your behaviour. This should involve:

coping with your feelings

understanding nutrition and starvation

helping you to make healthy food choices and manage what you eat.

You should be given simple 'homework' to help you put into practice what you have learned. You should also be taught how to monitor your own progress, and how to cope with times when you find it hard to stick to your new eating habits (this is called relapse prevention).

You should be offered 20 sessions with a practitioner. The first 10 should run weekly, and the next 10 can be on a flexible schedule based on what works best for you. Some people will have extra sessions, depending on how severe their problems are.

MANTRA helps people to understand what causes their anorexia. It focuses on what is important to you personally, and on encouraging you to change your behaviour when you are ready. Your family and carers can be involved in the therapy too if you think it could help.

You should be offered 20 or more weekly sessions. At these sessions your practitioner will help you to explore the main problems that cause your anorexia. You will learn about nutrition and how your eating habits cause your symptoms. Your practitioner will help you set a target weight and encourage you to reach it.

You can also include other things as part of the therapy if you want to (such as improving relationships with other people, or getting back into work or education).

If you are offered a therapy and you don't think it is right for you, or you try one and it doesn't help, you should be able to have a different therapy. Talk to your practitioner if you think you would like to try something different. It could be another of the therapies above, or a treatment called focal psychodynamic therapy.

What does focal psychodynamic therapy involve?

You should be offered weekly sessions over 40 weeks (9 to 10 months). Your therapy should include looking at how your eating habits are related to your thoughts, beliefs and self-esteem. It helps you to discuss feelings you have about yourself and other people in your life, and how these influence your eating behaviour.

During your treatment you may be given some advice about healthy eating by a dietitian. Although a healthy diet is important and will help you get to a healthy weight, dietary advice on its own does not work as a treatment for anorexia so you should be offered other therapies too.

While you are recovering you should take a multivitamin and mineral supplement, to make sure you get the vitamins and minerals you need.

If you have anorexia your bones can become weaker, especially if your weight has been very low for a long time. Losing bone strength makes you more likely to develop osteoporosis, a condition where your bones become fragile and break (fracture) easily, even from a minor knock or fall.

If you have osteoporosis or another bone disorder you will need to be careful about what types of exercise you do. To avoid broken bones you should avoid high-impact physical activities like running, and other activities that might increase your chance of falling. The best way to protect your bones is to work towards reaching a healthy weight or BMI.

Tests and treatment for low bone strength

Your doctor may offer you a special type of X-ray called a bone density scan to check the health of your bones. This is normally for adults who have been underweight for 2 years, but it may be offered earlier if you have pain in your bones or have had a lot of fractures. Your doctor should talk to you about bone scans and whether having one might be useful.

Women with anorexia are at particular risk of low bone strength. Because of this, if your bone strength is very low you might be offered a medicine called a bisphosphonate, which is used to treat osteoporosis. Before you start taking this medicine it's important to discuss with your doctor the pros and cons (including side effects), so you can decide if it's right for you.