What is Anorexia Nervosa?
Anorexia Nervosa is the refusal to maintain body weight at or above a minimal normal weight for age and height. Patients with anorexia are significantly underweight, they have a body mass index of less than 17.5. The normal healthy range for an adult is 20-25. (BMI = weight in kilograms divided by height in metres squared. For example, height of 170cm and weight of 62 kilograms = 1.7 x 1.7 = 2.89, therefore 62 divided by 2.89 = BMI of 21.5).

Diagnostic criteria for Anorexia Nervosa includes an intense fear of gaining weight or becoming fat even though underweight, a distorted body image, weight and shape being unduly important components in self esteem, denial of the seriousness of low body weight and the absence of three consecutive menstrual cycles.

There are two Subtypes of Anorexia Nervosa; i) restricting anorexia nervosa where weight is controlled primarily by starvation and ii) binge eating/purging type, where despite being underweight the individual engages in binge eating and also controls their weight through purging behavior (vomiting, consumption of laxatives).

Patients with Anorexia Nervosa often believe that they binge but this is usually a “subjective binge” where they feel out of control but they are in reality not eating a large amount of food.

What is Bulimia Nervosa?
Patients suffering from Bulimia Nervosa are usually of normal weight (BMI in normal weight range). Bulimia Nervosa is characterised by the presence of “binge eating”. A binge is a situation where the individual feels that they are out of control with their eating and they are eating an amount of food that other people would consider large for the context. Following the eating binges, an individual with bulimia nervosa uses compensatory behavior in order to prevent weight gain. This would include vomiting and consumption of laxatives. Bingeing and purging occur on average at least twice a week for three months. As in anorexia nervosa, self-evaluation is unduly influenced by body shape and weight.

Are there other types of Eating Disorders?
There are other types of eating disorders that do not specifically fit with the diagnostic criteria of anorexia and bulimia nervosa, however, this does not mean that the condition of the sufferer is less serious. For example an individual who has all the criteria of Anorexia Nervosa, but whose BMI is greater than 17.5 would be considered to have an “eating disorder not otherwise specified”. There is also a binge eating disorder, where an individual binges but then does not purge. This type of eating disorder is common in obesity.

Do males develop Anorexia Nervosa?
One in every ten people suffering from anorexia nervosa is male. Our research has shown that there are very few differences in the psychology of male and female anorexics. The one exception is that males are more likely than females to begin to lose weight through exercise and sport, whereas females are more likely to initiate weight loss through either dieting or exercise.

Is Anorexia Nervosa a Serious Illness?
Anorexia Nervosa is an extremely serious illness. Anorexia is the third most common chronic illness in women between 15 and 25 years in developed countries. Approximately 1 in 200 young women are affected. Anorexia patients have 11 times greater chance of dying then their peers of the same age and gender, and have 37 times greater rate of dying from suicide (compared with 25 times higher in patients with major depression). Anorexia Nervosa causes severe depression, psychological distress, family disruption, physical morbidity and has the highest mortality rate of any functional psychiatric illness, with 20% of patients dead in twenty (20) year follow up studies. It causes a degree of long-term handicap comparable to that of schizophrenia.

What type of person is more vulnerable to developing Anorexia Nervosa?
There appears to be a typical profile of an individual who may develop Anorexia Nervosa. Firstly, there is some evidence that there are genetic influences in the transmission of anorexia nervosa, particularly restricting anorexia nervosa. Female relatives of patients with anorexia nervosa have a 10 fold greater risk of developing anorexia nervosa than the general population. However, we do not know what this genetic predisposition may be. Possible influencing factors would include obsessionality, perfectionism, emotional reactivity and metabolism. The most common profile of an individual who is at risk for developing anorexia is a perfectionistic young woman who is eager to gain approval from others. They are often described as perfect children who never present a problem to their parents. They also typically have low self esteem and will often describe themselves as not feeling good enough because as they are perfectionistic; to be good enough means to be perfect, which is impossible. This perfectionistic personality and low self esteem are “setting conditions” for anorexia nervosa.

For anorexia to be triggered, an event may occur to make the young woman feel that she is losing control of her world. This can be a traumatic event, such as the memory of sexual abuse, but more commonly, it is a much more seemingly benign event. This can range from conflict in peer relationships or at home, difficulties at school, especially a perceived academic ‘failure’, or entering puberty. It is thought that these events challenge the individual’s need for control and consequently lower her self esteem further. These individuals begin to realise that all they can ultimately control is what they eat and their body weight. Weight loss helps them feel more in control of their life and also initially improves self esteem. This is because weight loss is highly valued and reinforced in Western society. As dieting and weight loss continues, a vicious cycle emerges which acts to make anorexia self perpetuating. If sufficient weight is lost the individual will become more driven to starve, more obsessional and more depressed as a result of biological changes caused by starvation. This leads to feeling more out of control and a greater need to feel in control which maintains the reduction in the intake of food.

In patients with bulimia nervosa, their body will fight back and compel them to eat as part of the cycle.

How is Anorexia Nervosa Treated?
We don’t really know the best treatment for anorexia nervosa; however, best practice guidelines are currently being developed. The consensus is that after formation of a good therapeutic relationship and developing motivation to change, the individual with anorexia nervosa needs to be encouraged to confront his/her fears about weight gain and normalising of eating. As in Fighting for Life, the patients suffering the most severe weight loss or those with medical complications will require hospitalisation. The average length of stay in hospital is 70 days. 30-50% of patients with anorexia nervosa will need at least a second admission into hospital and the average number of admissions per patient is between two and three.

In hospital programs now, there is a greater emphasis on psychological management and individual therapy. We have, in Australia, moved away from the regressive policy of placing patients in their rooms and allowing accessed privileges such as visiting or leave based on weight gain. Our research has shown that patients who are on non-restrictive programs gain weight at the same rate as those on restrictive programs.

Indeed, today we tend to use hospitals less often than even five years ago. More patients are now treated in day programs which run until after dinner, at which time the patients go home rather than stay in hospital overnight. This method of treatment is less disruptive to the patients and to their families and allows patients to remain in contact with family and friends, and to continue to go to school or work. This form of treatment combines containing the eating behavior, with administering intensive treatment. Patients attending Day Programs do so to prevent hospital admission, but this can also be helpful following hospitalisation. This aims to help reintegrate the sufferer back into the community and prevent relapse.

How many people recover from Anorexia Nervosa?
Research tells us that about 40%-50% of patients will go on to make a full recovery. This means that they stay at a normal weight and are eating normally (i.e. not restricting or binging or purging) and have a normal menstrual cycle. They recognise other components of self esteem apart from weight and shape. This group will also have developed appropriate relationships for their age. However, they may still remain more preoccupied by their weight than those that have never experienced anorexia nervosa.

30% will make a partial recovery. This group may stay slightly underweight or remain significantly more concerned about their weight and shape so that this concern interferes with their life in some way. The remaining 15% – 20% of patients will not recover from their anorexia nervosa. They will remain chronically underweight and consumed by thoughts about weight and shape. They are likely to be isolative and withdrawn, with little social contact. Relationships and work are likely to be effected. After 20 years, this group will die from the complications of their anorexia nervosa or from suicide.

For further information, go to the 'where to find help' section of this site.

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