Anorexia nervosa afflicts about 0.9 percent of women and 0.3 percent of men at some point in their lifetimes. These figures seem small until you consider that this means millions of people will struggle with this deadly mental health disorder. Even though it affects so many people, it’s hard to know what to do when someone you love begins to show the signs and symptoms.
Because of the severe health consequences, which we’ll discuss below, it’s important to make sure that parents, spouses, children, and other close family and friends know how to intervene and support their loved one in anorexia nervosa recovery.
In any situation involving discussing eating disorders with a loved one, the key thing to remember is not to be confrontational or judgmental. Eating disorders are often a self-destructive coping response to stress combined with severely distorted body image; increasing stress levels or trying to argue about their body can push a person further away from getting help. With almost 25 percent of people with anorexia nervosa attempting suicide, per one national study, and a mortality rate of about 20 percent if left untreated, this can be deadly.
Why Is Anorexia Treatment Necessary?
Before diving into the symptoms of anorexia nervosa, it’s essential to understand why it’s considered the most dangerous mental health disease. Anorexia nervosa is characterized in the DSM-V by the restriction of energy intake relative to requirements, leading to significantly low body weight in the context of the age, sex, developmental trajectory, and physical health (less than minimally normal/expected). Anorexia nervosa also includes an intense fear of gaining weight and a distorted body image that causes the individual to think they are fat or overweight, despite evidence to the contrary.
There are two main types of anorexia nervosa, the “typical” type, and atypical anorexia nervosa:
Typical anorexia nervosa
more common than the other forms, anorexia nervosa involves extreme weight loss, calorie restriction, and distorted body image. People with anorexia nervosa will normally avoid eating as much as possible and may experience malnutrition or starvation.
Atypical anorexia nervosa
this form of OSFED (Other Specified Feeding and Eating Disorder) features the same food restriction and distorted body image as anorexia nervosa, but without significant weight loss. Some people with atypical anorexia nervosa run the risk of being misdiagnosed or not diagnosed at all.
Contrary to the common idea that people with eating disorders, especially those who need specialized anorexia nervosa treatment, are always skinny or emaciated, people with atypical anorexia nervosa can be of “normal” weight or even overweight. In fact, specialized programs at anorexia nervosa treatment centers dealing with atypical anorexia nervosa often focus on strategies to increase the nutritional value of the meals eaten, to balance the need for more regular meals with proper nutrition.
By no means are most people with anorexia nervosa overweight, however. By making severe weight loss a prime diagnostic of the disorder, the scientists behind the DSM-V ensured that weight loss is something doctors should look for when making a diagnosis.
Some of the health consequences of untreated anorexia nervosa include:
- Stomach pain
- Loss of menstruation
- Lanugo (growth of small hairs all over the body)
- Muscle weakness and atrophy
Behavioral Symptoms of Anorexia Nervosa
The distinguishing features of anorexia nervosa are a combination of physical and behavioral factors.
In addition to the caloric restriction and weight loss people with anorexia nervosa often have intense feelings of shame, guilt, and self-loathing in reaction to their disordered behaviors. These feelings can often be tied up in comorbid mental health conditions including anxiety, depression, and OCD. Some disordered actions can cause repetitive behaviors similar to those of OCD, in fact. They act as coping mechanisms, releasing dopamine (a “feel-good” chemical naturally produced by the brain) into the system and temporarily relieving negative feelings.
People close to an individual suffering from anorexia nervosa should also be aware that other forms of mental health disorder are common comorbid factors. Anorexia nervosa treatment often has to incorporate a dual diagnosis methodology that treats both (or more) disorders simultaneously to achieve the desired recovery.
Other behavioral symptoms to be aware of include:
- Wearing baggy clothes to hide their body
- Nervousness or discomfort at mealtimes
- Preoccupation with weight or body size
- Frequent dieting and engaging in fad diets
- Low self-esteem or poor self-image (body dysmorphia)
- Excessive exercising
- Problems with the teeth
- Only consuming water or diet soda at meals
- Overuse of laxatives, diuretics, or enemas (or finding their packaging)
What Can Family and Friends Do?
It’s clear that anorexia nervosa is a troubling disorder that can devastate lives and ruin a person’s heath. When the initial warning signs are left ignored, it can quickly require medical care and subsequent specialized eating disorder treatment. That’s why it’s so essential for the people close to the individual with anorexia nervosa to take action.
When the signs and symptoms outlined above become noticeable, it’s time to calmly and delicately address the situation. There should be no accusations or attempts to “guilt” a person into changing their behavior; as mentioned earlier, this might be counterproductive. Instead, every interaction should be conducted with a compassionate, listen-first approach. Here are a few pointers to facilitate this difficult but necessary conversation:
1. Set the Stage for Treatment with a Direct but Compassionate Talk
The first step should always be to have a conversation with your loved one. Snooping around in their room to find “evidence” and then confronting them simply doesn’t work; accusations and coercion are more likely to accelerate the feelings of guilt, shame, and self-loathing than they are to prompt them to ask for help. Ask them kindly and gently if they’re all right and let them know they can talk to you about anything, without judgment.
If they respond to this, you can then proceed to gently ask if there’s been anything wrong recently. They may not want to talk about food or eating right away. It’s best to simply listen and continue to ask how they feel and slowly introduce the topic. Avoid saying things like “You’re scaring us,” or “You’re hurting yourself,” at this point. Eventually, therapy will raise these points, but they can be unnerving in the early stages of motivating someone to get help.
It’s essential that you remind your loved one that you love them and want to help. Never make them feel like they’re being punished, or that they should be ashamed – either of their body or their disordered behaviors. People with anorexia nervosa quite often go to great lengths to hide their disordered behaviors and can become defensive when pressed.
A final point about this first conversation – even though it’s going to be a difficult one, don’t wait too long to have it. Anorexia nervosa can cause malnutrition in a matter of weeks if it’s a particularly severe case, which can cause hospitalization and even death.
2. Contact a Therapist, Psychiatrist, or a Family Doctor
After the initial conversation or conversations, you should contact a trusted therapist, counselor, or even your family doctor to figure out the next step. Although they do not specialize in mental health or anorexia nervosa treatment, a general practitioner pediatrician is most likely at least generally familiar with the causes and symptoms of eating disorders. Your loved one might also feel more comfortable with a trusted doctor they’ve visited for years than with an unfamiliar specialist.
Another option at this point is to seek out a therapist or psychiatrist if they don’t already see one, and ask them to make an appointment with your loved one. Many therapists have lots of experience in diagnosing and treating eating disorders –they are common enough to affect millions of people, and even a therapist or psychiatrist who doesn’t specialize in eating disorder treatment should be able to recommend a colleague who is.
If your family doctor isn’t familiar with the diagnosis or treatment of eating disorders, he or she can normally provide a reference to someone who can. At this point, it should be clear to your loved one with anorexia nervosa that the people who love her are trying to help, and you can decide on how to get further assistance.
3. Get in Contact With an Anorexia Nervosa Treatment Facility
The last step you can take when the symptoms of anorexia nervosa have become clear is to start researching a specialized eating disorder treatment center. In many cases, your doctor or therapist will be able to put you and your loved one in contact with one of these centers that can most effectively treat the disorder. Usually, treatment centers offer both day treatment and residential anorexia nervosa treatment programs. One of the main advantages of a program like this is the presence of full-time specialized staff with years of experience treating eating disorders and co-occurring disorders.
Residential treatment might seem intimidating to your loved one, but it offers the most complete continuum of care and boasts the highest long-term recovery rates. Additionally, these facilities are normally equipped to handle co-occurring mental health illnesses such as anxiety disorder and depression, as well as any medical complications that may arise. This level of care is simply not available in outpatient or day treatment programs.
Outpatient eating disorder treatment is hardly useless, however. It’s ideal for step-down programs for people who’ve completed a residential program but still need significant care and regular therapy sessions. Outpatient programs can include many of the same methods of treatment as residential, such as CBT, DBT, group therapy sessions and family therapy, and many others. It’s also useful for parents, people who cannot leave work or school or have other responsibilities that would prevent a 30-day or longer absence.