Do I Have Anorexia?

This is a question that we’re frequently asked at the clinic. The very nature of anorexia means that it can be a tough question to answer, but we’re going to try!

Let’s start with a brief overview of anorexia. The stereotypical image of someone with anorexia is a white teenage girl from a fairly wealthy family. Although white teenage girls from fairly wealthy families can indeed develop anorexia, so can anyone else. Age, gender, ethnicity, socioeconomic background – none of these play any real role in determining who is at risk of developing anorexia and who isn’t.

There are two main types of anorexia – anorexia (restrictive) and anorexia (binge/purge).

Anorexia (restrictive) is the one that fits the general image of anorexia, although it is actually the least common type of anorexia. With anorexia (restrictive), you would reduce your food intake as much as possible but do not engage in many, if any, other eating disorder behaviours. 

If you have anorexia (binge/purge) you will restrict your food intake but you may also binge on foods, or purge through vomiting, exercising more than is healthy for you, using laxatives or using diuretics. Some people use all of these behaviours, other people use one or two.

Atypical anorexia is the diagnosis given to people who tick all of the other boxes for anorexia, but their weight isn’t below a BMI of 17. We do not believe in atypical anorexia at all. Anorexia is a mental illness so we firmly believe that it should not be diagnosed on physical symptoms. Also, BMI is b******s. BMI was never designed to be used as a way to measure an individual’s health. The vast majority of people will never reach a BMI of less than 17, even if they severely restricted their diet for years. In fact, only around 7% of people with anorexia do ever have a BMI below 17. At our clinic, it doesn’t matter what your weight is. If you have the thoughts, emotions and behaviours that link to an eating disorder, we will happily work with you.

Symptoms of anorexia

These are some of the most common symptoms, but definitely not all of them:

  • Experiencing an eating disorder voice (this is a voice in your head, which may or may not sound like your own voice, which gives you messages about food and your appearance).
  • Restricting your food, and sometimes your fluid, intake because you believe that you weigh too much or look fat and you want to lose weight.
  • Counting calories and trying to be below an unreasonably low limit.
  • Playing with your food, taking very small bites or otherwise taking as long as possible to eat.
  • Exercising excessively – which is almost all exercise if you’re restricting your food intake.
  • Making yourself sick after eating. This is typically because you feel extremly anxious about weight gain, and shame for eating an amount of food that you believe is too much or too unhealthy.
  • Using laxatives as a way to reduce your weight.
  • Using diuretics, also as a way to lose weight.
  • Thinking about food almost constantly. You might even spend time looking at recipes or making food for other people.
  • Believe that you are overweight or fat, even if other people say that you aren’t.
  • Frequent body checking through looking at your body, touching it, measuring it or comparing it.

Remember, most people will not have all of the symptoms we’ve listed here. If you believe that you have any of these symptoms, we highly recommend talking to your GP in the first instance and then talking to us if you want to discuss treatment options.

Signs of anorexia

You might be reading this blog because you’re worried about someone else. If that’s the case then you may not see all of the symptoms that the individual has. Always remember, eating disorders thrive on secrecy. So, here is a list of signs that could indicate someone has anorexia:

  • Rapid weight loss.
  • Constantly talking about food, with a focus on healthy eating or criticising food that is perceived to be unhealthy.
  • Periods may become less regular or stop completely.
  • Hair can become more brittle or start to fall out.
  • Nails can become more brittle.
  • They may become more agitated and argumentative, especially around food.
  • Avoiding socialising, especially if food is involved.
  • Eager to engage in tasks or activities that involve more exercise or walking. This can include breaking tasks down to increase exercising, like making multiple trips to take laundry upstairs.
  • General mood drops and they appear to be quite depressed.

As with the symptoms above, most people will not tick all of the signs off. However, if you notice that someone is ticking even one of the signs it could mean that something is wrong. It doesn’t necessarily mean that they have an eating disorder, but none of the signs should be ignored.

Do I have anorexia?

According to the Diagnostic and Statistical Manual of Mental Disorders (fifth edition), you can be diagnosed with anorexia if you:

  • Restrict your food intake to a level below that which your body needs, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
  • Have an intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with weight gain even if you’re at a low weight.
  • Disturbance in the way you experience your body weight or shape, and your body weight or shape have a large impact on your self-esteem.

Those symptoms are the starting point for a diagnosis of anorexia. If you tick off even one of them, we would absolutely recommend talking to your GP as soon as possible. 

Also, if you can tick off any of the symptoms listed at the top of this article, we would also recommend talking to your GP as soon as you can. 

What should I do if I think I have anorexia?

If you think that you, or someone you care about has anorexia, it’s important to start treatment as quickly as possible. Although we have seen clients successfully recover after being ill for a long time, the general rule is that earlier treatment has better outcomes.

The first step should be to talk to your GP. Tell them about the symptoms that you have and how much distress this is causing you.

Depending on how good your GP is with eating disorders, they will either recommend making a referral to the local mental health team or they will say that your symptoms don’t tick enough of the boxes for a referral to be made. Waiting times for treatment with the NHS vary and are based partly on location and how busy the eating disorder team is, and partly on severity of symptoms. 

It’s usually much quicker to access independent treatment outside of the NHS. For example, a new client contacting us can usually expect to start treatment in 1-2 weeks. If independent treatment is an option for you then you can contact one of the handful of organisations, including ourselves, who provide specialist treatment for eating disorders. The cost of independent treatment varies greatly. Our fees are £75 per session with a specialist therapist (with a 50% discount for emergency service employees), but it’s not uncommon to see fees up to £200-300 per therapy session. Remember, paying more doesn’t mean better treatment or outcomes, it usually means paying for a fancy location, the business is subsidising other overheads with the income from outpatient therapy (this is quite common in organisations who also provide day or inpatient treatment) or someone is charging a lot just because they can, which we strongly disagree with!

It’s important to remember that you’re unlikely to ever feel ready to recover. It’s entirely normal for you to frequently change your mind about whether you want to recover or not. It’s also normal for you to not be able to see how ill you are and so to not understand the concerns of the people around you. We ask about both of these when you start with us and will help you to make the decisions that are right for you.