Anorexia: Treating Anorexia Nervosa | Private Therapy Clinic

by Dr Becky Spelman on August 30, 2024

What is Anorexia Nervosa?

Anorexia nervosa, at its core is a psychological condition resulting in extreme starvation, due to poor body image. And with the increasing attention given to external beauty, owing to the unrealistic standards portrayed in fashion and media, it’s becoming more of an issue, not only for young women but also men, too. It’s estimated in the US approximately 0.9% of women have been or are affected by the condition in their lifetime with the number at 0.3% for men. However, there is such stigma surrounding eating disorders amongst males that this figure could be higher.

Anorexia is sometimes viewed as a contrarian form of mental illness that isn’t worthy of the coverage it receives – at least in some sections of the society. But the reality is the figures don’t lie. The mortality rate for the condition is higher than any other psychiatric condition (including depression). It accounts for twelve times the death rate of all other causes combined in females between 15-24 years old, and an estimated 20% of cases result in fatalities. These are quite alarming numbers, which begs the question not only what can be done?

As well as dramatic weight loss to well below a normal body weight, people with anorexia display a range of symptoms. In women, periods may cease. In both sexes, rituals around eating food and an obsession with calorie content are common, and sufferers can also show symptoms of obsessive compulsive disorder (OCD) and/or body dysmorphic disorder (BDD), when they don’t see themselves as they really are, but as grotesquely overweight. Anorexia can be accompanied by occasional binge-eating, accompanied by self-induced vomiting or the inappropriate use of laxatives or diet pills. Sufferers may often complain of feeling cold and have problems with low energy levels.

Anorexia is a complex condition, and multiple factors are involved. There can be biological and genetic elements as well as psychological and cultural. Anorexia can sometimes develop in response to a period of depression, or to low self-esteem. In many cultures thinness – especially in women – is prized, and the resulting social pressure to look a certain way can be a contributing factor to developing anorexia.

Sense of ‘Self’ in Anorexia Nervosa

The reason why there is such difficulty in reversing Anorexia is it is often self-motivated. It is an ego-centric mental illness, rooted in the searching for an idealised version of the self through ‘enhanced’ body image. Of course, there are social and cultural influences at play that spiral out of control when taken to their nth degree. But once they take root, this searching for identity through the distorted perception of self-image creates the problem of finding true identity during the recovery phase.

Examining the case of Becky, an 18-year old, reveals the challenges with cognitive and behavioural aspects of recovery- even when there is a willingness to change. Her struggle with anorexia began at age 16 while studying with stressors that included bullying and family difficulties as her sister was diagnosed with OCD.

She was treated by the Child and Adolescent Mental Health Service (CAMHS) for a 6-month course of therapy and was later referred to the adult eating disorder service at age 18. She continued to make good progress, raising her BMI from 15.5 in December to a BMI of 17 in July 2016. With support from her family, she stuck to a strict re-feeding plan was making steady improvement, taking on full responsibility for the planning and preparation of her meals.

However, there were still problems in her underlying thought processes. Becky was still experiencing a strong tendency towards perfectionist thinking that was affecting many areas of her life. There was a lot of rigidity around her eating habits that remained, and her social skills were also underdeveloped.

Throughout the study period, Becky was treated using the Maudsley Model of Anorexia Nervosa in Adults (MANTRA). The program places a strong focus on identity exploration and development as a means to alleviate the symptoms of Anorexia and increase focus around recovery.

During the latter stages, it was found that Becky’s eating difficulties were the result of pro-anorexia beliefs – the supposition that her condition made her a better person. There was also a correlation between being extremely detailed orientated, the presence of inflexible thinking, fear of making mistakes, self-criticism and unrelenting high standards. These findings were the result of the self-assessment Becky was asked to carry out in between her sessions. She later reported engaging in these reflective exercises gave her a clarity she might not otherwise have gained without them.

What this case demonstrated is when you place greater emphasis on identity instead of causative factors, the speed and quality of recovery improve, dramatically. The results of Becky’s cause show a marked improvement over the linear method of cause and effect. The strategy of creating a non-illness driven set of values were key in helping Becky with her recovery.

The issue with treating Anorexia Nervosa is the age at which it typically presents – between 15-25. These represent the peak years of young adulthood when we’re beginning to form our value systems. If the predominant mode of thinking during this time is rooted in poor self-image reinforced by restrictive behaviour patterns, it creates a problem of letting go. The overidentification with anorexia occurs because there is no other reference point of character. That is what makes recovery so challenging. It is the absence of a personality that hasn’t been fully realised yet. There is nothing tangible that can be held onto because the identity of the sufferer has been co-opted before it has had a chance to truly flourish. Anorexia is the identity.
Things to Consider when Seeking Treatment

Here are some things to consider if you or anyone else you know is struggling with the condition:

Belief
Quite simply, first and foremost, you need to believe you can recover. And one of the most effective ways of affecting positive change in your life is finding people who’ve done the same thing you’re trying to do, now. By having these points of reference, those people can serve as positive examples and help you condition the mind into believing you can rid yourself of yourillness. Reading other people’s success stories is a great way to encourage the subconscious mind to accept the pursuit of your goals.

Awareness
Becoming aware of how your anorexia functions is one of the biggest tools in your arsenal, but also one of the biggest hurdles you’ll face. Because not only does it require you to accept you have an eating disorder, it also requires you to have the presence of mind to catch these patterns as they’re occurring. It is only by doing this that you can begin the process of making choices at the conscious level to bed in new and more positive behavioural patterns. This is the process any therapist will to encourage you engage with, but is one you can work on by yourself.

Taming the Negative Self-Talk
When trying to bring a sense of mindfulness to your process and triggers, the most obvious thing catching your attention will be the negative self-talk around your food choices. You may often find yourself tempted to eat a favourite meal you’ve enjoyed for years, which has now become black-listed by the voice in your head warning you against it. This is the voice that attempts to justify your stance, encouraging avoidance, restrictive behaviours and even purging. It is the voice of your condition – it is not you. And for you to successfully recovery, it must be tamed and reconditioned with positive thoughts around food.

Changing Your Attitude Towards Food
Eating is necessary – there’s no getting around it. We need to ingest a certain amount of nutrient-rich food, so we can function at our best. Instead of holding the view that food is a form of punishment or penance that’s going to sabotage the way you look, let go of the concept of the external you. Re-imagine your food as your fuel for wellness, and be grateful for the nourishment it provides to sustain you for another day. You would literally die without it. Think about the ways (good) food makes you feel instead of how you perceive it makes you look.

Reconditioning the Mind
When you’re seeing the world through your ‘perception deception filters,’ it provides a distorted outlook on life, reinforcing negative self-image, telling you, ‘you’re fat,’ or ‘you’re ugly.’ That you’re imperfect and need to change. As long as this continues, it doesn’t matter how much you alter your appearance. The poor self-image will still be present. To fully rid yourself of the negative conditioning, you need to replace those programs with ones that promote positive self-worth. What you believe is what you become, and to overcome your anorexia you have to convince yourself that you’re not the person who’s stuck in this loop. You’re someone much stronger, capable and willing to accept themselves for who they are, regardless of society’s expectations.
Obstacles to Change

As we’ve touched on, there’s going to be obstacles. It’s inevitable. But if you have prior knowledge of what challenges you’re going to face, it can make the road to recovery that much easier. Here some of the most commonly observed hurdles that might halt your progress or even prevent you from seeking any further help:

Lack of Commitment
You can have all the support you need in the world. But ultimately, this journey starts and ends with your commitment. You are the one who must take the steps towards recovery. No one can force your hand. Be aware of trying to reason yourself out of making the necessary changes. When you come up against resistance, it’s your condition talking, not you.

Fear of Losing Control
At present, your life is probably structured around the maintenance of your anorexia. One of the initial ‘lifts’ you felt at the onset of your condition is that it afforded you a sense of control. But the reality is when you’ve reached a stage of physical and mental depletion, you are no longer in control. Your anorexia is controlling you.

Fear of Change
Very few of us like change. We have an inclination to preserve the status quo because it’s comfortable. It makes us feel safe. And this is especially true when it comes to overcoming anorexia. You may feel that by letting going of the behaviours that inform it, you’re losing something. You may feel that your world is going to come crashing down around you. But again, this is only your condition talking.

Isolation
One of the more challenging aspects to contend with is the lack of a proper support network. The deeper you find yourself in anorexia, the more you’ll be inclined to withdraw from your social relationships. But this isolation is only self-imposed. It’s an imagined prison that you step out of any time. But it’s you that must make that choice. There are people that care.

Self-Sabotaging Mechanisms
We’ve already touched the fact that your anorexia will often ‘speak up for itself.’ You may find a nagging voice in your head trying to convince you not to abandon your course. But it’s nothing more than your inner saboteur. You’re trying to recognise this complex web of thoughts as the intruders. Don’t allow yourself to believe you aren’t capable of change.

Finding the Motivation to Change
You need to remember that while your anorexia may seem to have helped you solve some problems, it has taken far more away from you than you may be willing to admit. You didn’t develop anorexia because you’re mentally defective. You most likely came to embrace these behaviours unknowingly because it offered you an out. But what it actually resulted in was giving your power away and conform to unrealistic expectations. Here, now, is your chance to counter that by enacting your own take-back of power. You start the process of releasing yourself from all of the self-limiting beliefs and behaviours. But you must be the one to stand up and acknowledge that you want to change and need to make it happen – for the sake of their physical, mental and emotional wellbeing
Treatment for Anorexia
If you have been diagnosed as having anorexia by a doctor, psychologist or psychiatrist, you may be feeling overwhelmed. However, regardless of the reasons why you have developed the problem, we can help you with proven techniques that will assist in managing your symptoms and working steadily towards a healthier relationship with food and your self-image.

We can work with you to help restore positive behaviours that will enable you to reach and maintain a healthy weight, and also to untangle the contributing factors to your condition. You may also need to consult a nutritionist or other specialist in diet and nutrition.

Here are some key steps and questions for assessing where you are right now:
- Try to remember as best you can what caused you to change your behaviour around food.
- Were you overweight? (or teased), were you on a restrictive diet? Were you trying to meet exacting expectations placed on you by others?
- What do you think is enabling your Anorexia more than anything else? (If it’s more than one create a list).
- Try and identify what triggering factors were (what caused you anorexia) and what your maintaining factors are. See if you can separate them from one another.
- Try referring to an app or website to work out your BMI and compare it to that of a healthy person. Does it fall within the ‘green zone?”
Cognitive behavioural therapy (CBT) can help by teaching you new ways to manage negative behaviours and reactions and by developing a plan to integrate healthier eating habits into your lifestyle. In addition to CBT there are many other effective therapies that can help with anorexia, to find out about the different treatment options. With effective treatment, you can get well again relatively quickly, and integrate your new, healthier habits with a positive self-image.
Who Could I Talk to Further about Treatment for Anorexia?

If you would like to talk to someone about counselling or treatment for anorexia nervosa, please get in touch with the Private Therapy Clinic on Whatsapp message at: +447511116565 email, chat bot or book online to arrange an appointment.

You read more about our eating disorder service. We also have a Psychiatrist at the clinic who will help you or your loved one manage the medical aspects of their eating disorder.