Anorexia Nervosa

Anorexia Nervosa is an eating disorder that’s characterised by weight loss caused through either restriction of food, or over-exercising, or a combination of both. Interestingly, many people don’t look for help with anorexia, they look for help for weight loss or conflict with their family.

Description of Anorexia

Anorexia typically is diagnosed when someone has a weight that is well below the healthy weight range, has a mood disorder and shows specific behaviours around eating, such as the following:

Rituals around eating include:

• Cutting food a certain way
• Cutting food into tiny pieces
• Positioning or sectioning of food on the plate
• Eating food in some particular order, such as all green vegetables must be eaten before all the orange vegetables; or, all potato must be left until last
• Using a pattern to eat and drink, such as one sip every three bites
• Chewing food ever so slowly which takes a long time

There may also be obsessive thinking about food and this can include pouring over recipe books and recipes.

Over-exercising is often associated with anorexia, as is self-harming, use of laxatives and restriction of fluids, or use of diuretics, all in the bid to lose weight.

Anorexia Nervosa Perceptual Disturbances

A person suffering from anorexia nervosa disorder doesn’t notice that they look increasingly thin, bony and gaunt, and may have a ‘lollipop’ head as their head seems too large for their body. 

Because they have a perceptual disturbance known as Body Dysmorphic Disorder, which exaggerates their view of how they look, it doesn’t register that they are too thin. 

They may also have a distorted perception of food portions and see a tiny serving of food as huge or enormous, yet at the same time they do not see someone else’s normal serving size as enormous, just their own. 

Health Issues from Anorexia

Anorexia can also cause osteoporosis and it is not unusual for anorexics to be at high risk of spinal or other fractures. This risk is compounded of course, when the person does high intensity jogging, (fractures of the feet are common), running and other contact sports.

As well, teeth get destroyed because of acid from vomiting, digestion becomes a problem, and there may also be associated stomach, and bowel problems.  In females, menstruation may cease, and in the long term with continuous avoidance of food, death may also occur.

People with anorexia may be very anxious, depressed and suicidal so it is imperative that someone suffering (and they do suffer) anorexia receives psychological help.

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Medicare Rebates

Under the Mental Health initiatives, a person with an Eating Disorder may be able to obtain a referral from their GP to see a psychologist and receive a rebate of approximately $80.  To obtain a referral you need to book a long appointment with your doctor, and provide the psychologist’s name for the referral, if you know who you would like to see.

On settling the account in full with the preferred psychologist, the client will be provided with a receipt that includes the doctor’s details, and this is what Medicare uses to match up the psychologist and the doctor to approve the claim.  Medicare should then rebate about $80 directly to the client.

You cannot claim a rebate on both Medicare and your health fund, it is an either or deal.  It is not possible to bulk bill through this practice.

Anorexia and starvation

When someone with anorexia does reach starvation levels, it is very important that a doctor oversees refeeding, because there is a risk of sudden death if the person is overfed nutritious food too much and too soon. This was the case when prisoners of war were released after being in prison for 5 years and surviving, and then they died due to refeeding.

Quite often, once the person has put on sufficient weight, anxiety and depression are reduced, and perceptual distortions may also be less fixed, simply because the brain and its neural networks are being nourished.  If the brain isn’t fed, it can’t function, just like a car won’t run without the correct fuel.

Anorexia makes it very difficult to manage thoughts and effects motivation as well, so balanced nutrition really does help.

Why does someone develop Anorexia Nervosa?

There are several factors that appear to be in the background history of someone who has developed an eating disorder, such as trauma or sexual assault or abuse, or bullying and harassment.  It can start out as something minor, nothing to worry about, and as the patterns become entrenched, and obsessive thinking occurs, it becomes much harder to let go.  As the brain is starved of nutrients, depression and anxiety may increase, and thinking becomes increasingly irrational.

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What help is available if Anorexia is a possibility?

1.  Urge him or her to see their doctor, and/or Psychologist, ASAP
2.  Provide information on Anorexia Nervosa
3.  Don’t harass the person at meal time. If they eat, great, if they don’t eat, don’t say anything about it. Provide fun, enjoyable conversation at meals or snacks to reduce tension and increase a relaxed approach to food.
4.  If you are very concerned because weight loss has been dramatic, then you need to speak to someone about getting an assessment done.  If need be, someone with anorexia can be admitted to hospital under what is called an “Involuntary Treatment Order” because they have a diminished mental capacity.

How do I as a psychologist, work with someone who has Anorexia?

Before I talk about that, let me just mention that I have experience in working with anorexic clients through having spent three and a half years working in an Adult Mental Health Unit, and I worked in a locum position at Royal Brisbane Hospital in the Eating Disorders Unit.  I have been practising as a registered psychologist since 1999.

Initially, an assessment is completed, so that I have baseline measures of Depression, Anxiety and Stress, and then from there we formulate an approach, based on what might work best for you.

Hypnotherapy for Anorexia

I have found that my clients have responded to NLP processes, and hypnotherapy for anorexia, and there are several that I utilise, along with other more standard approaches such as:

Training in deep breathing and mindfulness meditation.  This encourages an attitude of acceptance as you come to terms with being in the now, and focussing outside of yourself in the present moment.  When you practise deep breathing, there is a physiological response within that allows you to feel more calm, centred and relaxed, and then when you focus on things around you that are outside of you, it permits respite from all those thoughts and feelings that were going on inside.

Swish Pattern and the Blowout Compulsion Pattern, both from NLP, have also been used, along with Timeline Techniques for letting go of emotional baggage.

Clinical Hypnosis can be used as well, although I find that clients who are anorexic, are often uncomfortable with relaxing their body and relaxing into the hypnotic state. 

It is as if they are unwilling to trust themself to be safe and relaxed at the same time, let alone trust anyone else to guide them into feeling better.  Someone with anorexia would appear to have made a very strong link between the thought – “I am only in control when I control my food,” and the state of hyper-vigilance – “so therefore I must be on alert all the time” which doesn’t allow for a relaxed state.

There are numerous other techniques and approaches that may also help with depression, anxiety or any other events that may have been a trigger for the eating disorder to commence in the first place. 

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