Eating disorders (young people)

What is anorexia nervosa?

Anorexia Nervosa is an eating disorder and mental health condition where the person will severely limit or ‘restrict’ the amount of food they have, for long periods of time. It can be different from person to person but people with anorexia nervosa may:  

• Skip meals 
• Eat a lot less overall 
• Stop eating certain types of foods 
• Do unhealthy amounts of exercise 
• Vomit or use laxatives to ‘purge’ or remove food they have eaten from their body quickly

Although the most obvious symptom is severe weight loss, anorexia nervosa does not necessarily develop because the individual wants to lose weight. It is a complex mental health problem, linked to: 

• Low self-esteem (when a person has a negative view of themselves) 
• Negative thoughts  
• Difficulty with coping with life 

When Eva was 14, she started limiting what she ate, recorded everything that she ate and drank...

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Age at interview: 17
Sex: Female
Age at diagnosis: 14
Shortly after like my fourteenth birthday I was wasn’t fitting in very well with my friendship group at school, and I felt very academically pressured in the school that I was in, like I’d always try really hard in my school work, but I never felt as though it was good as my friends’ work and I started to feel like quite competitive about that. But it was getting me down that I wasn’t doing as well as them, and especially as I wasn’t fitting in and it felt very lonely. 
In, like I was best friends with a girl, but we stopped being friends and a new girl came to the school and took my place as this girl’s best friend. And she was like quite skinny and she was really clever, so I started to feel like maybe if I’m more like her people will like me more because she was popular and everything.
So I got really interested in diets and stuff and I started to like count how much fat I was eating. But it wasn’t really working and I was getting more and more unhappy. So I started going on the internet and found all thinspiration sites and stuff and I started to use them a lot. I signed up to lots of them and would talk to other people on them.
And from there I just got really obsessed with what I was eating and I’d start to write, because on some of the websites it would say things like, write down what you’re eating. So you could like cut out things the next day. So I used to obsessively record everything that I ate and drank, even when it was just things like water.
And I’d started to halve it, and it got to the point where I was throwing my lunch away at school and like my Mum obviously didn’t know that, but she started to click on that I wasn’t eating all my meals and stuff. So she took me to the doctors, and the doctor said to me that I had anorexia but my Mum didn’t tell the appointment was for like to getting a diagnosis for that, she told me it was because I’d been a bit ill, so I just went along with it.
It is difficult to know how many people are affected by anorexia nervosa, but it’s thought that 1 in 150 fifteen year old girls have this eating disorder and 1 in 1000 fifteen year old boys (Royal College of Psychiatrists August 2014). It is often thought of as something that starts in the teenage years but it can also start in childhood or later life. 9 in 1000 women will experience anorexia nervosa at some point in their lives (National Institute for Health and Care Excellence - NICE October 2014). It affects women more than men (ratio 10:1). However, men are more likely to be underdiagnosed, misdiagnosed and under-referred and they are more likely to develop their disorder in association with over-exercise and to want to be of a muscular build rather than a very skinny one (Royal College of Psychiatrists August 2015). 
Restricting food had often started out as a form of dieting for the young people we spoke with. They may have been on a “healthy eating kick” or skipping a meal here or there. It was common for people to say that their eating disorder had developed gradually, over months or years. It was often difficult to know when exactly the disorder had started. Gradually, people developed “fear foods” and started cutting out whole food groups. Some developed obsessions around food and eating, such as calorie-counting or weighing themselves repeatedly. 
Some took restricting further and would then start to limit their experience of fun or pleasure in life, becoming more isolated, focusing more on work and less on hobbies or seeing friends. Physical symptoms (such as weight loss, extreme tiredness, digestive problems, poor blood circulation, hair loss) often went hand in hand with increasing bad moods, perfectionist thinking, self-criticism and anxiety.
Many described restricting as the only form of control they could have over their lives, something that was just theirs and that they could be “good at”.  Anorexia Nervosa was a continuous cycle; the more weight that was lost, the less ill people felt and the less able they were to get help. This drove people to restrict even more and the cycle continued. People often said that stopping this way of thinking eventually helped them to get better and enabled them to “let go” of the eating disorder.

Elizabeth had ambitions to become a journalist and realised that she couldn’t be both good at her...

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Age at interview: 20
Sex: Female
Age at diagnosis: 12
To be honest like a lot of the time it’s just been I have to eat because I need the strength to do this. Like for example when I got made the deputy editor of the paper I had to like often do quite late nights on a Tuesday, a Monday and a Tuesday to get the paper done, for the deadline. And I just had to take like; I’d have to eat because I just got to the point where I just couldn’t concentrate anymore on like copy edit. Say I had to like sub-edit a, some news copy for somebody, I just had to eat because I just wouldn’t be doing my job properly anymore. So that was like the realisation that if I don’t eat, other people will think badly of my ability to do the job. And I just don’t want that. Like I want them to think I’m really good at my job. So like whereas in the past it would have been kind of I want to think that I’m really good at anorexia, now it’s more like important that there are other things in my life that I’m really good at. So that’s kind of that realisation and so I realise that I have to stop and eat.
Realising that other people, like I always thought that other people just don’t eat, like they just don’t make time for food. Other people just don’t eat whereas actually realising that people do say, “I’m gonna stop for lunch,” is quite handy.

Zoe needed to feel in control of everything in her life. She started controlling her weight to...

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Age at interview: 23
Sex: Female
I think I am very driven in everything I do. When I say everything I do, I mean I don’t actually do a lot other than work. Work is a large part of my life and it always has been and always will be I think. And I’ve always felt the need to push myself to the extreme. Not necessarily because I want to be the best, but just ‘cos there’s always this kind of underlying, “I’m not good enough.” If I worked, if I didn’t work as hard as I did I just wouldn’t be able to do this. So there’s all this kind of need, I guess it’s the perfectionism thing.
And so I’m, yeah, very driven. I also like to feel in control of whatever it is whether its work, whether it’s my body weight, I always need to feel in control. And so as soon as I think something goes, feels out of control in my life, nothing to do with food and weight. I’ve got this kind of safety blanket of, “Well, I can control my food and weight quite well. I’ve done it before. I can.” And so I always fall to that and I also have got sort of I think I’m sort of quite an anxious person. So I think all these things kind of don’t help. Yeah.
Would you say your worry about things? And what do you mean about anxious? How does it sort of manifest?
Yeah, I mean I think I do. I worry about not performing or not being good enough a lot. And it is all related to work and that sort of thing. It’s not anything to do with worry about my body or how I look. It’s all to do with not being good enough, people not thinking that I’m good enough, yeah.
When you that you want to work hard to feel good enough, would you say that this is linked to self-esteem? Is that sort of part of your identity, work?
I think it is. I mean I think I sort of value myself pretty much wholly on my ability to perform and do well in my work. And I don’t have I mean I realise this now, I don’t sort of have a lot else that’s important to me and I don’t value myself for much other than my performance academically. And so if that goes or I feel like I’m not up to scratch, it really feel very uncomfortable and I need to, you know, do something else like starting to control my weight or whatever.
Different aspects of the experience of anorexia nervosa have been covered across this website. 

Last reviewed October 2018.
Last updated October 2018.

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