Anorexia: how to help if someone you know may have it

What is it?

People who have anorexia think they are fat even when you are very thin and underweight. They often go to a lot of trouble to avoid putting on weight. They may skip meals to avoid eating. And they may also make themselves sick, take laxatives or spend hours exercising.

But someone with anorexia may not understand way they behave the way they do. They may feel ashamed and guilty about their behaviour but tell themselves there's nothing wrong. But anorexia is very bad for people's health. It is possible to die from starving yourself.

How can I tell if someone has anorexia?

People who have eating disorders often try hard to keep it a secret. But here are some things that might suggest someone has anorexia or another eating disorder:

• Eating small portions of food and skipping meals, even if they haven't eaten for a while
• Avoiding certain foods, such as meat and sweet foods. Instead they pile up their plates with low-calorie foods, like tomatoes and vegetables. Some people insist on eating these foods in set quantities, for example, 10 green beans or one tablespoon of ketchup
• Behaving strangely around food. They might cut their food into little pieces or crumble it and move it around their plate so it looks like they're eating. They may hoard food or keep lots of recipes
• Not wanting to eat with others
• Constantly talking about food
• Saying they feel very fat but being very thin
• Saying they are fatter than someone when they are clearly not
• Constantly checking their weight and how they look in the mirror.
• Complaining they are heavy or that they hate parts of their body
• Preparing big meals for family and friends but not eating the food, or eating just a little or only a few low-calorie foods
• Being irritable and distressed, especially around mealtimes
• Feeling full after eating only a small amount of food
• Leaving the table during or immediately after a meal, often to go to the toilet
• Lying about food and being very secretive. For example, saying, 'I ate earlier' to avoid a meal
• Exercising nearly all the time
• Being so thin that they're boney, with bones showing through their clothes
• Having fine downy hair on their face
• Always feeling cold and wearing lots of clothes to help stay warm (and to hide thinness)
• Drinking lots of water or fizzy, low-calorie drinks (which take away hunger pangs)
• Missing school or work.

If you're a parent, bear in mind that many children and teenagers are picky eaters at times. It isn't necessarily a sign of an eating disorder. But if you're worried that your child might have a problem with food, remember that he or she can’t help their behaviour. Your child may be scared or embarrassed and will need your support.

Talking to someone about whether they have an eating disorder can be very difficult. They may not want to admit they have a problem or say they don't want help. They may get angry. People who have anorexia may think others are just trying to fatten them up. You may end up feeling as if you don't know what to do. The most important thing is to encourage your friend or family member to see a doctor. You could offer to go with them if they feel that would help. But even if your friend or relative isn’t ready to see a doctor, you can still be there for them and keep offering your support.

You may also find it useful to talk to someone about your worries. Your doctor may be able to put you in touch with a local support group for people with anorexia and their families. The people there may be able to give you some advice about how to cope with someone who has an eating disorder.

What treatments work?

To get better, someone with anorexia needs to do three important things: start to eat more food, put on weight, and change how they think about themselves and food.

Unfortunately, there's very little good research about treatments for anorexia, so it’s difficult to say for certain what will work. One thing that the research does show is that getting treatment early can make recovery easier. But even if someone has had anorexia for a long time it’s important they seek help. The longer someone starves themselves the more harmful it is for their body.

Doctors agree that getting advice and support from professionals can help people put on weight. Specialists can provide advice about what to eat and monitor someone carefully. They can also advise about whether vitamin and mineral supplements are necessary. Studies have shown that people who have anorexia and are being treated by professionals prefer a more relaxed approach to gaining weight than one that is very strict. Weight gain is just as likely with an easy-going approach. A relaxed approach is one where patients aren’t denied the things they enjoy (like going shopping with friends) if they don’t put on a certain amount of weight each week.

Talking treatments (psychotherapy) often seem to help people with anorexia, although more research is needed to say for certain. Family therapy, where other family members or a spouse attend session with the patient, have been shown to help people gain weight. Cognitive behaviour therapy and focal analytical therapy have also proved helpful. These focus on how the symptoms and behaviour that anorexia causes can affect other people as well as the person with anorexia.

Being treated in hospital is crucial for some people with anorexia. But most people do just as well living at home and visiting a clinic. There’s no good research to show whether or not being treated with antidepressants or other drugs helps people with anorexia.

Where to get more help

If you are worried about someone who may have it, you can get more information from the Eating Disorders Association (http://www.edauk.com). The association can also put you in touch with local groups of people with eating disorders and their carers. Talking to someone about how they coped with a daughter, friend or spouse with anorexia may give you support and help you cope.