Do you have an unhealthy fear of gaining weight? Are you always looking for new techniques to lose weight, or at least to keep it off? Do you feel guilty after every meal? The need to lose weight rules your whole life and your daily life becomes difficult to manage. You may be suffering from anorexia nervosa.

personne qui se p├Ęse

1. What is anorexia nervosa?

Anorexia nervosa is an eating disorder, which consists in depriving oneself of food for a long period of time. This period can last for months or even years.

Anorexia nervosa is not related to an inability to eat, but rather to an intentional refusal to eat normally. This is because of a fear of gaining weight or a desire to lose weight.

A person suffering from anorexia nervosa has a strong anxiety. She has an almost phobic anxiety. These anxieties are linked to the consequences of eating food with this constant fear of becoming too fat. This is why, in this case, we will constantly control all the calories ingested. We will also increase our physical activity. And we will refuse to eat certain foods and/or regurgitate food at the end of a meal.

It is estimated that anorexia nervosa lasts, on average, from 1.5 to 3 years, and up to 5 years. Beyond 5 years, we talk about chronic anorexia nervosa.

2. Why this refusal to eat?

At the beginning of the disease, we still have the urge to eat food. The hunger is still there and the desire to eat is present. Yet we refuse to eat. It is a kind of struggle not to give in to this urge to eat. This struggle gives the impression of having complete control over our body, and deciding when it needs to be fed or not.

But very quickly, the fact of not eating leads to a weight loss which creates a strong satisfaction. Nevertheless, this joy is ephemeral. We start again to deprive ourselves of food, or to increase the physical exercise to find this experienced satisfaction. We then enter a vicious circle.

The most difficult thing to understand for those around us is the fact that we do not always see the thinness of our body. Or, in any case, we don’t see it in the same way as those around us. But this is normal, because the perception of our body is distorted. Anorexia nervosa is associated with “dysmorphophobia“. Dysmorphophobia is an exaggerated preoccupation with one’s physical appearance. It leads to suffering and to the adoption of certain behaviors to compensate for it.


3. What are the origins of this eating disorder?

There is no single cause for anorexia nervosa. We will speak of a multi-factorial origin, even if it is mostly associated with psychological disorders. The latter can come from an individual disorder or from a trauma.

Childhood trauma can have a negative impact on our body image, especially sexual touching or abuse. But not everything happens in childhood. In adolescence, other traumas, which may seem “less violent” to some, can have an equally harmful impact, such as a bereavement or a separation. Difficulties related to childbirth or perinatal complications can modify the individual’s body image.

In addition, the family environment can have an impact on our future body image, there may have been abuse in childhood. But without going that far, sometimes family pressure and demands are such that it has an impact on our body. For example, your parents have always expected you to be the best.

Social pressure and the cultural environment can also play a major role in anorexia nervosa. Indeed, social networks where many put filters on their body or face, television shows, cosmetic surgeries that are democratized, advertisements on different media etc..

Your professional environment and professional pressure can also play a role in this. Indeed, there is a greater risk of anorexia nervosa in certain professions such as modeling or in the competitive sports world.

Finally, it is also possible that it comes from abnormalities in certain neurological connections that may be genetic or not. Indeed, the serotonin (which processes mood) and dopamine (which processes reward) connections are biased. There is a release of endorphin (pleasure hormone) when fasting, which is normally released when eating.

4. What are the signs of anorexia?

You may notice signs that you or someone you know has anorexia nervosa.

First, their Body Mass Index (BMI) is below 17.5. We consider a “normal” BMI to be between 18.5 and 24.5.

Then, you can see that there is an obsession related to food, that calories are counted, that the idea is to always decrease the intake of food for example. But it can also be seen in the way we eat, with the adoption of certain practices. Or with the avoidance of certain places / situations (not eating with friends for example). There is also often an increase in physical exercise, with excessive sports practices.

We will also note that there is an amenorrhea, of more than 3 months, in girls suffering from anorexia nervosa. It is sometimes more difficult to notice this point, since some girls are taking a contraceptive pill that already suppresses menstruation.

Finally, we can see it in the way of being and living. The image of one’s body takes a predominant place in daily life, there is a certain form of hyperactivity and an important intellectual investment.

5. What are the criteria for diagnosing anorexia?

From a more medical point of view, professionals will have several criteria. They will allow them to make a diagnosis of anorexia nervosa. In this way, they will be able to assess whether or not there is a need for emergency hospitalization. In any case, if you have the slightest doubt, go see a health professional who will be able to give you the best advice.

At first, there is a categorical refusal to have or maintain a “normal” weight, with the desire to have a thinner body. They have a great fear of gaining weight.

There is also the adoption of certain behaviors that may seem strange, such as encouraging others to eat, hiding food so that they don’t see them, etc.

The guilt of having eaten after ingesting food is also very present. This is why we find many compensatory behaviors in order to relieve the guilt (or even to “punish” themselves). These compensatory behaviors can be the fact of vomiting, ingesting laxatives or practicing even more sports.

6. Which personality predominates in people with anorexia?

There are certain personality characteristics that are often found in people suffering from anorexia nervosa. Indeed, we note a particularly consistent low self-esteem. It is generally linked to a high level of perfectionism.

It is not uncommon either to notice an anxiety, that is to say to be easily stressed or distressed, in particular a social anxiety.

In general, there is a need to control the elements of one’s life. In particular, the idea of being able to totally control one’s body.

Finally, some patients have OCD (obsessive-compulsive disorder) related to food or not.

7. What are the health consequences of this eating disorder?

In the short as well as in the long term, anorexia nervosa has heavy consequences on physical health.

It is possible that you are regularly, and from the beginning, confronted with numerous panic attacks as well as discomfort, or at least, a feeling of uneasiness (head spinning, blurred vision…)

As time goes by, new difficulties can be added: malnutrition, slowed growth, neurological disturbance. Because there can be neurological disturbances, there are also emotional and intellectual disturbances.

We will also notice a damage at the cardiovascular level, that is to say that there is a risk of decrease of the cardiac rhythm, an increase of the blood pressure etc.

We also notice the appearance of hair loss.

From a digestive point of view, we will notice kidney problems and constipation.

We can also see consequences at the level of the bones: there can be an osteoporosis, that is to say a reduction of the bone density, but also dental complications (due, among other things, to the acidity of the vomit)

For the youngest, there can be a risk of slowing down growth, lacking vitamins and elements necessary for its proper development.

As a result, anorexia nervosa also decreases the functioning of the immune system since the body lacks the resources necessary for an effective immune system.

Finally, there is a high risk of death due to total undernutrition. Indeed, 5% of cases of anorexia (more generally of chronic anorexia) lead to death.

8. What are the consequences of anorexia in everyday life?

Beyond the purely health and physical aspect, anorexia nervosa has many consequences in everyday life.

Indeed, body image and self-esteem are so low that we limit our social and romantic interactions. We therefore limit our social activities by avoiding restaurants with friends, activities that risk showing the shape of our body (swimming pool for example). Anorexia nervosa therefore ends up affecting all school (or professional) and social life. There is therefore a significant social isolation that can lead to depression due to the lack of social relationships and loneliness.

For romantic relationships, it is difficult for someone who does not like his or her body to accept that another person may be in love with it, and even more so to risk having to reveal it in intimacy. In addition, anorexia nervosa causes a decrease in libido.

It also creates intra-family difficulties. Indeed, parents or siblings do not always understand your reactions, your actions, your thoughts and the vision you have of your body. This can create conflicts. You get a lot of attention from your parents, who are concerned, and your siblings may not always understand or be jealous of the attention you get. This dynamic can create many arguments with them.

From a physical point of view, anorexia nervosa causes muscle wasting. Our athletic performance is therefore diminished, and our physical capacities are weaker.

Finally, physically you are more tired because you lack nutrient intake. When we are tired, we are more irritable and may be less understanding or less accepting of certain remarks from those around us.

9. What are the prevalences of anorexia?

Women are more prone to anorexia nervosa than men. It affects an average of 0.5% of girls and 0.003% of boys.

The onset of this disorder is mostly between 14 and 17 years old, but more rarely, it can be earlier and develop as early as 8 years old. Nowadays, anorexia nervosa tends to appear younger and younger. It is also possible to engage in anorexic behaviors beyond the age of 18. The peak risk is around 16 years of age.

Anorexia nervosa affects all social classes, not just the wealthiest or most disadvantaged.

10. What is the treatment for this eating disorder?

Early treatment is essential. The earlier the diagnosis is made, the less the disorder lasts. On average, there is a 50% rate of total recovery. An early diagnosis reduces long-term complications and allows the symptoms to disappear completely in less than 5 years.

Systemic (i.e. family) therapy is recommended. It allows each person to find his or her place and to understand the experience of each member in a totally individual way in order to unify the siblings and reduce the symptoms of anorexia nervosa. It can be accompanied by Virtual Reality which allows to see what image of his body the person perceives, and gives more sense to what the person lives and feels. During this therapy, we will be able to share information, do dialogues, role play etc. so that everyone can get to know each other again.

Individual therapy is also necessary and important. During this therapy, cognitive remediation is performed. That is to say, work will be done on the cognitive rigidity and automatic thoughts that consolidate the CAT in order to come back to them and regulate the thoughts. Virtual reality is another essential tool for the success of this therapy, since we can be exposed to anxiety-provoking situations related to food. Indeed, we will be exposed to food or to the image of our body, or to the perception of our silhouette. The goal of this virtual reality therapy is to desensitize and decondition the anxiety and discomfort linked to the situation.

11. What is the EAT-26?

The EAT-26 is a test that detects if there is a risk of anorexia based on certain behaviors that may appear anorexic. It does not diagnose anorexia, but it is a good tool to guide the possible need for treatment.

This questionnaire, which has been scientifically validated, measures the frequency of occurrence of certain characteristic attitudes related to the eating disorder. It consists of 26 questions about your daily habits.

Recognizing the possibility that you are suffering from anorexia nervosa allows you to take charge of your life as quickly as possible and in the most appropriate way.

Answer in a completely honest and natural way. Your answers are not recorded or consulted. The sole purpose of this test is to help you understand the anguish you may be feeling and to guide you in your possibilities.