Anorexia nervosa is an eating disorder characterised by extreme dieting to the point of starvation and an inability to discriminate between normal and abnormal body images. It is commonest among young girls and may be caused by social, genetic or psychological factors, or a combination of these.

The incidence of anorexia is increasing but it is not known whether this is due to better reporting and diagnosis of anorexia or whether it is increasing in real terms.

Who is at risk?

Anorexia is commonest in women between 10 and 30 years of age. In rare cases, it can present in adulthood or before puberty. Many more girls than boys are affected and it is only seen in countries where thinness is considered desirable.

Research suggests that young people who diet during early adolescence are at particular risk of developing eating disorders later in life. This is worrying as:

• In one study as many as 68% of Dublin school girls under 15 admitted that they had tried to lose weight;
• 39% 11-year-old Irish school girls in another study wished to lose weight although only 6% of them were clinically overweight;

What causes anorexia?

• Psychological/emotional factors. Anorexia has been variously described as 'the slimmer's disease', 'a relentless pursuit of thinness' and 'a morbid fear of fatness'. However, for many sufferers anorexia is not just about dieting or losing weight, rather it is an outward sign of deep psychological and emotional turmoil. Their behaviour may be an unconscious attempt to avoid or control painful feelings, a way of asserting control over life or a reaction to stress.
• Social pressure. Stick thin magazine fashion models as well as skinny teen pop idols all help reinforce the idea that to be successful or admired you have to be thin.
• Parental attitudes. Parents have an important role to play in conveying messages about healthy food and healthy eating behaviour. American research showed that mothers play a central role in transmitting cultural values regarding weight, shape and appearance to daughters. As early as the preschool period, a mother's own dieting and eating behaviour may begin to influence children's eating patterns. Women should be aware that attempts to control their own weight may influence their daughters emerging ideas, concepts and beliefs about dieting.

What signs should I look out for?

Typical warning signs of anorexia may include:

• Severe weight loss;
• Distorted body image;
• Absence of menstruation (amenorrhoea);
• Insomnia;
• Depression;
• Dizziness;
• Feeling cold - especially the hands and feet;
• Irritability;
• Setting high standards;
• Isolation;
• Secretive behaviour;
• Dry skin;
• Gastrointestinal upset e.g. bloatedness, stomach pains, constipation.
• People with anorexia may also become involved in excessive exercise in an effort to lose more weight. Many young people with anorexia seek out sports such as athletics, gymnastics and ballet. Low body weight is expected in these sports and so they provide shelter under which to hide the condition. Sometimes a stress fracture will be the first obvious signal that body weight is excessively low, particularly in female athletes.

Can it have long-term effects on health?

Very low body weight endangers health and in some cases may result in death. There may be effects on the ovaries, the stomach and gut, the heart, kidneys, teeth and salivary glands, hormones and there may be changes in blood pressure.

People with anorexia usually have low bone density. It is due to the combined effect of low dietary calcium intakes and the lack of oestrogen, which is caused by amenorrhoea. Low bone density is usually apparent in those who have anorexia for more than a year.

Most of the changes and risks of eating disorders can be reversed by effective treatment.

What treatment is available?

The treatment for anorexia is multidimensional and consists of nutritional and medical attention as well as cognitive therapy and counselling.
Few patients refer themselves for treatment. If you suspect that someone you know has anorexia, the best way to deal with the problem is to persuade that person to talk to their G.P. or contact a support group for people with eating disorders such as Bodywhys as a first step