Anorexia Nervosa

What is Anorexia Nervosa?

Anorexia Nervosa (AN) is an eating disorder which is a relatively rare condition, affecting approximately 1% of the population. The majority of people with AN are female, with about 10% of cases being amongst men. AN can affect anyone in our society, with people from all backgrounds and ethnic groups being equally vulnerable.  The sufferer tries to lose weight deliberately as they have a severe dread (like a phobia) of weight gain; they also try to control how their body looks.  People with AN think that they are fat when they are actually very thin. Although other people see them as thin or underweight, it is very difficult for the sufferer to see this.

This illness is a serious condition and the weight loss can become life threatening. AN is the physical manifestation of an underlying psychological problem and therefore is classified as a mental health problem.

What are the symptoms of Anorexia Nervosa?

Deliberate weight loss is the main symptom.  Sufferers tend to restrict how much food they eat in an attempt to control their body shape.  They often pretend to others that they are eating much more than they really are.  They may also use other methods to lose weight for example over-exercising, using laxatives or even taking appetite suppressors or diuretics (water tablets). It is also common for people with AN to make themselves sick secretly after eating or try to mask their thinness by wearing baggy clothes.  People with AN may also become pre-occupied with what other people are eating. They may also obsess about their weight and may weigh themselves several times a day. It is also common  for sufferers to feel cold most of the time and to have irregular sleeping patterns and poor concentration.

Anorexia Nervosa is therefore not simply being on a diet.  Sufferers typically weigh 15% or more below the expected weight for their age, sex and height.  The Body Mass Index (BMI) is calculated by weight (in kilograms) divided by the square of height (in metres). A normal BMI for adults is approximately 20-25, however adults with AN have a BMI of 17.5 or below.

What are the health risks with Anorexia Nervosa?

There are many health risks associated with AN.  These relate to starvation and the methods sufferers use to rid themselves of extra weight (laxatives, vomiting over exercising etc).   AN has one of the highest death rates of all psychiatric illnesses, with an estimated 20% of those affected dying either from the effects of starvation or from suicide.

Health risks include:

Anaemia – a diet low in iron can lead to anaemia causing chronic tiredness and getting out of breath easily.
Dental problems – stomach acid can cause teeth to decay after being sick repeatedly.

Constipation – this may occur with fluid restriction or with laxative/water tablet use.  Chronic laxative use can also affect the muscles and nerves in the bowel wall leading to permanent constipation and abdominal pain.

Hair and skin problems – Over time people with AN can develop fine downy hair on their face and body, while the hair on their head becomes thinner.  Their skin may also become dry.

Low Mood – People with AN commonly feel more moody and irritable as they are constantly hungry.  However, some people develop clinical depression.

Chemical disturbances in the body – vomiting and laxative use can cause the salt balance in the body to alter.  If this happens swelling of the hands, feet and face may occur.  Potassium is also lost through vomiting and this can lead to tiredness, weakness, abnormal heart rhythms, kidney damage and convulsions (fitting). Low calcium levels can lead to tetany (muscle spasms).

Osteoporosis (thinning of the bones) – lack of vitamin D and Calcium can cause bones to become thinner and weaken.

Irregular periods – women with AN may find their periods become irregular, may stop altogether or may indeed never have started if AN started when they were young.  This may lead to difficulty in conceiving a baby.

Psychological Problems- Assessments made by the sufferers can be impaired. The ability to judge and consider may be altered. Thinking and concentration can be impaired.

What causes Anorexia Nervosa?

The exact causes of anorexia nervosa are unknown. However, the condition sometimes runs in families; young women with a parent or sibling with AN are at an increased risk of developing AN themselves. Other factors which may contribute to the development of AN include:

Psychological – anxious/perfectionistic personality, difficulty dealing with stress.

Environmental – Media messages which reinforce the idea that being thin is ideal.

Social – Bullying, stressful life events, occupations or hobbies where being thin is seen as the ideal e.g modeling/dancing.

Food is used as a way of coping in an environment in which the person with AN feels out of control. The underlying psychological causes are usually well concealed and will be different for each individual.  It is important to remember that AN is not an attention seeking device or tactic; it is a symptom of underlying emotional turmoil and distress.

What treatments are available for people with Anorexia Nervosa?

Many sufferers with AN may not acknowledge that they have a problem and therefore may angrily reject any offer of help. The first and most important step on the road to recovery is acknowledging that there is a problem and seeking the appropriate help. Recovery from an AN is possible but early intervention is vital, confers a better prognosis, and may prevent the need for subsequent referral to hospital.

Treatment for AN usually involves dietary, weight/blood monitoring and advice, either in the community or hospital setting. However the underlying psychological issues need to be addressed in parallel. Treatment should, therefore, include “talking therapies”. However, what works for one person does not necessarily work for another.  People with eating disorders are often afraid of asking for help and ambivalent about accepting it.

How can you support someone in the workplace with Anorexia Nervosa?

There are a number of ways in which an eating disorder in an employee may come to light.  It may be that colleagues of the sufferer suspect there is a problem.  It may also be highlighted during the occupational health questionnaire during recruitment.  It is more unlikely that the sufferer will themselves bring their eating disorder to the attention of their employer as sufferers usually go to great lengths to disguise the problem.  Whatever difficulties they have, they will often make strenuous efforts to keep them to themselves to avoid their disorder being noticed at work.  Encouraging them to get help though their GP in a non-critical way is important.  Putting too much pressure on an individual to get help may be detrimental however.

There are no specific employment roles which cause AN, and indeed employees of any level within an organization can be affected.  However there are certain work environments  which may make recovery from AN more difficult e.g employees in the food, fashion and fitness industries.

It is also unusual for an employees’ work to suffer through AN, unless tiredness, lack of concentration/fatigue or difficulty working in a team becomes a problem.  Most AN sufferers throw themselves into work and are highly valued members of the workforce.  If this is the case and their work is not affected, it is important not to invade the employees privacy, but be gently supportive and encouraging of help.

If an employee with AN is struggling with their role at work, or AN does impact on their ability to fulfill their role, it is important to acknowledge the problem and offer support.  Clear guidance on what is expected of them, with regular managerial support and feedback may help.    Referral to an occupational health psychiatrist may be an important first step in advising of the necessary changes which may make the difference between an unwell struggling employee and a more robust supported employee who is able to access effective and relevant treatment.

Information used in this article can be found at:

• www.b-eat.co.uk/index.php/download_file/view/57/83/
• www.nhs.uk/conditions/Eating-disorders/pages/introduction.aspx
• Royal College Psychiatrists  (www.rcpsych.ac.uk)

For further advice on dealing with Anorexia Nervosa in the workplace please contact us at:

E-mail: support@occupationalhealthltd.co.uk

Telephone: 023 8047 5000

Find out more about our Occupational Health and Health Surveillance services.