Counselling in Perth
Anorexia Nervosa (anorexia) is a disorder involving under-eating and requires the following criteria in order to be diagnosed1:
Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than minimally expected.
Intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight.
Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Statistics estimate that in 2012 approximately 4% of the Australian population had an eating disorder (ED), 3% of which had anorexia2. Anorexia can be seen as having a preoccupation with food – weight, calories, as well as a distorted body image. A person with anorexia denies their hunger in an obsessive effort to not gain weight, and often presents with other factors such as rigid thinking patterns, perfectionism, excessive exercise, and an increased risk of mortality through suicide and irreversible damage to their physical health through extreme weight loss.
Physical and Medical Co-Morbidities
There are significant medical problems associated with anorexia that include:
- Slowed heart rate and low blood pressure (leads to lack of energy, fatigue, dizziness),
- Osteoporosis, bone brittleness and density,
- Hair loss,
- Interruptions to menstrual cycle,
- Dehydration (potentially leading to renal failure),
- Lanugo (a growth of fine hair all over the body as an attempt to keep the body warm),
Psychosocial problems that accompany anorexia include:
- suicidal thoughts and behaviour, and self-harm,
- obsessive compulsive tendencies,
- mood swings,
- social withdrawal and isolation,
- school, study and employment problems.
How can a psychologist or counsellor help with anorexia?
Given that anorexia is such a serious illness, treatment is best managed as part of a team that includes a psychologist, dietician and a GP. The GP can monitor the medical condition of the individual, the dietician is responsible for managing the food and nutrition, and the psychologist monitors the self-harm risk (if any), and the overall psychological treatment of the ED and any other co-morbid psychological issues. Psychological treatment will focus on all or any of the following:
- Normalising eating – exploring any barriers to setting up a regular eating routine,
- Reducing or eliminating any avoidance of specific foods or strict dieting
- Exploring core beliefs about body image and the self
- Exploring fears relating to weight (loss) and body shape
- Exploring self-esteem
- Increasing a sense of self-control
- Increasing self-awareness of normal, healthy appetite cues
Cognitive Behavioural Therapy
CBT specifically for Eating Disorders (CBT-E) has been shown to be an effective treatment in adults when emotional dysregulation is the precursor to the eating disorder. This type of therapy addresses thoughts (cognitions), feelings, and behaviours directly.
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- American Psychiatric Association. (2013).Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Butterfly Foundation. (2012). Paying the price: the economic and social impact of eating disorders in Australia. Melbourne: Butterfly Foundation.