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What are the Symptoms of Anorexia Nervosa?

Feelings & Actions

Common feelings and actions that are linked to anorexia nervosa include:

  • Having an intense fear of gaining weight.
  • Restricting food or types of food, such as food that contains any kind of fat or sugar.
  • Weighing less than 85% of your expected body weight (In a child or teen, losing or not gaining weight during a growth spurt is a concern.)
  • Seeing your body as overweight, in spite of being underweight. This is called having a distorted body image.
  • Exercising too much.
  • Being secretive around food and not recognizing or wanting to talk about having a problem with eating or weight loss.

Eating disorders are in constant and rapid evolution, and we need to continue studying them on an ongoing basis in order to acquire more and more effective treatments.

Anorexia Nervosa

Anorexia is undoubtedly the most studied eating disorder in scientific literature, given the alarming threat of starvation and death. During the last 10 years Empirical-experimental research in Brief Strategic Clinics has lead to the understanding that there are two distinct types of anorexia: abstinent and sacrificial (Nardone, Milanese, Verbitz, 2004).

Sacrificial Anorexia

This is probably the best known type of anorexia. It has been very well described in the literature of the systemic tradition, particularly by the Milan school (Selvini Palazzoli, 1963). These young women typically experiencee difficulties and begin developing symptoms in conjunction with particular family situations.

In these cases, the family presents usually with one member unaware that they are assuming the whole weight of the problem by developing a psychological difficulty, usually (although not necessarily always) an eating disorder.

Often these symptoms offer to the patient a special place in the family, rendering her the focus of the family and this can extend to other social contexts such as school, work, group of friends etc. These effects can also provide a common enemy for the family to fight against, thus avoiding having to face other conflictual situations.

In clinical practice and literature clear indications are that this type of problem is decreasing in comparison with abstinent anorexia.

Abstinent Anorexics

Clients that we have seen with this problem are often metaphorically decribed as donning a medieval armour that protects them from their extreme sensitivity, but which entraps to eventually become their constraining prison.

Abstinence becomes the attempted solution that seems impossible to give up, because, if they took off their armour, they would be unable to manage their emotions. From our perspective abstinent anorexics avoid eating as well as other enjoyable experiences because of their fear of losing control.

Weight loss becomes a means of anesthetizing their emotions. Since abstinent anorexics cannot imagine any personal balance better than their own, they are extremely resistant to change (Nardone, Portelli, 2005).

Apart from individual solutions attempted by the abstinent anorexic, the solutions attempted by the system that surrounds her (particularly by her family) are also very important. Family members tend to make all kinds of efforts to help the person by insisting that she eat, give her more attention, constantly checking on her, etc.

Unfortunately, many of these attempted solutions complicate the problem instead of solving it.

“All bad art is the result of good intentions” – Oscar Wilde

Many good intentions attempted by families and friends can end up producing the worst consequences. We normally apply a “mixed strategic and systemic” type of treatment for anorexia.

We usually see the whole family in the first session and the young woman alone at the following sessions. If this is not possible, we try to see the family at a later session-but at least once in the course of the therapy. Sometimes we can of course see the family throughout treatment.

As mentioned, anorexia is a disorder that can entangle other people, and there are always direct or indirect attempts by the family to make the patient eat. We therefore need to enlist family members as co-therapists.

Sometimes, people suffering from anorexia, like those suffering from vomiting disorders, refuse to go into therapy. In such cases, it is often sufficient to see their parents only to create change in their daughter’s problem.

Bulimia Nervosa & Binge Eating

Bulimia is an eating disorder in which a person binges on food or has regular episodes of overeating and feels a loss of control. The affected person then uses various methods — such as vomiting or laxative abuse — to prevent weight gain. Some (but not all) people with bulimia may also have anorexia nervosa.

Causes, Incidence & Risk Factors

Many more women than men have bulimia. The disorder is most common in adolescent girls and young women. The affected person is usually aware that her eating pattern is abnormal and may feel fear or guilt with the binge-purge episodes. The exact cause of bulimia is unknown. Genetic, psychological, trauma, family, society, or cultural factors may play a role. Bulimia is likely due to more than one factor.


In bulimia, eating binges may occur as often as several times a day for many months. People with bulimia often eat large amounts of high-calorie foods, usually in secret. People can feel a lack of control over their eating during these episodes. Binges lead to self-disgust, which causes purging to prevent weight gain. Purging may include:

  • Forcing oneself to vomit
  • Excessive exercise
  • Use of laxatives, enemas, or diuretics (water pills)

Purging often brings a sense of relief.

People with bulimia are often at a normal weight, but they may see themselves as being overweight. Because the person’s weight is often normal, other people may not notice this eating disorder.

Symptoms can include:

  • Compulsive exercise
  • Throwing away packages of laxatives, diet pills, emetics (drugs that cause vomiting), or diuretics
  • Regularly going to the bathroom right after meals
  • Suddenly eating large amounts of food or buying large amounts of food that disappear right away

What are the Symptoms of Binge Eating Disorder?

Most people overeat from time to time, and many people believe they frequently eat more than they should. Eating large amounts of food, however, does not mean that a person has binge eating disorder.

Most people with serious binge eating problems have some of the following symptoms:

  • Frequent episodes of eating what others would consider an abnormally large amount of food
  • Frequent feelings of being unable to control what or how much is being eaten
  • Eating much more rapidly than usual
  • Eating until uncomfortably full
  • Eating large amounts of food, even when not physically hungry
  • Eating alone out of embarrassment at the quantity of food being eaten
  • Feelings of disgust, depression, or guilt after overeating
  • Fluctuations in weight
  • Feelings of low self-esteem
  • Loss of sexual desire
  • Frequent dieting

Eating Disorder Treatment at The Bateson Clinic

The Bateson Clinic provides a scientifically proven and currently most effective form of treatment available for eating Disorders. The clinical research on Brief Strategic Therapy in Europe and the USA has lead us to discover that often yyoung women or men with bulimic or anorexic shows a trend that eventually leads to the discovery that vomiting enables them to control their weight without having to give up the pleasure of eating.

Also they find that, by staying just a few kilos above or below their ideal weight, they avoid alarming their families and being pressured to eat normally. The problem with this is that in recent years, we have observed a considerable increase in cases of vomiting syndrome compared with the more “traditional” disorders of anorexia and bulimia.

Although the literature in field (APA, 1994) still classifies the vomiting disorder as a variant of anorexia and bulimia nervosa, BST empirical research has shown that the vomiting disorder is based on a completely different structure and model of perception of reality.

Although bulimia (bingeing and gaining weight) and anorexia (abstaining from food in order to lose weight) form the basic matrix of vomiting disorder, once established, vomiting loses all connections with the disorder that initially produced it.

In that sense, vomiting disorder is an example of an emerging quality, just as water is an example of an emerging quality of hydrogen and oxygen. Although hydrogen and oxygen are the elements that constitute water, they lose their individual characteristics, since water is something different and more than the sum of its elements.


When clients initially start to binge and vomit, the vomiting represents an attempted solution, a way to lose weight, or avoid gaining weight, while continuing to eat. In other words, it is a way for the person to keep eating without feeling the harmful effects of her relationship with food.

Initially, this is an attempted solution that works, but, when the cycle of eating and vomiting is continuously repeated, it becomes an increasingly enjoyable ritual; after a few months, it will have become the young woman’s greatest pleasure, and one that she can no longer do without.

Therefore, once the vomiting syndrome has become established, the problem is no longer one of weight control, but one of controlling the compulsion toward pleasure.

Eating and vomiting, which started out as an attempted solution with respect to anorexia and bulimia, becomes the problem, and the reason it persists lies in the pleasure that it provides. One of the findings of our research is that the obsessive search for pleasure and strong sensations is a prevalent characteristic of these clients’ life.

At The Bateson Clinic we provide treatment that this revolutionary discovery has offered. Brief Strategic Therapy’s important clinical discovery has allowed for the creation of effective and brief interventions to solve this problem quickly and effectively.

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