What is anorexia?

Anorexia nervosa is a serious eating disorder and mental health condition characterised by restrictive eating, intense fear of weight gain, and a distorted perception of body shape or weight.

However, anorexia is rarely just about food or appearance. It often develops in the context of emotional distress, perfectionism, anxiety, or neurodevelopmental differences.

Anorexia has one of the highest mortality rates of any psychiatric disorder and requires specialist, coordinated care.

Eating disorders such as anorexia can cause significant difficulties for those affected and their families. This includes social and relationship difficulties, mood difficulties such as depression and anxiety.

Anorexia can also impact an individual’s physical health, including bone health, energy levels, menstruation and internal organs such as the heart.

How is anorexia diagnosed?

Anorexia is typically diagnosed when:

• Energy intake is significantly restricted
• Body weight is substantially below expected levels for age and height
• Self-evaluation is unduly influenced by body weight or shape
• There is an intense fear of weight gain

Medical instability can develop quickly and may affect the heart, bones, hormones, and cognitive functioning.

Early specialist intervention significantly improves outcomes.

Common signs and symptoms

Signs and symptoms may include:

• Restricting food intake or skipping meals
• Avoiding certain food groups
• Excessive exercise
• Intense anxiety around food
• Rigid thinking patterns
• Social withdrawal
• Amenorrhoea (in some females)
• Hair thinning, dry skin, or fatigue
• Low BMI or significant weight loss

However, not all individuals with anorexia present in the same way. Some may appear medically stable, physically healthy but remain psychologically at high risk.

What causes eating disorders?

Eating disorders are influenced by a range of factors, including biology. We now know that genetics can play a role in the development of an eating disorder. Environmental factors also contribute, and there is evidence that eating disorders can have a metabolic component. This means that for some people, when they are in an “energy deficit” and do not get enough nutrition, disordered eating habits can be triggered.

There are many ways people can fall into an energy deficit, including dieting, not having the right nutrition, illness, or an increase in physical activity levels without sufficient increase in calories. Over the longer term, eating disorders cause changes in brain function and structure which can lead to maladaptive behaviours.

Maladaptive behaviours may include calorie counting, rumination, body image problems, and extreme dietary restriction.

While biological and metabolic factors play an important role, other factors such as psychological experiences, neurodevelopmental differences, stress, and relational dynamics can also influence how an eating disorder develops and is maintained.

Anorexia and neurodivergence

Many individuals with anorexia may also have underlying neurodevelopmental differences such as autism or ADHD.

In these cases:

• Sensory sensitivities may impact food choices
• Interoceptive differences may affect hunger and fullness awareness
• Executive functioning difficulties may impact routines and flexibility
• Anxiety may increase rigidity around eating

Without recognising neurodivergence, treatment can unintentionally become overly directive or confrontational, increasing distress rather than engagement.

Our approach integrates autism-informed care and sensory understanding into eating disorder treatment.

A trauma informed approach:

When eating plans are implemented without relational safety or flexibility, individuals may:

• Withdraw
• Escalate
• Engage in increased self-harm
• Become more rigid

A trauma-informed approach prioritises:

• Emotional safety
• Collaborative care planning
• Gradual exposure to feared foods
• Consistency without coercion

Physical health risks

Anorexia may affect the whole body.

Medical risks may include:

• Cardiac complications
• Muscle loss
• Bone density reduction
• Hormonal disruption
• Cognitive slowing
• Fertility issues

Nutritional rehabilitation must be carefully managed by experienced clinicians to reduce the risk of refeeding syndrome and other complications.

Ellern Mede provides specialist medical oversight throughout inpatient care.

Our treatment approach

Ellern Mede offers specialist, formulation-led inpatient treatment for anorexia nervosa within a multidisciplinary framework.

Our teams include:

• Consultant psychiatrists
• Specialist doctors
• Registered mental health nurses
• Psychologists
• Occupational therapists
• Dietitians
• Speech and language therapists where required
• Physiotherapy input where functional or mobility needs are present
• Social work and family therapy input

Treatment may include:

• Structured nutritional rehabilitation
• Family-Based Therapy (FBT) for children and adolescents and Family and systemic therapy for adults
• Cognitive Behavioural Therapy for Eating Disorders (CBT-E)
• Motivational Enhancement Therapy
• Cognitive Remediation Therapy
• DBT-informed skills for emotional regulation
• Autism-informed adaptations where needed

Across our services, we provide varying levels of therapeutic intensity and ward environments. This enables individuals to progress through staged support as medical stability improves and psychological flexibility develops.

Our aim is to reduce reliance on restrictive practices by fostering relational safety, consistency, and collaborative care.

Recovery and longer-term outcomes

Recovery from anorexia involves more than weight restoration.

It includes:

• Rebuilding trust in one’s body
• Developing emotional regulation skills
• Restoring cognitive flexibility
• Re-engaging in education, work, and relationships
• Supporting families to feel confident and equipped

Discharge planning begins early and is coordinated with community teams and commissioners to support sustainable recovery.

Enquiries and Referrals

If you are concerned about the difficulties described above, whether as an individual, family member, or professional, our team can provide guidance on assessment and referral pathways.

We welcome enquiries from families, clinicians, commissioners, and international referrers.

Please contact our referrals team to discuss suitability and next steps.