Anorexia Nervosa: A Condition That Is About More Than Food

During a period when everything around Ann was chaotic and impossible to predict, the wish to be thin crept quietly into her life.

At first it felt like a small corner she could control amid all the uncertainty. But as time passed, what had felt like control gradually became the thing controlling her. Ann’s world narrowed. The rules she had made for herself, and fears she could not resist, led her to withdraw from her friends and from what she had loved, until there was hardly room in her mind for anything else.

This article is an invitation to understand anorexia nervosa. It begins with the most important sentence first: this is a serious psychiatric illness, and it is treatable. It is not frivolousness on anyone’s part, it is not a bid for attention, and it is not a choice someone has made. If you or someone you love is facing this, asking a specialist for help is the most important thing of all. If you suspect that you or someone close to you is facing this condition, contact a doctor or a mental-health professional promptly, particularly where there are physical symptoms as well.

Anorexia is not a matter of wanting to be thin

The most common misunderstanding is to see this illness as simply a wish to be thin, or as dieting taken too far. The truth is a great deal more than that.

Anorexia nervosa is a psychiatric illness involving intense fear of gaining weight, a perception of one’s own body that departs from reality, and a relationship with food that seriously affects health. But behind the visible behavior there is usually deeper psychological distress. For many people, food, the control of eating, and the control of how they live become a way of coping with pain, with anxiety, or with a sense that life cannot be controlled. Put another way, what is visible on the surface is only the tip of an iceberg, and the heaviest part is submerged where nobody can see it.

Anorexia is among the psychiatric conditions with the greatest potential impact on the body and on a life. This is why care from specialists is a necessity.

The stereotype that leaves many people overlooked

Another dangerous misunderstanding is the stereotype that a person with anorexia must be a very thin young woman.

In truth, this illness occurs in people of every gender, every age, every body shape, and every background. Many people with it may not have a body shape that leads those around them to notice, while suffering with the same thoughts and the same fears, and deserving help no differently. Believing that a person must be thin to a certain degree before they are genuinely ill is a misunderstanding that leaves a great many people without the care they deserve. Nor is this illness merely a phase that will pass, and it is not the fault of the person or of their family.

A fortress that becomes a cage

An image that helps explain many people’s experience is a fortress.

In its early stages, this illness usually appears as something that feels safe, orderly, and controllable at a time when life feels chaotic. It is like a fortress built to protect oneself. What follows, though, is that the walls of that fortress gradually close in, until what was a place of safety becomes a cage that narrows our world further and further.

The voice of this illness lures a person with a promise of safety and inner steadiness. What it actually delivers is isolation and suffering. This is why telling someone to “just eat more” never works: the problem does not lie in food, but in the fear and the complex pain tangled up with it. And frequently the person themselves feels attached to the illness as the thing protecting them, even while it is harming them — which makes stepping out of it harder still, and makes appropriate help all the more necessary.

Where does this illness come from?

What is important to understand is that anorexia does not arise from a single cause, and it is nobody’s fault.

Research indicates that it arises from several contributing factors: biological and genetic factors, which play a larger role than many people assume; psychological factors such as perfectionism, anxiety, a need for control, past wounds, or low self-esteem; and social factors such as pressure about body shape. Understanding that its roots are this complex helps us stop calling people weak, or blaming families for raising a child wrongly, and turn our attention instead toward finding the right help.

Treatment and recovery: it begins with asking for help

The most important news in this article is that anorexia is treatable, and recovery is genuinely possible. Many people who were at their darkest point have been able to return to lives in which the world opens up again, with appropriate care. And the sooner help is received, the better the prospect of recovery.

Treating anorexia requires a team of specialists working together across several disciplines: medical care, nutritional care under specialist supervision, and psychological therapy. These are the pillars for which nothing can substitute, and they are the first thing a person should have access to. Stepping forward to ask for help — from a doctor, a mental-health professional, or someone you trust — is not a sign of weakness. It is one of the bravest steps there is.

How hypnotherapy fits in

As for approaches to caring for the mind such as hypnotherapy, we want to be clear here: it is not a treatment for anorexia, and it must never be used in place of, or in a way that delays, the primary treatment from a specialist team. At most it belongs as a complementary approach working alongside, and under, the treating team’s plan of care.

Within that limit, it may help support some of the underlying factors that often lie behind this condition: making it possible to regulate emotion better, easing perfectionism, releasing past wounds, gradually building a safer and gentler relationship with oneself, easing anxiety, and adjusting one’s view of self-care toward something gentler and more appropriate. All of this is complementary only. It is not treatment of the illness itself and cannot replace care from a specialist team. For an illness as serious as this, specialist treatment is the heart of the matter and must always come first.

At NBRH we hold that nobody should be defined by the illness they are facing, and we believe in the possibility of recovery when appropriate care is received. For a condition as serious as anorexia, we would say plainly, and with real care, that treatment from a specialist team is the most important and most necessary thing of all — and that reaching out for help today may be the beginning of getting a life back.

To understand the self-worth factors that often lie behind distress of this kind, we have written “Low Self-Esteem: When We See Ourselves in a Distorted Mirror”. And to learn how to treat yourself with more gentleness, “What Self-Compassion Is” may help steady you.