Anorexia nervosa involves a reduced food intake, below a person’s medical needs. Their mind will be very focused on eating habits to change their body’s size and shape. You might feel the need to have a very specific or “perfect”, body type. They might perceive their body type as being different, larger or less attractive than it is objectively (known as body dysmorphia). The idea of eating or potential weight gain may cause a lot of distress and anxiety or think it makes them ugly or not good enough. This will cause them to be very restrictive in their food intake, counting calories or exercising too much.

There are many reasons why this disorder develops but they are often around control and “fixing ourselves”. You may have developed an unrealistic view of what people should look like and feel a need to make yourself better. The person may feel that there is something unacceptable about them and they need to change it. Since weight, size and shape are partly under our control this can be a way to feel that they are fixing themself.

This means that these issues are connected to low self-esteem. The person may have had negative life experiences like abuse, neglect, bullying, etc that make them think they need to “correct” something about themselves. It can also be caused by perfectionism or competitiveness. One recent trend has been for people to compare themselves to other people they see on social media. They compare themselves to these “best bits” of others or digitally enhanced photos. This leads them to worry that there is something wrong with them or their life. Managing appearance through size and shape may be a maladaptive way to manage these feelings. We can fail to see the context around these and make negative social comparisons. These issues can result in a fixation on improving themselves through managing our shape and size.

Treatment for anorexia nervosa is highly specialised to the persons needs but is based on the CBT– Enhanced model. We work together to get an understanding of the eating issue, what the person is trying to correct or any inaccurate assumptions about themselves or eating (for example, how many calories a body actually needs). This can be intense and takes time. We work on challenging “rules for living” that say a person need to do or look a certain way, we affirm the person and work on anxiety, mood and self-esteem. This can also be partly educational about the function of nutrients, etc if that helps. This can be an intense treatment and some people work with their therapist for 40 sessions but it will always be tailored to the persons needs.