Anorexia

What it is

Anorexia nervosa is a condition in which a person severely restricts what they eat, loses significantly more weight than is healthy for them, and yet experiences themselves as too big, with an intense fear of gaining weight that does not ease as weight falls. The mind's perception of the body becomes unreliable: the mirror reports something the scales and the worried family contradict.

Anorexia is not vanity and not a lifestyle. It is a recognised illness with genetic, psychological and social roots, and the malnutrition itself changes the brain in ways that deepen the rigidity and fear, which is why willpower alone rarely breaks the cycle and why loving instructions to “just eat” do not work.

What it can look like

Shrinking meals and growing rules about food. Eating alone, cooking for others without partaking, new intolerances, intense interest in food paired with refusal of it. Excessive exercise, layered clothing hiding weight loss, withdrawal from friends, irritability, and for girls and women often the loss of monthly periods. The person usually does not believe anything is wrong, which is part of the illness, not stubbornness.

Medically, anorexia affects the heart, bones, hormones, digestion and brain. It carries one of the highest death rates of any mental health condition, from medical complications and from suicide, which is exactly why it deserves urgent, skilled care and never a wait-and-see approach.

Who it affects

Anorexia most often begins in adolescence and affects girls and women most, but boys, men and people of every background develop it. It exists in Africa; the old belief that eating disorders are a Western illness has delayed diagnosis on our continent, and rising urbanisation, social media and appearance pressure are closing whatever gap existed. A thin teenager who has stopped eating with the family deserves assessment in Nairobi exactly as in London.

What causes it

There is no single cause. Anorexia tends to run in families, which points to genes, and it often appears in people who are sensitive, anxious, and perfectionist. Stressful changes, trauma, and intense pressure about appearance or performance can act as triggers. Importantly, starvation itself changes the brain, deepening the fear and rigidity, so what may begin as dieting can become an illness that is no longer a choice. It is not caused by vanity or by family failure.

How it is diagnosed

There is no single test. A clinician makes the diagnosis through careful assessment of eating patterns, the fear of weight gain, body image, and the physical effects, alongside a medical check of the heart, blood, and other systems, because anorexia is a medical as well as a psychological illness. Because a person often does not see the problem, information from family is valuable. The aim is a prompt, skilled assessment, not delay until the illness is obvious.

How it is treated

Treatment has two inseparable parts: restoring nutrition and weight safely, and treating the thoughts and fears that drive restriction. For adolescents, family-based treatment has the strongest evidence; parents are coached to take charge of nourishment with warmth and persistence while the young person recovers, and it is the opposite of blaming families. For adults, specialised talking therapies, including an enhanced form of CBT developed for eating disorders, lead the evidence. Severe malnutrition needs medical monitoring, sometimes in hospital, because refeeding itself must be managed carefully by professionals.

No medication cures anorexia. Recovery is gradual, sometimes with setbacks, and genuinely achievable; the strongest predictor of a good outcome is early treatment, which makes the family's first brave conversation a medical intervention in itself.

Helping someone

Families are central to recovery, not to blame, and your steady support matters.

• Learn about the illness, so you understand that the resistance to eating is a symptom, not defiance.
• Avoid comments about weight, food, or appearance, even kind ones, and try not to be drawn into arguments about food or rules.
• Show love and concern for the person, separate from the illness, and keep the relationship warm.
• Seek specialist help early and stay involved, since for young people family-based treatment, where parents help restore nourishment, has the strongest evidence.
• Look after yourself and share the load, because supporting recovery is demanding and often long. Our find a therapist page can help.