Anorexia (Anorexia Nervosa)

Anorexia, medically known as anorexia nervosa (ICD-10: F50.0), is a serious mental illness classified as an eating disorder. Those affected maintain a body weight that is chronically too low through strict control of their food intake. At the core of the disorder is an intense fear of gaining weight or being too fat. This fear persists even when the child has long been significantly underweight.

Many people with the condition have a distorted perception of their bodies (body image disturbance): they feel too fat, even though their weight is already dangerously low. Losing weight gives them a sense of control and accomplishment. Anorexia is one of the most common chronic illnesses in adolescence. It usually begins between the ages of 14 and 18 and primarily affects girls and young women, but it can also affect boys and younger children.

Anorexia often develops slowly and begins innocently, such as with a desire to eat healthier or lose a little weight. Parents should be alert if several of these signs occur together:

• significant weight loss or failure to gain weight during growth
• Avoiding entire food groups, eating very small portions, eating slowly, making excuses at mealtimes
• constant preoccupation with calories, weight, and body shape
• excessive exercise, including in secret, and restlessness when sitting still
• Withdrawal from friends, irritability, and setting high standards for oneself
• In girls: absence of menstruation, constantly feeling cold, hair loss

Many children hide their illness and downplay their symptoms. A common characteristic is that they do not recognize their own illness as such (see denial of illness). Conversations about the body are then quickly brushed aside.

Anorexia does not have a single cause. It results from the interaction of several factors, and no parent is to blame.

• Genetic predisposition: First-degree relatives of those affected have a significantly increased risk. The brain’s neurotransmitter system also plays a role.
• Personality: Perfectionism, anxiety, and low self-esteem are common.
• Life stage: The physical and social changes of puberty can trigger the disorder.
• Environment: Pressure to be thin on social media and in society has a particularly strong effect on adolescents with low self-esteem.

Starvation further alters the body and the brain. This intensifies anxiety and rigid thinking, causing the disorder to perpetuate itself. This explains why a child rarely recovers on their own through encouragement alone.

Anorexia is treatable, and the earlier treatment begins, the better the prognosis. Therapy combines two goals: restoring weight to a safe range and addressing the underlying emotional issues.

For children and adolescents, the family plays a central role in treatment. In family-based therapy, parents initially take on responsibility for meals and then gradually hand that responsibility back. This is supplemented by psychotherapy—such as cognitive behavioral therapy—and nutritional counseling. Studies on family therapy show favorable outcomes for adolescents, even though the available data is limited overall.

Outpatient treatment is often sufficient. In cases of dangerously low weight or serious physical consequences, inpatient admission to a clinic is necessary. It helps parents to avoid arguments about food, to stay well-informed, and to distinguish between their child as a person and the illness.

If you suspect anorexia, don’t wait until the person’s weight drops further. The first places to turn to are a pediatrician or family doctor, as well as specialized counseling centers for eating disorders, which offer free and anonymous services. Family members can also find advice and support there.

A definitive diagnosis and treatment should be handled exclusively by a child and adolescent psychiatry (KJP) specialist or a medical or psychotherapeutic professional. Rückenwind “Parents” supports and empowers you as parents during this time, but it is not a substitute for a medical examination, a diagnosis, or psychotherapy. Janike is a social worker and parent coach currently training to become a child and adolescent psychotherapist and does not make diagnoses.