Strong-willed

Many parents describe their child with anorexia as determined, single-minded, and incredibly disciplined. The child gets up early in the morning to go running, avoids sweets, and sticks to plans that adults would have given up on long ago. From the outside, this appears to be a sign of a strong character. Teachers praise their self-control, and relatives marvel at their consistency.

This impression is misleading. In anorexia, the will is hardly directed freely toward one’s own goals anymore. It revolves around food, calories, and weight. What looks like a free choice is actually a strict necessity. The child often can’t do anything else—even if they present it outwardly as their own decision.

Anorexia takes personality traits—which may have been present from the start—to extremes. Specialized websites cite anxious and compulsive traits, a tendency toward perfectionism, low self-esteem, and a strong need for harmony. Such children are often very well-adjusted and ambitious. For them, abstaining from food feels like a success.

This is precisely where the illness hides. Those affected experience control over their own bodies as something positive, as an achievement. Fasting and exercise become proof that they have themselves under control. What those around them interpret as admirable discipline is the visible part of a compulsion. Some teenagers even feel more capable at first when they weigh less, which intensifies the pull of the disorder.

One warning sign is rigidity. True self-control allows for exceptions—a birthday cake, a spontaneous ice cream treat with friends. When an eating disorder begins to develop, this leeway disappears. Professional warning lists describe patterns such as:

• a growing interest in calories and the nutritional content of individual foods
• Avoiding main meals, especially in public
• Restricting oneself to a few “healthy” foods
• frequent weight checks and dissatisfaction with one’s figure
• intense physical activity and an increasing focus on performance
• Social withdrawal; in girls, the absence of menstruation

Parents should be on alert if their child adheres to these rules even though they are visibly losing weight or appear exhausted. Often, the child does not recognize the problem themselves—a pattern known as denial of illness.

Praise for self-control has the opposite effect than intended in the case of an eating disorder. When adults admire this iron-willed control, they are reinforcing the very mechanism that keeps the child sick. Information for family members on specialized websites advises against praising a child for gaining weight or eating well, as this can trigger feelings of guilt and lead to even more self-restriction.

It’s more helpful to focus on the person behind the behavior. Experts recommend distinguishing between the illness and your own child. Parents did not cause the anorexia. They are an important source of support on the road to recovery. Specifically, this means: no discussions about calories, weight, or body shape at the dinner table; no comments on appearance; instead, show genuine interest in school, friendships, and feelings beyond food.

The shorter the time between the onset of symptoms and treatment, the better the prognosis. It takes several years on average to make a full recovery, which is why every suspicion counts. The first point of contact is the pediatrician, who can assess the child’s weight and refer the child for further care. For children and adolescents, involving the family in treatment has proven effective.

Rückenwind Parents, we’re here to support you through this time, but this does not replace a medical evaluation. Only a medical or psychotherapeutic specialist—such as those at a child and adolescent psychiatry clinic (KJP)—can determine whether an eating disorder lies behind the unusually strict behavior. If the child is severely underweight or experiencing physical symptoms, they should be examined by a doctor as soon as possible.