Eating disorders
Anorexia nervosa
Anorexia is not a choice, not vanity, and not something a person can simply be reasoned out of. It can develop a logic of its own, one that may feel protective, safe or necessary from the inside, while gradually narrowing life from the outside. This is part of what makes anorexia so difficult to challenge, and why treatment works with the fears, beliefs and patterns holding it in place, rather than simply asking someone to eat.
Anorexia nervosa is characterised by restriction of what is eaten, an intense fear of weight gain, and a way of experiencing your own body that does not match what others see. It is often accompanied by rules that begin small and expand: foods that become unsafe, times of day that become fixed, quantities that must be measured, exercise that must be completed regardless of how you feel.
It can occur at any body weight. People are often surprised by this, and it is one of the reasons anorexia goes unrecognised for so long. Weight is one piece of information among many, and it is not the measure of how unwell someone is or of whether they deserve help.
From the outside it can look like self-destruction. From the inside it can feel like the one thing holding you steady.
What treatment involves
Ambivalence about change is expected.
Treatment is structured, collaborative and paced. We build a shared understanding of how anorexia works for you specifically: what it protects you from, what it costs, and which parts of the cycle can be interrupted first. Alongside the psychological work, we address eating itself in a way that is planned rather than sprung on you.
Where appropriate, I work alongside medical colleagues so that physical health is monitored while therapy continues. Ambivalence about change is expected. It is something we work with directly, not something you need to resolve before beginning.
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