Anorexia: a guide for parents

1. Before you begin

It is half past seven in the evening. Chloé, who is fourteen, has been at the table for forty minutes. She has cut her chicken breast into minuscule pieces, pushed them to the edge of the plate and eaten three of them. She says she had a big lunch at school. Since the start of the school year she has given up bread, then desserts, then cheese, each time with a good reason. She gets up at six to go running, wears baggy jumpers even when the weather is mild, and is cold all the time. The day you dared to say that she had lost weight, she slammed her bedroom door.

You wonder what you missed, whether it is your fault, whether you should insist or let things be, and who you can talk to without betraying her trust.

Three things, straight away.

You are not the cause of your child's anorexia. The Academy for Eating Disorders, an international scientific society that brings together specialists in eating disorders, has taken an unambiguous position: current knowledge refutes the idea that the family is the main cause, and the society condemns any discourse that holds parents responsible. Anorexia arises from the combination of many factors, including a substantial hereditary component. Feeling guilty is human; but guilt will teach you nothing useful, and it will wear you out.

For now, you are the most powerful resource in the treatment. In adolescents, the treatment with the strongest evidence relies on the parents. With the help of a therapist and under a doctor's supervision, it is the parents who temporarily take charge of meals, because the illness has taken away their child's ability to feed themselves. This guide describes in detail how this works.

Do not wait for your child to agree. Anorexia prevents people from seeing that they are ill: your child may tell you, quite sincerely, that everything is fine. Yet the earlier treatment begins, the better the chances of recovery. Making an appointment with the doctor this week is not a betrayal: it is the first act of care.

2. Anorexia nervosa, in plain words

What it is

Anorexia nervosa is a mental illness. The person eats considerably less than their body needs, until their weight is too low for their age, their height and their growth. They have an intense fear of gaining weight, or they keep up behaviours that prevent them from regaining weight. Weight and shape take up a disproportionate place in the way they judge themselves, and they do not grasp how serious their condition is. This summary puts into everyday language the criteria that doctors use. The word "anorexia" means "loss of appetite", which is misleading: the hunger is there, often intense, but it is being fought.

In adolescents, weight can be misleading

An adolescent is supposed to be growing and putting on weight. In a young person, the illness can therefore show itself as a weight that stalls, a height that stops increasing or a puberty that comes to a halt, without any dramatic weight loss. That is why doctors look at the growth charts in the child's health record rather than at a single figure. On these charts, each child usually follows a "channel", a band within which they progress from year to year. In France, the Haute Autorité de santé, the public authority that publishes care guidelines, asks for these charts to be followed in all children, and for anorexia to be considered from the age of eight when the curve leaves its channel downwards or when growth slows down.

A form that is often missed: atypical anorexia

Some adolescents have the full picture of the illness, medical complications included, but a weight that stays within the average range, because they started out from a high weight. This is called atypical anorexia. They are often congratulated on losing weight, and the illness goes unnoticed. In an Australian study of adolescents seen in a specialist service, a slowed heart, a fall in blood pressure or a racing pulse on standing up, and suicidal thoughts were not markedly less frequent in them than in very thin adolescents. A normal weight is therefore no reassurance when the weight loss has been large.

What it is not

It is not a diet that went wrong through a lack of willpower, nor a whim, nor a way of provoking you. Nobody chooses to be cold, hungry and afraid at every meal.

Nor is it avoidant/restrictive food intake disorder, in which a child eats very little or is very selective because they are afraid of choking or vomiting, because certain textures disgust them or because eating does not interest them, without any concern about their weight. The treatment is not quite the same, and it is for the doctor to tell the two apart.

Who it affects, and where it comes from

Anorexia most often begins in adolescence and mainly affects girls, but it also occurs in boys, in whom people think of it less often, and in younger children. It has no single cause. Twin studies show that a substantial part of the risk, of the order of half, is hereditary, and a large genetic study published in 2019, involving almost seventeen thousand people with the illness, showed that the genetic factors in anorexia overlap both with those of other mental disorders and with those of metabolism, that is, the way the body uses energy. On top of this ground come triggers: a diet, stress, a remark about the body, an illness that caused weight loss, a sport in which thinness matters. Many of the young people affected already had an anxious and perfectionist temperament before the illness.

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