Anorexia nervosa

Restriction driven by a distorted sense of one's own body. The mental illness with the highest death rate.

What it is

Anorexia nervosa has the highest mortality of any psychiatric condition. Around a fifth of those deaths are by suicide, and the rest are physical.

It involves restricting energy intake, an intense fear of weight gain, and a disturbance in how body weight or shape is experienced. Control is usually closer to the heart of it than appearance.

The starvation itself changes the brain, narrowing thinking, increasing rigidity and reducing insight. That is why reasoning with somebody who is severely underweight rarely works, and why physical restoration has to come alongside psychological treatment rather than after it.

It affects people of all genders, all body sizes and all ages, including a growing number of people over 40.

Signs you might notice

Restriction, rules, rituals, and a growing list of forbidden foods.

Excessive exercise, often driven and joyless.

Wearing layers, feeling cold, dizziness, fainting.

Periods stopping. Hair thinning on the head and fine downy hair on the body.

Slow pulse and low blood pressure, which are signs of a body conserving energy and are dangerous, not reassuring.

Withdrawal, irritability and a preoccupation with cooking for others.

How it can affect day-to-day life

Physical risk is not proportionate to how the person looks. Rapid weight loss is more dangerous than a stable low weight, and someone in a larger body can be medically compromised while being congratulated on losing weight.

The MEED guidance (Medical Emergencies in Eating Disorders) replaced the older MARSIPAN framework precisely because BMI was being used as a gate and people were being turned away while acutely unwell.

Refeeding syndrome is a real risk when nutrition restarts, and it needs medical supervision.

Supporting someone well

Get help early and be persistent. If you are told the person is not unwell enough, ask for that decision in writing and cite MEED.

Do not comment on appearance in any direction.

Eat together, calmly, without negotiating at the table. Agree the plan away from mealtimes.

Expect the illness to argue. Separate the person from it: "that's anorexia talking" is a useful and kind distinction.

For a young person, family-based treatment has the best evidence, and it puts parents in charge of refeeding rather than sidelining them.

Watch for physical emergency: fainting, chest pain, very slow pulse, confusion, or an inability to rise from squatting.

Where to get help

A GP can refer to a community eating disorder service. Under-19s should be seen quickly under NHS access standards.

Beat's helpline: 0808 801 0677.

Collapse, chest pain, confusion or a pulse under 40 needs emergency assessment. Say the words eating disorder at triage.