he girl in the coffee shop having ‘lunch’ with her friends orders only a glass of water. Her elbows are painfully large compared with her bone-thin arms. Her eyes are shadowed, her hair dull. She says she is not hungry. She is starving.

Anorexia Nervosa is a psychological disease that causes a patient to restrict food drastically or not to eat food at all. It is carelessly called a ‘slimmer’s disease’. Actually, it is self-imposed starvation to lose weight. Classic anorexics believe they are heading towards the mythical perfect body as demanded by society, and they believe that by controlling their bodies they are controlling their lives.

Anorexics may display abnormal neatness and control about themselves and their environment, and are perfectionists in every project. Their realities tend to be in extremes. Something is either fabulously good or disgusting, beautiful or ugly, fat or thin. Anorexics, and sometimes their families, may deny any problem and resent offers of help.

Classic anorexics often feel that what they think, say and do has little or no impact on other people. Control over their bodies substitutes for control over other parts of their lives. Potential anorexics and bulimics tend to be the ‘good children’ who please their parents, who presume this means there is nothing wrong with their children. Anorexics are often passive, agreeable children who do not express their own wants and needs and who can eventually rebel by not eating, creating the first major power struggle in the relationship.

Symptoms can include overexercise, vomiting, laxative abuse, diuretics, appetite suppressants, deceitful behaviour to avoid eating (‘I ate before’, ‘I’ve had lunch’, ‘I’m not hungry’), a relentless pursuit of thinness, covering up the body with baggy clothes, a failure to register what the body really looks like (saying ‘I’m fat’ when skeletal), an obsession with food, shape, size in oneself and others. Anorexics often memorise calorie charts, read nutritional books, shop for food and plan elaborate meals they do not eat.

Physical consequences can include loss of periods, weakness, osteoporosis or bone damage, hair loss, pigment changes, skeletal appearance, stunted growth, about a trillion vitamin and mineral deficiencies, starvation, hallucinations and ultimately, for some, death.

Doctors advise that the best way to help or cure anorexia is to get early recognition and diagnosis of the problem and early intervention. People who have the onset later in life often have a better chance of recovery. Support from friends or family is another crucial factor. A person who has displayed anorexic behaviour for 20 years has less chance of recovery.