'Why I won't eat': patient testimony from 15 anorexics concerning the causes of their disorder.

The following article describes the reasons given by 15 anorexic patients for their illness. The patients were asked the following question in an open-ended interview-'What would you say were the causes of your illness?' In reply detailed complex narratives were gathered from which a number of themes could be identified. These included unhappiness, control, being in a downward spiral, obsession and perfectionism. Most patients, for example explained that they were unhappy. To address their unhappiness, they adopted a strategy of control over food. Being able to exert this control gave patients a sense of enjoyment and pride and enabled them to address their underlying fear that a loss of control may be just around the corner. This pride persuaded patients to restrict further their food in the hope they would experience even greater enjoyment. Patients were thus caught in a dangerous 'spiral' of restriction, weight loss, euphoria and further food refusal. This spiralling behaviour resulted in many patients describing their illness as an obsession. Several patients equated this obsessional behaviour with a perfectionist trait in their personalities. In the following article, these themes of unhappiness, control, spiral, obsession and perfectionism, are presented, along with the patient testimony on which each theme was based.