Treating Anorexia

«We see so many parents who shy away from confrontation because their children refuse to cooperate. And then suddenly fifteen kilos are missing, and no one knows where they went.»

Erziehungskunst | What exactly is anorexia?

Schößler | Anorexia always involves an excessive and anxious preoccupation with food, one’s own body, body shape, and physical appearance—to such an extent that it tends to overshadow everything else. During puberty, so much is happening to the body anyway—the exterior often changes faster than the interior can keep up—and this can lead to feeling overwhelmed. The key factor is a lack of stability. Often, this way of thinking is linked to a desire to control or change something in life. And at some point, it replaces everything that’s actually important: friendships, joy, and connections with family. Ultimately, all of this leads to loneliness and a narrowing of one’s world. Clinically, anorexia is always characterized by a triad: being underweight, a narrowing of thought, and the loss of vital functions—in the narrower sense, the menstrual cycle, but in reality, one could say: the loss of natural vitality and one’s rhythm of life.

EK | How does this happen? Are there any typical triggers?

Schößler | The reasons are always complex. There’s never just one reason; it’s always a combination of factors. Developmental crises are often part of it: the fear of leaving the family home, a move, or a change in peer group.
Then there’s bullying and emotional wounds or trauma. Though I’m cautious about using the word trauma, since it’s used so loosely these days. We prefer to speak of emotional wounds and developmental deficits that make a person vulnerable. And then even a minor incident can be the trigger. Sometimes it’s thoughtless words from parents or doctors. It’s actually not that uncommon for a pediatrician to blurt out a sentence that then acts like a switch.

Kraus | Or purely physical things: braces that make it hard to eat properly. An illness that causes vomiting. Suddenly, you experience your own body as something that isn’t working, that doesn’t fit you. That can be a wake-up call for the illness.

Schößler | But what’s always in the background is usually a long history. These young people have often shown extreme over-conformity—to real or even just imagined expectations. They put themselves under intense pressure to perform. As children, they often didn’t stand up for themselves much. And refusing to eat can then also be understood as a form of resistance: against a trajectory that hasn’t been going well for quite some time. Like an inner voice saying, «I can’t grow up like this.» Of course, this isn’t a conscious thought, but there’s some truth to it.

EK | That sounds as if you treat the young people with a sense of respect.

Schößler | Absolutely. We assume that we’re dealing with a person with a healthy core who is trying to fulfill their potential through the opportunities available to them. Every symptom has a reason for being there. It must remain until it is understood and replaced by something better. We work very hard to figure out: Who is actually there? Who is behind it? What is trying to come out?

EK | What about social media? Does that play a role?

Schößler | An enormous one. Young people are strongly tied to current trends that sometimes go completely over our heads as adults. The fitness craze, veganism, orthorexia—that urge to eat only healthy foods. Under hashtags like «Thinspiration» or «Bonespiration,» anorexia and eating disorders are glorified online. These trends wield enormous power. We work through these issues with the young people and are repeatedly shocked by how deeply they’re already caught up in them.

Kraus | And the algorithms certainly don't make things any better. Once you start engaging with them, you're shown more and more of the same content. Groups form, dangerous dynamics develop, and as a parent or even as hospital staff, you sometimes don't even notice it. It all happens behind the scenes, and that's really dangerous.

EK | How can parents or teachers notice that a child is slipping into an eating disorder?

Kraus | If a child withdraws, no longer wants to sit at the dinner table, or claims to have already eaten—if this happens once in a while, it’s normal. But if it becomes a frequent occurrence, especially when combined with weight loss or a noticeable increase in physical activity, then you should be on the lookout. There are certain sports that simply lend themselves to this: Here, we see a disproportionately high number of young ballerinas or cheerleaders. Sometimes a sudden passion for cooking is also a sign: the girls cook for the whole family but don’t eat themselves. Or they insist on preparing all their own meals, leaving their parents with no insight into what they’re eating. And if you watch them while they eat: they eat slowly, picking at their food, shuffling it back and forth with their utensils, but hardly anything actually makes it into their mouths.

Schößler | But parents shouldn’t start staring at their children’s plates now. That quickly leads to a cycle of worry, control, and conflict. It can even result in a secondary benefit from the illness. This way, the children suddenly get a lot of attention. It’s better to go to the pediatrician or family doctor and say: I think this is a psychological issue, but I want a physical checkup. Have them weighed at the doctor’s office—don’t pull out the bathroom scale at home. Otherwise, it becomes part of the problem.

EK | Why is early action so crucial?

Schößler | Because anorexia is one of the most dangerous mental illnesses in this age group. It has a higher mortality rate than many other conditions, such as leukemia. And it causes long-term damage to the bones, the brain, and fertility—effects that are still visible in women twenty years later. There’s a huge difference between recognizing and treating it in the first year—and letting it go undetected or untreated for two or three years. The earlier it’s caught, the better the chances of recovery. That’s why I strongly urge this: if you suspect something, it’s better to see a doctor once too often than once too little.

Kraus | And seeing a pediatrician is a low-barrier first step—much more readily available than psychotherapy, for which you often have to wait months for an appointment. In addition, outpatient psychotherapy and perhaps parenting counseling should be added as soon as possible. Because in these conflicts, parents often instinctively do things that don’t really help. Not out of malice—they simply have no idea, and that’s perfectly normal. It’s something you have to learn first.

EK | Tell us about your treatment approach. What happens when a teenage girl is admitted to your ward?

Kraus | First, we have an initial meeting. We get to know each other and see if what the family is looking for matches what we offer. If so, we usually admit them relatively quickly. On the ward, the daily routine is highly structured. We start the day together; there are set mealtimes and set bedtimes, and on weekends, they might be allowed to sleep in a little longer. This structured routine is good for the young people—they know what’s happening and when, so they don’t feel so adrift.

Schößler | Mealtimes are supervised by nursing staff, therapists, and doctors. It is the patients’ responsibility to eat, but we are there with them and reflect back to them what they are doing. Many of them have a misconception: they think they’re the ones in control. But in reality, the illness is controlling them. We take charge of the external framework to some extent and show them: Look, in this or that area, you’re no longer in control of yourself. This allows them to come to terms with it and, step by step, regain a sense of genuine personal responsibility.

EK | And what makes your anthroposophical approach so special?

Schößler | Two things. First, the therapeutic gesture: We truly focus on the body. In psychosomatics, this happens surprisingly rarely, even though it’s right there in the name. But we have a trained eye for body temperature, movement patterns, and digestive function. Our nursing care supports this with wraps, rhythmic rubdowns, and massages—so that the body’s experience is truly addressed with seriousness. After all, recovery also takes place in the body. Second, artistic therapy has been central to our work since the clinic’s founding. Painting, music, theater, and rhythmics. These aren’t just nice extras; they’re a core component. Here, the young people rediscover themselves in a new way and form friendships with one another in a way that is truly supportive. Of course, conventional elements are also part of our program today: qualified individual therapy, group therapy, psychological assessment, and social skills groups. These are simply indispensable now. But we integrate these into our fundamental anthroposophical concept, rather than adding them as separate modules, as other facilities do. And we have a school for students with health challenges staffed by excellent special education teachers who address academic difficulties and help students stay on track. During rounds, representatives from every discipline truly come together—democratically, on an equal footing. Every aspect of life is discussed.

EK | How long does treatment take?

Schößler | Realistically, at least three months. When the young people come to us, they’re in such poor physical condition—they’re lacking everything. They can barely digest their food. Three months is a realistic estimate. After all, we don’t want to treat anyone long-term; we want to help these young people get back on their feet.

EK | How many and which patients do you treat?

Kraus | We have ten slots for treatment, which are used primarily by young women. Male patients account for well under ten percent.

Schößler | Another thing that has changed: The classic image of the ambitious, highly gifted, idealistic anorexic—the one who wants to save the world and, in the process, forgets to eat and gets straight A’s in everything else—is virtually nonexistent anymore. Today, we see far more cases of depression, teenagers who feel they have no support in their families, and who are driven by anxiety and a lack of purpose in life. Damage caused by neglect is more common than specific experiences of violence. And neurodivergent conditions such as autism are on the rise—people with autism often have distinctive eating patterns and are predisposed to being underweight.

EK | The clinic is located in the middle of a nature reserve. Do the surroundings play a role?

Kraus | Absolutely. We try to leave the ward once or twice a month—as long as it’s physically possible. A museum, mini-golf, a trip to the woods. It sounds trivial, but many of our patients have completely lost interest in everything. It’s always just about food—when, what, how much. Everything else is completely blocked out. During a visit to a museum, a teenager might suddenly realize: Wait a minute, I used to be really interested in art. And that interest comes back to life. Or something completely new emerges.

Schößler | We have a vegetarian, organic kitchen that’s really good. We live in a unique architectural setting where people have thought carefully about what we actually want here. That might sound like just superficialities, but it has a profound impact. I used to work in large psychiatric hospitals, and I only came back here because I thought: Something this beautiful shouldn’t just disappear. It has to do with the team’s experience, with the surroundings, and with what has grown here. I haven’t been able to recreate that anywhere else.

EK | If you could give parents one piece of advice—what would it be?

Schößler | Have the courage to set the record straight. We see so many parents who shy away from confrontation because their children refuse to cooperate. And then suddenly fifteen kilos are missing, and no one knows where they went. Shame always plays a role—on both sides. This leads to cover-ups, lies, and social toxicity for the whole family. Approaching the situation with loving objectivity—that’s the key. See a doctor. Have them weighed. Get support. It could be a phase, a lifestyle issue, or heartbreak. But it could just as easily be a serious, life-altering illness. You should leave it to those with experience to figure that out.

Kraus | And: Trust your gut. If something seems off to you, it usually is. It’s better to ask one too many questions than one too few.

EK | Thank you very much for the interview!

The interview was conducted by Angelika Lonnemann.