# Life Beyond Anorexia Nervosa

December 5, 2023  • Feature Story • 75th Anniversary

*This story is part of a special**75th Anniversary**series featuring the experiences of people living with mental illnesses. The opinions of the interviewees are their own and do not reflect the opinions of NIMH, NIH, HHS, or the federal government. This content may not be reused without permission. Please see**NIMH’s copyright policy**for more information.*

***Note:** This feature article contains information and depiction of eating disorders and warnings related to disordered weight and body thoughts. If you or someone you know has a mental illness, is struggling emotionally, or has concerns about their mental health,**there are ways to get help**. If you are in crisis, call or text **988** to connect with the**988 Suicide & Crisis Lifeline****.*

By age 10, it was clear that Kristina Saffran would have a bright future. She was intelligent, outgoing, and active in soccer. Then, a routine conversation derailed her life.

Saffran’s babysitter was going on a diet. Already athletic, Saffran didn’t want to change her looks; she was just a child who admired the older girl and followed suit.

Within a couple of months, she lost a significant amount of weight. Her parents brought her to a doctor, and her diagnosis was immediate: anorexia nervosa.

“Anorexia nervosa is a serious and potentially life-threatening illness that involves a complex range of biological, psychological, and social factors,” explained Mark Chavez, Ph.D., Program Chief of the National Institute of Mental Health’s (NIMH) Eating Disorders Research Program. “Anorexia nervosa is characterized by severely restricted food intake, severe weight loss (or lack of appropriate weight gain in growing children), intense fear of getting fat even if underweight, and often a distorted body image.”

Working with several medical providers over a year, Saffran got better. By middle school, she had returned to her usual activities. And for a moment in her childhood, her eating disorder became an afterthought.

Some people think eating disorders are a lifestyle choice, but in truth, eating disorders are serious and fatal illnesses, according to NIMH. And, as many people with these illnesses come to learn, relapse is common.

For Saffran, her second episode of anorexia nervosa would have devastating consequences.

## A shell of herself

Aware of her risk for an eating disorder, Saffran started to diet again at age 13. This time would be different, she thought. *It was only a few pounds*.

Except it wasn’t. This bout of anorexia nervosa proved more intense, and once Saffran started dieting, she couldn’t stop. As with all eating disorders, the toll wasn’t just physical.

“I have distinct memories of walking through school and it being hard to walk; breathing was hard, just going through any of the motions was so hard,” she said. “I knew at a certain point, ‘I can't do this anymore. I need to eat and gain weight.’ And yet the mental anguish was so incredibly strong that I couldn't bring myself to do it.”

This time, doctors admitted Saffran to a hospital. When treatment failed, they sent her to another. And another. In all, Saffran spent 7 months in four different hospitals, missing her entire freshman year of high school. As Saffran continued to backslide, the physical and emotional toll became too much for the 13-year-old.

“I became a shell of myself,” she said.

## Treatment that works

Having made eating disorders research his life’s work, Dr. Chavez knows the difference quality treatment can make in a person’s life. Unfortunately, for many people, access to good treatment is limited.

That was the case for Saffran’s parents, who wanted their daughter to remain at home. Combing through the literature, they stumbled across a form of therapy known as family-based treatment.

Family-based treatment aims to “allow patients to recover in their day-to-day environment with their support system around them, rather than separating them from their parents by sending them to an inpatient or residential treatment program,” according to the journal, *Adolescent Health, Medicine and Therapeutics***.

For Saffran, the new treatment was very hard and uncomfortable work for her and her family, but it also afforded her the ability to be in school and make friends, ultimately building a life worth living.

“It was a very, very hard year, but undoubtedly a good thing that they got me better,” she said.

By the end of her sophomore year, Saffran recovered.

“When I reached a place where I could eat freely and think about things other than food and weight and how it relates to my body, I wanted to shout it from the rooftops.”

In a way, she did. The events of those years compelled her to dive into learning everything she could about eating disorders. In investigating eating disorders, Saffran discovered what Dr. Chavez already knew: There’s a stark lack of access to good treatment. This inspired Saffran to devote her life to bettering outcomes for people with eating disorders.

While family-based treatment worked best for Saffran, there are several effective ways to treat eating disorders. Individual, group, or family psychotherapy; medical care and monitoring; nutritional counseling; and medications also can be beneficial, according to NIMH.

Dr. Chavez noted that anorexia nervosa is associated with a high mortality rate. In light of this, over the last few decades, NIMH has funded research that has furthered the understanding, treatment, and prevention of eating disorders.

“We have supported work in the basic sciences, genetics, clinical neuroscience, treatment development, prevention, and services research,” he said, noting a recent milestone of “NIMH-supported work in the area of human genetics, which clearly shows a genetic/biological contribution to anorexia nervosa.”

The good news is there’s hope.

“With proper treatment, many people with anorexia nervosa go on to make a full recovery and reach a place where food no longer rules their lives,” Dr. Chavez said.

## Using success to help others

Saffran, now 31, earned a degree in psychology and co-founded a company that provides virtual evidence-based treatment for eating disorders. She also co-founded a nonprofit that connects people with eating disorders to recovery resources.

A role model who draws on her own experiences to help others, Saffran was recently featured in the book, *You Are Not Alone*, by Ken Duckworth, M.D., Chief Medical Officer of the National Alliance on Mental Illness.

Reflecting on her experience, Saffran offered advice for anyone with an eating disorder.

“Get help. You don't have to do this alone,” she said. “Recovery is hard, and it is dirty, but it is absolutely possible—absolutely worth it, and nobody I've ever met has regretted going on the recovery journey.”

***To learn more and spread awareness about eating disorders, visit the******NIMH Eating Disorders health topic page******and******Digital Shareables on Eating Disorders page******. For the latest NIMH research in this area, check out******NIMH’s Science News About Eating Disorders******.***