How anorexia keeps itself going
A maintenance-cycle explainer on how judging yourself by shape, weight and control, strict restriction, the effects of starvation, and body checking or avoidance feed each other, and how the cycle can be broken with your team. Simplified from Fairburn, Cooper and Shafran (2003): binge eating and the four additional processes are left out, and there is no diagram.
Written by Tarun Vermani, Trainee Clinical Psychologist Updated
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How anorexia keeps itself going
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The trap
If anorexia has stuck around, it is not because you are weak or difficult. Anorexia has a trap built into it: eating less can feel like success and control, while the effects of eating too little quietly make the problem stronger. This sheet shows how the parts link up, and how the cycle can be broken with your team.
The anorexia cycle
At the centre of the cycle is how you judge yourself. Feeling good about yourself comes to depend a great deal on your shape, your weight and being in control of eating.
That leads to strict restriction: rules about what, when and how much you eat, and for some people driven exercise or getting rid of food. Keeping to the rules can feel like an achievement, and breaking them can feel like failure, so the rules tend to get stricter over time.
Eating too little then changes your body and mind. Thoughts about food take up more of the day. Thinking can become more rigid, mood lower and sleep poorer. You may feel full after very little, which makes eating feel even harder. Many people pull away from friends and things they used to enjoy.
These changes feed the cycle. With less going on in your life, shape, weight and control fill even more of the space, and the pull to restrict grows stronger. Round it goes.
If you are making yourself sick, using laxatives or eating very little, tell your therapist and your GP. If you faint, have chest pain or a racing or uneven heartbeat, get urgent medical help.
Checking and avoiding your body
Many people with anorexia check their body often, for example in mirrors, by weighing or by comparing themselves with others. Others avoid seeing their body or knowing their weight at all. Both are understandable, and both tend to keep the worry going. Checking tends to make the worry bigger, and avoiding means the worry never gets tested. Your therapist can help you change both, including agreeing when and how you are weighed together, rather than on your own.
Which parts fit you?
Tick any part of the cycle you recognise, or none. There is no score.
How the cycle breaks
The cycle breaks by working on it with your team, step by step, and with your own reasons for change at the centre.
Regular eating and getting enough food come first. Regaining weight is a central part of recovery from anorexia, because many of the effects that keep the cycle going ease as your body recovers. It is done gradually, with your team, while they keep an eye on your physical health.
At the same time you work on the things that keep the cycle going: loosening food rules, cutting down on checking and avoiding, and building up other parts of your life, such as friends, interests and the things you value, so that shape, weight and control become one part of who you are rather than the whole of it. Your therapist can share a sheet on the stages of this treatment.
Your team will agree a plan with you for these changes.
Agree this plan with your treatment team. If you are underweight or have been eating very little, check that they are monitoring your physical health before you make big changes to how you eat. If you faint, have chest pain or a racing or uneven heartbeat, get urgent medical help.
Over to you
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When to use ‘How anorexia keeps itself going’
‘How anorexia keeps itself going’ is a psychoeducation handout based on cognitive behavioural therapy (CBT), most often used in CBT for eating disorders.
It is designed to be read within therapy rather than as a standalone self-help tool: a therapist introduces it and discusses it with the client. You can preview the full handout above, then assign it for clients to read between sessions on any device or download it as a print-ready PDF. Where a short reflection is included, it offers space to respond to the reading.
How it works
Most people work through it in around 8 minutes. It moves through six short sections to read:
- The trap: If anorexia has stuck around, it is not because you are weak or difficult. Anorexia has a trap built into it: eating less can feel like…
- The anorexia cycle: At the centre of the cycle is how you judge yourself. Feeling good about yourself comes to depend a great deal on your shape, your weight…
- Checking and avoiding your body: Many people with anorexia check their body often, for example in mirrors, by weighing or by comparing themselves with others. Others avoid…
- Which parts fit you? Tick any part of the cycle you recognise, or none. There is no score.
- How the cycle breaks: The cycle breaks by working on it with your team, step by step, and with your own reasons for change at the centre. Regular eating and…
- Over to you
The handout can be read on a phone, tablet or computer, or downloaded as a print-ready PDF. If it includes a reflection, answers entered on the Formulate platform are saved automatically and shared back with the therapist for review before the next session.
The CBT approach behind it
‘How anorexia keeps itself going’ introduces a CBT approach that involves mapping how the parts of a problem connect and keep it going (formulation). The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This handout is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: a transdiagnostic theory and treatment. Behaviour Research and Therapy, 41(5), 509-528. doi:10.1016/S0005-7967(02)00088-8
- Fairburn, C. G. (2008). Cognitive Behavior Therapy and Eating Disorders. Guilford Press.
- Murphy, R., Straebler, S., Cooper, Z., & Fairburn, C. G. (2010). Cognitive behavioral therapy for eating disorders. Psychiatric Clinics of North America, 33(3), 611-627. doi:10.1016/j.psc.2010.04.004
- National Institute for Health and Care Excellence (2017). Eating disorders: recognition and treatment (NG69, updated 2020). NICE.
- Keys, A., Brožek, J., Henschel, A., Mickelsen, O., & Taylor, H. L. (1950). The Biology of Human Starvation. University of Minnesota Press.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
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