"You're robbing yourself of the best years." A young man and his battle with anorexia

In Germany, around 800,000 people live with oneeating disorder, a psychosomatic illness that has many facets. The fact that many men also suffer from this is often still a taboo and is rarely discussed.Esquire followed a young man in his everyday life as he battled anorexia.With his personal story he wants to encourage others to seek help. Because this disease brings everyone to their knees - including men.

It is a sunny Wednesday morning when we arrive in Rosenheim. Past a green strip and up a few steps, we are greeted by two men in a bright entrance area. One introduces himself as Tom, the other as Max. Tom is over 1.80 meters tall, wears jeans, a gray hoodie and sneakers. He's 23 years old and actually looks like most boys in their early 20s. But he's not like most boys in their early 20s. Because Tom is sick. He has anorexia nervosa, also called anorexia. Max, who is standing next to him, is called Max Penzkofer and is his therapist. The entrance area belongs to the Schön Klinik Roseneck, a specialist clinic for psychosomatic illnesses, where Tom has been treated for anorexia for two and a half months. Today Tom takes us into his everyday hospital life.

The clinic in Rosenheim is one of the most renowned for eating disorders. Getting a place here is correspondingly difficult. “I applied to several clinics where I had to expect a waiting time of twelve weeks, and here it was even eight to nine months. However, when I registered I was able to indicate whether I could arrive spontaneously. I did that. It was a Monday afternoon when I got the call asking if I could be here at nine o'clock the next morning. “I packed my things and my mother drove me to the clinic,” Tom begins his story. The medical director of the Schön Klinik Roseneck in Rosenheim and Prien and chief physician for psychosomatics and psychotherapy, Prof. Dr. Voderholzer knows the problem of therapy places: “It is not easy to get a place in a clinic, especially for eating disorders. For inpatient therapy places, it can take a few months because there are not many clinics that offer specialized eating disorder therapy. And it depends very much on the seasons. Many people drag themselves through the semester and want to come during the semester break. That’s why waiting times are longer in summer than in autumn and winter.”

Since that call, Tom is now living in the clinic. It is less common for men to develop an eating disorder than for women, but it does happen. “The ratio of men and women with anorexia nervosa is 1 to 8, in the clinic it is 1 to 15, probably because men seek treatment much less often. “The disease is still perceived by society as one that only affects women,” explains Prof. Dr. Voderholzer. “It is generally a phenomenon with mental illnesses that women seek help more often,” he adds. But what exactly is anorexia? “In anorexia nervosa, as anorexia is called, those affected eat too little and sometimes vomit food. This is related to the fear of gaining weight. Some also have binge eating beforehand, as in bulimia. What is crucial for the diagnosis of anorexia nervosa is that the weight loss is self-induced. It is also accompanied by body schema disorder, the distorted perception of one's own body. Those affected cannot see how thin they are or what their body really looks like. This often makes treatment so difficult because they do not realize that they have the disease,” explains Prof. Dr. Voderholzer. And the disease can have serious consequences: “If someone is underweight for years, the disease becomes chronic. The bones become more brittle and bone density decreases. It is then almost comparable to that of old people. This can even lead to osteopenia or osteoporosis. Then at some point it is irreversible. Long-term consequences also exist for fertility in women. Anorexia nervosa is one of the mental illnesses with the highest mortality,” said the medical director.

The average age at onset of anorexia is between 13 and 17 years, as is the case with Tom: “I would describe my childhood as very carefree and happy. But my youth was marked by the eating disorder. I lost a lot of weight very quickly, which also had an impact on my health. I was about 15 then. I hardly ate anything. I felt really, really bad. My mother already had a suspicion, but wanted to rule out other illnesses and took me to the doctor. They did several tests to see if there was anything else wrong, but I was soon diagnosed with anorexia. And then I went to outpatient therapy. But I didn't want to believe it and just didn't see it. At a certain point, even the therapy no longer helped,” says Tom, describing the initial phase. “Outpatient therapy for eating disorders is very often not specific and intensive enough. A lot of people with an eating disorder benefit from specialized inpatient therapy,” says Prof. Dr. Voderholzer. “My whole life, my everyday life, everything revolved around the eating disorder. Spontaneously doing something with people, partying or going out to eat wasn't possible. I had to know days in advance if I was going to a restaurant so I would eat even less before and that day. I worked full time and really enjoyed my job, but at a certain point my performance decreased significantly. A few months before the clinic I had started a new job, but because I was no longer productive and couldn't concentrate at all due to anorexia, I didn't pass the probationary period and was fired. At that point I was no longer resilient and became very socially isolated,” says Tom, describing the last time before the clinic. “The illness was triggered by my desire for perfection. I put a lot of pressure on myself at school because my performance wasn't that good anymore. And then I slipped into this whirlwind of thoughts: I can't do anything, I can't control anything, but I have to be able to control something, and I started to control my body. “This led to a strong desire for perfectionism: everything had to be perfect at work, and hobbies also had to be carried out perfectly,” says Tom.

Such effects are observed by Prof. Dr. Voderholzer often applies to those affected: “There are many causes for an eating disorder. Depression and trauma can partly contribute to this; this sometimes occurs in women who are affected by sexual violence and who starve themselves down in order to appear unattractive to men. Then genetics also play a role. But socialization, such as how parents model nutrition and body ideals, also has an influence. But if there is something that is really characteristic of the disease, it is a pervasive feeling of one's own inadequacy, as well as performance orientation and perfectionism. At least 70 to 80 percent of the sufferers we treat are compulsive perfectionists. They often study excessively, want to do everything, but are also anxious. It's much more about gaining control. Control in an uncertain situation. Life is structured and controlled through eating behavior, which was often seen during the pandemic when people were so unsettled. Many people slipped into an eating disorder.”

At the Schön Klinik Roseneck in Haus Rosenheim, 48 patients are currently being treated as inpatients with a form of eating disorder - and they are all undergoing holistic therapy. “On the one hand, it’s about gaining weight and learning normal eating habits. On the other hand, it's about the underlying emotional issues and conflicts that are being worked through. And that in the form of individual and group psychotherapy, movement and design therapy or the teaching kitchen. It all has something to do with self-care. One doesn't work without the other. Some patients only want one thing: to work through trauma, but not to eat. But it doesn’t work like that,” describes Prof. Dr. Voderholzer the therapeutic approach. “On the weekends, the patients also have free time and can go on trips to Munich, Rosenheim or Lake Chiemsee, and they can go out to eat. Nobody is locked up here and the treatment is voluntary,” he emphasizes. Tom's first stop for today is the therapy kitchen, which is run by ecotrophologist Julia Hinz. Every two weeks, eight patients diagnosed with an eating disorder choose dishes from a menu, which are then prepared, cooked and eaten together. “The teaching kitchen therapy program is a very strenuous therapy module because the patients are confronted with food. It's about daring to tackle bans, getting back to normality and seeing what's possible. There are very different hurdles, there are also different types of eating disorders,” explains Julia Hinz. Because all patients diagnosed with an eating disorder come together in the teaching kitchen, regardless of what type they are affected by. “Basically, therapy for patients with eating disorders is about separating eating from feelings. Food must be seen again as something that you don't have to earn or treat yourself to, but rather as part of your everyday routine, as part of your survival."

Today Tom is cooking an omelette with vegetables – and a good portion of oil. Previously this would have been unthinkable. “Especially at the beginning of the therapy kitchen I was scared. Before my hospital stay, I was incredibly strict about my diet. Anorexia is a very bad critic in the head that constantly says that you can't eat. So I banned myself from almost everything: sugar, fat, foods with a high calorie density. I ate almost exclusively light products. In the morning there was a bit of low-fat quark with fruit, at lunchtime maybe a sandwich, then in the evening there was chicken, some rice and vegetables. And after eating I always had a guilty conscience,” remembers Tom. But it wasn't just the relationship with food that was problematic: “It was only in the clinic that I really learned what a normal portion was for me. At home I haven't even eaten half the normal amount.” And Tom is making good progress. “I think shopping could be a big challenge when I'm back home, but I'm also looking forward to cooking again or going out to eat with my friends.” They can come visit him in the clinic and Tom can Sometimes you can go home for a weekend if you don't have therapy, "but of course that's not the same," he says.

His friends and family always support him during his illness: “I hid my anorexia for a long time and didn't tell anyone about it. You start lying and making excuses. It took about a year and a half before I told those closest to me about it; my family found out about it earlier through my parents. And nine months ago I started to deal with it more openly. Also because I couldn't hide it anymore. “It was then clear that I was going to the clinic,” he says. “Of course it was a difficult situation for everyone at first. But I was always supported, and the older we got, the better everyone was able to deal with it. There were never any stupid comments and you should avoid that,” he appeals. Dealing with outsiders is important. Prof. Dr. Voderholzer advises: “What you should never do is look away. This happens quite often with eating disorders, even though the illness is visible. It can happen that you get an aggressive reaction from those affected. But what's even worse is doing nothing. When it comes to mental illnesses, we often experience that the environment looks the other way. What is also not helpful is advice like: 'Pull yourself together' or 'Eat more.' It's about taking the illness seriously and offering help." That's what Tom would also like: "We have to address eating disorders. Not only among women, but also among men, it is still ignored. Eating disorders must be accepted like other illnesses. Like a broken leg, you get help.”

Once a week, Tom has a 50-minute individual therapy session with his therapist Max Penzkofer. It is cognitive behavioral therapy that focuses on one's own self-image. “It is challenging because you go into depth using mindfulness exercises, role plays and conversations. That opened my eyes. “A plan is also made on how to deal with the eating disorder at home,” says Tom, describing the sessions. Next to Tom is a big ball that is part of the therapy, as Max Penzkofer explains to us: “The eating disorder often enables those affected to suppress emotions. The goal of therapy is to deal with the past and emotions and why you needed the eating disorder to suppress them. You learn to accept yourself. This can happen, for example, in a playful way using the ball and the water polo metaphor.” Opposite the ball, there is a body-sized mirror leaning against a wall, which is also part of the therapy. “The mirror addresses body image – and that is a vulnerable topic. It's gotten better since I've been here, but it's still tough. Seeing myself and how skinny I really am. That's why anything with nudity, like swimming, is still a problem for me. Sexuality certainly cannot arise. In front of the mirror you become even more aware of your own body and I feel ashamed of myself,” says Tom. The body is a central issue when it comes to eating disorders: “I already had an ideal body image of myself, not a pumped-up bundle of muscles, more of a fit and healthy body,” he says. “Social media has also played its part. In the past I would have denied the question of whether Instagram and the like fueled my eating disorder, but today I see it differently. “Especially light products and diets that are constantly being advertised there really triggered me.”

Prof. Dr. also sees the danger of eating disorders caused by social media. Voderholzer: “There is a connection between people who are frequently on social media and those who therefore have a higher risk of developing an eating disorder. The reason for this is that comparing yourself to ideals of beauty and other people is very present and can reduce self-esteem. Diets are sold that pose a risk of developing an eating disorder. We try to teach those affected not to constantly compare themselves with others only to find that they are inadequate. They should learn to reflect on their strengths and themselves and accept themselves as they are. It's about the questions: Who am I and how can I find my place in society without having to compare myself? I don't want to demonize social media, but there are negative sides. One of the therapy goals is often to delete certain accounts. Pro-ana forums are particularly harmful, where anorexia is glorified and an emaciated body is the ideal of life,” warns Prof. Dr. Voderholzer. These forums are available on the Internet and on WhatsApp. Eating disorders are glorified there, those affected encourage each other to slide further into the illness, to eat even less and to exercise even more.

Because exercise is fundamentally important, patients in the clinic have the opportunity to do sports: dancing, climbing, mindfulness exercises, ergometers. “With eating disorders, there is often an enormous urge to exercise and even an addiction to sports. But not just to burn calories, but also in response to negative feelings. And from a biological component. It is assumed that if you are severely underweight, the urge to move arises because food-seeking behavior was important for survival in development; the metabolism of the satiety hormone leptin seems to play a role here," explains Prof. Dr. Voderholzer. “The very worst thing I saw was a woman who had a hip fracture. But because the urge to move was so strong, she ran through Prien with crutches. That must have been hellish pain.” Prien is the clinic location on Lake Chiemsee, 20 kilometers away: “This is where those affected lie who, with a BMI of less than 13 kg/m², end up in a physically dangerous condition. The ward is called a “complex ward” and those affected can receive even better medical monitoring and support there,” he says. At some point, physical exertion was no longer possible for Tom due to his illness: “I always enjoyed doing sports, up to three times a week, going to the gym, but especially skiing, climbing or hiking. But shortly before the clinic, sports were no longer possible. I didn’t have the strength for it.”

Another module is creative therapy. Jasmine Follert is a design therapist at the clinic and once a week, patients can let their feelings through art flow with her for 100 minutes. “Creative therapy supports your own emotional exploration, expressing inner images and topics for which you sometimes cannot find words. Or for which you have learned not to find words because they are taboo topics. There should be access to emotions again,” she explains. “The therapy takes place in a group of eight patients. At the beginning there is a quick discussion about how the patients feel and what impulses they bring with them to the therapy, then you can choose an art form such as painting, Clay work or crafts.” Today Tom decides on paint and paper: “Opening up is very difficult at the beginning, but you quickly get used to it because you are often in groups and you just have to talk.” – “You are but also someone who listens well to themselves can,” says Jasmine Follert to Tom. He goes wild with colors, especially magenta and yellow. “Is there an association with the colors?” Jasmine Follert wants to know from Tom. “The magenta is bright, with yellow in the mix it gives me hope, a good feeling,” answers Tom. “Design therapy helps me to better deal with my perfectionism, that not everything has to be perfect, that you can paint outside the box. This is not about rules,” he emphasizes.

When it comes to anorexia, it is often said that the disease is incurable, Prof. Dr. Voderholzer corrects: “A cure is possible. Healing also means that you can deal with the illness well. Even though many people after recovery are not able to deal with food and eating situations as easily as people who have never had an eating disorder." Tom is optimistic: "I don't think I'll ever get rid of anorexia completely, but the main thing I'm learning here is how to deal with it to live, to deal with the feeling and the emotions in order to counteract the idea of ​​not acting with the eating disorder again, but to choose a better path - for my health. I was able to work extremely hard on myself here. I haven't been as far as I am today in the last eight years." But Tom is also realistic: "Of course I have a healthy respect for slipping back into the eating disorder and not being able to implement what I've learned." Realistic because " “The relapse rate is around 30 percent,” adds Prof. Dr. Voderholzer.

Our day with Tom ends and while we drive again, he remains in the clinic. If everything goes well, Tom can go home in a month. If he could go back in time and appeal to his younger self, he would say, “Go to the clinic, get help. You're destroying yourself. And you're robbing yourself of the best years." Now Tom looks ahead: "I've met great people here with whom I want to keep in touch. But I'm also looking forward to home, to my family and friends. And on schnitzel. And pistachio ice cream.”