One of the lesser known symptoms of early onset anorexia nervosa is “self abnegation” or even “self punishment.” Although these symptoms can be seen in older patients (adolescents) too, our experience has shown it to be most common in the younger patients. And most heartbreaking too.

What does it look like? Well, let me tell you, it is torture, both for the child as well as for the parents. It looks like this:

The 12 year old boy of very engaged and devoted parents who calls himself “stupid” despite his excellent school work, and who claims no one likes him and he doesn’t blame them.

The 10 year old girl who will not watch movies but who, in fact, sits with her back to the screen whenever her family tries to relax and enjoy one. When asked why, she replies that she doesn’t want “fun,” because she “doesn’t deserve it.”

The 12 year old girl who refuses to wear anything new and huddles in the same old, unwashed, limp jacket and run-down shoes. She doesn’t want her parents to spend money on her.

The 13 year old who won’t open her birthday presents at all.

The 12 year old who refuses to let her parents buy her a much needed new computer because, again, she “doesn’t deserve it.”

The 13 year old who, in her meltdowns of self hatred, bites herself all over her arms.

The ten year old girl who hits herself repeatedly in the face or bangs her head against the wall because she is “worthless” and “fat” and “stupid” and “everyone hates her because they should.”

Why do I recite this list of miseries? Because when a family experiences these upsetting symptoms they commonly believe their children are exhibiting something rare. Sometimes it just helps that this disturbing behavior is not unheard of, and that other children have exhibited these behaviors and gone onto to achieve good remission.

Take home message: don’t lose hope. Observe, console, hug and never lose hope.