The Simpson Prize 2025 | Highly Commended - Emma Bryant
Bodies. Weâre obsessed with them. From an evolutionary perspective, it makes sense â our body is our armour, our vessel, the means through which we experience our self and our world. Post industrial revolution, our bodies have been quantified, objectified, and commodified. We are plucked, preened, injected, and sold, and we are made aware from a very young age that fatness is the same as badness, that our weight will be our end or our beginning. These days, disordered eating is hoi polloi; it feels an anomaly not to have some kind of antagonistic relationship with food.
It is easy, then, to think of anorexia nervosa - the only observable symptom is an extreme drive for thinness - as a downstream effect of this ideal: a manifestation of our contemporary obsession with size - and for at least four decades, thatâs exactly what weâve thought. But what if this framing is wrong?
"I lost everything about myself that made me human: my sense of purpose, my ambition, my ability to connect with people on any kind of meaningful level, my sense of self - and perhaps most profoundly - my ability to feel joy. Yes, I numbed my fear and my anxiety and my pain, but I also numbed my motivation, my pleasure, my sense of surprise and my laughter; my feeling of place in the world and my ability to sit with myself - to be bored, angry, determined, hopeful."
Dr Emma Bryant
Self-starvation long preceded modern body ideals: reports of prolonged inedia stretch as far back as the Middle Ages to the âstarving saintsâ and medieval mystics like Catherine of Siena, who starved herself to death aged 33 in pursuit of holiness. From an emaciated Pythagoras intent on âobserving the heavensâ; to the Victorian Fasting girls, the Suffragettes and Mahatma Gandhi, from Byron and fellow âstarving artistsâ to the hunger strikes of displaced peoples interred in decrepit detention conditions around the world, with fasting playing a key role in almost every major religion from Yom Kippur to Ramadan to Lent â we see our hunger as weapon, our lack as a tool. Across historical and cultural epochs, refusal to eat has rarely been about body or weight manipulation. It is a form of meaning-making. A mode of communication. A manifestation of control, protest, devotion, or transcendence.
In 2025, despite widespread body-image-based prevention campaigns, theoretical models centred on weight preoccupation, and public movements championing body positivity, eating disorders continue to rise. Anorexia maintains the highest mortality rate of the mental disorders and only 30 percent of people have recovered after ten years. This crisis reflects not only systemic underfunding (eating disorders receive $2 in research funding per affected individual compared to $176 for schizophrenia), but also a deeper epistemic inertia within psychological science - a reluctance to question the foundational assumptions of its own taxonomy.
Anorexia remains tethered to a diagnostic system built largely on clinical observation and theoretical constructs that have remained stubbornly unchanged since the 1990s.
What if anorexia actually has very little to do with body and weight? Historically, psychiatric diagnoses have emerged from a top-down process - derived from cliniciansâ observations, codified by committees, and reinforced by institutional power. As the only medical speciality without measurable biomarkers, psychiatry relies almost entirely on self-reported internal states that are inherently complex, often heterogeneous and deeply subjective. This has led to a therapeutic guessing game, where presumed core features of psychopathology - often abstracted from a narrow clinical vantage - serve as the basis for treatment - treatments which, in anorexia, arenât working.
To have lived this, is to feel it deeply. I first wrote about my experience with longstanding anorexia in The Lancet Psychiatry in 2021. At various points in my almost two-decade-long journey I had severe restrictive anorexia, binged and purged so much I was leaching white blood cells, been actively suicidal, mildly anhedonic (the inability to feel enjoyment or pleasure from activities that would typically be pleasurable) and everything in between. I was hospitalised more than twenty times.
I lost everything about myself that made me human: my sense of purpose, my ambition, my ability to connect with people on any kind of meaningful level, my sense of self - and perhaps most profoundly - my ability to feel joy. Yes, I numbed my fear and my anxiety and my pain, but I also numbed my motivation, my pleasure, my sense of surprise and my laughter; my feeling of place in the world and my ability to sit with myself - to be bored, angry, determined, hopeful.
I didnât want to be thin - I wanted to break myself down into infinitesimal pieces, to erase myself from the equation entirely. And eventually, I simply couldnât stop. Never once did it feel like the narrative I was sold by the system that treated me, truly fitted.
At Charles Perkins Centreâs InsideOut Institute, my work aims to address this gap. We recently undertook a study that seeks to illuminate what has long felt impenetrable - to get to the very guts of anorexia and its core psychopathology, in an effort to re-direct our treatments. Through a blend of grounded theory and network analysis, we explored a new theoretical model bringing lived experience to the forefront of scientific understanding: instead of studying those who live it from a distance, we invited them in - right into the heart of the process.
Our study was conducted in two phases. First, we teamed up with people who really know anorexia - those whoâve lived it, treated it, and studied it. Together, we co-designed a 286-item survey spanning 28 key constructs exploring the inner experience of the illness: thoughts, emotions, behaviours, and the underlying psychological patterns that shape them. Then we took it global. Nearly 1,300 people from 35 countries took part. Using advanced network modelling, we mapped how symptoms and experiences connectâspotting patterns, clusters, and potential core features that might drive or sustain the illness over time.
To our knowledge, this is the first attempt to theorise psychological illness with those affected not merely as subjects of research, but as co-authors in its direction. And so far, it seems to be working. Preliminary results suggest that the prevailing body-focused paradigm within which we measure and understand anorexia may be insufficient. For the first time, weâre seeing patterns that elude conventional metrics - rooted instead in constructs of self, emotion regulation, psychic scaffolding, and addiction.
Far from being the most âcentralâ feature of anorexia, overvaluation of weight and shape emerged as significantly less important than other factors (including defectiveness, anxiety and hunger euphoria)âand did not significantly differ between individuals with and without anorexia. Instead, what emerges are themes of fragmentation, where a profound disruption or even absence of self appears to underlie the illness. In anorexia, the very structures of self that hold us togetherâidentity, continuity, agencyâare gradually eroded, for many people on a background of trauma or disrupted attachment.
But even in shared experiences, people differ. Our data showed no singular path into the illness: for some it appeared to be adaptive, for others, accidental. It was deeply enmeshed in relational, developmental, and neurobiological processes; often addictive in form, producing a powerful numbing response that reinforced the restrictive behaviour. It is clear that anorexia is a supremely complex disorder that resists reduction to any singular framework - be it psychological, physiological, or otherwise. It seems time, then, for a different kind of response - nuanced, personalised, and grounded in complex systems thinking, drawing from neurobiology, metabolomics, physiology, and philosophy.
This reflects a broader momentum in the psychological sciences towards personalised approaches that rethink who defines whatâs real, what matters, and how to intervene. Our study offers such a blueprintâthrough collaboration, innovation, and a willingness to challenge entrenched assumptions we may create conceptual frameworks that are not only more effective, but also more humane.
If we are to meaningfully engage with psychiatryâs deadliest disorder, we must look beyond the body and ask what it means to be unwell in a culture obsessed with legibility and optimisation yet hostile to suffering and incoherence. Our results show that anorexia cannot be reduced to a physical state or even a drive for thinness - instead, it is a disorder of being, a crisis of embodiment. Its logic is not irrational but existentially coherent: a way to exist when the self feels diffuse or unreal.
For me personally, this work is not only about advancing knowledge; it is about reforming systems that once left me feeling invisible - systems that paradoxically reinforced oppressive, body-focused structures, so that even as I got better, I felt I had failed: by allowing myself to be hungry, to surpass the BMI threshold that had once validated my suffering.
In The Farther Reaches of Human Nature (The Viking Press, 1971), Abraham Maslow suggests understanding does not always arise from distance or detachment, but from immersion, from proximity to the experience itself. Just as those who have navigated altered states of mind can become the most sensitive interpreters of their depths, so too can those of us who have lived anorexia begin to illuminate it differently.
Through co-design and shared experience, we are beginning to unpick and reweave the narratives that have long defined this condition. It is a careful revolution - less about certainty than about listening: as much about connection as it is about solutions.
My own journey can be summarised thus: it didnât go as planned. And thatâs okay. I now find myself in the privileged position of working alongside others who have known this terrain. Together, we aim to reshape how anorexia is seen, felt, and ultimately, understood.
