When the body becomes a page on which to write suffering, and a place where we can no longer stay, it stops being home. It is there that, when it becomes foreign and enemy, the attack begins: we do not eat, we starve ourselves or we bloat beyond measure.
This is the observation that guides Laura Dalla Ragione‘s work. Hence the intial questions she asks each patient. The first, disarming in its simplicity: how much do you think about food and weight? The second, more revealing: do you remember what your life was like before the disorder?
Laura Dalla Ragione is a psychiatrist, founder of a network of specialized centers, contact person for the Umbria Region and the Ministry of Health on eating disorders, and professor at the Biomedical Campus in Rome. Her latest book, Attack on the Body, comes after Social Hunger – a title that plays on the homonymy between the English hunger and the Italian fame – where he had analyzed the link between social media, body image and nutrition. Two books that form a diptych: first the cultural diagnosis, then the x-ray of the body as a battlefield.
She has worked in psychiatry for 30 years, which gives her a perspective that few have: she watches disorders change over time, adapt, take on new forms.“Eating disorders transform every five or six years. They adapt to the era in which they are expressed.”
The numbers we can no longer ignore
Before we talk about trends and new forms, there are the numbers. In the 1970s, there were about 300,000 people with eating disorders in Italy. In the late 1990s, the epidemic exploded. Today there are an estimated 3 million-probably more, because the figure covers only those who have come to the attention of the health care system. The undeclared, Dalla Ragione says, is never counted. And then there is the mortality figure: in 2025, 3,500 people died in Italy from eating disorder-related diagnoses.
Yet 99 percent of those deaths, the psychiatrist says, involve people who never made it to treatment: either because they had refused it or because they lived in regions without adequate facilities. “Eating disorders are very treatable conditions. I have treated thousands of people who are leading normal lives today.” Getting to treatment is the first step. There is a toll-free number: 800 180 969, SOS Eating Disorders.
Who gets sick today
Until not too many years ago, the profile of the patient was fairly defined: adolescent, female, between 12 and 25 years old. That profile no longer exists today.“The range has widened enormously,” Dalla Ragione explains. “We treat 8-, 9-, 10-year-olds, as well as people in their 40s, 50s, 60s who are getting sick for the first time.” And then there are the males, who were almost absent from the clinic until a decade ago. Today they make up 20 percent of patients. Among those under 13 they rise to 30 percent.
Anorexia nervosa affects 30% of patients today. The majority, however, present different pictures: binge eating disorder, bulimia nervosa, selective eating disorder, orthorexia, bigorexia.“There is no longer a sketch. Weight is not always the indicator of the problem.”
The new forms: from ARFID to orthorexia
Among the fastest growing disorders are selective feeding disorders, particularlyARFID. “It used to belong almost exclusively to children. Today we also diagnose it in adolescents and young adults.” These are people who eat very few things, with a very limited food repertoire.
But ARFID is neither whim nor defect in education. It is set in a cultural context in which selectivity has become almost a shared norm: Della Ragione paraphrases Feuerbach:“We are what we (do not) eat. What we exclude defines our identity.”
Orthorexia has a different nature: it is an obsession with healthy eating, a form of food hypochondria in which the fear of food grows.“The search for the right food becomes exhausting.” It starts from a legitimate need, but can become an obsession that takes away joy and isolates socially. It predominantly affects males in their 30s and 40s.
The role of social media: neither guilty nor innocent
The question Dalla Ragione hears most often – are social media responsible? – deserves a nuanced answer.“They are not the cause, but they have had a very strong impact,” because they act on two issues: food and body image. Together they produce dissatisfaction. The quantitative leap has occurred since 2020: the lockdown normalized unlimited use of platforms, and since then the impact has become “most powerful.”
The problem is not just the exposure time, but the absence of content regulation: anyone can provide nutrition advice without a title. Yet social can also be a support. “Today, no one would imagine doing prevention among adolescents with a brochure. Platforms have become a valuable tool of correct information, for those who know how to use them.”
The question is not to suppress the tool, but to govern it. Australia has introduced a limit on social access at age 16, and the early data, Dalla Ragione says, are encouraging. But that’s not enough:“We need to work on digital literacy and teach kids to recognize the emotional and cognitive effect these mediums have on them. Kids are digital natives: they know the device, but they don’t know the impact.”
The body as a page
In the psychiatrist’s new book, Attack on the Body, the focus broadens beyond eating disorders: self-harm, increased suicide, gender dysphoria. “The body is a minefield, a theater in which much suffering is concentrated.” The common root, he says, is a growing difficulty in constructing a solid identity.
“We wanted the happiest generation ever, we end up with the unhappiest generation ever. A certain value system has blown up, and the one that replaced it is much more fragile,” Dalla Ragione adds. Eating disorders interpret this discomfort because they anchor themselves in two central elements in our culture: the body and food. When what you don’t eat defines who you are, it is almost inevitable that that field becomes the place where malaise is expressed. It is no accident that these disorders have exploded in Western countries, and that they spread rapidly wherever cultural patterns change-in Eastern Europe after the fall of the Wall, in China, in Japan, even in Iran.
How to recognize the signs
Dalla Ragione lists the signs of this malaise with the precision of one who has observed them thousands of times. The first, often the most underestimated, is the change in character:“People who develop an eating disorder change their attitude. From sunny, open, sociable kids, they become sad, closed, suffering. This, together with repeated and very rigid eating behaviors, is a sign that something has cracked.”
Rigidity, in particular, is the most reliable tell-tale: when food is no longer part of life, but becomes its controller. Food, he reminds us, is by nature an endorphin producer — the gut is the body’s first organ in natural endorphin production, even before sex and physical activity. It is joy, conviviality, discovery.“When it becomes tiring, obsessive, when you are afraid to eat with others or to taste something new, that is the moment when something is broken.”
The good news-and Dalla Ragione says this as a period, not a consolation-is that you can be saved:“Getting help is the first step. No one recovers from an eating disorder alone, just as no one recovers from diabetes alone. But from these diseases, if treated, in 99 percent of cases they are cured.”
