By Dr Siham Ahmed Sa’ed, Medical Doctor, Somaliland

It has been a while since I have spoken openly and deeply about eating disorders. Perhaps because, after years of living with it, there is still a certain discomfort attached to the topic; a quiet irritation, a lingering ache, and a deep sense of being triggered by what it represents. Yet today, I choose to speak about it again.

This time, I am speaking not only as someone who has struggled with an eating disorder, but also as a certified medical doctor. Between those two identities lies a long journey of learning, healing, self-discovery, and understanding the profound impact eating disorders have on the human being as a whole.

One of the most important things I want to emphasize is this:
Eating disorders are not simply about food, weight, or body image. They are far deeper than that.

As someone whose eating disorder began around the age of eleven, I did not grow up immersed in obvious diet culture, pressure to be thin, or conversations centered around appearance. The development of my disorder was subtle, natural, and largely unnoticed. Looking back, I can see that it never truly started with food. It started much earlier.

For as long as I can remember, I lived in a constant state of hypervigilance. My nervous system was always scanning for danger. My body existed in fear, urgency, and survival mode. I never learned what genuine safety felt like. And when a child grows up without an internal sense of safety, the psyche searches for ways to cope.
For many people, that coping mechanism becomes food.

Food restriction, emotional eating, purging behaviors, and other disordered patterns often emerge as attempts to create a sense of control when life feels overwhelmingly uncontrollable.

This is where many eating disorders truly begin.

Of course, there are genetic and epigenetic vulnerabilities involved. Not everyone exposed to similar circumstances develops an eating disorder. But understanding these early foundations is crucial because eating disorders are rarely about food itself.

At their core, they are often built upon three deeply interconnected themes:
Control.
Identity.
Attachment.

When the external world feels unpredictable, the body becomes the one thing that appears manageable. When identity feels fragile, disordered eating behaviors can create an illusion of certainty and stability. And beneath much of it lies an attachment wound; a self that learned very early that having needs, expressing emotions, or depending on others was somehow unsafe.

The restriction is not about appearance. It is about survival. It is the mind and body attempting to manage an internal experience that feels unbearable, using the only strategies they know. Understanding this changes everything about how treatment should be approached.

Eating disorders are among the deadliest psychiatric illnesses, not only because of their psychological consequences but also because of their devastating physical effects.

They carry an immense burden of depression, anxiety, obsessive thinking, impaired cognition, emotional suffering, and social isolation. At the same time, prolonged malnutrition affects virtually every organ system in the body. The longer the illness persists, the more difficult it becomes to tolerate the realities of nutritional rehabilitation, weight restoration, and recovery itself.

The illness gradually convinces the individual to fear the very things that could help them heal.

As someone living in Africa, in a setting where mental health conditions remain deeply misunderstood, stigmatized, and under-resourced, I have witnessed another painful reality.

Despite the growing global influence of social media, diet culture, and appearance-based pressures, awareness and expertise surrounding eating disorders remain alarmingly limited.

In my own experience, there was not a single healthcare professional around me with sufficient knowledge or training to recognize and properly approach an eating disorder. Ironically, I became the person who had to study, understand, and eventually identify what was happening to me. It was only much later, when a physician from outside the country evaluated me, that my condition was formally recognized and diagnosed.

Because of this, the shame, secrecy, isolation, lack of acknowledgment, and absence of support from family, community, and healthcare systems often become heavier burdens than the disorder itself.

And perhaps one of the greatest lessons this journey has taught me is the necessity of a truly holistic approach to healing.

Human beings cannot be separated into isolated parts.

We are mind, body, heart, and soul.

To heal, we must address all of them.

The body requires nourishment through wholesome food, water, movement, rest, sunlight, and oxygen.
The mind requires clarity, understanding, emotional processing, self-awareness, and the ability to make sense of life’s experiences.

The heart requires safety, love, compassion, belonging, meaningful relationships, and genuine human connection.
And the soul requires something equally essential: a connection with God.

For me, that spiritual dimension has been indispensable. Healing is not simply the absence of symptoms. It is the restoration of balance within the whole human being.

Perhaps this is why I find myself increasingly drawn toward psychiatry. And now heading down that path to my specialty in this field.

Not merely as a specialty, but as a calling.

Because behind every diagnosis is a story.

Behind every symptom is a human being.

And behind every struggle is a person trying to survive with the tools they have.

My hope is that through this path, I can contribute to greater awareness, compassion, and understanding within my community so that future generations do not have to navigate these battles alone, unseen, or misunderstood.

On this World Eating Disorders Action Day, may we move beyond simplistic conversations about food and weight, and instead recognize the deeper wounds, unmet needs, and hidden suffering that often lie beneath them.

And may we create communities where healing is met not with judgment, but with knowledge, compassion, dignity, and hope.