1 Emma Louise Pudge Anorexia nervosa and survival: Exploring self-preservation through eating disordered practices Despite intensive research efforts, anorexia nervosa (AN) remains poorly understood. The clinical picture of AN consists of practices of food restriction and/or increased physical activity leading to physical degradation, co-occurring with significant psychological distress focusing on eating and embodiment. AN is divided into two subtypes: restricting type (ANR) and binge/purge type (ANBP), distinguished by the absence or presence of binge eating and purging alongside restrictive practices (APA, 2013). However, longitudinal research does not support the current subtyping system: Eddy et al. (2002) demonstrated that over an 8-year study period only 12% of women with AN never reported regular bingeing and purging, and 62% of women with ANR crossed over to ANBP prospectively. Whilst the prevalence and experiential significance of binge eating remains under-acknowledged (Eli, 2015), research on restrictive practices tends to overlook the paradoxical requirement that in order “to be anorexic, one must both eat and yet not eat” (Lavis, 2013, p. 3). Several studies have analyzed binge eating as physiologically and psychologically functional responses to hunger and negative affect within larger cycles of body weight regulation and emotional mediation (Waters et al., 2001; Davis & Jamieson, 2005). However, eating in AN does not occur exclusively in the context of binge eating. Eating, in its myriad yet typically restrictive and idiosyncratic forms, is necessary to maintain the modes of embodiment and selfhood produced with and through AN. In turn, life itself is sustained, albeit ambivalently, precariously and paradoxically. Hence, eating, as well as not-eating, is constitutive of and integral to AN, irrespective of sub-type (c.f. Lavis, 2015). By engaging with the multiplicity of embodied practices and sensations that shape the lives and experiences of individuals with AN, this paper asks what it means to ‘live’ with, within, through, or even for, AN. Exploring how individuals with AN may experience potentially fatal practices as paradoxically essential to life – even life-saving – requires that AN’s clinical realities are “acknowledged but ‘bracketed’ (see Biehl and Locke 2010: 318) in order that other narratives may also be heard” (Lavis, 2015, p. 2). AN commonly entails medical complications, psychiatric co- morbidity and psychosocial impairment (Klump et al., 2009). Currently, there are no effective psychopharmacological treatments (Preston, O’Neal & Talaga, 2013) and the evidence-base for psychotherapeutic interventions is limited and conflicted (Fairburn, 2005). There is a particular lack of consensus concerning the care of individuals who do not respond to initial interventions (Wonderlich et al., 2012). AN is frequently chronic and intractable: over 50% of people develop a severe and enduring form of illness (Treasure et al., 2015). Longitudinal research suggests the likelihood of recovery plateaus and fails to reach zero after 6 or 7 years of illness duration (Fichter et al., 2006; Wentz et al., 2009). The clinical literature on chronic AN broadly recommends clinicians do not pursue significant reduction of symptoms beyond what is necessary for medical stability and instead focus on improving the patient’s quality of life (Wonderlich et al., 2012). This cleaves a space between goals of preserving life and reducing symptoms into which particular forms of care can be fitted. Here, it is possible to explore how and why individuals with AN may consider eating disordered practices as modalities of self-care essential to their lived existence, and to recognize how these simultaneously overlap and contrast with clinical modes of caring. Clinical research on outcomes in AN frames chronicity and illness severity as risk factors or predictors of mortality (Fichter et al., 2006), proposing a teleological trajectory from present eating disorder towards death. Qualitative research on the ‘lived experience’ of AN complicates this picture, acknowledging biological realities whilst also bringing embodied, sensory, psychic and social experiences into view. Ethnographic research has been particularly useful in illuminating everyday lifeworlds of AN (Warin, 2009). These studies have highlighted the diversity of eating disordered practices (Eli, 2015; Lavis, 2016; 2017; Warin, 2009) and the out-of-the-ordinary meanings individuals attribute to mundane experiences of being anorexic (Gooldin, 2008). They have also mapped convoluted illness trajectories (Lavis, 2011); explored how individuals negotiate the physiological, psychological, existential and social challenges of sustaining life-threatening practices (Eli, 2017; Lavis, 2011; 2013; 2015; Malson & Ussher, 1997), and situated experiences of suffering with and as a result of AN within wider contexts of social suffering (Eli, 2017; Lester, 2016; Thompson, 1994). This paper draws specifically on ethnographic research by Anna Lavis (2013;