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Anorexia Nervosa – Eating Disorder

What is anorexia?

It’s a serious eating disorder during which a person (usually a teenage girl) becomes so obsessed with her weight and shape that she starves herself down to nothing.

Specifically, Anorexia is characterized by a loss of 15-25 per cent of usual body weight, an unnatural fear of becoming fat, a distorted perception of body image and an absence of a menstrual cycle. This extreme weight loss leads directly to malnutrition and failing health.

Like bulimia, binge-eating and other eating disorders, anorexia is fundamentally a psychological condition. Weight loss is a symptom not the cause.

The anorexia sufferer

No matter how thin she gets, the anorexic sufferer (anorectic) continues to believe that she’s too fat. In fact, her whole attitude becomes a process of denial. She denies herself food, she denies she has a problem, she denies she’s emaciated and, above all, she denies help.

Anorexia is not about being slim

It’s far more complex than that. It’s mainly about gaining control. Sufferers feel they lack control over their lives and seek to reassert it by focusing on their weight. It may seem crazy to outsiders, but to the anorexic it makes perfect sense. To her, every pound lost is a victory in her battle for control and every pound regained is a defeat.

The causes of anorexia

The exact cause of anorexia nervosa is unknown. It Anorexia can also be the delayed result of unresolved conflicts or painful experiences from childhood.

Who is likely to develop anorexia?

Anyone. However, the majority of people with anorexia are white girls from middle/upper income families, aged 12 to 18 years. Typically, they are intelligent, sensitive, well-behaved individuals but with a low self esteem. What causes them to develop anorexia? No one knows for sure. It may be a traumatic event, a failed relationship, or a build-up of things. Perhaps they are not doing well at school. Or maybe they did well at school but are now very unsure about their career or college situation.

Anorectics yearn for control

Responding to perceived stress, most anorectics start dieting to lose a few pounds. They begin to focus on their body as if to say . I might not be able to control other things in my life, but I can control my weight. Doing this makes them feel in charge. They begin to feel in control again.

Unfortunately, the dieting usually gets out of control and a few pounds leads to 20, 30, 40 pounds or more. When friends and family express concern about the anorectic’s reduced weight and shape, their concern is viewed by the anorectic as a threat to her weight control. Despite being extremely thin and underweight, she maintains a self-perception of being fat. This leads her to try to lose even more weight in an effort to retain control.

Purging, use of laxatives

As an anorectic’s weight drops to below 100 pounds, the body slows down. Breathing, pulse and blood pressure rates drop, and thyroid function slows, causing weight loss to slow down or stop, even though very little food is being consumed. This frustrates the anorectic who quickly learns other behaviors to rid themselves of weight, like: extreme exercise routines; vomiting; laxatives abuse and other behaviors to help purge their system of calories.

Medical problems associated with anorexia

In patients with anorexia, starvation can damage vital organs such as the brain and heart. Menstrual periods stop (a condition called amenorrhea), skin, nails and hair become dry and the skin becomes covered with soft hair as a natural defense mechanism against extreme weight loss. Excessive thirst and urination are also common. Dehydration contributes to constipation, and reduced body fat leads to lowered body temperature and the inability to withstand cold. The anorectic becomes vulnerable to illness. The National Institute of Mental Health estimates that 1 in 10 cases of anorexia ends in death from starvation, suicide or medical complications like heart attacks or kidney failure.

Scientists have found that many patients with anorexia also suffer from other psychiatric conditions. Most anorectics suffer from clinical depression, while others suffer from anxiety or personality disorders, and in consequence may have suicidal tendencies. Obsessive-compulsive disorder (OCD), a condition typified by compulsive, repetitive behavior, can also accompany anorexia.

Warning signs of anorexia

If you think that your loved one might be in danger from anorexia, here are some warning signs to watch out for.

  • Is she losing a lot of weight? Has she fallen 7 pounds below the normal weight range for someone of her height?
  • Is she becoming an obsessive calorie-counter? Does she eat only very low-calorie foods, like salad and fruit?
  • Is she becoming secretive or evasive about her eating habits? Does she eat out of sight or in private?
  • Has she started to become obsessive about exercise, or any other daily routine (e.g. homework)?
  • Is she suffering unusually from infections, constipation, dizzy spells, insomnia, or does she complain of the cold?

If she has started to develop these behavior patterns, you should definitely speak to your doctor and the sooner, the better. However, don’t expect your loved one to thank you for intervening. Most anorectics deny they have any sort of problem, let alone anorexia.

When speaking to a loved one whom you think is becoming anorexic, don’t tell them they’re looking thin..
Instead, tell them they look unhealthy and offer to go with them to see their doctor.

What is the treatment for anorexia

Anorexia is a mental problem that causes irrational / unnatural eating patterns. Treatment for this eating disorder should include both a mental health professional as well as a primary health care physician.

Clinical treatment may include ongoing medical care, regular therapy, nutritional counseling, and possibly medication. Eating disorders can be treated with anti-depressants, however, this is less effective for anorexia nervosa.

Co-occurring psychological treatment is also essential to help identify the important issues, and replace the anorectic’s destructive thoughts and behaviors with more positive ones. Support groups are also invaluable in treating anorexia. Patients may meet weekly to discuss their fears and help each other recover. Most cases of anorexia can be treated successfully, but not instantly. For many patients, treatments may need to be long-term.

How family and friends can help

The most important thing that family/ friends can offer a person with anorexia is unconditional love.
To put it another way, they should love the individual without supporting their actions.

But under no circumstances try to ‘treat’ the anorexia sufferer yourself. It is essential to seek professional medical help at the earliest possible opportunity.

Having spoken at length with several anorexia patients, the best advice I can offer in dealing with an individual anorectic is as follows: (1) Don’t lecture her, it makes things worse! Instead, listen to her. (2) Try to be patient! Remember, she doesn’t see things like you do. (3) No matter how provocative her behavior, try to be there for her. Easier said than done, I know, but it’s the only way to bridge her sense of isolation. (4) If she puts on weight, don’t mention her improved appearance. Mention something else, like her improved confidence.

Anorexia and guilt

Many parents of anorectics feel guilty that their child has developed this condition. They feel responsible. If this sounds like you, let me emphasize that anorexia could happen to any daughter, my own included. There are no firm causes and no simple solutions. If you need help, don’t delay. See your doctor.

In the mid-nineteenth century successful Western businessmen and politicians “tummy bulged.” Their relative obesity in societies in which the scourge of potential famine had only relatively recently been overcome was a sign of their high status and social success. Eating disorders were relatively rare then. They have now become much more common and are quite possibly increasing in the developed countries where there is relatively ample food. Only in countries where there is ample food can there be a cultural fashion for thinness.

Almost all women everywhere are concerned with being attractive within the terms of their cultures and in Western cultures now almost all women are self-conscious about their weight. Most believe themselves to be overweight and the diet industry is enormous.A survey of 5,000 women in the UK by Real magazine published in November 2002 has some rather depressing statistics. 91% of women were unhappy with their hips and thighs and 60% were depressed by their body image. 84% of those who were normal weight wished they were lighter. Only 3% of women were happy with their bodies. However, anorexia nervosa is a serious mental health disorder which is characterised by an exaggerated preoccupation with the appearance of the body. It can be considered a disorder of beauty in that the sufferer believes, despite all evidence to the contrary, that he or she is too fat and therefore unattractive. The anorexic wishes to be thinner. The disorder is typically characterised by a refusal to attain or maintain a normal body weight (body weight of less than 85% of the norm). There is a terror of becoming fat or gaining weight. In girls and women menstruation is not attained at an appropriate age or ceases (amenorrhoea). It has one of the highest mortality rates of all mental disorders with a long term mortality of over 10%.

The first medical case history was published in 1689 by Richard Morton. It was named in the 1868 by Sir William Gull and the name means “nervous loss of appetite” but actually loss of appetite is rare. It has more to do with control of appetite and therefore with self-control. The anorexic is preoccupied with their appearance and body image. While there are male anorexics, and the incidence of male anorexics may be increasing, most anorexics are female. She will wear baggy clothes to both hide fat, and in a curious paradox, hide the signs of emaciation from others and to stay warm. She might spend a lot of time in front of a mirror inspecting the different parts of her body particularly those which have some significance for female reproduction, sexuality, and the nurturing of children-the breasts, the hips, the thighs, the stomach and the buttocks.

Venus of Willendorf

In our ancestral past the food supply would not have been constant-there were no 24 hour supermarkets or Internet food delivery services to the door. Our ancestors were hunter-gatherers for hundreds of thousands of years and our bodies evolved in adaptation to that lifestyle and those environmental conditions in which the availability of food varied. Primitive agriculture only began about 10,000 years ago and that is a small fraction (.16%-not even one per cent-check our maths! 10,000 is only 1% of 1,000,000) of the 6,000,000 years that humans have been evolving. Anatomically modern human bodies have only been around for about 150,000 years (about 2.5% of the time). Bodies which could not cope with periods of relative scarcity and abundance did not survive to pass on their genes. It would have been adaptive in days gone by to binge eat when food was available and for as much of that food as possible to have been stored in the body.

Especially those foods which were sweet, fat, or salty tasting. Women, in particular, need to have bodies which are capable of storing up food reserves as fat in order to be able to feed their children. It would also have been adaptive to develop mechanisms to be able to control the body in the absence of food and to control the appetite. In anorexia some of these evolved mechanisms have clearly gone awry. The photo is of the Venus of Willendorf, a prehistoric ‘Venus’ about 30,000 years old. The exact meanings of this and the many other ‘Venus’ figurines of prehistoric Europe has been a matter of considerable debate among archaeologists but, if it represents some kind of feminine ideal of prehistoric European hunter-gatherer societies, it is a vastly different feminine ideal than that of today’s world.

Anyone involved in treating anorexics soon becomes aware of the contradiction of potentially beautiful young girls, who while denying their actual beauty, pursue an ideal of beauty and often end up emaciated and extremely unattractive. In cultures in which food is scarce then obesity symbolizes high social rank and access to resources. When food is readily available and anyone can be fat, then to be thin can symbolize high social status. It signifies self-control. These days even 6-9 year olds in western cultures are concerned about their weight and shape. Immigrants to western societies do not themselves develop eating disorders but their daughters do. There is no single cause of anorexia but rather it is caused by a combination of factors including genetic, biological, family, individual and social/cultural. Evidence for the social/cultural causation can be seen in that here are relatively few anorexics in a culture in which most people do not get enough to eat.

Karen Carpenter

In 1983 the singer Karen Carpenter died at age of 32 from anorexia nervosa. This brought eating disorders to America’s attention. In 1987 the average model weighed 23 percent less than the average American woman and by the 1990s five million American women were suffering from eating disorders.

The fashion industry doesn’t cause eating disorders in young women. Glamorous images of thin models reflect something else which is going on. All of us have genes which seek to reproduce themselves-it is built into our psychologies. Status means access to resources like food and mating opportunities. There is an inherent psychological preference for status because, in our ancestral past, higher status meant better chances of survival as it usually meant greater access to resources and greater comforts. This, of course, is still true today in many parts of the world. In the Western world where there is a surplus of food to aspire to be thin is associated with aspiring to higher status. The tragic paradox is that the aspiration to be thin, when over exaggerated as in anorexia, carries with it a significant risk of other health problems or, in extreme cases, mortality.

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