When is Thin Too Thin?: Anorexia

What does anorexia mean?
Anorexia nervosa (also referred to simply as anorexia) is a condition characterized by significant weight loss due to a purposeful attempt to stop eating. While the word anorexia is Greek for "without hunger," it is a misnomer, for the person with anorexia is actually painfully hungry, despite her or his denial of food. She or he just won't admit the hunger. A formal diagnosis of anorexia is made when a person is:

• at least 15 percent below what would be considered a normal body weight (for their height and age),
• still dieting to lose more weight, and is unwilling or unable to stop doing so,
• when, if it is a female, she has stopped menstruating for three consecutive months,
• and when there is a distortion in how the individual perceives their shape and size, with an excessive investment of their self-esteem in this, and an intense fear of being "fat".

One does not have to meet these specific symptoms, to be considered to have an eating disorder and to need help. Many persons do not have the full-blown condition; rather they range in their symptoms of anorexia. Additionally, many individuals with anorexic symptoms also have symptoms of bulimia: weight loss can occur through food-deprivation and also through vomiting, taking laxatives, using diuretics or exercising excessively and rigorously.

Why deprive oneself of food?
Anorexia often begins with a diet or an intent to shape up physically. Nobody starts this with the intention of developing anorexia. However, for the person who becomes anorexic, the dieting and weight loss take on psychological functions that, although unanticipated and unplanned, are very powerful. As the individual begins to lose weight, for instance, she/he may enjoy having a new sense of control in a life in which she/he previously did not feel effective or strong at all. Oftentimes the person who becomes anorexic does not have a comfortable sense of her/his own abilities and is driven to keep proving or establishing her/his competence in a variety of things. Being able to say "no" to food, to hold forth over hunger, and being able to command one's body weight, all may shore up a person's self-esteem or sense of self if they are not very secure.

Other psychological dynamics
It often turns out that the person who develops anorexia or is at risk for developing it, lives with a great amount of secret emotional pain. Some of this may come from feelings and beliefs about being inadequate or incompetent, like those mentioned above. The person may struggle with very negative views of her/himself, even when others see them as almost perfect. Another common psychological aspect of anorexia is a belief that in order to be cared about, one must win the approval of others -- even if this means squelching one's own feelings or acting in ways that make one feel uncomfortable. To live by this set of beliefs is virtually annihilating to one's natural healthy self-hood. When a person turns to excessive weight-loss as a means of asserting something worthy of her/himself, ironically they are likewise doing something annihilating of their natural, healthy physical being.

It takes on a life of its own
Initially, through dieting and weight loss, the person who develops anorexia may feel powerful and full of good feelings about themselves. First off, they probably "look good" and probably get a great deal of positive reinforcement for this, given our culture's admiration of thinness and glamorizing of the very thin body shape. They've probably achieved the so-called "BC look". However, as the body enters a more and more food-deprived state, the mental effort needed to sustain continued dieting and weight loss drives the person into obsessional thinking and ritualistic means of controlling their food intake. The person becomes more self-absorbed, becomes more secretive and hidden from those they were close to, and less able to engage with a full range of their interests and activities. What compounds this of course is that meanwhile, the person's body is entering a state of malnourishment and is not getting what it needs to support normal mental and physical functioning.

Denial
The person with anorexia will strongly deny that anything is wrong. She or he will deny the fatigue and weakness they feel constantly, they will deny that they need more food than they are eating, and when confronted by concerned others, they will typically deny that there is a problem-or if there is a problem, that they need help for it. While this is terrible for those who care and want to intervene, the person in this kind of state is not just being stubborn-in their own way, they are holding on for dear life to the one thing they believe saves them from their worst fear, of being utterly terrible, insignificant, alone, or out of control.

The progression of anorexia
Anorexia, more than other eating disorders, can be fatal. Truly so. The more entrenched the behavior becomes, the more damage is done to a person's body. Much of this is reversible with treatment and with restoration of a healthy body weight and healthy nutrition. However, without these things, the person with anorexia may literally starve themselves to death. Other sections of this web-site suggest treatment resources, as well as ways for others to help a person with an eating disorder be open and able to receive help. At minimum, medical care (by a physician knowledgeable about the effects of eating disorders), and psychological or psychiatric care (also by a person experienced in the treatment of eating disorders) will be required. Change will not be easy, but it is possible, and its reward will be a finding and claiming of one's self and one's life.
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Adapted from: Siegel, M., Brisman, J., and Weinshel, M. (1997). "Surviving an Eating Disorder." Harper Perennial Publishers, NY, NY.