| Eating Disorders & Dieting - Anorexia |
WHAT IS ANOREXIA?
Anorexia is a conundrum, Its name means “appetite loss of nervous origins”. We must distinguish it as a condition from the loss of appetite that comes from overeating, from illness, from other emotional reasons such as fear and depression, and from damage to certain areas of the brain which we know are associated with eating. What is special about anorexia is that it is SPECIFICALLY associated with other feelings and behaviours related to the fear of “fatness”. These feelings include poor body image, phobic feelings about food in relation to its ability to create fatness, and an intense fear of being a normal body weight.
WHAT HAPPENS IN ANOREXIA?
The Start
Typically a young person, most usually female, feels overweight. This may be because she is overweight, has gained a little more weight than average at puberty, or has slim friends with whom she compares herself. There is always a decision to go on a diet or cut down, which may be triggered by a specific event such as an unguarded comment or contagion from a peer. The diet is most usually the first ever tried and it initially goes along quite easily, giving the young person a real sense of achievement at an otherwise insecure time of life. There may initially be approval from friends or members of the family which is a positive form of attention.
The anorexic never starts off intending to starve herself into emaciation. She just feels her life will be better if she lost a few pounds - which it is for a while. At some point in the diet there is a subtle psychological change - which is not experienced by normal dieters - and dieting actually becomes more intense as the diet progresses and the target weight - if it exists- is near.
The Switch
The dieting behaviour goes underground so that it can become a private, secret rather than a public activity and strategies are developed to convince “others” that eating is taking place when in fact it is not. This requires a great deal of subterfuge such as throwing food away, finding ways to secrete it off a plate at mealtimes, or pretending to have eaten elsewhere, even dirtying dishes deliberately before the rest of the family have eaten. Hence by the time that weight loss is a matter for concern in the family, the anorexia is already well entrenched. For this reason, awareness of the early signs of anorexia seen in context would help the dieter and her family to register changes which could indicate a serious potential problem ( see later).
In her own private eating world, the person developing anorexia will become very “ritualised” around food. This may take the form of eating fractions of portions of food at specific times of the day, - like one third of an apple - or eating the crusts around a sandwich but not any of the middle. She will toy with her food, cut it up into tiny pieces and eat them very slowly. The range of foods experienced as “safe” will become- for no logical reason, very limited until even water in some cases is seen as “bulking me out”. Many anorexics limit their fluid intake drastically, because liquid makes them feel fat - perhaps confining themselves to water or diet coke. Naturally, they are phobic about fat in food and ascribe magical properties to food which bear no relation to reality - i.e. that eating a pound of apples would make one gain seven pounds in weight. These magical feelings make it almost impossible to seduce the anorexia out of her illness by logical means.
One of the rituals usually developed in anorexia is self-weighing. Many anorexics weigh themselves several times each day, and ascribe the greatest meanings to the smallest fluctuations in weight. It is quite normal for anorexics in treatment to say that they have put on a lot of weight when in fact is .2 of one kilo in a week. An anorexic can panic if she shows a small change in weight after eating one lettuce.
The most significant feature of anorexia is denial. In denying the illness to others, the anorexic denies it to herself. So long as she is in control, nothing is wrong. The anorexia will do anything to avoid “treatment” which she is will view as a conspiracy to “make her fat.”
Later Stages
As the anorexia entrenches, it becomes a sort of freeze frame condition. Social interactions are usually non existent, usually because of fatigue, depression or fear of social food situations. All emotions are centered around food and weight. Physical development is suspended. The anorectic is in a no-win situation. No matter how thin she is it’s never enough, and if weight fails to be lost she feels as if she has gained.
PHYSICALLY EFFECTS OF ANOREXIA
The physical effects of anorexia are mostly connected with the effects of starvation on the body. There is lowered resistance to illness, physical weakness and sensitivity to heat and cold. Anorectics bruise easily and appear to need less sleep than normal eaters. As body weight falls to low levels the anorexic may be covered with a fine downy hair and in cases of prolonged starvation there is impoverished circulation leading to discoloured rough skin and possible ulceration of legs and feet.
Anorectics experience digestive problems as a result of starvation which compound their anxieties about eating. Digestion slows up so that there are real feelings of bloatedness after eating even small amounts, and constipation which make the abdomen feel dense and large. Poor digestion may lead to food intolerance creating swelling of the stomach, face or ankles.
Bone loss as a result of under nourishment can be extreme, and is can occur in the early stages of anorexia. There may be shrinkage of the reproductive organs in men and women, and destruction of areas of the brain which are responsible for endocrine production.
The human body is a resilient instrument and its powers of recovery even after prolonged periods of starving are remarkable, if specific measures are taken to promote a healthy lifestyle and to remedy bone loss.
Although each anorexic is a unique person with a unique lifestyle and history the emotional changes are predictable. Irrespective of the unique factors which precipitated each person’s illness, changes in brain chemistry which are a direct function of degree of weight loss will have predictable effects on emotional reason and emotional functioning.
As weight is lost, depression sets in and the desire for emotional participation is lost, emotional range reduces and there will be an increased intensity of negative affect such as guilt and anger and general obsessionality with reduced emotional resource to contain it.
TREATMENT AND OUTCOMES
Anorexia is dangerous and untreated, it can be fatal. About one fifth of persons with anorexia recover,
a further two fifths gain weight but develop other problems with eating such as bulimia nervosa or binge eating disorder. About one third of sufferers remain anorexic, living as if nothing but the pursuit of thinness is of importance. Many of these long term anorexics develop the bulimic form of anorexia. Here, control breaks down, and the anorexic will binge eat but adopt strategies such as vomiting or laxative abuse to deal with the unwanted calories. The bulimic form of anorexia is not the same as bulimia nervosa where sufferers do not have a phobic avoidance of normal body weight.
Death rates in long term anorexics is as high as ten percent, usually due to heart failure in the case of bulimic anorexia, suicide or lack of resistance to illness.
Emphasis in treatment must be on how to live rather than how to get “cured” because the only way an anorexic copes with feelings and risk is to starve. Learning to trust oneself and other people again, and learning to take responsibility for self care is crucial. This require the input of both medical and psychological help. There is no single formula which works for all cases.
Treatment is most likely to have a good outcome the earlier it is done and before too much weight has been lost. Weight held at a low level for a long time gives a poor prognosis for recovery. But getting anorexics to agree to help remains problematical. 95% of anorexics deny that they need help and refuse treatment when they are first brought to medical attention. But most of these who are obliged or forced to get help say in the end that they are glad that they did.
|
|
 |
| The Story of an Anorexic Girl |
| Hello, my name is Allison, I'm 15 years old. I'm the youngest of two children, my sister is bright and its hard to live up to her. I am close to my mother, she's a housewife, and my father is a businessman. They get along okay I think, they're not very demonstrative.
I've always done well at school; I suppose the teachers would call me an ideal pupil - not much trouble. I’m aiming for A's in my GCSE, because I'm expected to go to University. Everyone says it should be a doddle for me but I don’t have their confidence in myself. God, it would be terrible if I somehow failed!
It all really started when I was 13 and started putting on a bit of weight, it all didn't feel right. When the gym teacher remarked that I was looking a little podgy I thought right! that’s it! and decided to diet there and then. I cut down on the sweets and stopped eating breakfast. It was a great feeling when those first few pounds came off and soon I was throwing away my lunch as well, I wasn't really hungry.
I guess I was always rather shy and not as popular as I wanted to be, so it was nice when people began to notice that I had lost weight - "you look really good” they'd say and “when are you going to stop?”. I suppose you could say that I enjoyed the attention, and later their concern. Fighting my hunger pangs at first was not too easy but when I started doing aerobics it took the edge off my appetite. Now, if I don't exercise I feel anxious and fat.
I don't honestly remember the point at which I started to be afraid of food. Everything I eat bloats me out and I'm terrified of gaining weight. So long as I am losing I know I'm safe. Of course people are starting to nag me now and I have become quite clever at pushing food around on my plate or hiding it in a napkin on my lap. Most of the time I pretend that I have eaten somewhere else.
I'm down to 6 stones now but strange, when I look in the mirror I just see an enormous blob and my stomach feels huge. My Mum cries a lot now and I am sorry about that, she's threatening to take me to the doctor but I am certainly not going to let them make me fat again. I wont eat.
I am afraid to admit to myself that I am starving all the time and I'd love to let go and sink my teeth into some bread and butter but when I manage to resist and I have won, I feel totally in control. Believe me, I'm happy just the way I am and I wish they'd all just leave me alone.
|
|
 |
| Advertise with us |
|
