Any eating disorder, including anorexia nervosa, is special torment for both the sufferer and those who care for them. Anyone who has not experienced this condition has difficulty understanding how completely it takes over your life and happiness. The word ‘anorexia’ simply means loss of appetite. Anorexia nervosa, however, is a more complicated disorder, as much psychological as physical. Anorexia nervosa is a condition marked by reduced eating and loss of body weight, and can lead to tragic consequences. It usually begins at adolescence, but can start as early as 9 years old and, sadly, can continue throughout life. Only about 5 per cent of anorexia nervosa cases are male, although this figure is on the increase; men tend to develop exercise addiction, particularly weight training, rather than anorexia. A high percentage of patients are from the middle and upper socio-economic stratum and are typically high academic achievers.
- Marked weight loss. At least 15 per cent below normal weight is a warning sign.
- Disordered body image (dysmorphia). Anorexics believe they are fat or overweight even when they are clearly not.
- Preoccupied with food and further weight loss.
- Loss of menstrual cycle in women.
- May also exercise to excess. Continuing to exercising even when injured.
- May also be taking diuretics (increase urination), laxatives and appetite suppressants.
- Will often feel uncomfortable eating with others.
- Have a fear of gaining weight or becoming fat.
- Fine long hair on arms and legs and face.
Complications of long-term anorexia may include:
- Osteoporosis. Below a certain percentage of body fat, women cease menstruating and oestrogen levels drop. Oestrogen increases bone strength, and so women who have been anorexic for some time will have a greater risk of osteoporosis.
- For those who have recovered from eating disorders such as bulimia and anorexia nervosa, a large percentage will suffer from ongoing gastrointestinal problems such as Irritable Bowel Syndrome and constipation.
- Thyroid hormone problems.
- The mortality rate of anorexia is 10 per cent. This is a scary disease, particularly for family members who can do little but watch and worry.
What causes it?
There is rarely just one simple ‘cause’, however, the following may offer some explanation for anorexia nervosa:
- Addiction. Anorexia nervosa is similar to, and may coincide with other sorts of addictive behaviour such as overeating, bulimia, laxative abuse, over-exercising, alcohol and drug abuse. Many anorexics are children of parents who have addictions such as alcohol and gambling.
- Control. Many adolescents feel that they have little or no control over their life and are not yet old enough to have gained perspective. Issues such as divorce or separation of parents, moving home or school, jealousy of a sibling, illness or death of a parent, are all hard for an adolescent or child to understand and beyond their control. However, the amount of food you eat is something you can control.
- Loss. Anorexia nervosa can be viewed as an insidious form of suicide. The anorexic may be expressing a wish to ‘not be here’ or fade away, after suffering a traumatic loss. The death of a parent, particularly the father, can have this effect. However, the loss through death or separation of parent, sibling, pet or close friend may trigger the onset of anorexia.
- Fear of fat. A study which confirmed our society’s morbid fear of fat, revealed that most of the school-aged children surveyed would prefer to be confined to a wheelchair for life than be fat. Many anorexics feel disgust when looking at their body. Even when pathetically thin, they can still pull a loose piece of skin as proof that they need to lose even more weight.
- Sexuality. One theory is that anorexia nervosa may be an expression of fear of maturing sexually, of what it might mean. Anorexia often first appears around puberty and it will often delay or stop the monthly cycle of hormones. After all, the poor little body is struggling to survive, let alone breed! The change from girl to woman is difficult, and society has many unreasonable expectations of what ‘the sexual woman’ should be and look like.
- At puberty, a girl’s role in the family changes and it has been suggested that some parents might subconsciously fear the signs of their child becoming a woman, and want to keep her a ‘little girl’ for as long as possible. Children are pretty good at picking up on their parents’ subconscious thoughts.
- Another theory suggests that the onset of sexual maturity may cause immense subconscious anxiety in any child who has experienced sexual abuse.
- An overwrought sense of perfectionism may be driving anorexia nervosa.
What to do
Successful treatment depends entirely on whether you have had enough of being obsessed by food and weight. If the anorexia nervosa has become life-threatening then medical intervention including intravenous feeding will be necessary. Many people fighting anorexia substitute this addiction with another, such as bulimia or exercise addiction. If this happens, don’t judge yourself harshly. As long as you are committed to addressing the underlying issues, and learn to like then love yourself, all will be well. For the family and friends of an anorexic person, you have a tricky path to tread. Showing concern but try not to be overbearing or controlling. It’s almost impossible to say the right words, but your love and acceptance for them no matter what is vitally important.
- Do not under any circumstances fall prey to any diet, however ‘healthy’ it is meant to be. It will only serve to bring your focus back on food. After you feel you are ‘over’ the anorexia you might wish to explore such diets. Although my advice to all my patients who have suffered from eating disorders in the past is don’t. The same goes for ‘diet’ foods and drinks; buying them is buying into the same psychological game that you are trying to get out of.
- Eat whatever you want. At the beginning of your recovery it doesn’t matter if it is bean sprouts or hamburgers. Any food is better than no food. Many anorexics tend to eat from only a small range of ‘safe’ foods – generally low-fat or vegetarian. It is best not to try to force the issue. In your own good time, new foods can be introduced gradually, one at a time.
- At least 50 g of protein is needed by the body every day. In anorexia nervosa, the body starts to ‘eat’ its own muscle because not enough protein is provided in the diet. Because high-protein foods often contain fat, many anorexics avoid protein foods. Some low-fat protein options include fish, egg white, tofu, legumes, cottage and ricotta cheese, low-fat yoghurt and protein powders.
- By definition, an anorexic is deficient in all nutrients. At the very least a multivitamin and mineral supplement should be taken every day.
- Absorption of nutrients is often poor, so the best supplement is in a liquid form.
- Serotonin, the happy neurotransmitter is often low in this condition. St. John’s wort is an excellent choice of herb to help counteract this.
- Several studies show that anorexics’ zinc levels are especially low. A liquid zinc supplement is the best option, to be taken daily in conjunction with a multivitamin.
- Bach flower remedies which may help include crab apple for ‘dislike of self’, mimulus for fear (of putting on weight), walnut for ‘times of change’, rock water for those who are hard taskmasters of themselves and white chestnut for incessant thoughts (usually about food and body image).
- There is no one correct way to treat anorexia nervosa. Each patient must find his or her own unique path.
- Anorexia nervosa if very much a psychological condition. Good counselling is a must. It may help if the therapist is familiar with eating disorders, however, an ‘eating disorder therapist’ may not always be the best choice, as this condition is a symptom of inner troubles. Choose a therapist you feel comfortable with and who ‘gets’ you.
- Accept the fact you probably have a disordered image of yourself. This can be helpful as you start to fill in some curves. Accepting you are not the best judge of what is a healthy or attractive body, takes some heat off.
- The images of women perpetuated in the media show that society’s standards can be devastating to those who are anything but stick-thin. But consider this: Grace, a slim woman who recently returned from India, spoke of her visit to a village where she met a woman with a very full, rounded figure, whom she described as luscious, and extremely feminine. Grace said, ‘Standing next to this woman, I felt malnourished, somehow not quite ripe’.
- Meditation. Anorexics often find it hard to ‘switch off’ and relax. Learning meditation will help.
- Gentle exercise is all that is needed. Not punishing gym schedules or marathons.
- The inner child. During the 1980s, the concept of the ‘inner child’ was popular. The idea being that at some level, we all react to situations initially as a small child, and then our ‘adult’ self intervenes with the appropriate reaction to the situation. This can be taken a step further if you ask yourself how would you feel if your small child (imagined if you don’t have children) was suffering in this way because anorexia nervosa is a condition of great suffering. Would you be stern with her or him? Or would you be kind and gentle? The anorexic is usually their own harshest critic, so imagining ‘another’ may allow some sorely needed compassion in.
At a glance
- Any food is good food initially.
- Trying to increase protein is important, as the body will use muscle if there are not enough calories. Lean meats, legumes, egg whites, ricotta cheese are all low fat and low in kilojoules, so are more likely to be acceptable. Protein powders are a good compromise until ‘real’ food is eaten with joy.
- A good quality multivitamin will go someway to replacing nutrients not consumed in food. A liquid supplement is a good choice as absorption is poor.
- St. John’s wort helps to increase serotonin, the happy neurotransmitter, which is often low in anorexia nervosa.
- Each person must find their own way. The journey to healing will most likely give you skills and a depth of life knowledge that will serve you later in life.
- A good therapist is invaluable. Be prepared to kiss a few frogs before you find your therapeutic match.
- Learn to meditate. Find respite from that busy, judgmental mind.