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The Truth of Anorexia
At first we are in control. We look good; we feel good." writes blogger Starving4More, a girl who details her struggle with anorexia on the web. "Next, we become weaker as the world becomes darker...Now we have given in. Everything is out of control."
Anorexia nervosa is an eating disorder that is more than just a girl trying to be thin. It is a serious psychological problem that causes people—girls, boys, men and women—to try to gain control over their lives by controlling their weight. And, over time, they can lose control over even that: obsessing over every calorie, every morsel of food, as they slowly wither.
Dede Kammerling, licensed clinical social worker for the Eating Disorder Resource Center in New York explains what anorexia is, who it affects, and how you can help a loved-one get the help he or she needs.
What is anorexia?
Anorexia is a condition in which what starts as a diet becomes a regular pattern in a person’s life. It tends to express all sorts of things emotionally that the person, for any number of reasons, isn’t able to express more directly. And as the strict diet continues, a person’s weight is rapidly lowered. There are all sorts of physical problems that can happen in connection with it, but it is primarily a physical expression of what is, in fact, a psychological problem.
How many people does anorexia affect?
It usually occurs in younger women, and some statistics estimate that one-half to one percent of females in the United States will have anorexia. However, the disease can also occur with older women, and occasionally with younger men, more than adult men.
What causes the anorexia?
Well, that is complicated. It usually happens in the context of a family experience in which the person who develops the disorder is not freely able to express her feelings. So, these feelings get stuffed down and disowned. That person then turns to eating habits as a way of trying to control what she’s feeling indirectly, often without being aware that’s what’s happening.
Does the anorexia come from a desire to be thin?
On the face of it, it’s about being thin. But once it starts to go beyond the normal boundaries of a diet, where the eating becomes much more restricted and there’s too much weight loss too quickly, then we’re talking about a psychological condition that is all about regaining some lost or diminishing feeling of control.
What are factors that affect whether a person will develop anorexia?
All sorts of things can affect one’s risk of developing anorexia. Growing up in a family where there is enormous emphasis on appearance or body size is a key factor. It can happen to someone who grows up in a family where there are very rigid rules that inhibit the expression of feelings.
Often, the young woman who develops an eating disorder is the type of girl who has always played the role of the good girl; she is always attentive to other people’s feelings at the sacrifice of her own needs.
On the other hand, when there are not enough rules, especially for the parents, anorexia can also begin. For example, when boundaries are not established and respected by a parent, as in not allowing a child to close her door. Also, by going into a child’s room and reading her personal things without asking, that’s the other extreme that can make a girl turn to anorexia.
What are the symptoms of anorexia?
Obviously, restricted eating is one, but also a severe diet, a fast or eating habits that include the use of diet pills or laxatives. Sometimes anorexics sit at the table and appear to be eating, but what they’re really just cutting their food into little pieces or pushing it around the plate. Sometimes they prepare foods, but don’t want to eat them. Sometimes, they will begin to binge.
There is also a very intense fear of becoming fat, regardless of one’s actual appearance and weight. Anorexics are often people who will avoid social situations, especially when they have reason to expect that there’s going to be food present. Often, they have rigid exercise patterns or dress in a lot of layers to hide weight loss.
Physical signs include obvious weight loss, especially if it happens in a short period of time and the end of menstruation. A young woman who has been menstruating for a few years and suddenly loses her period without any other physiological reason may have anorexia. These kids often look pale, complain of feeling cold all the time, and sometimes they have dizziness and fainting spells.
What is the mind-set of a person with anorexia?
There is often a shift in attitude; the young woman becomes more moody. More often than not, anorexic young women are perfectionists. And, in the same way that they see fat on their bodies that isn’t there, they worry tremendously about their capabilities when they may be performing well in reality.
For them, self-esteem or self-worth becomes determined by how able they are to lose weight or to eat minimally. And, often, there is a kind of withdrawal from other people, not just a general social withdrawal, but a withdrawal from friends, sometimes from school.
What does treatment for anorexia consist of?
At least early on, treatment is usually one-on-one therapy sessions. And for the person who is truly anorexic, but is in a state of denial, the therapist needs to use the treatment as a kind of reality-testing experience. The therapist tries to assess whether or not that young woman is able to recognize that she has an eating disorder. If she cannot, then it becomes the job of the therapist to begin to help her to look at that.
The long-term goal is to help the person understand the development of an eating disorder, especially in the context of the family experience. Another goal is to help the young woman recognize that she may be sacrificing her own needs, afraid to disappoint somebody else, afraid to express aggressive feelings and so forth. But it takes time. It’s a slow process. It does happen that, if a young woman loses too much weight and is at real physical risk, she may have to be hospitalized.
Sometimes, if there is an existing group that is appropriate in age, the girl may eventually feel ready to discuss her issues with other people with similar problems.
Is there any family counseling involved?
If it’s a teenager with anorexia, it’s pretty common that there would be some kind of family contact. Sometimes, the parents will be seen by that same therapist or, if the young woman’s not comfortable with that, maybe another therapist will become involved.
What advice do you have for approaching somebody who you think has anorexia?
Be direct, but, initially, feel the person out to see if she is ready to take a look at herself. If she denies it, or if she becomes angry, then it has to be let go of temporarily. Now, obviously, if a parent waits too long and there is real physical danger, then it may have to be addressed in a more insistent way. The main goal is to help the person feel safe, so don’t make any threats. It’s important to be respectful of that person’s feelings and create a safe atmosphere where the person can feel supported.
If parents can’t get anywhere with their child, they might make arrangements to see a therapist, just to talk with that person about how to approach the issue.