When my wife and I got together she had long ago defeated the eating disorder aspect of her anorexia. As a teenager she had starved herself so much that she had stopped menstruating and was close to death. The only thing that saved her was guilt and her belief that others were more important than her. She had to stay alive to make sure her mother continued to receive mother's allowance checks. In a sense the disease saved her from herself; because she thought so little of herself she sacrificed her plan of starvation for somebody else's needs.
The problem she had was that even though she had managed to overcome starving herself, all the mental/emotional baggage that had caused the eating disorder in the first place still existed, the primary cause being she did not believe herself worthy of anything positive — love, affection, and nurturing. When you don't believe you deserve anything good in your life, or that even thinking of yourself and what's good for you is wrong, guilt becomes a constant companion.
Feeling guilty of course only deepens your self-hatred and you spiral downwards to the place where you no longer even believe you are deserving of nutrition, so you stop eating. You will do anything to win the acceptance of your peers, whether it's people you know, or people who you haven't met yet but know there is no way they will want to have anything to do with a loser like you.
In his wonderful book The Deadly Diet, Dr. Terence J. Sandbek talks about what he calls "The Voice." This is what he calls the continual negative reinforcement that happens in the mind of a person suffering from an eating disorder, a one-sided dialogue that whispers things like how can you expect anyone to like you?
Dr. Sandbek outlines in his book the ways in which a sufferer can combat these voices by learning to identify them and recognising their ridiculous nature. Of course this is a lot harder than it sounds, and he recommends that patients create two lists: one that itemizes all the negative beliefs the voice reinforces, and the other positives and proofs that the situations the negative beliefs arose from no longer exist.
There's a catch to doing the work that Dr. Sandbek recommends — you have to be in circumstances where none of your negative beliefs about yourself are being triggered. If you are in an abusive relationship, be it either emotional or physical, your chances of recovery are limited. Every time you're either hit or made to suffer in other ways, your self worth takes as much a beating as anything else.
Article comments
1 - Bryan McKay
[...] although rare, there have been cases of men with eating disorders [...].
This may have been more rare several years ago, but now young gay men are entering the new cohort of anorexics. Straight men, too, but it's been specifically a problem with gay teenagers. I don't believe the number has reached anything near what women suffer, but it's a large enough number to be significant.
2 - Virginia Dare
My sociology professor in college called eating disorders social diseases because they were almost exclusive to North America. They showed a direct proportional rise between North American media in Europe and the first reports of eating disorders there. I understand that eating disorders have psychological root that is deeper than wanting to look like the women we see on television, but perhaps there are more sinister undertones in our media that we don't even recognize that trigger this kind of self-loathing in vulnerable women.
3 - Bryan McKay
Virginia: I don't know if the rise of North American media can be traced to European eating disorders, especially without having seen the hard data, because I have also heard of African women from the former colonies developing eating disorders while being schooled abroad in Europe - and this was long before anorexia was a "popular disease." It's also important to note that the first reports of eating disorders and the first eating disorders are not necessarily correlated - they probably existed much earlier than we had been diagnosing and identifying them.
4 - Michelle Hope
I have a recovery blog (onbulimia.blogs.com) and web site (michellehope.org) that I've kept since finally recovering from 14 years of bulimia, as well as associated anxiety, depression, panic, and rage, about a year and a half ago. While I'm a white woman from the States, I promise you - my readers are both men and women from all over the world. I have a surprising many from New Zealand and Australia as well as Canada. I also have women I've worked with from Croatia and Kuwait. I have people referred to me from search engines in Greece, Spain, China, as well as places where I don't recognize the language. I have kids, PTA moms, executive men, and grandmothers who all read and write me.
Believe me -it's all over the world, across genders, age ranges, backgrounds, and it's getting worse. Why? Because food is universally calming to humans. And, because our children are increasingly being raised in uncertainty, poverty, chaos, pain, and with little instruction in coping well with life, so they need artificial means to help them cope. When children grow up with poor coping skills and/or extreme amounts of fear inside them, their kids end up worse then they.
Treatment these days also falls short. It focuses on correcting the problem - getting people to eat or to stop purging. But, it fails to teach them the skills and self-trust needed so that they no longer NEED a coping mechanism to help calm the chaos within. This is why people believe, "once you have an eating disorder, you always have an eating disorder."
We've got to teach our kids (and adults!) better. Until we stop the cycle, it's just going to get worse.
With respect and gratitude for your article,
Michelle Hope
5 - Bryan McKay
If food is "universally calming," then why would people not eat is to "calm the chaos within"? Yours is a worthy cause, but I'm not sure if I agree with the explanation you offer - it all seems a big vague to me (althought your website might offer more information - I haven't had time to read it all). It should also be noted that while related, anorexia and bulimia are different in many important (psychological) ways.
6 - Luke
Bryan:
In my experience, not eating is a way that an anorexic asserts "control" over his or her life, and thus "calms the chaos within". It is bizarre and nearly impossible for someone who has not been through it to understand - just as it seems difficult to understand why a patient with OCD must wash his hands 50 times a day.
Also, with respect to the influence of the North American media, it's interesting to note that eating disorders were present in Medieval Europe - thinness was seen as a "holy" characteristic and there are accounts of nuns developing what would now be diagnosed as anorexia.
7 - Bryan McKay
Luke: I understand the aspect of asserting control, but if the commenter suggests that food itself is calming, then one would assume that eating would be enough to calm the chaos. They're two mutually exclusive ideas, as far as I'm concerned.
8 - Michelle Hope
Hi Bryan and Luke. You are both right.
While I feel qualified (sadly enough) as a bulima "expert," I admit that I can't figure out anorexics for the life of me! I went through what could be termed "anorexic" phase during my first summer in college when I was so dirt poor (my mother was too deep in poverty to help), that I had to prioritize where my money went. In my sick eyes at that point, food was mostly a luxury that I couldn't afford. So, I ate as little and as cheaply as I could. Of course, once I got back on the meal plan in the fall, I indulged in food so much and so often that I ended up bulimic.
But, that's not the typical "anorexic" by any means. I wish I understood more. But, I don't.
I'm glad you're talking about it!!
By the way, a producer from a NYC daytime talk show contacted me a week or so ago. She is putting together an episode on eating disorders. The host is Dr. Keith Ablow. You can find out about him here and about his show here. It's a new Dr. Phil-like show that will begin airing in the fall, although they're beginning taping over the summer.
I am helping her to find people with interesting, non-stereotypical stories of eating disorder hell to share with Dr. Albow and his audience.
If you or anyone you know might be interested in joining us on the show, please let me know at michelle at michellehope.org.
9 - Snarkattack
I hate to be pedantic, but I assume you're referring to anorexia nervosa, where a person starves themselves due to believing themselves to be too fat?
This is different to anorexia, the phenomenon of decreased appetite, which is common in some serious illnesses, and can also be a side effect of various medications.
My apologies, but it's important that people are able to distinguish between the two terms, as someone who suffers from anorexia (not anorexia nervosa) as a result of another illness.
From a psychological point of view, there are actually a couple of reasons as to why one would choose not to eat, far removed from concern of one's body image, as Luke (#6) briefly explains.
10 - sheila
I am anerexic, I can't eat. I am not sure who's right. I just know that I have a problem with noone to help!!!! people say just eat, but I can't. I will probably die of this. Please keep researching so others won't
11 - Michelle Hope
Snarkattack - when you see letters like the one from Sheila, do you continue to insist on correct terminology?
It shouldn't matter so much WHY people are suffering with illnesses like these -that does nothing to help them recover. And, I promise you that anyone suffering from anorexia nervosa has many reasons why they don't (or can't) eat. The obsession with food and body is a facade, however compulsive, - a way to avoid thinking about the deeper problems.
What matters is helping anorexics (and ALL addicts, for that matter) to develop their sense of self - self-trust, self-knowledge, self-love, self-respect. When we admire and consistently care about ourselves, it's impossible to knowingly abuse ourselves.
12 - nanna
Sheila, I know where you are with this. I am 44 and weigh 85 lbs. I KNOW this is killing me and have yet to find any help!
13 - Tania
I have an existing ana condition and I find it gives me a sense of control. However, I am also ensuring I stay healthy at the same time as when I realised what was happening to me I looked up all the information I could on fasting and calorie restrictions from real MEDICAL PROFESSIONALS that have studied and implemented these for many years. I make sure that I follow these medical guidelines in order to stay healthy and I encourage other ana's to do the same research to ensure that they stay safe and healthy too. Pro-Ana sites are not just for feeling a sense of belonging but also to encourage a healthy approach to our problems and to encourage recovery when one of us chooses that path.
14 - Eriana
Hello,
I thought I had an idea; a rant ready to explode when I decided that I would put a comment here; when my husband told me last night that this article was still getting comments.
Why did this subject come up?
A few reasons . . .I've lost count, but I'll guess; I'm recovering from likely the 8th surgery I have had to have on my jaw and now cheekbone due to osteomyelitis.
The body will do anything to keep an infection from the bone, so health slowly deteriorates for anywhere from a year to four years before the explosion of infection and pain centralizes.
During which I spend alot of time in bed, extremely weak and fatiqued, feeling hopeless and listening to my head.
Yes, anorexia nervosa - is a mental illness - and you have to fight it - for life.
It will attack you when you are down, depressed, even in tiny moments when you are full of incredible joy - in fact - that is when it enjoys attacking you the most.
While lying in bed, not getting well fast enough, still angry because I'm 47 years old and I don't feel that I have done anything significant to help the world - I did a sketch of a beast; representing all my sorrow, anger, grief, frustration - aimed at the injustice in the world.
The Beast wears a banner: #1.The Big Lie, awarded for the Victories of Secrets.
I'll get to the point. I told myself the sketch was done . . . an hour later I was still adding things to it. My husband offered me a neck rub, and I wanted to refuse - then I cried.
I pointed to the sketch and said "that's me - that's how much I hate myself."
That is a piece of what anorexia is.
Anyone who thinks that they are in control are victim to "The Big Lie" - it is a Dis-Ease.
And the Dis-Ease controls the victim.
I could go on and on about the studying I've done, the counselling I've gone through - the women I've seen die; or lose their gall-bladders by the age of 26.
I'm lucky. What I remember truly, is that way back whenever; I thought I heard my mother crying, and I started to eat. Learning to eat regularly took years.
Seeing this illness become 'fashionable' has me more distressed than I can find words to express.
I'll try to put into a nutshell what I understand anorexia nervosa by my own terms: having so much love and want of love for everything in the world; and feeling a failure for not being able to help. Self-shame made me want to 'disappear' - hence - melt away. Wanting to be seen and loved and not wanting to be noticed (people will find out what a failure I am inside) all at the same time.
I love everything so much; and after all these years, no matter what my duration of experience, learning, education, etc . . .
I still don't know how to love myself.
While I write this I think that it sounds self-pitying - don't pity me - just read this; because you won't find it in a text book.
NOTE: to Michell Hope - thankyou.
to Sheila and Nanna who left comments here -
I dearly hope that you are well; and if you come back and read this; here's what I want to say to you - if you are sensitive and aware enough to want help - you are braver than you know.
And finally; about "ana" I didnt' know that this term was being used until just recently-
my name should be read Eri-Ana.
I call the beauty of creation: Ana - Long before I addressed creation by name - I made a promise. Creation gave me a gift to look after - I am blessed that I have a body, eyes to see with, hands to sketch with; I am blessed that I live in an area where there is food available; I promised to look after this gift. Life.
Eri
15 - mark
i'm pretty sick with this as well. i'm a 34 year old male... it's absolutely insaine the things that i will do so that i can't eat... gamble drinking drugs... the core is the not wanting to succeed or not feeling like i deserve to or maliciously doing things to myself or who knows but its a damn hard one