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Just getting patients to eat again is only half the battle -- getting them to change their minds is even harder.

Anorexia: More Than Just Starving

There's a new trend happening on the Internet that is worrying doctors who treat patients who suffer from eating disorders. Sites are popping up online for people suffering from either anorexia or bulimia that are encouraging them in their behaviour by calling it a lifestyle choice rather than recognising it as an illness.

Visitors to the site are encouraged to write about their accomplishments in losing weight, eating little or no food of caloric substance, and generally exhorting them to be thin. Features include what products – laxatives, diet pills, enemas and purgatives – work best in what situations and list heroines of the cause like Kate Moss and Mary-Kate Olsen.

Being thin is a legitimate aspiration for a healthy life, and anything you can do to accomplish this goal is well worth the effort. What has the doctors so worried is not that it's just sending the wrong message, but that it encourages thinking that makes it even more difficult to treat the victims of the disease. The biggest obstacle that doctors claim they have to overcome when treating sufferers of anorexia is convincing the patient that there is anything wrong with them, that starving yourself to death is not a lifestyle choice but an illness.

A preliminary study of these websites by four doctors who work with patients with eating disorders has resulted in the rather lame warning that doctors shouldn't discount the negative impact these sites have on their ability to treat. The primary reason for the danger is that they provide sufferers of eating disorders with a community, a sense of belonging.

In talking with one young woman about her former "pro-ana" (ana being a pet name for anorexia) site she spoke about the feeling of control it gave her to be able to write down how little she had eaten each day. She also made the comment that she didn't believe her site encouraged anybody to continue on with an eating disorder because "I know I would have done what I've done even if there weren't websites out there encouraging people to have a pro-ana lifestyle.”

Despite claiming to have given up her "pro-ana lifestyle", it's interesting to see her refer to eating disorders as a lifestyle choice still and not a disease. As I mentioned earlier, this is the attitude that has doctors so worried; how do you treat someone who doesn’t think there is anything wrong with them?

The trouble with anorexia nervosa is that it is more than just an eating disorder. Starving oneself to death is a symptom of even deeper underlying problems. Look at what the young woman said about how dieting made her feel she had control of her life. Think about what the doctors have said about these sites giving visitors a sense of community. The other thing that the doctors have found that these sites have in common is how much they focus on the feelings of self-hate that the visitors harbour.

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.

Anorexics are looking for acceptance and are going to take it where they can find it. For those who don't have it anywhere else, the type of website described earlier in this article is going to be heaven-sent. Not only do these sites accept them, but they are also confirming everything that the voice in their head says.

What my wife and I discovered is that because I was willing to accept her unconditionally she was able to deal with all the underlying feelings that caused her to stop eating in the first place. Now that she had somewhere safe to belong she had the strength to challenge those beliefs.

If a young woman (or man — although rare, there have been cases of men with eating disorders) has sufficient cause to start exhibiting the eating disorder symptoms of anorexia nervosa, then it doesn't surprise me that she will look for some sort of acceptance, no matter what the source.

What mystifies me is that the doctors still do not understand that basic truth about the disease. Instead of panicking about these sites, they should be looking at them for clues as to how they might be able to counter the mindset that creates the conditions that fosters the eating disorder. Worrying about whether these sites are causing eating disorders is a pointless exercise because the only people they will appeal to are those who are so inclined already.

In the article linked to above, it is reported that across Canada the incidence of eating disorders is on the rise, and as that is only the number of people who are actively seeking treatment, the numbers are probably higher. These "ana sites" are giving sufferers a place where they feel accepted and know they won't be judged. For what may be the first time in their lives for some, they feel like they belong.

Without being able to provide an alternative means of feeling good about themselves, or overcoming their sense of not belonging, doctors are not going to have much of a success rate amongst people with eating disorders. Just getting them to eat again is only half the battle — getting them to change their minds is even harder.

About Richard Marcus

Richard Marcus is the author of two books commissioned by Ulysses Press, "What Will Happen In Eragon IV?" (2009) and "The Unofficial Heroes Of Olympus Companion". Aside from Blogcritics his work has appeared around the world in publications like the German edition of Rolling Stone Magazine and the multilingual web site He has been writing for since 2005 and has published around 1900 articles at the site.

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