Anorexia nervosa (usually just called anorexia) is characterized by an abnormally low body weight, an intense fear of gaining weight, and a distorted perception of one’s body image. Anorexia has the highest death rate of any psychiatric illness, including major depression. The mortality rate associated with the disorder is 12 times higher than the death rate of ALL causes of death for females 15-24 years old, the population most vulnerable to it. Without treatment up to 20 percent of people with serious eating disorders die. Yet many sufferers refuse treatment, at least initially, either because they are in denial or their desire to be thin overrides concerns about their health.
Anorexics may eat tiny amounts of a few “safe” foods, severely restrict their food intake, and/or frequently fast. Some sufferers also exercise excessively. Despite their own spare eating habits, anorexics may prepare elaborate meals for others. They may engage in rigid mealtime rituals, shy away from eating in public, have trouble sleeping and become increasingly irritable. They often try to hide their condition.
According to the Mayo Clinic, the causes of anorexia are complex. As with many diseases, it's most likely a combination of biological, psychological, social, and environmental factors. The Clinic explains that some young people may have a genetic tendency toward perfectionism, sensitivity and perseverance — all traits associated with anorexia. Some may have obsessive-compulsive personality traits that make it easier to stick to strict diets and forgo food despite being hungry. And they may have high levels of anxiety and engage in restrictive eating to reduce it.
Moreover, modern Western culture emphasizes thinness to an alarming degree. Success and worth are often equated with being thin, and there’s enormous peer pressure to look a certain way, particularly among young girls. Finally, people are more vulnerable to anorexia during a transition, such as a new school, home, job or the breakup of a relationship, and while experiencing a loss, especially the death or illness of a loved one.
“Anorexia has nothing to do with food and everything to do with distorted body image,” contends therapist Deborah Levinson, LCSW. “And this distorted body image is a metaphor for the young people’s feeling about themselves. They feel they are being controlled and by not eating, they’re saying, ‘You can’t make me; I’m the one in control here.’”
Ms. Levinson continues, “Unfortunately, our society equates thinness with beauty, and you’re shamed if you can’t fit that model. Today, with bullying on social media, the pressures are magnified. Social media is instantaneous, but a young woman can’t get thin in an instant and in some cases she can’t get thin at all. Often, she shouldn’t even be trying.”
Wendi from Rock Island wrote in to say that she used to have her own issues with body image, and she’s worried because she’s starting to see them in her teenage daughter. In Wendi’s case, the anorexia was triggered by a boy telling her no one would date her because she had a big behind. With hindsight she realizes that there were many family dynamics and genetics operating beneath the surface, but at the time she took this boy’s cruel remark at face value and began an endless diet. “I never felt thin enough,” she said.
Deborah Levinson sees hope. “I have had success by working alongside a nutritionist, who prescribes five small meals a day, and adding structure to the anorexics’ lives. I never pressure them to eat. Rather, I concentrate on their strengths and help them feel better about themselves. This positive reinforcement can move mountains.”
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