I’m sure you’ve heard of anorexia nervosa and bulimia nervosa, the famed eating disorders of supermodels and Hollywood stars. Unfortunately, these eating disorders are becoming more common and, as interviewees reveal, much closer to home.
Tisha*, a second-year student at the University of Otago who is suffering from anorexia, says that her family and friends are still grappling with the complexity of her eating disorder. “They know I have a problem, but they don’t really know what it is, or what to do.”
“THEY KNEW I HAD A PROBLEM...”
It’s difficult to estimate the incidence of eating disorders, as only a fraction of sufferers seek treatment. However, statistics indicate that the lifetime prevalence of anorexia among females is 0.5%, and the prevalence in males is one tenth of that.Anorexia and bulimia are the most common types of eating disorder. In the Diagnostic and Statistical Manual of Mental Disorders, anorexia is characterised by the refusal to maintain bodyweight at or above a minimally “normal” weight for one’s age and height, intense fear of gaining weight, undue influence of body shape on self-evaluation, denial of the seriousness of the current low bodyweight, and (in females, when relevant) the absence of at least three consecutive menstrual cycles.
Bulimia is characterised by regular (“at least twice a week for three months,” according to the DSM) binge eating, and inappropriate “compensatory methods” to prevent weight gain. Such methods include fasting, excessive exercise, and purging. Although rare, both anorexia and bulimia lead to serious health concerns, making eating disorders among the most lethal of all psychiatric conditions.
NOT JUST A GIRL THING:
In his book, First Person Accounts of Mental Ilness and Recovery, Craig LeCroy interviews a 27-year-old male, recently diagnosed with depression and bulimia. “Do I have a problem? I guess so,” he says. “I work so hard at my body, but underneath I still hate the way I look. In my mind I know that I am bigger than most of the guys on the street, but I still feel inadequate. I don’t like undressing in front of my girlfriend, and I don’t enjoy sex because I’m too busy worrying about the way I look. Even just looking at my body in the mirror when I come out of the shower makes me feel horrible.”Although 90% of people with anorexia are female, another more recently identified eating disorder, muscle dysmorphia, is predominantly associated with males. The condition was first termed “reverse anorexia”, describing male bodybuilders in the early 1990s. It is characterised by a preoccupation with the idea that one’s body is not sufficiently muscular. Studies show that up to 95% of college-aged males may be dissatisfied with some aspect of their body, but of course this doesn’t qualify them as having a dysmorphic disorder. In response to this self-dissatisfaction, someone with muscle dysmorphia will rearrange their lives around their compulsive need to work out, diet, or use ergogenic substances (such as steroids), despite harmful physical or psychological consequences.
MEDIA INFLUENCE
Research suggests that the media is partly to blame for the increase in eating disorders among both males and females in Western countries. Thinness is constantly emphasised on television and in movies, while overweight people are underrepresented. Characters in today’s media are thinner than ever before, and significantly smaller than the average person. Viewers are led to accept these often unhealthy portrayals as representations of reality. Adopting this reality can cause decreased satisfaction with one’s own body, and people – particularly women – begin to engage in behaviours aimed at meeting this ideal (such as dieting, bingeing, purging, and skipping meals).Tisha admits that “That sort of media encouraged me, and pushed me to keep going. I felt better in my own skin, and I could wear clothes I wanted to. I knew that I could go into any store, pick a size 8, and it would fit me.”
JESS’S STORY:
Jess* can hardly remember when she began to suffer from anorexia. She was only a toddler when she first felt self-conscious about her weight. She remembers being at kindergarten, “hating” herself because she was “fat”. The onset of anorexia is typically a deficient coping strategy for dealing with deep emotional issues, in response to stress or a traumatic life event. Evidence suggests that eating disorders come under the broad anxiety disorder spectrum, as many sufferers of anorexia and bulimia display an intolerance of uncertainty not only regarding food intake, but also in other areas of life.“I was only 12 years old, holidaying the summer before high school began, wearing a bikini on the beach, when a boy compared me to a whale. I didn’t cry, I didn’t try to disagree with him, or defend myself. Instead, I took it as a sort of constructive criticism, and internally vowed that I would lose weight, so I could look like everyone else. Looking back now, I can see how much being teased affected me.”
As she began shedding kilos, “cutting out foods here and there”, and training hard for a sports team, Jess says she didn’t realise the extent of her weight loss until her mother said, “You’re looking thin, too thin.” “I couldn’t believe my ears,” Jess says, “Too thin! There was no such thing as too thin. That was like telling someone they were too pretty, or too nice. It was the ultimate compliment.”
During her first year of high school, she continued to lose weight, and shrank to 45 kilos, but was still far from satisfied. “By this point, I had become a shadow of my former self. The anorexia had fully consumed me.”As her dangerous restriction of food continued, Jess says that “Mum’s crying at dinner time became an everyday thing. I became desensitised to her pleas, and heartless to her tears. I was walking around completely numb of any sort of emotion... I hardly ever saw my friends. I knew everyone was worried about me, but I didn’t care.”
It wasn’t until her mother made her go to the doctor that Jess realised the severity of her physical condition. Straight from the doctor’s clinic she was rushed to hospital for tests. As a 13-year old, her weight was lower than it had been in the past five years. “They explained that my heart rate was so slow (40-45 beats per minute), and my body was so weak, that I could have dropped dead at any second.” Jess spent over two months in hospital, and she gradually got better. “My friends and family were incredibly supportive during this time... It was through happy times with my friends and family that I started to have positive connections with food. My friends showed me how fun living could be, and genuinely put the light back into my life.”
“IT’S NOT JUST A CASE OF EATING MORE”
It’s imperative that treatment of eating disorders focuses not only on increasing calorie intake, but also on the psychiatric roots of a patient’s condition. If rapid and effective professional treatment isn’t sought as soon as possible, the consequences are potentially fatal: 10-20% of individuals with anorexia will die within 20 years of its onset. Although most of these deaths are due to health complications, over a quarter result from suicide. Eating disorders are mental disorders; immeasurable by scales, unfixable by forced feeding. Cognitive distortions and beliefs about food and bodyweight must be remedied before the patient can fully recover from an eating disorder.Tisha sees a huge gap in society’s understanding and acceptance of mental health, especially regarding eating disorders: “Growing up, we’re taught to not share germs, because germs make us sick. But we are never taught about depression, or schizophrenia, or eating disorders, and how mental health is just as important as physical health. There’s a lot of fear, and a lot of shame associated with anorexia and bulimia.”
Tisha’s disorder developed later than Jess’: “I got anorexia when I was around 16 years old. I was a bit overweight at the time, and started dieting. I became obsessed with the number on the scale, and I would weigh myself four to five times a day, trying to get that number down. It just snowballed from there.” Through purging (vomiting), she attempted to empty her stomach after eating. “I hate the feeling of food inside me,” she says. “[Bingeing and purging] has landed me in hospital, because of my potassium levels.”
Tisha wishes that people would realise that “there’s a lot more to an eating disorder than simply the need to eat. Some people say, oh, it’s not good for you, you should probably eat more. And I’m like, really? I’ve been through three years of treatment, and that’s all I needed to know? Yes, I knew that what I was doing wasn’t good for me. I still know that it’s not good for me. But, in the moment, it’s hard to change.”
TREATMENT AND PROGNOSIS:
Tisha says that Dunedin provides a “pretty shocking service” for those with eating disorders. “They’ve got limited information, and limited care.” As a result of this, her parents sent her to spend three months at Christchurch’s Eating Disorder Clinic. “Within the ward there are a few different programmes... It definitely helped through teaching me techniques for situations when I have a strong desire to binge and purge. It reminded me of what a normal diet was like. One fantastic thing about the ward was being surrounded by people who could actually relate [to anorexia]; it was so good being around people who knew what I was going through.”Early intervention, support from family and friends, lower levels of depression, and avoidance of drug and alcohol abuse all increase the likelihood of treatment success for those suffering from an eating disorder. The outcome of anorexia is highly variable; some individuals fully recover after a single episode, some suffer with weight fluctuation followed by relapse, and others experience a chronically deteriorating course of the illness over many years.
After gaining weight during her time in hospital, Tisha is now back at university. She still meets with her counsellor, and admits that while one’s bodyweight can benefit from intense physical treatment, the psychological element of eating disorders requires a more long-term approach. “Body image is one thing that I’m working on. It’s important to realise that it’s normal to have curves, and wobbly bits, as such.” From here, Tisha’s future looks positive as she continues towards a normal weight range and a healthier mindset.
Through sharing their stories, both Jess and Tisha hope that people will realise how serious anorexia is, and, as Jess says, “how much it affects not only the sufferer, but everyone around them.” Jess emphasises an anti-bullying message: “It may not mean anything to you, but your harsh words could result in someone dying.”
*Names have been changed to protect interviewees’ anonymity.
