What is anorexia?
“It can’t be that hard — why don’t you just eat?”
Anorexia is probably the most well-known eating disorder. If you asked someone on the street, they would probably say that anorexia is someone who is starving themself to lose weight but can’t seem to stop even when they are thin.
Well, it’s far from that simple. And it’s infinitely more heart-breaking than people simply wanting to lose weight because that’s cool in our culture. My intention here is to give a broad spectrum definition of anorexia to help us have a better understanding and empathy for the suffering of those around us.
Before I start, I want to acknowledge that there is no way an article of this nature can completely capture the complexities of this disease — but this is my attempt to give a snapshot in a five-minute read.
Anorexia: A technical definition
According to the DSM-V, there are three criteria that must be met for someone to have anorexia nervosa (the official name):
- Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
- Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
So to boil it down…
- Consuming less than the amount of energy your body needs, causing your weight to be “significantly low” (we’ll talk about what this means later).
- Having the intense fear of weight gain/being fat.
- Hyper-focusing on weight and/or denying the gravity of your current low weight situation.
Now that you know the definition of anorexia, let’s talk about some red flags:
- Preoccupation with calories, weighing self, and/or dieting
- Refusal to eat certain foods or food groups (i.e. no carbohydrates, no dairy, no fat, etc)
- Denial of feeling hungry
- Dramatic weight loss
- Comments about feeling “fat” or “overweight”
- Avoidance of mealtimes and social gatherings involving food
- Withdrawal and isolation, increased secrecy
- Inflexible thinking
- Need for control
- Rigid exercise regimen maintained even when sick or injured
You may be thinking, “Wow, I see some of these things in a lot of people around me, and some of this is even celebrated in our culture today!” It is a sad reality that our society is a breeding ground for eating disorders.
Anorexia can bring with it serious physical symptoms due to the malnutrition going on. The list is extensive, but here are a few:
- Loss of menstrual period in females, which can lead to osteoporosis (bone disease)
- Slowed digestion and stomach cramps, constipation, and/or diarrhea
- Dizziness, fainting
- Cold intolerance, poor circulation in hands and feet
- Loss of hair
- Impaired immune function
- Severe electrolyte imbalances
- Depletion of body’s stored sugar (can be fatal)
- Slow resting heart rate (the body trying to conserve energy) which can eventually lead to cardiac arrest
….and that’s just the tip of the iceberg. Malnutrition affects basically every body system. It’s pretty amazing how hard the body works to keep itself alive, but things eventually start deteriorating.
So we’ve covered the definition of anorexia, some warning signs, and some physical complications. Now I’d like to do some myth debunking around this illness.
Myth #1: Everyone fighting anorexia looks like they just survived the Holocaust. Just like I talked about in my first post, the truth is that a good number of people with anorexia don’t look that different from the rest of society. The body can be in the depths of malnutrition without looking shockingly thin. And that leads me to the second myth…
Myth #2: People in larger bodies can’t have anorexia. Although the diagnostic criteria is based on current weight compared “ideal body weight,” human beings are all genetically programmed to be at different weights. The term “atypical anorexia” was recently coined as a diagnosis for those exhibiting weight loss and all the symptoms of classic anorexia, but taking the ideal body weight part out of it (which doesn’t belong in the first place, in my opinion). And interestingly enough, all the physical complications are the same for these people. Malnutrition is malnutrition, no matter how much body fat you have. So guess what? Your larger-bodied, or even average-bodied, friend who meets criteria can still have anorexia.
Myth #3: People with anorexia don’t eat food. Actually, it’s quite rare to find someone with anorexia who is engaging in total restriction. The key is restriction relative to requirements — meaning they’re not eating enough to support their body’s needs. So if someone says, “I don’t have an eating disorder; I eat!” …nope, not relevant.
Myth #4: Anorexia is about getting attention. This would be like saying someone developed heart disease to get attention. It doesn’t work like that. Anorexia, like all eating disorders, is a mental illness and develops from a complex web of different factors. It’s about so much more than vanity or seeking attention.
How anorexia helps people
Wait, what? Wasn’t I just saying how terrible anorexia is? How could it actually be helpful to someone?
I once had a client with anorexia who came to me and explained her abusive husband, her family history of trauma, and her terrible job situation. She said, “I’m afraid to let my eating disorder go because it feels like the only friend I’ve ever had who never left me.” This statement helped me realize the reason people hold on to eating disorders is because it gives them relief from the hell around them.
When the world feels uncontrollable, at least you can control your weight. When people make you feel awful about yourself, at least you can avoid certain foods and feel better.
Addressing anorexia, and all eating disorders, means going deeper than the behaviors and finding the “why.” It also means helping people find alternative, healthier skills to deal with the very real stresses of their lives. And above all, it means having empathy for someone who is just doing the best they can.
One final note: There are diagnostic criteria that help us understand eating disorders. However, a diagnosis can never fully explain a human being, nor does it define them. For this reason, we say “person with anorexia” rather than “anorexic.” If you have or had the diagnosis of anorexia, and you feel this article doesn’t fully explain you, you will be correct. My intention is not to detail the beautiful complexities of one human being, but to give a simple framework to help others better understand in order to empathize.