Thinking about this topic took me back to remembering a patient I had a long time ago who suffered from Anorexia. She was an intelligent, successful woman who had been dealing with it since her teen years. She hated it. She wanted to make it go away. She told me about how people would tell her she was so lucky that she was so thin. She hated that thinking about food consumed so much of her time and her mental energy and that everyone thought she could just Decide not to starve herself.It also reminded me about when I was teaching a Women’s Health curriculum to medical students. We visited a local eating disorders treatment center. They were a tremendous organization as many are, but what has stayed with me all these years is seeing women in their 50s and 60s STILL struggling with anorexia. They wished they had gotten help earlier in their lives. They talked about how hard it was when they wanted to have babies and build a family. It was hard to hear that these women had been struggling with eating disorders for 40 and 50 years.
And then I see the pro-anorexia web communities. Awful. I know everyone wants to belong and interact with people like them, but just because you find others on the web that have the same eating issues as you, does not make your behavior (nor theirs!) healthy or normal.
And a reminder….. as I say, the internet is not a substitute for reaching out to a supportive adult or doctor, and this blog does not make specific recommendations for you – it is just a source of accurate info for you to use and to help you decide if you need help….
So, here we are. Let’s tackle this one…
So, exactly what IS anorexia?
It is an eating disorder with extreme thinness and refusal to maintain a healthy body weight. So extreme thinness is less that 15% of ideal body weight. Let’s say you are 5’4”. Ideal body weight is around 125 pounds. There is of course a range of healthy weights, but this is about right in the middle. So say you are 100 pounds and still dieting and when your mom says you need to eat more since you are too thin, or your doctor wants you to gain 10 or 15 pounds, and you get all PO'd and you simply refuse. THAT is typical of anorectic behaviors.
Other signs and symptoms:
- Intense fear of gaining weight
- Distorted body image – no matter how much you lose or how people tell you you are too thin, you still see yourself as fat.
- Extremely restricted eating – times of day, food types, amounts – and obsession with calories
- For girls, stopping having periods.
"So what?", you ask. "Look at the magazines. Look at celebs… can they really ALL be abnormal?."
Why, yes, in fact many of them do have a weight that is abnormally low.Along with your extreme thinness, otherwise known as cachexia or emaciation or skeletal appearance, you may have dry yellow nails, dry skin, feeling cold all the time, feeling super tired and weak, being really constipated. Oh, and hair loss. But you might get a fuzzy fine hair called lanugo over your body.
Again, not impressed? OK, so if this goes on chronically, you can DIE from your disease. Die? Really? You gotta be kidding me….
People with anorexia are about 15 times more likely to die early than the regular folks without. OK, spun another way, 20%, yes one fifth, or 1 in 5 people with anorexia will die prematurely from complications from their eating disorder – including suicide and heart problems. Anorexia has the highest death rates of any mental health disease. Other problems are low blood pressure, body temperature and heart rate and heart rhythm problems, heart damage to both the structure of the heart itself and to how it functions, brain damage, organ failure (when you get super dehydrated you can have kidney failure). You can easily break a bone since extreme weight loss causes bone thinning and weakness.
Now, the whole point of all this is to make you think about if you or a friend you know might need help. Sooner is obviously better than later.
But does it go away on its own?
Sometimes it does. Some people get relapses where it goes away and comes back later. Some people go on and suffer from it chronically. Treatment DOES HELP!
Tell me, what is treatment?
Well, the short answer is that treatment looks different for everyone. Anorexia can develop out of excessive dieting habits, or can travel with other problems like depression, obsessive disorder, need for control. Some people have other dangerous eating behaviors as well, like abusing laxatives and diuretics, or making themselves vomit, or exercising way way too much to burn off excessive calories.
So taking all that together, if you get treatment, a treatment plan will try to get at 3 goals:
- Get to and maintain a healthy body weight so that your body can function they way it is supposed to, to let you do all the things you like to do now and want to do later with your life.
- Treat what is behind the eating disorder. Is there depression? School pressure making you want to control at least ONE thing in your life? Something else going on?
- Then figuring out what the thoughts and behaviors you have that might make you relapse, so that you can deal with those.
There probably would be a nutritionist involved, and you might have a therapist, and medications might be prescribed. But again, all this would be based on what YOU need for YOUR specific situation, and requires a thorough, in person, medical evaluation.
OK, things anorexia is NOT:
- It is NOT an accomplishment – showing how self disciplined you are.
- It is NOT a lifestyle choice.
- It is NOT a diet that you go on.
Pay Attention Here:
The last thing I want to touch on is the online eating disorder community. A lot of social media sites shut this stuff down, and thanks to them for doing this. People go to these sites to make themselves feel like they have company and that they are not alone. That part would be good, except what these pro-ana and other sites do is reinforce really unhealthy and dangerous behaviors and try to make these behaviors seem normal by pulling together people that suffer from them. So, the good news is, there are some really great online communities where people with eating disorders can join. Or even people who are worried about their eating habits can learn more.
I came across two websites that I think have a great bit of info, including blogs, help lines and screening tools. I looked all over these sites and am sharing them with you guys here:
ANAD Get Help
NEDA Get Help and Support
Lastly, giving credit where credit is due – The National Institute of Mental Health provided a lot of the factoids discussed here – more can be found on their site.
Not sure you have an issue? Try this online screening tool (from NEDA).
Screening test - not a diagnosis but learn more about yourself