More than 60 percent of adolescent girls in our society believe they are “too fat.” The difference for the anorexic, however, is the degree of distress this feeling causes, compounded by her inability to perceive her body accurately.
Ironically, her “realization” that she is fat, though distorted and incorrect, produces a tremendous sense of relief. At last she feels she has identified the problem. Now she can begin to manage it: She will diet.
The snowball has begun to roll. Any success at dieting -”Hey, I’ve lost two pounds in five days!”- provides a sense of accomplishment. Feelings of insecurity fade, replaced by a sense of mastery, competence, and self-control. Such emotions reinforce themselves. The greater the feeling of competence, the more she wants to feel competent. Success (weight loss) breeds the desire for more success (more weight loss).
Relief! No longer is she a passive, helpless victim of her inadequacy. Now she’s regaining control over her life.
What’s more, she feels relieved because weight loss reverses maturity. Menstruation stops. She becomes like a child again – physically, at least. Now she can “legitimately” avoid entering into more adult relationships. She reduces the risk of rejection and thus prevents damage to her fragile psyche. Preoccupied with her body, she focuses inwardly, avoiding the need to grow outwardly through interaction with other people.
The devastating effects of starvation are usually obvious. Sometimes, though, parents may be too close to the problem to see what is happening to their daughter until an outsider brings it to their attention.
Even if they fail to notice her weight loss, parents may find their daughter’s eating behavior becoming increasingly strange. She dawdles over her meal for an hour, poking at her food, creating meticulous piles of peas or mashed-potato sculptures. She cuts her food into tiny pieces, nibbles one bite, and then claims she is full. She puts herself in charge of all food shopping and preparation. She bakes cakes and cookies and insists that the family eat every bite, yet eats nothing herself. Eventually her preoccupation with food absorbs every waking moment. She may exercise compulsively for three, four, even five hours a day.
Starvation, though, is an unstable state. Besieged by hunger signals from her body, the girl must constantly resist the desire to eat. The longer she goes without food, the greater her hunger and the greater her preoccupation with eating.
In a weird way, this need for vigilance perpetuates the illness. Each victory over her appetite reinforces her sense that she is at last in control of her destiny. The thinner she gets, the higher her self-esteem; the higher her self-esteem, the greater her desire to be thin.
Sometimes, though, hunger becomes overpowering. The result: an eating binge. Horrified that she has failed, burdened by guilt over her weakness and loss of control, she resorts to drastic measures to purge herself of food.
Briefly, I want to mention that at some point the body, robbed of a supply of nutrients, begins to steal from itself. That is, it “confiscates” essential chemicals stored in certain tissues, such as the protein required keeping muscles strong. Metabolism slows down to conserve dwindling fuel. Usually the anorexic begins to feel very cold; she may experience fainting spells.
Despite these warnings, the girl persists in her behavior, ignoring the pleas of family and friends and resisting the need for treatment. She sees as her enemy anyone who wants her to eat. I can’t count the number of times I have confronted a patient with anorexia-a skeletal figure, pale, trembling with cold – who gazes at me through empty eyes and says, in effect: “Why do they want to take away the one thing that makes me special-my ability to be thin?”
How hard it is to convince these people of the one fact that everyone around them knows: Without treatment, they may die.
*21/35/5*