Anorexia Nervosa— From the Perspective of an Anorexic

Anorexia nervosa is an eating disorder defined as having a distorted perception of weight, an abnormally low body weight, and an intense fear of weight gain. But there is much more to it. It is not simply about maintaining a low body weight. It is a disease that dictates your decisions, your relationships, and your life as a whole. So, what causes anorexia? That is a question many people do not know the answer to. As someone who has been diagnosed with anorexia and still struggles with it, I can provide my input. In simple terms, there is no one cause of a mental disorder. It is something I believe one is born with, but it does not necessarily come to the surface until there is some sort of trigger. There can be many triggers that may cause someone to develop their anorexia deeper. It can be as simple as someone commenting on your body as a child, or it can be a way of gaining control, or it can be simply having low self-esteem and a distorted thought process. It varies for every individual.

Eating disorders have the highest mortality rate of any mental illness for a reason. And anorexia leads the pack. According to State.sc.us, “Eating disorders have the highest mortality rate of any mental illness. A study by the National Association of Anorexia Nervosa and Associated Disorders reported that 5 – 10% of anorexics die within 10 years after contracting the disease; 18-20% of anorexics will be dead after 20 years and only 30 – 40% ever fully recover The mortality rate associated with anorexia nervosa is 12 times higher than the death rate of ALL causes of death for females 15 – 24 years old. 20% of people suffering from anorexia will prematurely die from complications related to their eating disorder, including suicide and heart problems” It affects the person mentally and physically. When someone is starving themselves, they are lacking basic nutrients that allow their body to function. There have been many people who have died from anorexia. I met a girl in my first inpatient unit who also struggled with anorexia, and a couple years later, I found out she never got better, and the disease killed her. I did not know her too well, but I did know her, so I was devastated. She was 20 years old when she passed. That is way too young. Karen Carpenter was a very talented singer and musician who unfortunately succumbed to her anorexia when she died at 32 from heart complications due to her malnourishment. There are many examples of celebrities and regular people who have passed away due to the illness, and every time I read about it, my heart breaks.

I am either crying or on the verge of tears when I see videos and pictures of myself when I was less than 70 pounds. My little brother has admitted he was scared of me during that time, and I do not blame him at all– I looked like I was on the verge of death. And quite literally, I was. I was anemic, I was weak, frail, dizzy, light-headed, and always cold. My arms were sticks, I was at risk for osteoporosis, I could barely walk up the stairs without losing my breath, I was underdeveloped, and I was sixteen and looked like a twelve-year-old. My hair was falling out, I lost my period for two years, and I was constantly fatigued. My stomach had literally shrunk so much to the point where I physically could not stomach eating food. I would be satiated after a cup of water. There are a lot of medical and mental complications that come with this illness. I could not focus on anything but food, my weight, my body, and calories. I was completely consumed, no pun intended, by my eating disorder. I would have to leave the room or go to the bathroom to cry when eating in front of people because I was so uncomfortable and self-conscious. I went through a period of abusing laxatives. I did whatever it took to lose weight and maintain what I thought was the perfect physique.

Some emotional and behavioral symptoms of anorexia include, but are not limited to– social withdrawal, preoccupation with food, sometimes cooking meals for others but not eating themselves, refusing to eat, denial of hunger, making excuses for not eating, constantly weighing themselves or measuring their body parts, discussion of fear of weight gain, mirror checking, refusal to eat in public, and irritability. My mother also struggled with an eating disorder around college-age. When she met my father, she was unhealthy and thin. She was abusing drugs which suppressed her appetite as well. She was harming herself in multiple ways. Her main trigger was homesickness. According to her, her disorder was mainly caused by her depression and low self-esteem, and as a means of control. She had just gotten out of an abusive relationship when she met my father as well, which affected her and her disorder greatly. So there are many factors that can trigger the growth and development of the disease. And my genetic predisposition to having anorexia could have contributed to me having it as well.

My anorexia has also caused a tremendous amount of gastrointestinal issues. I have always had a sensitive stomach, but because of the damage I have done to my body, I made those issues a lot worse. My purging damaged my esophagus, I have a high white blood cell count in my stomach and colon, I had to have an endoscopy and colonoscopy recently, and I struggle with having no appetite every single day. I dry heave and throw up stomach acid every other day. The disease is not something to be jealous of. Some ignorant individuals envy those with anorexia because they can be the societal standard of beauty, which needs to be altered. They have no idea the damage it causes to your health and life as a whole.

There are also barriers for those with anorexia to receive treatment, the most basic being the fear of getting better. A person with the disease may also simply be in denial that it is, in fact, a disease. Their cognitive distortions just may be so extreme that they do not see it as an issue, therefore, they think they do not need treatment. I personally did not want treatment for it. I was so stuck in my illness that I could neither see myself getting better, nor did I have the motivation to try. Another barrier is the financial barrier. The healthcare system in the United States, where I live, is not up to par. According to Goodrx.com, it is so difficult to receive treatment because, “Recent U.S. laws require ‘mental health parity,’ which means insurers can’t offer a lower level of coverage or higher copayments or coinsurance for mental health care than for physical or medical care. But sometimes difficulty arises when the diagnosis doesn’t meet exact criteria for insurance coverage. For instance, coverage may be denied if your weight is not low enough for anorexia treatment or you have had no medical consequences from bulimia. You can advocate for coverage by writing a letter to the insurance company.” It simply should not be this difficult to receive treatment for an eating disorder. One’s weight not being “low enough” should not be cause for denial of insurance coverage. Having “no medical consequences” should not be cause for denial of insurance coverage either. It is frankly ridiculous how the criteria is met. Some insurers categorize anorexia and bulimia as severe disorders that require intensive treatment, while others do not. I do not understand why everyone is not on the same playing field. Anorexia is indeed a life-threatening illness, no ifs, ands or buts.

The BMI calculator is a load of nonsense as well. If I was my height (5’1”) and my age (19 years and 2 months), and 95 pounds, I would be considered at the low-end of a healthy weight. A 19-year-old who is 5’1” should not be 95 pounds. The BMI calculator does not account for muscle mass, fat distribution, or waist circumference. There have been many studies that prove the BMI way of calculating if one is healthy or not, is bogus.

But back to the question “what causes anorexia?” Well, as I previously mentioned, there is no one cause. However, there are triggers, factors, and co-occurring illnesses that play a role in the disorder. Many experts believe that anorexia may be a part of an unconscious attempt to accept unresolved conflicts or difficult childhood experiences through this form of control. Obsessive-compulsive disorder (OCD) is another disorder that has been commonly linked with anorexia, due to the similarities in regards to overachieving and perfectionism. A lot of anorexics are perfectionists, including myself. I do not struggle with OCD as severely as I used to, but I have been diagnosed with it. I have an obsessive and addictive personality in general. I am stubborn and hyperfocus on tasks when I am motivated. When I am depressed and unmotivated, I fall into a deep, black hole of wallowing that is difficult to escape. That is also an aspect of my borderline personality disorder. Personality disorders are also often linked with anorexia. I have BPD, which is mainly instability, in relationships and emotionally, including rapid mood changes. It causes me to be extra sensitive, so when someone or something triggers me, it can affect me for an extreme period of time. According to Verywellmind.com, “People with borderline personality disorder have a greater prevalence of eating disorders than people in the general population. For example, a widely cited study by Dr. Mary Zanarini and her colleagues at McLean Hospital found that 53.8% of patients with BPD also met criteria for an eating disorder (compared to 24.6% of patients with other personality disorders).” So clearly there is a link between BPD and eating disorders. But why? According to the same article, “some experts have suggested that it may be that the symptoms of BPD put one at risk for developing an eating disorder. For example, chronic impulsivity and urges to self-harm may lead one to engage in problematic eating behavior, which may over time rise to the level of an eating disorder. Conversely, engaging in eating disordered behavior may lead to experiences of stress (e.g., intense shame, hospitalization, family disruption) that may trigger BPD in someone with a genetic vulnerability for the disorder.” Essentially, the two co-occurring illnesses can have an adverse effect on each other. Aspects of BPD like impulsivity can cause someone to engage in eating disorder behaviors, and engaging in eating disorder behaviors can cause effects that trigger BPD behaviors. All in all, co-occurring illnesses can be a main aspect of the development and severity of anorexia.

Another major trigger that is not spoken about as often is health class in schools. “Healthy eating” education, in which children are taught mainly about portion control and nutrition facts. This can cause someone with a predisposition to anorexia to be triggered into focusing on food labels to a point of obsession. Or “portion control” can be used as an excuse to restrict. There needs to be more awareness brought to these issues in schools, and health classes need to be more inclusive of them. Students have stated that they begin to worry and obsess over things they were not previously worried about because of the approach health classes take to teach their students. And the lack of proper nutrition and illness education can allow people with anorexia to genuinely believe some behavior or restriction is healthy, when it is not.

Social media plays a big role in the triggering of anorexia as well. Social media allows people to put on a facade that their life is put together. Usually, it’s all a front. However, people with distorted thoughts are envious of these people’s ideal lives and more particularly, bodies. The classic model type is tall and thin. People, especially females, are susceptible to being jealous of these body types and will do what they can to look like that. Comparison in general is a major aspect of anorexia. I personally will see a girl with a body type I strive to have, and I will start to restrict and exercise excessively to look that certain way because my disorder believes that is the solution. A lot of people with anorexia have the mentality that the lower the number on scale, the better. They believe that number defines their worth. It’s an irrational mentality, but mental illnesses are not rational. Many people do not understand or empathize with that mentality simply because they think it’s ignorance. Some of the smartest people have anorexia, it is not about intelligence. It is an illness that causes some very unwise decisions regarding one’s own well-being.

Trauma can also be a contributing factor to eating disorders. Purging does not have to necessarily be about ridding food. It could be about ridding emotions, memories, and experiences. According to Centerfordiscovery.com, “Eating disorders are not entirely about food but rather a way to control that specific aspect in an individual’s life. An individual may feel out of control or powerless after experiencing a traumatic event and as a result, they use restricting or binging behaviors to control that aspect of their life in order to hide their feelings of shame, hopelessness and fear. Other self-destructive behaviors that are used to self-medicate after a traumatic event is non-suicidal self-injury, which includes cutting and other forms of self-mutilation in order to release feelings of guilt and anger. Eating disorders like other self-destructive behaviors are ways to maintain control while distancing oneself from the pain. Others may not even realize their loved one is strongly affected by the traumatic event because they are able to bury their emotions through their eating habits to the point the individual may completely forget why their eating disorder began in the first place.” So, eating disorders can become fatal very quickly. Especially when the individual is good at hiding their struggles.

Eating disorders can cause the victims to become dishonest and manipulative– but the victims are also being lied to and manipulated by their illness. It is simply a vicious cycle. Anorexics often lie that they ate when they didn’t. They lie about how much they ate and what they ate, they manipulate the scale to appear they are gaining weight when they know they’re not, and they lie about how they feel so others are not concerned. Anorexics often do not even want people to know they are struggling because they do not want to bring attention to it. Once attention is brought to it, they know their recovery will be a focus to people who care about them, but their illness manipulates them into believing they do not want to recover.

There needs to be more awareness brought to anorexia and other eating disorders as well. There is currently a stigma surrounding it and changes need to be made. The stigma can be a significant obstacle in reaching out for help. Anorexia is already incredibly isolating, and the stigma just justifies anorexics isolation. They are afraid to be open and honest because they are afraid of the pity, the attention, the insensitivity, the lack of understanding, the lack of empathy, and belittling that comes with having anorexia. So please, do your research on the signs and symptoms of eating disorders, raise awareness, support eating disorder causes, and most importantly, if you know someone struggling, support them the best you can and try to understand their mental state. I know it’s difficult to comprehend the mentality they have but it’s important you empathize and at least attempt to understand.