Anorexia
nervosa is not simply a disorder of choice. There is a clear genetic
[cause] for this disorder that we need to incorporate into our
understanding of what anorexia nervosa is.
Cynthia
M. Bulik
My sister,
Lynda’s story
suffered from anorexia nervosa for the last twenty years of her
life and this may have been partly instrumental in her deteriorating
heart condition. Anorexia nervosa can exist comorbidly with
obsessive-compulsive disorder OCD and is often included amongst
Obsessive-Compulsive spectrum disorders.
Like OCD anorexia nervosa is characterised by an obsessive type
of thinking, however unlike OCD it gives rise to a certain sense of
satisfaction, a sense of achievement in the sufferer’s ability to be in
control. Also sufferers may not have any insight into their condition in
the same way that OCD sufferers tend to, and they may even welcome it
and see it as a rewarding and meaningful part of their lives.
There is a certain pleasure derived from this enforced starvation that
is not present with OCD. Sufferers of OCD derive no pleasure or
satisfaction from their OCD, it is purely and simply enslavement and for
the most part sufferers of OCD would rather be rid of their crippling
symptoms. Unfortunately the satisfaction derived by some anorexics is in
fact a stubbing block to recovery, it is so much harder to fight an
obsession or a compulsion that one derives some pleasure from albeit in
a perverse and destructive way. For instance a compulsive gambler will
find if more difficult to give up gambling because there is some
pleasure or gain derived from this activity. Some anorexics take pride
in their “slim” appearance notwithstanding concerns of loved ones who
see only an emaciated skeleton. A number of sufferers experience great
satisfaction in their “accomplishment”, sometimes feeling superior and
even competitive with other sufferers who may appear even slimmer making
the sufferer feel fat. I recall when I was in hospital for my OCD that a
fellow patient, who presented with anorexia as her main illness comorbid
with OCD, was greatly concerned when she heard that a new arrival was
coming who was only four stones, she complained that she would feel fat
having never been that low in weight. However the even more dangerous
situation exists when the sufferer actually fails to see the wasted
skeletal figure that others see and continues to perceive his or herself
as being overweight and in need of even more stringent dieting.
I have little personal experience of anorexia nervosa with the
exception of a couple of episodes of compulsive dieting during which my
weight fell to six and a half stone at its lowest level I would
therefore not classify myself as having been anorexic. However during
the phase in which I was compulsively drawn towards dieting I did in
fact draw enormous satisfaction from my emaciated body, gaining a
perverse delight from seeing how my ribs protruded and how my collar
bones were greatly empathised. I even took a perverse pleasure from the
fact that my husband could not bring himself to look at my emaciated
body and I felt some pleasure from his sense of shock, pleasure that I
cannot quite define. Although I was not than anorexic (when I became
prone to daily headaches I stated to eat normally thinking that not
eating would exacerbate them), these two episodes in my life gave me
some tiny glimpse into this disorder.
It is commonly considered that anorexia nervosa presents only in
adolescent females but this is an erroneous assumption as it manifests
in older women, preadolescent girls, boys and men. It appears in all
cultures and classes of people and is not a new phenomenon. There are
cases of anorexia throughout history and there seem to be certain time
periods when the condition appears to be prevalent. During medieval
times the condition was clearly manifest but seemingly for altogether
different reasons than those of today. At this time in history the
condition presented itself as a form of asceticism. Notably Saint
Catherine of Siena appears to have had anorexic like symptoms after
making a vow to God to abstain from eating meat and eventually from
eating anything at all save fruit or vegetables when compelled to do so
as a result of social pressures, however, she would surreptitiously spit
it out, a behaviour seen in modern eating disorders. She was also
observed to exhibit bulimic types of behaviours such as the induction of
vomiting.
My
sister’s anorexia begin in her late twenties after a period of
overeating and considerable weight gain due to comfort eating as a
result of being confined to the house with severe agoraphobia. Although
as a child she was a finicky eater often refusing to eat at all. She
suffered from this disease until her death at 51.
This disorder is
characterised by an intense fear of gaining weight and becoming "fat".
This intensely powerful fear prevents sufferers from eating despite
either quite profound feelings of hunger or the thin emaciated figure in
the mirror that belies this irrational fear. Conversely, as previously
described, some sufferers do recognise that they are emaciated and take
pleasure and derive satisfaction from observing their thin
undernourished form. However most cannot or will not recognise the
potential health hazards in which their predicament places them.
Anorexia does lead to fatalities. My sister who already suffered from a
congenital heart condition was aware of the serious repercussions that
anorexia imposed, including severe damage to the heart. Yet she ignored
this threat to her health despite suffering also from anxieties
concerning death and illness. My sister much like myself spent her life
haunted by the fear of death and did anything and everything to avoid
its occurrence. She feared surgery should she die under the anesthetic
and she suffered hyphochonriasis and was forever anxious that she had
cancer or some other fatal disease. Notwithstanding such fears
when it came to her obsession with thinness the fear of death took a
back seat, over ridden by her fear of becoming fat.
Health problems resulting from anorexia nervosa include:
Physical:
Amenorrhea
(cessation of menstrual period), development of downy like body hair,
loss of hair on scalp, dry skin, brittle nails, loss of calcium from
bones which has the potential to lead to osteoporosis, failure of
internal organs, muscle degeneration, low blood pressure, poor
circulation, exaggerated feeling of cold even on a hot summer’s day,
heart failure and death. Anorexia nervosa has the highest mortality rate
of any mental health problem. It is not a fad but a very serious and
dangerous health problem needing immediate and sustained treatment.
Mental:
Depression, social withdrawal, irritability, anxiety and
insomnia.
Sadly many
sufferers diet to the point of starvation ignoring concerns about health
risks. Foods of high calorific value are avoided along with foods high
in fat content. Suffers will know the calories preset in every item of
food which is carefully weighed and calculated. My sister would not
allow herself above 500 calories per day during the times when her
condition was severe.
For a more detailed and expert explanation of
anorexia nervosa please click:
Useful links
Important:
This web site is a personal web site intended to
encourage sufferers to feel less alone by sharing experiences and
accomplishments. This not a medical site, I have no medical
qualifications. I am not a mental health professional. This web site
represents my own perspective, some of which may not necessarily agree
with current medical practice. Consult a doctor or mental health
professional for treatment and never discontinue treatment prescribed by
your doctor or mental health professional without prior consultation.
Also note that I do not endorse or recommend any of the complimentary
treatments mentioned in my book
Demons of the Mind: A Memoir of
Obsessive-Compulsive Disorder.
For
further interest:
A
day in the life of a sufferer of agoraphobia and anorexia nervosa
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