What is Anorexia Nervosa

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