To begin with I will define anorexia as it is explained in the DSM-IV. This is the most basic diagnostic criteria for 307.1 Symptoms of Anorexia Nervosa:
A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected, or failure to make expected weight gain during period of growth leading to body weight less than 85% of that expected).
B. Intense fear of gaining weight or becoming fat, even though underweight.
C. Disturbance in the way in which one's body weight of shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
D. In postmenarcheal females, amenorrhea [the absence of at least 3 consecutive menstrual cycles] will occur.
-Restricting Type: during the current episode of anorexia nervosa, the person has NOT regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).-Binge-Eating/Purging Type: during the current episode of anorexia nervosa, the person has regularly engaged in binge-eating or purging behavior.
Other symptoms include: hypothermia, bradycardia, hypotension, edema, lanugo, and a variety of other metabolic changes.
I have experienced most of this, minus the enemas and laxatives. It's a scary time for most. We feel like we have control over what we are doing; our eating, not eating, purging, working out to burn off every calorie we consumed. But the truth is this behavior shows a complete lack of control over what is happening to us. It is as if we are answering to a separate entity other than our selves.
One of the first case studies about the disorder was recorded in the early 1900s, it is one of the most descriptive details we have from the patient's perspective. The patient's name was Ellen West. she committed suicide at age 33 because she could no longer handle her disorder and the struggle she had manifested itself with an obsession with food. She wrote this in her diary:
"Everything agitates me, and I experience every agitation as a sensation of hunger, even if I have just eaten.
I am afraid of myself, I am afraid of the feelings to which I am defenselessly delivered over every minute. I am in prison and I cannot get out. It does no good for the analyst to tell me that I myself have placed the armed men there, that they are theatrical figments and not real. To me they are very real."
This is powerful. I mean, I can recall a very specific instance where I was crying on my kitchen floor. Something overcame me and I could stop crying. I felt pathetic and weak. I felt useless and wasteful. I had lost all control. If I were to read an excerpt from my journal it may say some of the same things as Ellen West. In fact, during my senior year of high school there is a passage that is three pages of nothing but "You are a worthless, fat big. No one wants to be around you" over and over again.
I was so ashamed. I didn't want to tell anyone. It wasn't until recently that I told my husband, my sister Andrea, and my friend Christine. I told them how severe it once was and how I still suffer with it. Even as I sit here now I feel guilty about what I ate today. It doesn't matter how irrational I know it is, rationality doesn't exist in the world of someone with an eating disorder.
Then there's bulimia nervosa. While it is very similar to anorexia some of the behaviors vary as well as some of the basic mentalities or reasons for their behavior.
307.5 Symptoms of Bulimia Nervosa:A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following-
1) eating, in a discreet period of time, an amount of food that is definitely larger than most people would eat during a similar period period of time under similar circumstances.
2) a sense of lack of control over eating during the episode (e.g., that one cannot stop eating or control what or how much one is eating).
B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.
C. The binge eating and other inappropriate compensatory behaviors both occur, on the average, at least twice a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
-Purging type: during the current episode of bulimia nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.
-Non-purging Type: During the current episode of bulimia nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive excercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.
Other than bulimia and anorexia, there is also an activity disorder which is characterized by excessive activity to burn calories and not stay still.
I used to use my toothbrush to trigger my gag reflex to purge after eating. I have done a good job of not doing that, but I remember a friend of mine and I in high school getting our hands on some ipecac.
But the question is, how did this happen? How did we get this way? There are various theories as to how these disorders can develop within a person. And that will be addressed in the next post...that will be equally long.
sources:
The Eating Disorder Sourecebook by Carolyn Costin, M.S., M.Ed., M.F.T
The Secret Language of Eating Disorders by Peggy Claude-Pierre
The Thin Woman by Helen Malson
you remind me of you by Eireann Corrigan
and myself
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