Anorexia has the highest death rate of any mental disorder says the NIH. That’s why I want more people to know about eating disorders, and how to respond to those who are struggling.
Eating disorders are among the most difficult mental health conditions to understand and treat. Because they are so often misunderstood, eating disorders can go undiagnosed or misdiagnosed for a long time. Delay is a concern, because the earlier someone gets treatment, the better.
More of us can help those impacted by eating disorders. We can start by learning how anorexia shapes the way someone may think and act. Family and friends can make a huge difference by learning how to reach out to those who are suffering. Clearer understanding and recognition are keys to helping people with anorexia find the support they need.
A Definition of Anorexia
Anorexia literally translates as “loss of appetite.” Unfortunately, this literal meaning gives us a rather poor idea of what a person with anorexia is going through.
Digging deeper, we find anorexia comes from the Greek an- for “without” and orexis, for appetite or desire. Orexis, from oregein is to reach out with one’s hand.
Indeed, part of the anguish of anorexia is an inability to reach out for vital support. It’s about the inability to connect with the world in almost every essential way — for emotional connection, healthy relationships, family support, and even food.
Anorexia is a fear of eating that comes from a consuming drive to look thin. It’s a means of coping with feeling invalidated, isolated or inadequate as a person. Anorexia functions by attaching self-worth to body size.
Compulsive attention to weight and food may help numb and distract from an inner world rife with pain such as:
- Negative self-talk
- A sense of being “not good enough”
- Feeling “unwanted ”
- Feeling like “a bad person”
- Believing one is failing to measure up in some way
Maintaining a constant focus on one’s body is one way to keep complex, painful and nuanced emotions out of awareness.
On the surface, restricted eating behavior is about controlling what’s “allowable” to eat. But underneath, the person may desperately want a sense of belonging, imperfections and all. Seeking approval for thinness can become a means to cope with trouble with negativity, isolation, and low self-acceptance.
How Food Restriction Starts
Most of the children and adolescents in my practice who suffer from anorexia describe how they first decided to change their eating habits. It was their attempt to do the right thing.
For many, the struggle with food began after hearing about healthy eating from a person in authority, such as a parent, teacher, coach or pediatrician.
They may be told something like: “You shouldn’t drink juice because it has too much sugar.” The young brain takes the information from a trusted source and makes a life-changing decision: “Sugar must be bad. So I better not eat any sugar.” A decision to avoid all sugar can expand to include other processed foods that society labels “bad.”
In our culture, health and body size are often directly linked. Even adults in the medical community promote the false belief that a large body is inherently “unhealthy” and a thinner body is “healthy.” We see popular but, unsustainable drastic diets promoted for quick weight loss.
While not every young person or adult exposed to misleading ideas develops an eating disorder, some do. As the person watches their weight going down, they become more attached to the results and social validation. They may even redouble their commitment to “eat healthy” and anorexia takes hold, the person becomes afraid to eat any but a narrow range of foods and every day becomes an internal mental battle of what’s allowed to be consumed.
Anorexia Is a Brain Disease
Researchers are working hard to figure out what causes anorexia and what, if any, lasting effects anorexia has on the brain.
We know that the brains of people with anorexia are different than other people’s brains. What we don’t know is what brain conditions were present before the onset of the illness and what brain conditions are a result of the illness. While the research can be overwhelming and hard to keep up with for family members and friends, here are some takeaways that can help support a loved one.
People with anorexia have an altered nervous system that overrides “will.”
People with anorexia make many of their decisions regarding food and their body as a result of changes in brain and hormone functions. These are not subject to “will.” This is critical for family members to understand. It can minimize the frustration and helplessness of watching a loved one fail to use ” reason” or “willpower.” Blaming a person with anorexia for their behavior is akin to blaming a person with a broken leg for not being able to walk. There is considerable pain in the activity.
The body’s natural pleasure response to food is no longer working.
People with anorexia have a hard time experiencing pleasure. With anorexia, a key neurotransmitter that controls pleasure and other states — serotonin — is out of balance. Serotonin helps regulate memory, learning, sleep, mood, and appetite. For people with anorexia, sometimes there’s too much serotonin and sometimes there’s not enough. With starvation, serotonin levels drop, which can lead to depression. When serotonin levels are, high, anxiety or obsessiveness often result. As people with anorexia often cycle through lower and higher levels of serotonin, they create a catch-22 situation which reinforces a hyper-focus on food restriction.
The body is in survival mode, and stress hormones are working overtime.
Dopamine levels are also different in the brains of people with anorexia. The over-production of dopamine in anorexic brains leads to anxiety, harm avoidance, hyperactivity and the ability to go without pleasurable things like food.
Parts of the nervous system needed to process sensations have grown smaller.
Gray matter is the part of the central nervous system involved in muscle control, perception from the five senses, memory, emotions, speech, decision-making, and self-control. People with anorexia have less gray matter than non-eating disordered counterparts. The good news is that with full weight restoration in long-term recovery, gray matter volume can increase.
Signs a Loved One May Need Support for Anorexia: What To Look For
So as a parent, sibling or loved one, what can you do?
- Keep an eye out for rigid eating behavior. Inflexible behavior may signal that a person is struggling emotionally inside.
- Also pay attention to isolation – All eating disorders thrive in isolation where negative self-talk and internal criticism are left to flourish.
- Be aware of persistent avoidance. To control their exposure to food, and their sense of shame, people with anorexia may avoid activities that friends and family want them to participate in. For example, a person may refuse to go to parties or birthday gatherings where food plays a prominent role. There is a desire to avoid eating with others and publicly refusing cake or other “fun foods.” And no one wants to show up only to be judged for their food choices or appearance.
- Look out for exhaustion. Anorexia takes up a lot of a person’s time and mental energy, which to the outsider seems selfish. In reality, the mental gymnastics a person is going through to keep restricting food is exhausting.
Understanding Recovery from Anorexia
For a person with anorexia, working with a treatment team specializing in treating eating disorders is very important. Friends and family can also learn a lot about positive changes to make at home and in relationships. There are a number of resources dedicated to recovery from eating disorders — a few are listed below.
Coming to terms with anorexia and over-controlled eating may be one of the most difficult things a person can ever do. A person’s body image is often closely tied to one’s sense of worth, value and wellbeing. Shifting the mental link between body size and self-worth can take years and does not happen easily.
Anorexia Treatment: What to Expect in Therapy
Therapy itself may involve the challenge of giving up self-controlled eating. Part of recovery means working with health professionals such as specially trained dietitians about what and how much to eat.
The other part of recovery includes learning how to disentangle self-worth from body size, manage uncomfortable feelings such as disappointment, rejection, failure, or loneliness once numbed by compulsive food control, and trusting one’s body to signal hunger and satiation.
Skilled therapy is key to finding support for overwhelming, negative responses linked to regaining weight. New studies show anorexia isn’t limited to certain demographics; it impacts more diverse populations than people may believe. Our understanding needs to keep growing, based on continued research to determine causes and treatments.
Support for wellness can start with awareness of the difficult challenges people are facing when they seek recovery.
We Are Here For You.
We have special training and experience in the treatment of eating disorders in Alexandria, VA. To learn more please contact us:
FEAST – An organization with many resources for caregivers, family and friends – anyone impacted by an eating disorder
Resources for Health at Every Size from Dr. Linda Bacon
Eating Disorder Hope – https://www.eatingdisorderhope.com