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Middle class and starving to death in America – An Eating Disorder called Anorexia

Posted May 25 2012 4:00am

Anorexia is a killer  

We know Anorexia Nervosa, Anorexia for short, is out there. This eating disorder can be a fatal disease. Most of us can name a famous celebrity or two who suffered and died as a result of Anorexia. But when someone we know, someone in our family develops Anorexia we are likely to look the other way until it is too late.

Anorexia Nervosa, along with Bulimia and Eating Disorder Not Otherwise specified, mostly binge eating without an effort to lose the weight, these are the three currently recognized eating disorders. There are many misconceptions about Anorexia.

Anorexia is not dieting gone to far. Anorexia’s most recognizable feature is a refusal to maintain normal body weight. It is a distortion in the way the person sees themselves. The person with Anorexia sits in front of me. It is hard for me to look at them. The bones are visible and they look like a skeleton walking. They hid this from people for a long time with baggy clothes, strange secretive eating habits or other devices.

Anorexia is not a loss of appetite. Even in the presence of extreme hunger someone with Anorexia will refuse to eat.

I ask the person with Anorexia what she thinks of her weight. She says she needs to lose some weight, she is getting fat. I ask how much weight, she tells me five maybe ten pounds.  If I were to show her the mirror, let her see the bones sticking out, would that change her mind? Not likely. People with Anorexia even when confronted with a look at the bones that stick out will still insist they are too fat; they need to lose more weight. The problem is not in the diet but in the mind. The image in the mirror looks fat to them.

It is not about a lack of interest in food. Many with Anorexia watch cooking shows, own recipe books and even hoard food. In the early stages they may develop odd picky eating preferences and habits. Some appear to have Obsessive Compulsive Disorder when it involves food, weight and dieting. They may refuse to eat in public and insist on taking their food to their rooms. They may have a strong perfectionistic inclination.   

They know the ingredients in the foods and can tell you more about the nutritional values than most dietitians, only they refuse to eat until they damage some organs. Sometimes the dieting and the other behaviors continue until death.

You don’t see a lot of Anorexia in poor families. It is more likely among the middle class and rich. All the resources in the richest country on earth and still they starve – on purpose.

The thing that matters most to the anorexic is not the food – it is the control. They may have no control in any other area of their life but you can’t make them eat. Force feed them and they will vomit. The ways a person with Anorexia may reduce their weight are varied and imaginative. The may restrict, purge, use laxatives or exercise to the extreme.

Anorexia doesn’t just cost weight. It affects a persons overall psychical health, their psychology and their social life.

Anorexia is most often not a stand alone disorder. It like the other eating disorders, Bulimia and Binge Eating, frequently co-occur with anxiety and depression.

Besides the low weight how can you tell if it is Anorexia and not just a dedicated dieter?

Someone with Anorexia will weigh less than 85% of what is considered normal for their height and age. They become extremely fearful of gaining any weight even when they know that they are thinner than their peers.

In women they will have missed three or more menstrual cycles.

Someone with Anorexia sees their extremely low weight as a great achievement rather than a life threatening illness.

Anorexia is not a phase teenagers go through even though many first develop the symptoms in their teen years. It is a life threatening illness. Without treatment it is highly unlikely to go away and is very likely to get worse until eventually it impairs heath and may result in death.

Dieting is not the only way someone with Anorexia might control their weight. Some binge eat and then purge, they may develop a ritual around their efforts to vomit and undo the binge eating. Those with Anorexia who binge and purge are more likely to develop other impulse control problems; they may abuse drugs and alcohol and engage in excessive risky sex. Those who binge and purge are more likely to attempt suicide.

Anorexia Nervosa affects about one in two hundred people. Lots more case come close but don’t get diagnosed because they don’t get below the 85 % of normal weight measure. Most clients with Anorexia are female and this disorder most often starts in the early to middle teenage years, but not always.  

Most any clinician can recognize and diagnose Anorexia but very few are willing to treat this condition. Even psychiatric hospitals are likely to refuse clients with Anorexia because of the high risk of permanent medical problems or death. There are effective techniques for treating Anorexia but they are specialized and often treatment occurs at treatment facilities that specialize in eating disorders.

Anorexia is a dangerous sometimes fatal condition. If you or someone you know has signs of this disorder please seek professional help before it is too late.

In a future post we should look at Anorexia’s cousins, Bulimia, Binge Eating and a proposed new DSM-5 eating disorder Avoidant/Restrictive Food Intake Disorder.   


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