5 Questions & Answers About Anorexia

I'm pleased to re-introduce today's guest blogger, Dana Lise Shavin, author of The Body Tourist, a memoir about the six years following her recovery from anorexia nervosa.   Last year she wrote a guest post about her experience and it was so well-received that I'm thrilled to have her back.  

5 Questions for the Anorexic—and Answers

by Dana Lise Shavin

If you’ve been told you’re anorexic, then you’re familiar with the questions below.

Aren’t you hungry?

Yes. I’m starving—literally and literally. It is excruciatingly difficult to severely restrict calories and at the same time maintain an exercise regime designed to burn off what little I still allow myself, so that I can continue to lose weight.

I am never “not hungry” except for in the minutes just after I (guiltily) ingested a few calories. I have never lost my appetite, only my ability to appease it. Because malnutrition interferes with the brain’s pleasure sensors, what I feel in the presence of food is powerful hunger wrapped up inexorably with extreme anxiety about eating it.

Can’t you see how thin you are?

No, I can’t. The reason for this lies partly in the realm of physiology and partly in the realm of psychology.

Physiologically my body, having used up its reserve of excess fat, turned to my muscles and connective tissues for fuel, and once those reserves were gone, it went after the neurons in my brain. Compromised (read: shrunken) brain capacity means I have serious problems with concentration, emotional lability (this is why I cry a lot or am otherwise moody), and difficulty remembering facts and events.

It has also thrown off my judgment, impaired my insight, deregulated my impulse control, and even interfered with my understanding of consequences.

Psychologically, I can’t see how thin I am because I have linked being happy with being thin, and although the number on the scale shows that I am extremely thin, I don’t believe it because I’m not happy yet.

And rather than question my hypothesis, I conclude I haven’t lost enough weight. I also can’t see myself clearly because I am emotionally unstable and wrapped up in control issues centering around my family, my body, and my independence, all weighty issues (if you will) that are causing me tremendous anxiety.

Also, look at our culture’s celebrities and models! Thin is in, and the thinner the better, right?  In short, I can’t see how thin I am because my brain is not processing information correctly anymore, I am anxious and emotionally unstable, I have erroneously linked happiness and thinness, and celebrities are modeling extreme thinness as desirable. All of this is why you telling me I’m sick and holding up a mirror to prove it just doesn’t work.

I dieted and I didn’t become anorexic. Why did you?

The short answer is that dieting alone didn’t lead to my eating disorder. Anorexia is a complex disorder that arranges itself around the seemingly innocuous behavior of dieting to lose a few pounds.

While most people will not become anorexic as a result of dieting, those who, like me, are also struggling with depression (50% of those with eating disorders meet the criteria for depression) (source: National Association of Anorexia Nervosa and Associated Disorders: ANAD), familial instability, a history of physical or sexual abuse, and/or who have absentee or weight-focused parents, are at a much greater risk for eating disorders.

Magical thinking also plays a role in the development of anorexia, whereby individuals who will become anorexic erroneously believe that weight loss insulates against pain, disappointment, and even death.

What will help you recover?

This is such a wonderful question, and one that will figure prominently in my treatment. First and foremost what must happen is I must be restored to a non-starvation weight, so that my brain can begin to function properly again. Without this, I cannot know that I am ill, and thus cannot begin to do the emotional work of recovery.

           

The second most important thing that will help me recover is posing this question to myself: Do I want to do this (i.e. starve, exercise myself into oblivion, live in the hospital or in my parents’ home) for the rest of my life? At twenty, despite my illness, what I know is this: I am unrelentingly hungry, always cold, and very lonely.

Losing weight has not dispelled my depression or won me more friends or a boyfriend, like I thought it would; in fact, it has pushed people away, isolated me, and made me MORE dependent on my parents: I’m unable to live independently because I’m a danger to myself.

Is this what I was going for when I set out to lose ten pounds? No. Is this what I want for the rest of my life? No. Is this what I’ll have if I don’t do the work of recovery? Yes, if I don’t die first. Because here’s a fact: eating disorders have the highest rate of mortality of any of the mental illnesses (source: ANAD).

What should I do if I think I, or someone I know, is in danger of becoming anorexic (or having any kind of eating disorder)?  

When I was 16, a friend confided that she had lost twenty pounds and couldn’t stop dieting, although ten pounds had been her goal. I called her mother. My friend was furious. But she got help.

There are professionals specializing in the treatment of eating disorders, and inpatient, outpatient and day treatment centers across the US. Getting help—for yourself or someone else—begins with your understanding that disordered eating can consume years of your life (at best) or, if allowed to go unchecked, can take your life.

If you are struggling with anorexic thinking—even if you’re of normal weight—make an appointment to talk to a professional. If it’s a friend or family member who’s suffering, don’t get into in a power struggle around food, eating, or weight loss.

You won’t get her (or him) to see herself clearly no matter how many mirrors you hold up. You will be of the most help if you invite her to talk, are supportive, and offer to make an appointment and go with her to speak to a professional. If it’s a friend and she refuses your help, tell someone else close to her (a parent, teacher, or spouse) what you suspect. If it’s your child, you must insist on treatment. Look into ANAD or the National Eating Disorder Association (NEDA) for help about how to proceed.

Dana Shavin, M.S., CPCC, is a certified professional life coach, speaker, and author of the memoir, The Body Tourist, about the intersection of her struggle with anorexia with her mental health career. 

Her book has been featured on the Remuda Ranch treatment center website, on Shape.com, and on the San Francisco Review of Books list. New York Times best-selling author Jacqueline Mitchard called The Body Tourist “…riveting reading, the biography of an illness as stubborn as the woman determined to kill it. Dana Lise Shavin can write with both hands, by turns comic and tragic, and always fiercely honest.” 

In addition to her long-running personal column in the Chattanooga Times Free Press, Dana speaks often about recovery and best life practices at both nondenominational and religious institutions and universities. She was a guest educator this past fall at the Meacham Writers Conference at the University of Tennessee at Chattanooga. Her essays have appeared in numerous literary journals and magazines including Oxford American, The Sun, and The Writer.  Her website is Danashavin.com.