How many times have you glanced at the cover of Vogue or Men’s Health and felt overwhelmed by the impossibility of looking like the flawless models gracing the cover? If so, you’re not alone. Even for those blessed with good genes and a strong discipline for both diet and fitness, the reaction to these unrealistic images is understandable. Most people either ignore them, or use them as motivation to skip dessert or get up for that 5:30am run.
But for a growing segment of adolescents and adults, women and men with certain genetic, emotional and/or life experience predispositions, seemingly healthy attempts to improve their diet can trigger the onset of a disease with life-threatening consequences. It can sometimes be difficult to distinguish the line between what looks like efforts to improve one’s health and when those same behaviors become symptoms of a potentially life-threatening eating disorder known as anorexia (anorexia nervosa).
Anorexia nervosa is characterized by the conscious refusal to maintain a healthy body weight, and by the distorted perception of being overweight by someone who is underweight (often severely so). In total, it affects one to two percent of the female population and 0.1 percent to 0.2 percent of males in the U.S. The first symptoms of anorexia often begin to appear in early adolescence, yet is most common among women aged 18 to 25. Most people in recovery describe that their earliest symptoms involved becoming more and more preoccupied with thoughts about weight, food, and body—sometimes for years before taking any noticeable actions to control their weight.
How do I recognize anorexia?
Dieting that moves beyond healthy behavior, such that one becomes fixated on achieving and maintaining an unrealistically low body weight is the strongest observable symptom of anorexia nervosa. People with anorexia are obsessively preoccupied with their weight and body composition, and intensely afraid of any weight gain, real or perceived. Their self-esteem becomes disproportionately linked to what they see in the mirror, and they gradually lose the ability to see themselves accurately, or to make healthy decisions about food.
While the exact causes of anorexia are unknown, recent research indicates that neurotransmitters in the brain are frequently decreased in patients with anorexia in much the same way as individuals with depression. Besides weight loss, the most common signs or symptoms of progressing anorexia are personality changes, decreased time spent with family and friends, increased amount of time spent exercising,, and an increase in obsessive tendencies or perfectionism.
Why is it so hard for a person with anorexia nervosa to acknowledge the problem?
Like other professionals who regularly treat people with anorexia, I’ve observed that many women and men diagnosed with this disease are very driven to succeed at the highest levels in academics, sports and professionally, and at times project an image of confidence, strength, power and control. But on the inside, these seemingly successful people are never satisfied with themselves or their performance. They turn their energy to controlling what they think they can, their bodies, to avoid facing all that really is beyond their control. Many people with anorexia blame their physical form and appearance for any perceived shortcomings or failures, and respond by severely restricting their food intake.
They may also have extreme difficulty experiencing emotions and other uncontrollable circumstances associate with being human. Self-induced starving serves as a way to “medicate” and numb these feelings for people with anorexia. Controlling their food intake, they may not eat for days at a time, or limit themselves to eating only a few foods they identify as low in fat, high in protein, or otherwise fitting into an extreme or peculiar diet. Some people with anorexia nervosa also engage in binge-purge behaviors with food.
As anorexia progresses, the disease begins to rob its sufferers of their most important life goals. Patients with severe anorexia lack the ability to acknowledge seemingly clear signs that their health is in danger. Their anxiety over weight is often made worse by well-meaning efforts from friends and family to call attention to their emaciated appearance, or to suggest a connection between their relationship with food and other problems they are having.
What happens if anorexia goes untreated?
The physical complications associated with anorexia nervosa are potentially life threatening. Dehydration and malnutrition can result in low blood pressure and damage to vital organ systems leading to cardiovascular problems, osteoporosis and even death. While some people with anorexia receive proper treatment and recover before their health is irreversibly compromised, the majority of untreated or under-treated people with the disease experience a chronically deteriorating course of illness over many years. The mortality rate for anorexia nervosa is the highest for any psychiatric illness in the U.S. To put this in perspective for you, among women ages 15 to 24 with anorexia, the death rate is 12 times higher than the annual death rate due to all other causes. The most common causes of death are cardiovascular complications and suicide.
That’s why it’s so important to recognize the early symptoms of anorexia and to seek help from a professional specializing in treating eating disorders. What I’ve learned over the past decade of practice is that anorexia nervosa rarely occurs in a vacuum, and is most often accompanied by other co-occurring disorders that can go unrecognized or untreated. Successful treatment of anorexia usually involves coordination among several different healthcare professionals, such as a psychiatrist, a psychologist or other therapist, an internal medicine specialist or cardiologist, a nutritionist, and a family therapist. It is important to realize that the disease impacts the whole family, and the whole family deserves support in recovery. Commonly, once the family takes initiative to begin family therapy, the member with anorexia becomes more willing to engage in her own treatment.
By the time you notice signs in your own behavior or in a family member, spouse, or friend, it’s likely that the problem is already serious and the risk of long-term medical complications is very real. Despite all the attention to body image in the media and pop culture, we must recognize anorexia nervosa for what it is: a deadly and serious medical problem, not just something in the affected individual’s head and not just a phase that all girls go through.