Understanding the misunderstanding of Anorexia
Anorexia is a first world problem, right? A middle class, attention seeking, vanity-driven ‘fad’, right? Wrong. The common misconception that eating disorders are about striving for the ‘perfect body’ is still rife.
In reality, while ‘perfectionism’ is indeed a huge driver of the illness, weight loss is in fact just a side effect of this incredibly dangerous mental health condition. Anorexia has the highest mortality rate of any mental illness, either through suicide or heart failure.
Anorexia is about control. Control of self and control over emotions. When the body is starving, emotional response is numbed by the cognitive impairment of malnutrition. One might seek this kind of control if they feel out of control in other areas of their life causing emotional distress. Anorexia is addictive, and much like an addict misusing drugs or alcohol for escapism and avoidance, maintaining an eating disorder serves a similar purpose. Don’t eat, don’t feel. Shut down so no-one can hurt you. Be as small as you can so no-one can notice you until it has you all to itself – your best friend. People use many different methods to cope with emotional pain and while these methods do provide a short-term relief, as they take hold and become part of your identity, your own identity is being lost. Your true self is hijacked by an illness that claims you for its own. The sufferer knows it and loved ones witnessing the changes in behaviour, physical health and ability to function know it too.
Anorexia hooks onto any vulnerability it can until self-worth and self-esteem are completely destroyed and the sufferer becomes socially isolated from family and friends because anorexia is a hard taskmaster. It demands perfection and it demands total commitment, at all costs.
Clients I’ve worked with over the years have often described living with an eating disorder as like being in an abusive relationship; brainwashed to believe it’s the right thing for them and all they deserve, yet being brutally psychologically punished at the same time. Imagine for a moment, having someone standing directly behind you at all times, constantly shouting at you that you’re worthless, pathetic, weak and you must eat less and less and exercise more and more to dull the shouting on the promise that you’ll feel better if you do. Except you don’t, because it’s never enough. No number on the scales is low enough and no amount of sit-ups or miles run, all day, every day, is enough. The expectation of anorexia is unachievable because it’s never satisfied, but you must keep trying or you’re a failure. Maintaining an eating disorder requires the most extraordinary amount of discipline, time and energy and becomes obsessional and compulsive. It creates a mistrust of any other influences which intensifies social isolation as sufferers strive to avoid situations where they might be challenged on their health, both physically and mentally. As a result, sufferers can become de-skilled at interacting with others and work harder to avoid social contact. Left with a core belief that they don’t deserve comfort, rest, food, friends or happiness, leaves little room for anything else but to continue to appease the illness.
The paradox of living with any addiction, be it an eating disorder or substance misuse, is that while the function of the illness is to numb and escape, what usually remains and therefore drives the illness further, is the sense of shame, guilt and disgust that the sufferer experiences and it’s often these powerful emotions that have led someone to use their chosen form of escapism in the first place. Understanding and acceptance of this emotional pain is the first step in recovery for someone seeking help. Learning to re-build relationships, both with others, but importantly with ones self, is the beginning of the journey of reclaiming your identity and self-worth.
Sadly, due to lack of community services in this field, the mental health system in the UK currently tends to only take action when someone with an eating disorder is at a critically low BMI, which of course reinforces the belief that ‘you’re not ill enough to deserve help’ until you can hardly walk. What people don’t always understand is that anorexia is a psychological illness, regardless of what weight someone is. A person can still be anorexic at a healthy weight because it’s the core beliefs, emotional trauma and thought processes that really matter, not just how underweight someone is. So yes, those living in third world countries who might not have the option to use food as a coping mechanism probably don’t have as high a rate of eating disorders as we do in the west, but I’m sure that the human core of dealing with emotional distress will manifest in different ways to achieve the same goal, and it’s this that we need to be attending to.