Living with Anorexia Nervosa
Most cases of eating disorders can be treated successfully by trained mental health care professionals. Treatments do not work instantly, however; it may take time to shift habits and thinking. The key to understanding anorexia, and other eating disorders, is that it’s not about food or food intake. It’s a coping mechanism for dealing with emotional problems. When you have anorexia, you often equate thinness with self-worth.
It is estimated that 1.0% to 4.2% of women have suffered from anorexia in their lifetime.
Approaches may vary, depending on severity of the disease, as well as personal choices.
Jennifer L. Gaudiani, MD, CEDS worked with Dr. Philip Mehler to open up the nation’s only medical stabilization program for patients with severe anorexia nervosa, the ACUTE Center for Eating Disorders at Denver Health.
“My personal philosophy on the way I treat my own patients is to bring an authentically loving, enthusiastic, evidence-based, and straight-talking manner to the bedside. I believe strongly as an internist in emphasizing the ways each patient’s body is responding poorly to starvation or purging, in order to motivate change,” Gaudiani says of her own approach.
She emphasizes empowering the patients own healthy voice with responses based on objective evidence.
For those struggling with anorexia, it serves a number of functions. Uncovering those functions, or emotional needs, and discovering healthier ways for you to fulfill them is imperative to successful treatment and rehabilitation. Restricting your food intake gives you a sense of empowerment and control in life, when it may feel unattainable otherwise.
What is Anorexia Nervosa?
Diagnostic criteria for Anorexia Nervosa from the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) is as follows:
- Restriction of energy intake relative to requirement, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
- Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Accompanying personality traits include:
- Sensitivity to reward and punishment, harm avoidance
- Obsessive thinking
- Neuroticism (emotional instability and hypersensitivity)
- Rigidity and excessive persistence
When asked about contributing factors to those with anorexia, Kait Fortunato Greenberg, RD, CEDRD, Certified Eating Disorder Registered Dietitian at Begin Within Center, cited particular ones she’d seen directly in her own work, which include genetics, cultural factors, dieting, and physiological co-morbidities. “Often times an eating disorder presents with other co-morbidities, such as depression, anxiety, loneliness, and high stress, and it is important for recovery that these be treated in addition to treating the eating disorder,” she says. “Treatment is most effective when clients get nourished properly and weight restored and work through the mental aspect of the disease with therapy and psychology.”
Addressing all aspects of this disorder — mental, emotional, and physical — in equal part is critical. However, there is misinformation out there, too. Below are some myths about anorexia:
Myths About Anorexia
Myth: Skinny Models Are the Problem.
Beautiful, thin people get a lot of attention, and they become the ideal for a lot of young women. But while images of dangerously thin women in the media play a role in promoting anorexia, they’re just one of many factors — and probably not the most important one.
University of Michigan eating disorder specialist Dr. David S. Rosen says heredity plays an important role. “Scientists have discovered that the genetics of eating disorders are pretty similar to the genetics of depression, schizophrenia, and other psychological disorders,” he says. And personality traits such as lack of flexibility and anxiety often accompany anorexia.
Myth: Eating Disorders Are Rare.
Only about 0.5 percent of the population have anorexia, and 1 percent to 2 percent have bulimia, says Dr. Rosen. So yes, the disorders are rare. But that’s only because the criteria doctors use to diagnose the disorders are so strict.
Myth: Anorexia Is All about Starvation.
A desire for extreme thinness and actively starving one’s self are common traits of women with anorexia, but they’re not the main ingredients of the disorder. Anorexia is really all about having a distorted body image, Dr. Rosen says. So just because someone isn’t skeletal doesn’t mean he/she doesn’t have anorexia. For example, a woman who had been overweight may now be of normal weight and still have anorexia.
Myth: Individuals with Anorexia Are Just Trying to Get Attention.
People do not develop anorexia in order to gain attention. Although it is maladaptive, anorexia can sometimes serve as a person’s way to cope with something painful in his or her life.
Myth: Anorexia Is a Rich, Young, White Girls’ Problem.
Research has shown that this is not true. Those from any racial, ethnic, or economic background may suffer from this disease — anorexia does not discriminate. It affects young and old, male as well as female.
Myth: People with Anorexia Do Not Engage in Binge Eating.
People with anorexia may sometimes engage in binge eating. Binge episodes are often followed by an attempt to purge what has been consumed through the use of laxatives, vomiting, or excessive exercise.
Myth: People Choose to Have Anorexia.
People do not choose to have anorexia. Like other forms of eating disorders, it is a serious psychiatric illness.
Treatment for Anorexia
Anorexia will always require treatment. This may mean doctors’ visits and regular counseling sessions. A inpatient hospital stay is necessary for those with severe medical problems or who are severely underweight. The goals of treatment are to restore a healthy weight and healthy eating habits.
If you have an eating disorder, try not to resist treatment. Although you may be very afraid of gaining weight, it is imperative to understand that increasing body weight is a actually life-saving measure. With professional help, you can learn to eat properly and keep your weight at a healthy level.
Professionals who will help you overcome this disease include either a licensed counselor or a psychologist, a registered dietitian, and a medical health professional, such as a nurse or a doctor — each with experience in treating eating disorders.
If your medical condition is not life-threatening, your treatment likely will include:
Medical treatment. Medical intervention will be a top priority if malnutrition or starvation has started to break down your body. Your doctor may treat conditions such as osteoporosis, heart problems, or depression. You may also need frequent monitoring of vital signs, hydration level and electrolytes, as well as related physical conditions. As you begin to get better, your doctor will continue to follow your health and weight.
Nutritional counseling. A registered dietitian will help you by developing healthy eating patterns and give a you a better understanding of the importance of nutrition. They will help you take control of your weight in a healthy manner.
Psychotherapy. Talking with a psychologist will help you determine the emotional reasons behind anorexia. For example, you may discuss life stresses, unhelpful beliefs about food and weight, or certain personality traits that may be, in part, causing anorexia.
- Family-based therapy. This therapy helps to mobilize parents to assist their child with developing healthy eating habits and encourage weight restoration until the child is capable of making their own health choices. This the only evidence-based treatment for teenagers with anorexia. Parental involvement is critical, as the teenager suffering from anorexia is unable to make good choices about eating and health while battling this serious condition.
- Individual therapy. For adults, cognitive behavioral therapy — specifically enhanced cognitive behavioral therapy — is a proven method for treatment. Developing healthy eating patterns and behaviors to support weight gain is the main goal of CBT. Additionally, seeking to modify distorted beliefs and thoughts that revolve around restrictive eating is another goal. This type of therapy is generally done once a week or in a day treatment program, but in some cases, it may be part of treatment in a psychiatric hospital.
Programs. Some clinics specialize in treating people with eating disorders. Some may offer day programs or residential programs rather than full hospitalization. Specialized eating disorder programs may offer more intensive treatment over longer periods of time.
If you are suffering from a severe case of anorexia, your treatment will likely include:
It may be necessary for hospital ER treatment for the following issues: heart rhythm disturbance, dehydration, electrolyte imbalances or psychiatric problems. Your life might be in danger with these physical effects. You may need to be hospitalized for medical complications, psychiatric emergencies, severe malnutrition or continued refusal to eat. If you are admitted to a hospital, it could be on a medical or psychiatric ward.
It is important to be mindful of some of these practices when working toward recovery of anorexia:
- Taking control of your eating habits
- Learning emotional self-care
- Building trust in people who are trying to help you
Treatment for Teens with Anorexia
For the teen with anorexia, family involvement is a key part of treatment. Family therapy helps parents support their child, both emotionally and physically. The Maudsley method is a form of family therapy that helps children and teens who have anorexia. This method assists parents to properly feed their child and develop healthy eating habits for their child. It can require a bit of perseverance and be a challenging task that involves the whole family, however, a Maudsley therapist can help the family attain their goals. After your child or teen has gained enough weight, treatment will begin to address more general family issues.
Siblings will also need support during treatment. Family, group, and individual counseling can all be effective and are often combined.
When asked about the future of anorexia nervosa treatment, Dr. Gaudiani says it best:
“For eating disorder treatment particularly, I hope that medical professionals can get better at treating eating disorder patients at all stages of the disease. And broadly speaking, as a feminist, sister, mother, daughter, and friend, I hope we find ways to support (not undercut) each other’s successes, challenges, health, general wellness, and joy in life.”
Carmosino, A. (2020). Living with Anorexia Nervosa. Psych Central. Retrieved on October 1, 2020, from https://psychcentral.com/eating-disorders/living-with-anorexia-nervosa/