Anorexia in Limbo
When I was sixteen years old, I met every requirement in the DSM-IV criteria for Anorexia Nervosa. My Body Mass Index (BMI) hovered just below 17.5, I was obsessed with counting calories and becoming skinnier, I was terrified of gaining even a single pound of weight, and I lost my period for longer than three consecutive cycles. My iron and ferritin levels fell below normal and I was tired all of the time. Before long, I was avoiding eating with my friends and family, and I had given up my favorite sports because I was too weak to run the warm-ups. I was never diagnosed with an eating disorder, however; I refused help because I felt that I was never thin enough.
When we think of someone with Anorexia Nervosa, we might picture someone like who I just described: underweight, sickly, and perpetually exhausted. However, these physical characteristics appear only over long periods of time; in order to actually exhibit them, one needs to have been struggling mentally for a while beforehand. One does not simply go to sleep one day healthy and wake up the next underweight and malnourished. Anorexia takes hold and develops over months or even years, and it is mentally debilitating long before its physical implications begin to emerge. Why, then, does our perception of Anorexia Nervosa hinge so heavily on its physical side-effects, and tend to focus less on the mental state that precedes it? The DSM recognized this issue in part and updated the criteria for Anorexia Nervosa in the new DSM-V; no longer is it necessary to have an absent menstrual cycle or to be at a particular BMI in order to be diagnosed — although a “significantly low body weight” is still required. In theory, such an emendation allows those who are struggling with the mental aspects of Anorexia to receive diagnosis and treatment, before all of the dire physical effects set in. But why is physical appearance still being factored into the equation at all? Is it merely perpetuating the concept of being “not thin enough” to have Anorexia?
At sixteen, I was lucky enough to eventually re-attain a healthy weight, thanks to the intervention of my family, support from close friends, and a year of veganism. My energy levels rose, my blood normalized, and I deleted the calorie-counting apps from my phone. I didn’t learn how to love my body, but I learned how to live in it.
In retrospect, I ask myself why I never felt like I deserved to get help. In fact, I was doing quite the opposite of getting help — I was actively trying to dig myself deeper into my disorder. I spent a good part of my time on MyProAna (a pro-Anorexia forum) getting advice on how to reach new “goal weights” and how to starve myself without passing out in class. I was swept into an entire community of people who I felt understood me the way that no one else did. Worst of all, I felt like I needed to lose more weight to become comfortable in my body, and eating normal quantities of food filled me with intense feelings of shame and disgust.
It seems that eating disorders have a knack for giving their victims a nasty case of Stockholm Syndrome. Could this be one of the most dangerous, but least addressed, features of Anorexia Nervosa?
When I realized that I was slipping back into disordered eating in college, I wanted to get help as quickly as possible. My old habits took hold subtly, beginning with an effort to eat less sweets and hit the gym a few times a week; then I was looking back and realizing that I hadn’t eaten dinner with my friends in months. I was counting pistachios into tiny tupperware containers, living off yogurt and applesauce for days at a time, refusing lunches with my parents on weekends, and avoiding hangouts with my friends like the plague.
I couldn’t focus on anything other than food and calories. Schoolwork went on the backburner. My days very quickly became reduced to numbers: numbers on the backs of labels, on scales, and on tape measurers. I obsessively counted and recounted every single calorie in every morsel of food that I consumed, over and over again. I scribbled down meal plans into every notebook and onto every handout in class, and made checklist after checklist in the Notes application on my phone. The amount of calories in an ounce of walnuts, half a spoonful of peanut butter, and a cupful of blueberries became second nature to me.
As the months went on, the physical symptoms began to follow suit; I lost fifteen pounds, my collarbones and hip bones began to protrude, and my clothes sagged. I had been a healthy weight to begin with, so this was enough of a loss that the people who knew me pulled me aside to ask if I was alright. This time around, I knew that I wasn’t; what was happening was all too familiar to me. I felt afraid and unwell, and yet still I hesitated to get help. I feared that maybe, because my weight was still within the “normal” range for BMI, going to the doctor would be an overreaction. It wasn’t until a few weeks later, when I nearly fainted at a coffee shop, that I finally booked an appointment.