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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. 

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My doctor checked me over and told me to come back in two weeks so that she could monitor my weight — by the time I went back, I had lost almost seven more pounds. I now scraped the bottom of the normal BMI range for my height. This time, I was told in no uncertain terms that I needed to start eating more, and that if I didn’t, my heart rate would start falling and my body would begin to shut down in response to starvation. I needed to come back that very Monday — only five days away. Monday came around and another two pounds had gone. 

I was quickly diagnosed with Anorexia Nervosa and was told to come back for weekly weigh-ins in addition to psychotherapy and appointments with a nutritionist, but, oddly enough, I no longer thought I needed help. I rejected the meal plans that I was given, refused to continue meeting with my nutritionist, shuddered at the suggestion to “restore my weight,” and brushed off my parents’ worries. I know what I’m doing, I thought with frustration. They don’t get it

It’s such a slippery thing to fall into the open arms of an eating disorder. It happens so quickly; you feel like you have complete control and like it’s all harmless, and then suddenly it gets away from you and becomes a monster all on its own. Even as I went through the motions of “recovery,” I mentally rejected the diagnosis. How could I have Anorexia? My weight might be a little low, but I wasn’t skeletal. I didn’t look like the poster girl for Anorexia. I didn’t look like I needed treatment.

That is the insidiousness of this eating disorder: it tricks you into thinking that you don’t need help when you do, all because of a number on a scale that will never be low enough. You tell yourself that you will be happy once you lose a certain amount more, but when you reach that amount, you will not be satisfied and you will set another goal. It will become a ceaseless game of limbo that could very well land you in a hospital bed one day, if not an early grave. Anorexia is the deadliest of all mental illnesses, with a whopping 20% mortality rate when left untreated. Death rates increase ten-fold if the individual is diagnosed between the ages of 15 and 19, and 18-fold if they are diagnosed between the ages of 20 and 29. Early treatment is critical for a better shot at recovery, but how can early treatment be provided if the DSM specifies low weight as a requirement for diagnosis? 

Listing “significant low body weight” as a criterion for Anorexia Nervosa may be seriously exacerbating sufferers’ hesitancy to get help. To a healthy mind, there is such a thing as too thin, but to a mind sickened with Anorexia, that simply doesn’t exist — and the more the disorder kicks into gear, the more it tightens its grasp.

Because Anorexia progresses rapidly and becomes increasingly more difficult to treat down the line, perhaps the point that should be driven home is this: struggling mentally is enough of an indicator that you need and deserve help. At the end of the day, eating disorders are mental illnesses that wreak havoc on your body regardless of what you weigh. Removing physical characteristics from the DSM’s diagnostic criteria may be the first step towards acknowledging this fact, and to helping sufferers understand that their body is never going to be — and never has been — a defining factor in their illness.

Anorexia in Limbo


Anna Beloborodova

Anna Beloborodova is a Senior at Columbia University studying Psychology and English. She is a portrait photographer, videographer, dog owner and an aspiring writer. Anna is also the founder of Hearts over Hands, a volunteer-run service that provides childcare support to families impacted by COVID-19.

APA Reference
Beloborodova, A. (2020). Anorexia in Limbo. Psych Central. Retrieved on July 10, 2020, from https://psychcentral.com/lib/anorexia-in-limbo/
Scientifically Reviewed
Last updated: 3 Jun 2020 (Originally: 2 Jun 2020)
Last reviewed: By a member of our scientific advisory board on 3 Jun 2020
Published on Psych Central.com. All rights reserved.