mental health mondays :: the skinny on anorexia

anorexic patient photos from 1900

like most people, i first heard about anorexia nervosa in conjunction with the story of karen carpenter. like rock hudson with aids, the death of a celebrity suddenly pushed a little-known and widely misunderstood condition into the public eye. unfortunately, decades later, we're not really much closer to solving the mystery of why someone would actively starve themselves, possibly to death. what's more startling is that the nature of the disease itself may be changing.

the medical history of anorexia begins- more or less- with the work of sir william gull. gull's name, insofar as it's known today, is associated chiefly with a conspiracy theory that involves him being involved in the slayings of london prostitutes under the moniker "jack the ripper" [he's the bad guy in both the graphic novel and the film "from hell", although, for what it's worth, it's pretty damn unlikely he was in any way involved]. in his time, however, gull was known as a gifted physician whose patients included queen victoria. in 1873, he gave an address on two cases he had worked on, both of women who had been otherwise healthy, but who had lost shocking amounts of weight, to the point of becoming fragile and sick.

the condition remained virtually unknown outside the medical community until the 1970s, when hilde bruch published books on the subject that helped raise some awareness and finally became widely discussed with carpenter's death in 1983.



even now, anorexia is poorly understood. officially characterised as the refusal to maintain a body weight higher than 85% of what is considered healthy, along with other symptoms such as the cessation of menses, the definition itself has met with criticism since some doctors have noted that some patients continue to menstruate even though they are clearly anorexic. the causes remain mysterious, with genetics, childhood trauma, blood flow to the brain, hormones and neurotransmitters such as serotonin [which appears to be implicated in just about everything that goes wrong with the brain] all playing a role. interestingly, some studies have shown that dieting may actually serve as a trigger that causes anorexia in certain patients, rather than the other way around, setting in motion a chemical chain reaction that causes the person to perpetually, obsessively refuse food and attempt to lose weight.

that last element indicates why those in professions where the maintenance of low weight is deemed a priority are particularly vulnerable to the disease. what starts as a conscious effort to live up to the [sometimes unrealistic] standards of beauty and health becomes all-consuming [pun unintended] and takes on a life of its own.

generally, anorexia has been understood to be co-morbid with body dysmorphic disorder, a psychological disorder where the subject obsesses over a specific physical feature or trait, to the point of its causing severe anxiety or depression. body weight is one of the most common "problem areas" in those with bdd. not all bdd sufferers will develop anorexia nervosa or another eating disorder, but it has been widely accepted that anorexic patients have a form of bdd, where their preoccupation prevents them from accurately judging their own appearance- they become so obsessed with the fact that something is wrong that it literally can't see properly. the established logic was that anorexics simply didn't see that they were perilously thin because they weren't "seeing properly".

model eliana ramos, dead at 18

however, in the last several years, as models of beauty have grown increasingly waifish and their health has increasingly come into question, a new type of anorexia has developed. dubbed the "pro-anorexia" movement, those who have it exhibit the same obsessiveness about weight control and fixation on their bodies as traditional anorexics, but are fully committed to pursuing a goal that they know to be unhealthy. [previous popular understanding had been that anorexics didn't understand that they were thinner than the ideals they had set for themselves.] this newer twist seems to make the perversion of anorexia all the more salient- healthy individuals seeking to make themselves desperately unhealthy, to the point of causing serious and long-term physical harm.

the confusing nature of anorexia makes it notoriously difficult to treat. first of all, in a culture obsessed with weight and the achievement and maintenance of a perfect body, it's difficult to get someone to admit that they have a problem. second, treatment tends to be very long term. while the effects of malnutrition can be dealt with immediately, treating the underlying complications of depression and anxiety is a very long, arduous process. add to this the new "twist" that sufferers gain temporary happiness and a sense of self from their accomplishments in weight loss, the cultural trope that weight loss is always healthy, as well as the fact that, unlike other compulsive problems, it's damn difficult to avoid "triggers" [things that tend to make one dwell on the problem] and you have a real mess of a situation. a 2007 finnish study indicated that only about half of anorexia cases were even detected by the health care system and, in a result that is equal parts reassuring and chilling, recovery rates were about the same whether the subjects received treatment or not.

one of the things that works against anorexic patients, even more so than patients with other forms of mental disorders, is that it simply isn't taken that seriously. while diseases that disproportionately affect the poor and disenfranchised may lack for research and funding, there is an opposite problem, where conditions [like anorexia] that disproportionately effect the privileged are dismissed as being trivial. in addition, conditions that effect women to a far greater extent than men also tend to be trivialised. most people, in fact, if asked to list off all the mental disorders they could think of, wouldn't likely even include anorexia, despite the fact that it [according to the study cited earlier] is as prevalent as other conditions such as bipolar disorder.

because those who have anorexia, unlike those who have schizophrenia or autism, for instance, are aware that they need to take some steps to hiding their behaviour from others [particularly "new" anorexics who are aware of the unhealthiness of their compulsions], it's a condition that relies heavily on a sense of community and interpersonal responsibility to find treatment. that's a tall order, but something you might want to think about the next time you notice someone who exhibits symptoms of the disorder. sometimes dieting is not just dieting.