Sarah Lucas, LMFT

Anorexia nervosa is a very difficult illness to understand. Its literal meaning “loss of appetite for nervous reasons” is misleading because sufferers have not actually lost their appetites - they have lost the ability to allow themselves to satisfy their appetite. Contrary to popular belief, anorexia is an attempt to cope with life, rather than an effort to starve to death. Sufferers focus on food in order to cope with external and internal conflicts including stress, anxiety, and deep-rooted psychological issues. The eating disorder may become a way of asserting control over one aspect of their lives - their body weight and shape - when the rest of life feels out of control. In people with anorexia, these issue combined with low self-esteem and a strong desire for acceptance lead to obsessive dieting or starving to control more than just weight: it is a coping mechanism to avoid facing scary and painful feelings.

People suffering from anorexia nervosa restrict the amount they eat, often to dangerous levels. Ultimately, however, the illness itself takes control and the chemical changes in the body affect the brain and distort thinking, making it impossible for the person to make rational decisions about food. Eating and controlling food becomes an addictive-like obsession. Avoiding food and meals develops into a practice of self-restraint, and odd “rituals” like cutting food into tiny bites, eating strange foods in small amounts, or carefully and methodically weighing and portioning food. Because of the powerful need to control their body weight, all kinds of strict weight-control methods are used, including severe calorie restriction, intense and compulsive exercise, or ridding their bodies of the calories through vomiting or other compensatory methods.

Most people with anorexia nervosa are especially sensitive about being perceived as fat, and because of their distorted self-image, they often see themselves as “fat” even when they are dangerously underweight. This distorted view increases their anxiety, especially with regards to food and emotions. Many deprive themselves of any and all pleasurable activities, especially eating. As the illness progresses, many people suffer the extreme effects of starvation.

The course and outcome of anorexia nervosa is different for each individual: some people recover after a single episode; some struggle with ongoing cycles of weight gain and relapse; some experience anorexia nervosa as a chronic illness over many years, and some die. Full recovery from anorexia nervosa is not easy, and many patients continue to struggle with ongoing body image disturbances and disordered eating behaviors throughout their lives. Fortunately, with early treatment, the chances of recovery are much better. However, it is important to keep in mind that the recovery process is a gradual step-by-step process (often with some setbacks) and usually tends to take a long time, even years. However, patients in treatment can be monitored medically and psychologically in order to keep them safe. Without any treatment, patients may get worse and become medically and/or psychologically unsafe.

According to the American Psychiatric Association, an estimated one out of every 200 females and one out of every 400 of males have anorexia nervosa in their lifetime.