Anorexia and Bulimia: Starving to be Understood

Hello, Beautiful World!

This is going to be one, very exiting post as I'm entering uncharted territory. Although anxiety and depression were amazingly interesting topics, this week I'm going to be learning about two disorders I know very little about: anorexia and bulimia. The media examples will be all-new, so hopefully you guys will find that section even more interesting!

Before I begin, as always, I'd like to present some general statistics (and the definitions from NEDA) on anorexia and bulimia*:

• Anorexia (aka Anorexia Nervosa): a serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss.
• Affects 0.9% of the female population in America 
• 1 in 5 people with anorexia die by suicide
• 50-80% of the risk for anorexia and bulimia is genetic
• ~half of anorexia patients have comorbid anxiety disorders, and 33-50% have comorbid mood disorders
• Bulimia Nervosa: a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge-eating.
• Affects 1.5% of the female population in America
• ~50% of bulimia patients have comorbid mood disorder, and more than 50% have comorbid anxiety disorders

Something that really surprised me (but also didn't, oddly enough) was that patients with these eating disorders also suffered from other mental health issues, such as depression and anxiety. This was shocking because of the incidence; but also not, because I think these eating disorders are related in part due to a lack of self-confidence, poor self/body-image, and unhealthy eating behaviors. 

Similar to previous weeks, I conducted a survey and looked through modern, everyday media relevant to these eating disorders (and perhaps what contributes to them) before going in to meet with... Dr. Anné! To those who have never been graced with her wonderful, calming presence, Dr. Anné is a licensed clinical psychologist, eating-disorder specialist, and the founder and clinical director of A New Beginning. 

Julie T. Anné, PhD.

Her Beautiful Office

In terms of our meeting itself (which ended far too quickly), we started off the discussion by talking about what types of misconceptions patients generally come in with. Similar to anxiety and depression disorders, patients with anorexia and bulimia tend to come in feeling ashamed about their issues. However, the biggest thing that differentiates these patients is that they come in thinking that they will never fully recover from their eating disorder. This is the biggest, most common myth in the eating disorder realm. People can and do fully recover. Eating disorders, like anorexia and bulimia, are not like alcoholism (once an addict, always an addict). Although recovery can be hard and arduous, it is absolutely possible to achieve by getting through all of the layers of the disorder, thus preventing relapse.

From here, Dr. Anné and I discussed more about eating disorders, especially anorexia and bulimia, using the survey questions as a basis:

Misconceptions:

• Myth: Eating Disorders are solely about food, weight, and appearance.
• Truth: Anorexia and bulimia are very complex, seemingly abstract disorders. They are very deep-seeded psychological coping mechanisms that utilize one's body image and relationship with food, and use that to meet deeper psychological needs. 
• Myth: Eating Disorders are a choice ("someone is choosing to do this, starving him/herself, so they can simply choose to start eating again").
• Truth: Eating disorders are not a choice, but rather compulsive disorders, in a way. Although one has a choice to get help regarding his/her eating disorder, one does not have a choice to simply start eating again. Anorexia and bulimia are unconscious coping mechanisms, becoming an emotional lifeline for people until they develop healthy ways to deal with their emotional issues. 
• Myth: Anorexia and bulimia affect mostly females, especially in adolescence. 
• Truth: At least 10% of those who develop eating disorders are males; however, this percentage is likely greater because these are the only the men that have stepped forward to get treatment. Although eating disorders are very shameful for women, they're even more so for men because of the societal association between eating disorders and women. In terms of age, there is an uprise in middle-age disorders, meaning there are more and more clients in their 30's, 40's, 50's, and 60's with eating disorder issues with:
• one-third always having had an eating disorder, but never getting over it nor seeking treatment
• one-third having had an eating disorder that went away and then came back
• one-third being brand new cases (never having had an eating disorder)
• Myth: Bulimia is an effective means of weight control.
• Truth: With bulimia, although one will lose weight initially, it actually puts weight on him/her as the disorder continues. 
• Myth: Anorexia means eating only a very small amount of food, and bulimia is a simply a cycle of binging-purging (with purging being done through self-induced vomiting). 
• In terms of anorexia, you can have "anorexia" thought and behavioral processes even though you may be eating a relatively normal amount of food (whether that be counting every calorie or measuring the amount of food eaten). 
• In terms of bulimia, purging is a compensatory behavior to undo the calories consumed while binging. Hence, purging can also be carried out through intense exercise and restrictive dieting behavior (eating a lot one day, and then starving/eating less the next).

Some things that can be myths or truths, depending on the case:

• When it comes to eating disorders, many people say that they are caused by families and peers through their body-image related comments, or the media and photoshop. However, anorexia and bulimia are multifaceted disorders, a multitude of factors creating 'the perfect imperfect storm.' Although one contributing factor can be a family culture that focuses on body image, appearance, and weight, this alone will not cause an eating disorder. There has to be enough of the risk factors that come together, making one vulnerable. From here, something like the media can help pull the trigger. Some other primary, risk factors include:
• Biochemistry in the brain that is obsessive-compulsive and/or anxious in nature
• Temperament that is perfectionistic - one who wants the perfect body-image, high achiever, etc.
• Being a highly sensitive person (HSP) - one who is easily affected by interpersonal judgement, conflict, and constantly seeks approval from others
• Low self-esteem, lack of self/self-identity/self-confidence, lack of personal empowerment, being a people-pleaser (can come from anxiety or depression disorders) 
• Since these characteristics allows for other people to have too much influence over one's life, and suddenly, one's body becomes the only thing one can control (and this is where the eating disorder comes into play). 
• Trauma or a history of dieting (sometimes, but not always)
• Can you tell someone has anorexia or bulimia simply by their appearance? 
• No, because lots of people with an eating disorder look perfectly normal, especially in the case of bulimia. Someone can be anorexic in mentality, but weigh normal or slightly lower than normal, not making an impact on his/her appearance. 
• Yes, because there are some symptoms of eating disorders that cause changes in appearance:
• Bulimia: may have swollen parotid glands; tooth enamel eroded by stomach acid
• Anorexia: thin, dry hair; dry skin (because low fat intake or content in the body can decrease estrogen, impacting hormones and the skin); lanugo (fine, white hair that grows on the face)

Since we talked about the media and photoshop during our discussion on the survey questions, I asked Dr. Anné how she felt regarding the portrayal of eating disorders in/through Never Enough, barbie dolls, and models in popular runways (Victoria's Secret and New York Fashion Week).

• Never Enough 
• Recovery is about more than just gaining weight. It's about getting to the roots of the different pieces that have created the problem, and rebuilding them (especially one's self-esteem, how one deals with emotions, and feeling in true control over oneself). Simply gaining weight is not an effective form of treatment alone, because neural pathways have been formed and run the risk of going back to the eating disorder behaviors as a coping mechanism to gain a sense of control if nothing else changes. Too many times, treatment is focused solely on behavioral aspects, and not enough on the underlying creation of an emotional foundation that will help the patients be more emotionally resilient and eating disorder resistant. Treatment has to be multifaceted, like the disorder, to allow for full recovery and to prevent relapse. 

• Barbie Dolls
• There are many things a parent can do to promote better, more positive body-image in kids, building self-esteem and confidence from a young age. Barbie dolls don't promote that, because no one actually looks like that. Instead, parents should avoid talking about body-image, diet, and weight at home; they should rather have a healthy relationship with their body, self, and food as an example for their kids. 

• Models in popular runways (NYFW, VS, etc.)
• How are runway models seen as models for how people should look like, men or women?! Companies tend to use very young females to sell items to women in older-age groups, creating a fraudulent image of what is and what one is capable of. It can be very damaging to one's self-esteem and confidence. Rather, we should want to see models with healthy curves, and celebrate the natural body. 

Eating disorders, such as anorexia and bulimia, are so complex that it is very hard for a layperson to understand them. We look at someone with an eating disorder and it looks so simplistic. Just eat! We don't understand that eating disorders are compulsive disorders, not allowing a person to do what he/she knows he/she should be rationally doing. These disorders are even too complicated for generalists, who end up referring these patients to specialists in order to be treated most effectively. It can be difficult to understand that eating disorders are not just about food, rather about deeper, psychological processes. Beyond that, anorexia and bulimia can be very scary, making it difficult for us to try and understand them; it's hard to see someone starving and be able to understand the reason behind what they're doing. People with anorexia and bulimia need to be looked at and treated through a compassionate and knowledgable lenses, because they need to know and realize that recovery is possible. 

To talk about my own experiences this week, it was absolutely amazing to be able to learn about two disorders I knew next to nothing about. Dr. Anné provided such wonderful insight, and it was a delight to be able to talk with her. In terms of what I did for the rest of the week, I mostly helped with the business side: putting together folders for events and for new clients (this included stapling close to 400 sheets of paper, and putting step-sheets and business cards in 170 folders!). 

I hope you guys like my Week 3 post! Thank you all for following me on this enlightening journey, and showing me so much support on previous posts!

Lots of love 💗,

--Saleena 

Sources:

*Eating Disorder Statistics (n.d.). Retrieved February 22, 2017, from http://www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics/