Dying to be Thin

 

The friend who has lost over 20 pounds in the past month.  The mother who is criticizing her daughter about every empty calorie she eats.  The brother who obsesses over the scale for the wrestling team.  All these scenarios are more real and more prevalent than most people may think.  Most of you reading this probably know a person who suffers from an eating disorder.  The question is...are you catching the signs?  Or are you pushing the red flags under the rug?  Its easier to pretend it doesn't exist than to face it head-on.

Obsessions with body image are beginning at younger and younger ages every year.  The median age of onset for eating disorders across the population ranges from 18 to 21 years, depending on the condition, with the earliest onset at 10 years for anorexia nervosa and 15 years for other disorders.  Up to one in four 11-year olds has already tried to diet once.  Can you imagine your 5th grade daughter coming home from school and refusing to eat day after day because someone made fun of her for being fat?  That's the recipe for a parent's worst nightmare.

What Specifies an Eating Disorder?
Just because you see someone walking down the street who is extremely thin, does not necessarily automatically indicate that person suffers from an eating disorder.  According to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), the following are the specific criteria:

Anorexia Nervosa

• Exaggerated drive for thinness
• Refusal to maintain a body weight above the standard minimum (<85% of expected weight)
• Intense fear of becoming fat with self-worth based on weight or shape
• Evidence of an endocrine disorder

 Bulemia Nervosa

• Overwhelming urges to overeat and inappropriate compensatory behaviors or purging that follow the binge episodes 
• Similar to anorexia nervosa, individuals also display psychopathology, including fear of being overweight 

Although there is no perfect "concoction" of traits an individual has that causes an eating disorder to develop, there are some risk factors that have been identified as being common with the majority of individuals who suffer.  Some include: being female, family history, family influences, dieting, change/transitions in life, or emotional disorders.  Keep in mind, some individuals may have many or all of those risk factors and never develop an eating disorder, and some individuals may only have one risk factor and suffer from an eating disorder their entire life.  It is entirely subjective.

I know what most of us are thinking...how does anyone really get sucked into that black hole of a disease??  How would you not realize what that person was going through?  How are you not able to shake them until they start making some sort of sense?  Below is an exerpt written by an individual suffering from an eating disorder, it may shed some light into the dark corners of how an eating disorder thinks:

How It Feels...

Eating disorders are diseases of silence. We are all silently screaming for something: attention, love, help, escape or forgiveness. Although we might be looking to fill different voids, we never ask for the things we need. We feel unworthy, that for some reason we don't deserve them. So, we play the game of guess what I need from you. You're inability to guess just feeds our feelings of worthlessness.

When you finally realize there is a problem, it is much too late. We will now fight, lie, and cheat to hold on to the one thing that has given us support. You see the symptoms, weight loss, weight gain, or depression. You watch us starve, eat, purge, and isolate. You tell us to eat or not eat, to sleep or to get up and do something, you can't understand why we can't just get better.

If it were only that easy! Some of us have been living with this, like this, in this hell for half our lives or more. We honestly believe it is the thing holding us together. Even when all others see it as the thing that's making us crumble to pieces. It is not just a part of us, but it has become us. It is our identity and who are we without it? Many of us are afraid to find out. Fearing without it we are nothing.

It becomes our sole companion. It is the thing that makes us strong, so that we don't need, don't want and don't feel. It is our cape of invisibility. With it on you can not see us, you can not see our pain and shame, we begin to disappear. Slowly at first and then before you know it we are gone. Lost in a world of pain. Always fighting for control that we never seem to get.

In the beginning the control is easy and the high from it incredible. I can not eat for 4 days, I can exercise for 4 hours a day, or I can throw up everything I eat. I am in control. But somewhere along the road we lose that control and the eating disorder takes on a life of its own. We no longer control it. It controls us. We wake in the morning hearing it's voice and can't sleep at night because that voice is too loud.

We stop listening to anybody except our eating disorder. We believe we are fat, useless, unworthy, unlovable, and weak. We honestly believe that losing weight will on some level make things better. We wake up with thoughts of food; they consume us all day long, and often cause sleepless nights. It becomes all that matters. We listen to the voices that constantly tell us we are not good enough, thin enough, strong enough, a little more and then we can stop. But there's always a little more and it doesn't stop.

Although we say we hate the voices and the disorder. We don't hate it all. We love the high of seeing the number go down. We long for that empty, numb feeling that comes with starvation. We thrive on what begins as compliments and turns to worry about our weigh loss. Nothing gets rid of feelings the way throwing up does. The disorder is the thing that makes us feel strong and special, while at the same time letting us disappear and run away from life.

We will say we don't want your help. Sometimes because we are in denial and actually believe things are fine, sometimes we feel guilty receiving help, because we feel unworthy, and sometimes it has just gone on so long that we have given up hope and accepted that "I will live with this until it kills me".

When we say we don't want your help, those are the times we need it the most. We need you to stand up for us when we can barely stand, love us when we hate ourselves, hold our hope when we feel hopeless, and never give up on us, the way we give up our ourselves.

Wow...Scary Stuff, Right??

But if these individuals really don't want to change (as evidenced by the commentary above), or are trying to convince themselves that they don't, what can we actually do to help them?  Is there any hope? 

Prevention is the key word in this situation!  If there is a way to prevent the onset of an eating disorder prior to the disordered behavior and thinking, that makes all the difference!  Parents talking with young kids about the importance of nutrition AND modeling the good behavior, having topics relating to eating disorders in health classes in elementary schools, and being focused on prevention in the young girls in weight-related sports (i.e. ballet, gymnastics, and ice skating) should be stressed.  This may sound way too aggressive (why put thoughts into a child's head that weren't there before?) but it is essential.  Some specific steps to help prevention are:

1. Enlist your child's doctor for help. At well-child doctor visits, pediatricians may be in a good position to identify early indicators of an eating disorder and prevent the development of full-blown illness. 
2. Encourage healthy-eating habits. Family dining habits may also influence the relationships children develop with food. Eating meals together gives you an opportunity to teach children about the pitfalls of dieting, and encourage healthy eating.
3.  Keep an eye on computer use. Because there are numerous Web sites that promote anorexia (commonly called "pro-ana" sites) as a lifestyle choice rather than an eating disorder, it's important to monitor your child's computer use.
4. Cultivate and reinforce a healthy body image in your children, whatever their shape or size. Talk to children about their self-image and offer reassurance that body shapes can vary. Encourage your own children or family members to refrain from joking about other children or adults who are overweight or have a large body frame. 

 About 10-20% of individuals suffering from an eating disorder will never recover, and those who do will most likely relapse at some point in their life.  Unfortunately, around 5-10% of individuals will die.  Be proactive and a healthy role model for our young kids.  You might be their only hope.