The Real Weight of Truth: An Eye-Opening Perspective on Eating Disorders (Advocacy Project)

I was looking through some magazines, admiring the slender models in the catalog. They could fit into any clothes and look amazing in them… I remember thinking to myself, I wanted to look like them. So I started to try and change myself. I thought, perhaps, if I could just make myself thinner, I’d appear smaller and more feminine. I wouldn’t seem as sturdy and bulky and maybe someone could give me a piggyback ride. Maybe a boy would find me cute. Maybe shopping for clothing would be much less of an embarrassing hassle.

(Johanna Chestnut, former anorexic)

Eating disorders are complex, often misunderstood forms of psychological disorders that are incredibly prevalent in modern society, especially among young women (DSM-V). Despite popular misconception, men — both young and old — also suffer from these types of illnesses. According to statistics, these illnesses have the highest mortality rate of all mental disorders. The psychological, social, and personal side effects that come along with them are utterly crippling to those afflicted. If allowed to run its course, the disorder runs amok. Slowly worsening with time, the disorder eventually takes complete control of the person as they flounder under its immense weight. In the most serious of cases, it can lead to their untimely demise.

There are three main categories of disordered eating: anorexia nervosa, bulimia nervosa, and EDNOS, or eating disorder not otherwise specified (Couturier & Lock, 234). People who suffer from anorexia, depending on whether it is the restrictive or binge-purge type, engage in restrictive behaviors. They limit their caloric intake through precise measurements of the foods that they eat, by not eating at all, or by binge eating and then “making up” for this dramatic calorie intake by fasting for extensive periods of time. Anorexic people usually have a body weight that falls slightly or dramatically underweight (DSM-V). Contrary to this, behavior of bulimic individuals is characterized by repeated episodes of binge eating, or consuming large amounts of food. Bulimic individuals then compensate for this behavior through purging the food by vomiting, by taking laxatives, or through fasting and exercise. People who are bulimic also generally have a relatively normal body weight, so it can be harder to identify than anorexia (DSM-V). EDNOS varieties of eating disorders include binge-eating disorder, as well as various other, slightly different forms of disordered eating that don’t fit the criteria for either anorexia or bulimia nervosa (Couturier & Lock). This paper will not focus as much on EDNOS as the other two forms.

There are a wide variety of causal factors that lie behind disordered eating. It is not by any means a lifestyle choice. From personal propensities to social pressures, each independent factor works much like individual threads in a weave — coming together to form a potentially life-threatening final product.

Depending on the nature of the person and their psychological state, they may be naturally predisposed to falling under the initial allure of an eating disorder (hereon ED). Anxious, depressed, and lonely people who suffer from low self-esteem, and who feel very inadequate and tend to compare themselves to others are at a much greater risk. In addition to this, variable interpersonal circumstances – such as bullying, physical or verbal abuse, or difficulty conveying emotion or opinion in a public setting – can have a direct effect on one’s mental state. Therefore these factors also could contribute and affect their likelihood of ED development (NEDA). A person’s genetics can determine whether they are likely to develop disordered eating as it tends to run in families through chemical imbalances and personal tendencies (NEDA). In addition, early or late pubertal development can play a definite role (Klump).

Lastly, social pressures have altogether too much to do with the development of these types of disorders. Throughout the entirety of modern culture, the idea of unnatural thinness is held in high regard, and has become almost the expectation and norm in our society (Doctor et. al.). The “perfect body” screams at the populace from its high pedestal in the music, entertainment, and advertisement industries. Due to this prevalence, these narrow and flawed interpretations of beauty are ingrained into the minds of girls and boys from the moment they can begin to form a memory. So is it any wonder that they might feel uncomfortable in their own skin when they begin to develop and don’t quite fit the mold?

It all happened, without my ability to even realize. There was no concern for my choices, or worries of my health. No one thought that I was doing myself harm and neither did I. With all that had been occurring in my life, all of the stress, all of the depression, I needed a way to cope.

(Sophia Wolf, former anorexic)

According to the DSM-V, the authority for psychiatric diagnosis in the U.S., the known prevalence of eating disorders (all types) in young females alone is 3-3.5% of the U.S. population (DSM-V). To put that into perspective, according to the 2015 census that would equal roughly 11.2 million people (Schlesinger). That figure represents only a tally of females, not males, and only those who are willing to seek help and talk about their disorder. As eating disorders tend to be “closet” illnesses, there’s no telling how underrepresented the total truly is.

With every day, meals lessened. The meals lessened in portion. The meals lessened in value. The meals lessened to nothing. Breakfast turned into an instant drink, lunch fell straight into the depths of the trashcan, and dinner was a skillful method of organization of food on a plate – no food goes in, the food is just carefully maneuvered around to make it seem as though a decent portion was consumed. Lift the fork, giggle, cover the mouth, fork down, mix things up, make people try different things you’re supposed to be consuming, and suddenly you have a pretty normal looking post-dinner plate.

It became uncontrollable. Each day I looked in the mirror, I saw the progress. My weight fell and fell. I went from 115 to an underweight 108, to 95 pounds. Clothes fell in a baggy fashion, and nothing fit anymore. It felt incredible. I felt powerful. I had control over something in my life for once. The winter wind felt colder with every pound I dropped. My dancing abilities lessened as my stamina began to decrease. Walking through the halls of my high school was an incredible effort. I needed water constantly. I was winded easily. Beauty is a little difficult, right? What could possibly be the issue? After a while, my mental abilities started to fade. My memory was hazy, and my emotions were wild. I started to spiral.

(Sophia)

Those who are forced to live with the crushing effects of eating disorders have to face various inhibitions throughout their daily lives. Personal time is not a time of relaxation. Even the calmest moments are not entirely free from phantom thoughts of food and its effects. Every single moment of every day is endlessly haunted by worry and fear of judgment from those around them. Every person observed serves as a basis of comparison, a measure against which they can weigh the attributes, looks and traits that they lack. Some individuals also engage in self-harming rituals. This either serves to act as punishment for falling out of line with their eating ideals or as a sort of coping mechanism. These acts can vary, from hitting, burning, and cutting, to even pulling out one’s hair and eyelashes (Judd). Over-exercise is a prevalent feature of both major types of ED’s. It is used as a method of “purification” after eating too much, or as a method of weight management.

Things started out rough, because I loved food, but I was determined. I started out by eating smaller portions of food, then I started counting calories. After a while, I was obsessing over my calorie intake to the point where I limited myself to only 300 calories per day. If I went over the 300 mark, I would punish myself via self-harm in the form of punching and pinching myself till I was covered in bruises, biting myself till I bled, or pushing myself to exhaustion from over-exercising. Sometimes I would induce vomiting to “purify” myself, but that method was a final resort because it caused a lot of pain.

(Johanna)

As aforementioned, these individuals also engage in purging and starvation rituals. They are constantly haunted by paranoia and obsessive thoughts concerning food, including what they have already eaten, or what they will eat in the future. When the time comes to eat, restrictive anorexics will go to great lengths to eat as little as possible. Precisely measuring each part of their meals — or in some cases even switching labels of foods — enables them to intake low-calorie substitutes unbeknownst to their loved ones (HEAL). Many ED sufferers are very self-conscious about their eating behaviors, not to mention themselves. It is due to these factors that many of these individuals lead a life of social isolation. They not only eat by themselves, but also avoid human interaction as much as possible (DSM-V).

The plethora of health concerns that accompany an eating disorder are the true source of lethality that lies behind these illnesses. As previously stated, anorexia nervosa has the highest mortality rate of all mental disorders (Doctor et. al). The constant starvation, exercise, or purging that is involved for any variety of ED puts a tremendous strain on the heart and it weakens the muscles. The gastrointestinal system is affected, resulting in delayed emptying, constipation, and inflammation of the stomach lining (in bulimics). In some cases, it can even cause tears and ruptures within the stomach, intestines, and esophagus (Goldstein et. al.). Furthermore, constant binging, purging, and fasting can result in severe electrolyte and chemical imbalances, as well as irregular or absent menstruation in females. They have much lower bone densities, causing greater risk of fracture and osteoporosis. Bulimic individuals suffer from severe enamel loss due to constant contact of the teeth with stomach acids. Those with anorexia are much more likely to become anemic and/or experience loss of white blood cell count (Goldstein et. al.). Even the brain cannot escape the cruel tyranny of these illnesses, sometimes shrinking in the face of this horrible mistreatment (Couturier & Lock). And these are just a few of the many, various, health-related side effects that accompany this “quick fix” to a person’s weight problem, real or otherwise.

In addition to these health risks, one must also take into account the many psychological disturbances that walk hand-in-hand with EDs. A point of major fixation for these individuals is distorted body-image perception: a condition of self-viewing in which, no matter how much or how little a person weighs, they will perceive themselves as overweight or “fat.” This misperception is by far the driving force behind eating disorders, as any attempts at recovery often fall victim to its skewed perspective. Even a healthy body weight is considered as too heavy from this viewpoint (DSM-V).

Various other mental instabilities are comorbid, or tend to be simultaneously present, with EDs. These include, but are not limited to, moderate to severe depression, anxiety, obsessive-compulsive disorders, social phobias, bipolar disorder, and predispositions toward substance abuse (DSM-V). Depression plays a large role in the mortality rate, as it can lead to greater risk of suicide.

EDs also have a very big social impact on those who suffer from them. As their stress levels escalate, along with the haunting torture that food imparts on their life, they become more and more consumed by their illness. Greater amounts of time are allotted for exercise, or for binging and purging. This leaves less time for activities normally experienced by others of their own age, such as extracurricular activities and fun get-togethers with friends.

I was constantly exercising, measuring, and weighing myself and after I wasn’t getting any instant results, I started to starve myself. I made it into a little game where I’d see how many days I could go without eating, and each day I would inspect my mid-section to see if I could see my ribs yet or not.

(Johanna)

As an eating disorder worsens and the signs and side effects become present and noticeable to those around them, family and friends may not know how to properly breach the topic or issue. Instead, they may put distance between themselves and the person suffering from the ED (Goldstein et. al.). This, in turn, will increase stress levels and the cycle will continually worsen unless something is done to stop it.

There are a few different approaches to starting the ED recovery process. Some individuals choose a self-propelled route. This relies solely on self-will, determination, and family support as opposed to many doctor visits and medicine regiments. However, this is not always an option, depending on the severity of the illness and how badly a person has been affected by its negative side effects. Medical-centric approaches can vary, but generally consist of multi-disciplinary teams of physicians, therapists, and nutritionists working together to attack the illness from all angles (NEDA). In fact, Penn State’s Healthy Eating and Living Support (HEALS) program, geared toward people suffering from EDs, utilizes such an approach. Group or individual therapies, support groups, counseling, and medicinal regiments may also be necessary.

The take home point to be considered, however, is this: recovering from an eating disorder is a long and complicated process, and even after a person has been successfully “healed” and is “all better,” there are still pieces of the disorder that will always remain. Like shattering fragile glass and attempting to glue all the pieces back together, it is not easily done, and sometimes may not even be possible to achieve. There will always be those little shards that are untouchable or lying just out of reach — infinitesimal fragments of body-induced anxiety here, a missed meal that brings satisfaction there (Couturier & Lock, 235).

Anorexia is a disease. It affects the mind, and it alters the ability to live in a sane manner for the rest of your life. No matter how far you run from it, it will continue to hover within the depths of your mind. It changes your vision, and steals away the ability to ever feel complete confidence. While I am able to survive and live just as well as anyone else, I will always be haunted. There will always be satisfaction when a meal is skipped. There will always be a desire for control. I will never truly escape it.

(Sophia)

It’s small, nit-picking tendencies like these, as well as reoccurring food-obsessive mindsets, that open the door to possible relapse. However, with a strong support system and a lot of determination, recovery from an eating disorder is possible.

The public needs to take a stand against the spread of these violent and life-shattering illnesses. Too often, the media jokes about eating disorders. It spreads the horribly inaccurate fallacy that a person’s worth and beauty is determined solely by the way they appear.

The idea of an eating disorder had never even occurred to me, until one night, everything changed. I was 11 years old at the time, and had always struggled with my body image. My siblings used to tease me about my weight, and I’d always been significantly bulkier than all of my classmates. Anyway, one night my brother and sister were watching an episode of Family Guy, which wasn’t very odd. But in this particular episode, Brian had a girlfriend who had something they called bulimia. They made it seem very silly.

I just remember hearing Brian say something along the lines of, “I know it’s bad for her, but she looks great!” And that’s where I got my inspiration. That’s when I first stuck the back of a table knife down my throat. That’s when I became bulimic. They had showed me a quick fix to my problem, and so I took the plunge, not realizing the true depth and weight of my action. That clueless, innocent moment has, without a shadow of a doubt, ruined my life. It’s now been close to eight years. My doctor is begging me to attend an in-patient residence treatment facility because she’s afraid it might kill me. And for some reason, bulimia doesn’t seem so silly anymore.

(Thaddeus Woodsen, current day sufferer of bulimia)

Eating disorders are not a lifestyle choice, but a life-threatening disease that should be taken just as seriously as any other health issue. The horizon is not all doom and gloom, however. The people can take a stand. We can set the gears in motion to end this horribly veiled issue by tearing away the drape of mystery. We can increase awareness, whether through papers like this one, or through other avenues of advocacy. From blog posts, to social media, or even just telling friends to tell their friends, the power of knowledge and persistence is strong.

There are more than a few organizations already in existence that are combatting the common misconceptions that shroud EDs and cause their sufferers to remain silent and afraid. Project HEAL is a non-profit organization, founded by two teenage girls who made a full recovery from anorexia nervosa. Their organization works at providing inspiration, hope, and treatment funding for other people who struggle under the immense burden of EDs (HEAL). The National Eating Disorders Association is another non-profit that works as an advocate and supporter of people who suffer from eating disorders. They provide a vast variety of different information as well as resources for the start of the journey toward recovery (NEDA). And as previously mentioned, here at Penn State, University Health Services offers the HEALS program to those suffering from the effects of EDs. These are just a few examples of the many different options and lines of support that are already in existence for men and women alike who struggle with disordered eating.

But we must not be complacent, for the journey is only just beginning. Only by increasing awareness about EDs and their crippling effects can people truly begin to understand. Without a strong voice against media injustice, with unnaturally thin and unrealistic ideals of beauty, as well as its mocking stance toward these serious disorders, nothing will ever be truly solved.

Works Cited
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American Psychiatric Association. “Feeding and Eating Disorders.” : Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Publishing, n.d. Web. 27 Apr. 2015. (DSM-V)

Couturier, Jennifer, and James Lock. “Eating Disorders.” Mental Health Care Issues in America: An Encyclopedia. Ed. Michael Shally-Jensen. Vol. 1. Santa Barbara, CA: ABC-CLIO, 2013. 233-40. Gale Virtual Reference Library. Web. 26 Apr. 2015. (Couturier & Lock)

Schlesinger, Robert. “The 2015 U.S. and World Populations.” US News. U.S.News & World Report, 31 Dec. 2014. Web. 27 Apr. 2015. (Schlesinger)

Goldstein, Mark A., Esther J. Dechant, and Eugene V. Beresin. “WebAccess.” Penn State Secure Login:. Pediatrics In Review, 1 Dec. 2011. Web. 27 Apr. 2015. (Goldstein et. al.)

“National Eating Disorders Association.” National Eating Disorders Association. N.p., n.d. Web. 27 Apr. 2015. (NEDA)

“Eating Disorders.” The Encyclopedia of Phobias, Fears, and Anxieties. Ronald M. Doctor, Ada P. Kahn, and Christine Adamec. 3rd ed. New York: Facts on File, 2008. 207-209. Facts on File Library of Health and Living. Gale Virtual Reference Library. Web. 27 Apr. 2015. (Doctor et. al.)

Klump, Kelly L. “Puberty as a Critical Risk Period for Eating Disorders: A Review of Human and Animal Studies.” Hormones and Behavior. U.S. National Library of Medicine, July 2013. Web. 27 Apr. 2015. (Klump)

Saffron, Kristina. “Kristina’s Story.” Project HEAL. Project HEAL, n.d. Web. 27 Apr. 2015. (HEAL)