50 important things about anorexia
The stereotype of “anorexia” is quite well known. Media articles make this quite clear. The stereotypical emaciated young woman who thinks she’s fat when she isn’t and wants to look like all the beautiful models and celebrities. Pro-anorexia websites are full of “thinspiration”. Black and white photographs of thigh gaps, collarbones, sticking out rids, apples and measuring tapes, alongside ‘mantras’ and quotes such as ‘Nothing tastes as good as skinny feels’, ‘What you eat in private you wear in public’, ‘Pretty girls don’t eat’. It is possibly the most glamourised of mental illnesses, seen by some as having ‘willpower’ and ‘being in control’. But anorexia is a life-threatening mental illness, and there is so much more to anorexia nervosa than being underweight, eating low calorie meals and having a thigh gap.
Although the most common age of onset is between 14-18 years, anorexia can occur at any age. Furthermore, some research has shown that later age of onset can actually be associated with poorer long-term outcome
Both females and males can suffer from anorexia. Statistics from Beat (eating disorder charity) suggest that between 11% to 25% of sufferers are male.
You will become obsessed with food. As you deny your body of food and your brain and body start to cry out for nutrition, thoughts of food will start to dominate your life. This can lead to an obsession with baking and cooking, with some sufferers of anorexia nervosa cooking elaborate meals for others or spending hours baking beautiful creations to give away, yet allowing themselves none of what they have made. For some, reading recipes and cookbooks becomes an obsessive hobby, watching cooking programmes or TV shows about weight loss and diets. You can spend hours looking at restaurant menus online, collecting recipes, looking at pictures of food
Food shopping becomes an unbearable overwhelming task. You may find yourself walking up and down the aisles of supermarkets for hours (another outlet for the obsession with food), picking up items and scrutinising the packets, comparing calorie contents, fat content, saturated fat, carbohydrates, sugar, and then putting those items down again and leaving with nothing, unable to try anything but the same ‘safe’ foods you always choose. At some points you may find yourself breaking down in tears in the middle of the supermarket when it all becomes too much.
Similarly, making decisions regarding food becomes impossible. You will become paralysed and unable to make simple decisions. So much thought goes into having to decide a meal. What if you choose the wrong option? Is it ok to choose that? What if it’s unhealthy? What if it makes you gain weight? Which option has least calories? What if it has lower calories but more fat, which option is best? Which is healthier of these options? What if the portion size is too big? What if you don’t like it and it’s a waste of calories? What if it’s more than the person you’re eating with wants to eat and they think you’re greedy? You will become overwhelmed, distressed, paralysed by the anxiety that making a decision causes.
You will become irritated by other people eating – the way they eat, what they are eating, the fact that they are eating in general. You will be jealous of them for eating, and everything they do will seem to be set out to irritate you.
You will start to feel intense anger and resentment towards people being around you when you are in the kitchen or preparing food.
In fact, you will become irritated with people in general. Lack of food, lack of energy… makes you grumpy. You will stop wanting to be around people, and will start to isolate yourself.
Eventually the social isolation will intensify more and more. Interacting with friends means possible occasions where you may be expected to eat. This will start to terrify you, and it will seem easier to avoid socialising at all. You will prefer to stay at home shut away in your bedroom than to be with your family and friends and risk having to eat.
You will start to use anything as an excuse to avoid eating. Illness, ‘it’s too early’, ‘it’s too late’, ‘there wasn’t time’, ‘I ate when I was out’, ‘I’m not hungry’, ‘I’ll get something later’, ‘I was upset’, ‘I was tired, I just wanted to go to bed’.
You will start to lie to people. And despite the guilt and self-hatred you feel for doing it, you will also feel secretly proud of yourself. You will do things to pretend to people that you have eaten so that they don’t get suspicious. You will hide meals, in particularly unglamorous places, and you will feel secretly thrilled to get away with it, before once again the self-loathing kicks in.
You will start to fear having food in your house, in case you binge on it. You will tell yourself ‘Well, if it’s not in the house I can’t eat it’. You may throw every single piece of food out to stop yourself from eating it. You will feel guilty for the waste of food and for the money this costs, but it will feel safer than having it in the house. You will then have to replace all of this food when you ‘come to your senses’ and realise that you need to try and eat something.
On the other side, you will probably find yourself hoarding food at some point. You may have a whole drawer full of chocolate, sweets, bars, biscuits. You may hide things that family or friends have given you, which you have pretended to eat. You may hoard things which you have bought to convince yourself that you will try one day, but have not managed to convince yourself to do yet. You may have cupboards full of food, which you jokingly show to friends and family, laughing at how well stocked up you are but knowing you cannot allow yourself to touch.
You will start to weigh everything. And every single gram will matter to you. You will panic about whether you have had an extra piece of pasta in your meal. You will panic about whether you have been given 210ml of juice instead of the 200ml which you are ‘meant’ to have. You will argue forcefully about this, memorising exactly how far up the cup your juice is supposed to reach. If you accidentally pour 5ml too much milk into your cereal, you will pour it out again rather than to simply accept these ‘unnecessary’ calories.
If you do ever have a moment of ‘allowing’ yourself something – as an extra, as a ‘treat’, as a ‘challenge’ – you will be tormented afterwards by the guilt, distress, anger at yourself, loathing yourself for being so greedy and unnecessary, for allowing yourself something when you didn’t ‘deserve’ it.
You will become constantly cold. Cold through to the bone, and unable to warm up. You won’t be confidently wearing pretty crop tops and skinny jeans like pro-anorexia sights suggest, showing off your body happily. You will hide inside, wearing thick baggy layers of clothing underneath a duvet, extra blankets, a hat, scarf and fingerless gloves inside because you are so cold that you can’t think straight.
You will also live in baggy, shapeless clothing because the thought of seeing your body disgusts you. You will be stuck in the contradiction of covering up your body shape because you feel so huge and grotesque, and covering up your body shape due to the fear that people will notice your weight loss and start to notice your eating habits.
Showering (preferable to baths because there is less opportunity to see the body that you loathe so much) becomes just another form of torture, another opportunity to body check, another reason to hate yourself.
If you usually wear make-up, this is likely to stop at some point. Because why would you want to spend time looking in the mirror to see the disgusting human being that looks back at you? You won’t feel worth the effort of putting time and care into your appearance.
Your skin will become horrible. Dry, flaky, spotty. The lack of nutrition will affect your body, and it will become obvious in more ways than you think.
Your hair will also feel horrible. Dry, thin, straggly, lanky. Clumps of your hair will begin to fall out. This is also likely to worsen as you begin the refeeding process, which is yet another reason to hate refeeding. You will probably chuck it into a ponytail, again because you don’t the energy to spend effort on straightening it, putting it up or even washing it.
You will become anxious about the calories in things you have never even thought about before. The calories in your medication, the calories in antibiotics or throat sweets, the calories in toothpaste, even the possibility of there being calories in water. You will order a Diet Coke when out and be terrified that they may have accidentally given you a ‘normal’ Coke. You will have to double check this by asking, no matter how silly you feel.
You will become obsessed by the numbers on the scale. Your whole day will become determined by what that number is. You convince yourself that if it is lower you will allow yourself to eat. You won’t. Because if you do, that will surely make the number go up again? You will start to weigh yourself multiple times a day. With clothes, without clothes. Before and after going to the bathroom. Before and after a meal. Before and after purging. Before and after exercise. With your watch on and without. Taking out your hair bobbles in case they make a difference. You will start to worry about every single detail. You will even consider cutting your hair, just in case that makes a difference.
You will develop elaborate, obsessive rituals to body-check. Standing in the mirror looking at yourself from every angle, changing your outfit multiple times to find something that feels acceptable to cover up the size of your thighs and stomach, holding your arms in different positions to find a way to hold yourself to look as small as possible. Checking the tightness of your watch on your wrist, how far your wristbands fall up your arm, gripping your body parts to check their width, standing with your feet together, then apart, to check on your thigh gap. You will feel shallow and vain for caring so much, but despite seeing other people for their personalities and qualities, you will reduce yourself to nothing but a body shape, a weight, a blob of lard taking up too much space.
You will be consumed with more self-hatred than you have ever felt before. If the number on the scale is increased even by the tiniest amount, you will despise yourself. You will loathe every fibre of your being. You will detest yourself to the point of feeling unable to be in your own skin. You will want to tear your skin off, to cut all the fat out. You will feel utterly disgusted and horrified by your own body, unable to bear touching your skin or even to sit down.
You will start to believe that you can feel the fat running through your arteries. If you are given a meal which you perceive to be unhealthy, ‘too big’, ‘more than usual’, you will convince yourself that you can physically feel the weight piling onto your body, that you can feel it creeping around your arteries and increasing your weight.
You will develop insomnia. You may be on medication to help your mood or the rigid thoughts. But despite this medication, lack of food means that sleeping becomes impossible. You will lie awake thinking about what you have eaten that day, what you will eat tomorrow and the next day and the day after that. You will be exhausted by the effort of even existing through the day, but however tired you feel you will lie wide awake, thoughts racing, hating yourself, unable to relax.
When you do sleep, your sleep will not be peaceful. You will start to suffer nightmares. Memories of the traumas you have experienced, of being forced to eat against your will. You will dream of food, you will wake up panicking that you have eaten something, only to realise that it was just a dream but still unable to shake off the feeling that you may have somehow consumed more calories.
You will get headaches, and you will get dizziness. But you will stop seeing this as a concern. You will start to feel pleased when you get dizzy, because it is a sign that it is working, that you are causing harm to yourself. You may even find yourself feeling guilty, greedy, angry with yourself if you don’t feel these things, because it is a sign to you that you are not working hard enough.
You will have stomach pain. Awful, awful stomach pain. Stomach pain from the hunger, even worse stomach pain when you eat and your body tries to cope with the little nutrition it gets. The stomach pain will become far worse as you start to refeed. But however much it hurts, you will not be allowed to eat less. You will have to sit through it until that horrible stage of refeeding has passed.
You will ache. Your muscles will ache, your bones will ache. Walking will ache, standing will ache, sitting will ache, lying down will ache.
You will be weak. When it is windy outside, you will find yourself unable to find the strength to walk through it, instead huddling down further into your coat as you try to brace yourself against the wind. You will lose the ability to walk tall. Instead you will start to walk hunched over with your arms crossed over your stomach. Your steps will become smaller and smaller, until you are barely more than shuffling.
Your bones will become weaker and weaker as well. You will bruise more easily, you will get injuries from doing everyday tasks. You may be sent for bone scans, you may find yourself diagnosed with osteopenia or even osteoporosis, risking permanent damage to your body.
If you are female, you will possibly lose your periods. If you do, you will secretly take this as a sign that you are working hard enough. If you don’t, you will see this as yet another reason to hate yourself, as ‘proof’ that you are not ‘sick enough’, even if your rational mind knows that people can still have periods at low weights. A part of you will be excited for the return of your periods, to know that one day you will be able to have a child. But another part of you despises yourself when it arrives, just another sign that you have gained weight and proof that you are ‘fat’.
Your days will start to be filled, but not with normal everyday things, not with work or education, hobbies or socialising. Instead, your days will be filled by doctor’s appointments, blood tests, ECGs, scans, psychiatrist appointments, psychologist or therapist appointments, therapy groups or hospitals.
You will feel fat. This feeling won’t lessen as you lose more weight. You convince yourself that you will feel happier when you reach the weight you are aiming for, but you won’t. In fact, you will probably feel more and more fat the more weight you lose.
It will never, ever be enough. You will never feel happier with yourself. You will never feel satisfied with your goal weight. You will reach it and feel a brief satisfaction, and then you will convince yourself that you need to reach a new goal weight. You will continue to lose weight, always convincing yourself that you need to lose just a little bit more. Even when you are admitted to hospital you will feel like you don’t deserve to be there. You will convince yourself that you are the biggest person there by far, that you are not ill enough to deserve help.
There will be times when you convince yourself that you are ‘recovered’, that you are ‘fine now’. You will take your eye off the ball. You will ignore the warning signs – the increase of time spent exercising, the skipping of meals because you ‘weren’t hungry’ or ‘didn’t have time’, the cutting out of certain food groups. You will convince yourself that you are stable and can be flexible now. You will let your meal plan go astray. Months later, when the control is once again taken from you because you are deemed ‘too ill’ to have any insight and to turn things around, when you have gone through the refeeding process again and are eating regularly and sufficiently again, you will realise that you were not stable or recovered. If only you could see it at the time.
At some point during anorexia nervosa, you will almost certainly end up binging. Not just general overeating in the way that every person does at some point, but out of control binging, feeling unable to stop yourself as you cram food into your mouth faster and faster. You will feel intense shame and distress, sometimes to the point of wanting to die and feeling the need to punish yourself. Binging may be ‘objective’ (eating what other people would consider an unusually large amount of food at one time) or ‘subjective’ (even eating a spoonful of peanut butter out of a jar when you are desperately hungry can feel like this). Both are distressing and the guilt is unbearable.
You are also likely to try purging at some point. For some, this can become a regular occurrence – this can lead to the binge-purge subtype of anorexia nervosa. You will very rarely feel less in control and less glamorous than as you lean over a toilet with your fingers down your throat, your hair stuck to your forehead and your eyes watering and bloodshot.
You may also start to take diet pills or laxatives. However much you know the dangers and know that it is not ‘real’ weight, this will become more and more addictive. You will start with maybe one or two after what you consider ‘too much’. Eventually you will find yourself taking more and more, reaching double figures each day. You will potentially find yourself in embarrassing situations in public as the effects kick in, and if you are at home you will find yourself curled up in a ball suffering from excruciating stomach pain.
Exercise will become an obsession. It will stop being fun, enjoyable, a feeling of achievement. It will be painful, exhausting as you push yourself further and further, berating yourself and torturing herself afterwards for not doing enough, for being so weak and pathetic. You will convince yourself that it is healthy. Exercise is healthy, it is well known that as a society we don’t do enough exercise! The government recommend it, it’s good for you, it’s not healthy to do no exercise. You convince yourself as you try to convince other people, that you are doing it because you enjoy it, you like exercising like this, you like the endorphins. But what started off as a healthy, enjoyable, sociable love for sport and exercise will come to dominate your whole day. You will do sit-ups, push-ups and jogging until you are retching. You will get sores on your spine from the pressure. You will pace your room for hours and hours each day, unable to allow yourself to sit down until you have ‘justified’ it. Exercise becomes nothing more than a compensatory behaviour for the food you are having to eat, a way to justify allowing yourself the nutrition, another way to punish yourself and to prove to yourself that you are not ‘lazy’. If anybody tries to stop your exercising you become anxious, angry, resentful. Exercise becomes your priority, socialising falls aside. Every single activity becomes a way to burn just a few extra calories – an extra trip upstairs, jogging on the spot as you wait for the kettle to boil, a few jumping jacks in between getting dressed, shaking your legs as you sit despite being told numerous times to sit still.
You will look pale, drawn, tired. People will tell you this. They may start to comment on your weight loss. At first they will say this like it is a good thing, and you will feel pleased. As time goes on you will hear the concern in their voices. But you will still take it as a good thing.
On the other hand, when you have been in refeeding and have gained weight, and people tell you that you ‘look better!’ or ‘look so much healthier!’ or even so much ‘happier’, you will not take this as a good thing. You will take this to mean ‘You’ve gained weight’ or that ‘You look fat now’. The reality of their comments – the life back in your eyes, the glowing skin, the stronger, taller posture – will be irrelevant to you. Looking ‘better’, looking ‘healthy’ equates to looking fat in your eyes. You will be devastated, tormenting yourself and determined that from now on you will never eat again in order to lose all that weight you’ve gained again.
You will see your family terrified for your life. You will see their faces become etched with worry, hear the whispered conversations, listen to your parents or loved ones cry as they hug you and tell you how afraid they are to see you wasting away.
You will start to feel numb. Shut down, unable to concentrate on anything at all. Sitting and staring into space for hours on end, feeling like a zombie. Unable to care about anything, unable to take interest in anything, unable to find joy in the things you used to enjoy. Your concentration will become so bad that you are unable to pick up a pen and write a single sentence of an essay. You will stop being able to watch TV programmes or to read even a few paragraphs of a book. Nothing will matter to you but thoughts of food, weight, calories, exercise.
You will start to consider self-harm, suicide. You will start to consider whether it would be easier to die than to live feeling like this, because what’s the point of life if you have to feel like this, if you have to be so huge that you despise yourself this much? You will start to get impulses to harm yourself after you eat, when you feel unable to be in your own body. You will be distressed by these feelings and thoughts, and it will start to feel easier and safer to ‘give in’ to the eating disorder and do what it wants, than to challenge the eating disorder and to have to sit with those distressing thoughts and urges.
Your life will be determined by the professionals involved in your care. They will determine how your day goes, how your week goes, your month, or your life for the foreseeable future. If you don’t agree with them, if you try to argue your case, this will be seen as ‘the anorexia talking’. You will be told on the one hand that it’s ‘not just about weight’ and that your eating disorder is not your identity, and yet on the other hand you will be treated as though your eating disorder is all there is to you. You will feel patronised, like a small child being told off by a rational adult.
You will see your future falling away from you. The world will carry on as you spend your days, weeks, months, years, consumed by your eating disorder. Sitting in groups, sitting in appointments, sitting in a dining room, sitting in supervision, as your peers go to university, work, and enjoy nights out. You will feel hopeless, worthless, pointless. You will be unable to see a life free from your eating disorder, unable to imagine a time when you can eat a meal and not think twice about it, a time when you can go out with friends, eat a meal and then a dessert with a few glasses of wine alongside, a time when you can have a few extra chocolates at Christmas or an extra slice of cake ‘just because’ without factoring it into your meal plan, compensating for it or hating yourself.
But know, that no matter what, and no matter how impossible it seems, however hopeless things feel, however far off it feels, there is hope. Recovery is possible. You do have a future. You are worthwhile. You are more than a weight, a body shape, a number. You are made up of so much more than calories, fat, muscle, bone. You are the things that make you laugh. The things you enjoy doing. The people you love, the things you love. A hope for the future. A word you love. A sound that relaxes you. A nostalgic thing that takes you back to your childhood. A happy memory. An inspiring quote. A song lyric. A sense of healthy achievement. A feeling of freedom. And however hard recovery feels, it is worth the fight. In time, you find yourself able to move on slightly quicker from the overanalysis of a meal, you find yourself able to lie in bed for a bit longer without having to get up and pace. You can laugh with a friend and take genuine pleasure in being silly and free. You can go for a swim and enjoy floating in a pool, feeling the movement and enjoying the relaxation rather than pushing yourself to do more and more lengths. You find yourself able to accept an offer to go out and socialise. To buy a bar of chocolate and enjoy it while you watch TV in the evening. To go back to university, or to find a job that you enjoy, a career that makes you look forward to the future. You will never, ever look back at your life in years and years to come and wish you hadn’t eaten a particular meal on a particular date in the past. You will look back and regret the time spent consumed by anorexia. We can’t change the past. But we can learn from it. We can use it to make a difference, to know what we truly want for ourselves. We can change our futures.
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