Dying to be Thin

It works something like the proverbial Catch 22—we see beautiful bodies, then observe our own paunches, sags and cellulite. In despair, we self-medicate with food. A cycle begins. We get fatter, get sadder, and then get another bowl of ice-cream.

Anorexia Nervosa

Anorexia is a misnomer. Anorexia literally means “no appetite,” but in reality sufferers are extremely hungry and obsess over food. Anorexia is characterised by severe, prolonged limiting of food intake and a refusal to maintain normal body weight. With it comes an irrational fear of becoming fat and cognitive distortion regarding one's own body image. Often anorexics, who are typically underweight, think themselves fat. A high rate of adolescent girls develop anorexia, perhaps in an attempt to reduce an increasingly complicated life to one primary quest—to be thin.

The effects of anorexia can be grave.

Left untreated, anorexics often become amenorrhoic (without periods). The resultant low levels of oestrogen can contribute to bone loss, and a failure to shed the cells of the uterine lining each month can predispose a woman to female cancers. Malnourishment can open the door to heart problems, as was the case with singer Karen Carpenter, who died of an anorexia-related heart attack at the age of 32. A lack of fat “padding” can lead to bone and joint injury. Nervous-system challenges arise, including insomnia. The brain may actually shrink, exacerbating cognitive dysfunctions.

Although anorexics often feel a sense of pride about being thin, they can collapse in despair when the condition worsens to the point of health breakdown.

Up to 15 per cent of anorexics die—the highest fatality rate of any psychiatric illness. Most victims are young females.

Bulimia Nervosa

Bulimia is Greek for “hunger of an ox.” This time the name matches the illness, for bulimics eat with a seemingly endless appetite. Characteristics include recurrent episodes of bingeing on high ‑ caloric foods, secretive eating, compulsive dieting, use of diuretics and laxatives, and self ‑ induced vomiting to “purge” excess, unwanted calories. While anorexics are thin, bulimics are typically average or a little overweight. They're fully aware that their eating patterns are abnormal, but there's a loss of control as the compulsion takes on a life of its own.

Typical post-binge emotions include a sense of self-loathing and shame.

The typical binge averages more than 14,300 kJ, but binges as high as 48,150 kJ have been reported. Some people force-feed themselves at such levels several times a day. Typical foods of choice include caloric ‑ dense junk foods such as biscuits and ice-cream, purchase of which causes food bills to skyrocket.

This eating disorder isn't often as fatal as anorexia, but it can cause a heart attack by throwing off the balance of electrolytes that give the chemical signal necessary for the heartbeat. The digestive system of a bulimic is constantly insulted by both binge eating and frequent vomiting.

The stomach becomes overexpanded, and the pancreas can become inflamed as it is repeatedly jolted into action.

Oesophageal inflammation, loss of natural gag reflex, and a predisposition to oesophageal cancer can also result from frequent vomiting. The throat becomes strained and the vocal cords compromised from contact with stomach acid.

Bulimics sometimes experience swelling in the parotid glands, giving them a chipmunk-like appearance. Frequent use of laxatives results in the breakdown of the protective mucous lining of the intestine, leaving the bowel vulnerable to diseases of various kinds.

A telltale sign of bulimia are sores that develop on the back of the bulimic's hands as a result of repeatedly shoving fingers down the throat. Impulse-control weaknesses pave the way for substance abuse, promiscuity and even shoplifting.

In attempting to understand complex issues, we often search for a simple answer. Eating disorders have no single cause, but rather an interplay of causes that can be summed up into three categories: psychological, biological and cultural.

Psychology

Although it's difficult to find a typical family profile for eating-disorder patients, there are certain prevailing psychological tendencies in both anorexia and bulimia.

These can be inherited either environmentally or genetically. Among them are perfectionism, low self ‑ worth, sexual-identity confusions and depression.

Like so many who resort to escapist behaviours, eating-disorder sufferers have trouble perceiving their real value and usefulness. Lacking this spark of personal vision and purpose, they pursue either elusive physical perfection, sensual indulgence or both. Once the disorder is in place, they often fluctuate between self ‑ loathing and self-indulgence. As the isolation that accompanies addictive behaviours increases, the sufferer has an even keener sense of worthlessness and despair.

Many who have suffered sexual abuse will resort to disordered eating later in life in an attempt to regain lost control.

Childhood abuse generally predisposes an individual to escapist behaviour. More than this, sexual abuse often triggers feelings of abhorrence in a young person toward their budding sexuality. Self-starvation can conveniently “desexualise” a person by lowering vital forces and thus minimising sex drive. This also reduces the sexual attractiveness of the body.

Research is indicating that social connection has a profound effect upon physical and psychological health. Those who don't reach out to others for help and comfort may face higher stress levels and increased health risks including eating disorders.

Biology

There's an intimate relationship between the mind and the body.

Thoughts can affect health, and the reverse is also true—the body can affect the mind. Since the mind is housed in a physical organ, and that organ is connected to other bodily organs and systems, the condition of the body can powerfully impact thoughts and emotions.

Because of this, biological factors can contribute to eating disorders.

For instance, research has linked eating disorders with a family history of depression and other mental health problems such as bipolar disorder. This suggests a genetic predisposition, especially to bulimia.

This genetic factor does not always cause an eating disorder, but can contribute when combined with other factors.

Culture

Various feminists have spoken out on the exploits of fashion contained in books and magazines that focus on dieting and eating disorders. And something called “looksism.” Looks-ism is charac terised by two things: an undue emphasis upon the importance of physical appearance and a distorted ideal of beauty. This phenomenon has factored into the eating disorder issue by placing pressure on women to be figureperfect.

At the same time, it has purveyed a distorted definition of what a perfect figure is.

When the gangly Twiggy made her debut in a 1965 issue of Vogue , she was 167 cm tall and weighed 44 kg. Suddenly teen girls believed they had to be rail thin in order to be fashionable. Such standards change at the whims of the fashion industry.

As women try to outdo one another by redefining beauty in their own terms, everything from muscle-man athleticism to oversized breasts are idealised.

But the rail-thin idea of beauty has been a constant in the catwalk culture simply because clothes hang on the models' waif-like bodies as they would on a hanger, thus keeping the focus on the clothes.

This is why victims of eating disorders are more often young women. Unlike their older more mature counterparts, teen- and university-aged girls are more likely to strive to follow fashion trends.

In the early 1900s women's magazines began to extol a thinner and thinner ideal of beauty. As the model female weight decreased, two things increased: the weight of real women and eating disorders. It seems that the more unrealistic and unattainable the perfect body becomes, fewer women actually try to reach it. But of those who do, more and more are resorting to anorexia and bulimia.

A Complex Interplay of Forces

Why some women explore these practices and others do not is due to a complex interplay between psychological, biological and cultural forces.

Being surrounded by a looksist society, combined with a history of abuse, a lack of social connections, an absence of faith or a genetic tendency toward depression can result in an eating disorder.

Thank God there's more to the picture than the odds life has dealt. There's an often ignored factor called choice, which is what makes the ultimate difference.

Choice is the way an eating disorder sufferer takes hold of the grace of God, as well as the lifestyle and treatment options available. Even though a sufferer has the psychological, biological and cultural odds stacked against them, there is hope of prevention and of recovery.

For more information: www.aedweb.org The Bronte Foundation 1300 0726 881 www.thebrontefoundation.com.au