Anorexia, Bulimia, Overeating and Self-Harming
If you go onto YouTube and type in the word ‘anorexia’ something very disturbing happens. You’ll see video after video containing harrowing photographs of skeletal young women. Many of the girls are so emaciated that their bodies are clearly in danger of shutting down through lack of nourishment.
The pictures are so shocking that you need to do a double take. They’re hauntingly reminiscent of images of concentration camp victims.
The women’s ribs protrude from their saggy skin and the bumps of their spines are clearly visible down the length of their backs. Some of the videos are posted as warnings about the dangers of eating disorders, but it’s my belief that many of them have a much darker purpose. The pictures on display are often self-portraits taken by anorexia sufferers who are posing in front of mirrors.
The garish photos fade from one to another while trendy pop music plays in the background. The message is clear: ‘Look at me; don’t I look great?’ Not only are the anorexics willing to display their bodies, but they are also proud of the way they look – horrific as that may seem.
Anorexics suffer from a condition called body dysmorphia. In this, the sufferer becomes obsessively worried about some aspect of his or her appearance, such as their weight. It leads to them having a distorted view of their own body shape.
When they look at themselves in the mirror anorexics don’t see someone who is close to starvation; instead, in their own mind, they see someone who needs to slim, and they aspire to lose even more weight. It illustrates the power that eating disorders can have over people – and it makes their condition very hard to treat.
People with an addictive nature often use their relationship with food as a way of medicating their negative feelings and their emotional problems. The eating disorders they develop tend to fall into three distinct categories. These are anorexia, bulimia and overeating (which I touched on in the earlier chapter about sugar).
Anorexia manifests itself through starvation due to the avoidance of food. Sufferers become painfully thin and they may go for many days on end without eating a single thing. Bulimia, meanwhile, is when somebody binges on food, but they maintain a normal weight by purging their body by inducing themselves to vomit. In contrast, people who overeat gorge daily, over a long period of time, and their weight balloons to gargantuan proportions.
A strange aspect of these three distinct types of eating disorder is that a sufferer may potentially swap from one state to another as time goes on. For example, if somebody is anorexic they may swap to bingeing on food and force themselves to throw up (in which case they develop bulimia), or they may even go on to become an overeater.
All three types of eating disorder are self-harming in their nature.
Many people don’t readily see anorexia as a form of addiction, but that’s exactly what it is. The sufferer becomes addicted to the effect that the anorexia has on their feelings – and in particular on the control that they perceive it gives them over their body.
Avoiding food becomes a compulsion that’s rooted in the same causes that drive other types of addictive behaviour. These are usually fear, insecurity, low self-confidence and an inability to deal with emotional pain. At the heart of anorexia – as with all addictive processes – lies codependency. It’s an emotional and psychological condition.
If someone’s life feels out of control, being very rigid about what they eat may feel like a way of reasserting some order. It’s the reason why an anorexic is very iron-willed about how to control what they eat. The need to avoid food becomes a compulsive obsession.
The feelings generated by the process of starvation become a distraction from the emotional distress that the sufferer would otherwise be feeling due to other factors in their life or childhood.
Of course, far from giving them control, what actually happens is that the eating disorder comes to control them. It may spill over into other areas of their life aside from food.
Anorexia is about avoidance: and this can manifest itself into avoiding sex, avoiding intimacy, and even the avoidance of spending money. Typically, an anorexic will be very scared of sex, and they’ll go to great lengths to avoid the intimacy it involves. Others will make a huge effort to avoid spending cash, forcing themselves to live a very austere existence, or to rely on others for their financial needs.
It’s important to note that anorexia does not just affect women. We’re starting to see an increasing number of boys in treatment centres who are anorexic. In fact, I suspect it’s a condition that has affected males throughout history, but it may have been misdiagnosed as other illnesses in the past.
Anorexia is a mechanism for control, and this manifests itself in all sorts of ways. Strange as it may seem, a tell-tale sign of whether or not someone has an eating disorder can often be found in the shape of their handwriting. Anorexics tend to have the smallest, neatest handwriting in the world.
They’ll write line after line of little tidy script, all perfectly formed. Bulimics and overeaters tend to write in slightly bigger letters, but they’re still very perfect in their formation. This too often gives me a clue that someone is trying to exert a lot of control over their handwriting, just as they do with their diet.
Anorexics exhibit willpower that can be extraordinarily strong. As a way of breaking the ice with them I often joke that I’d want them on my side in a war because they’re so strong-willed! They’re highly astute and intelligent, and more than capable of working out that their life isn’t as they would like it to be.
Unfortunately, the path they choose in order to try and fix things is highly destructive and it follows the classic addictive process. They feel like shit, so they starve themselves. The physiological effect that this creates gives them a temporary reassurance that they’re dealing with their problems. They get high on being light-headed from starvation.
Of course, sooner or later, they need to eat something to survive, which makes them feel guilty and disgusted with themselves. They feel like shit again, which triggers a repeat of the whole process. Body dysmorphia exacerbates this process because they may be convinced that they’re as fat as an elephant, whereas in reality they’re actually unnaturally skinny.
Occasionally an anorexic may allow themselves to indulge in a ‘forbidden’ food like ice cream. This can trigger temporary feelings of euphoria, which are quickly followed by more shame and disgust for losing control. Anorexics are also prone to over-exercising in an attempt to burn off calories. I’ve known girls who will go out of their way to walk many miles every day as they try to lose weight. They may also resort to swallowing laxatives in large doses to further accentuate their weight loss.
The internet may play a large role in an anorexic’s behaviour, as they typically exchange tips and advice on so-called ‘pro-ana’ bulletin boards (which also contain the sort of videos that appear on YouTube). Some of this advice is very detailed and it can make harrowing reading. I know of one case in which a teenage girl was advised to sleep with her bedroom window wide open so that her body would burn more calories in the cold.
The mainstream media is often accused of triggering anorexic behaviour by presenting skinny fashion models as icons for girls to aspire to. I believe there’s some truth in this, but it’s an over-simplification to attribute it as an underlying cause of eating disorders, which are rooted in emotional issues.
Anorexia is a condition that’s notoriously hard to treat – simply because sufferers are so determined. Many women never succeed in fully shaking it off, although thankfully, by the time they reach their forties, they often manage to find a way of keeping their disorder in check. This involves a need for constant vigilance – and working out ways of dealing with emotional stress that don’t involve acting out compulsions via food.
Bulimia is a process whereby the sufferer is locked in an endless cycle of binge eating, followed by vomiting, in an attempt to avoid putting on weight. Just like anorexia, it’s usually triggered by a deep-rooted sense of low self-worth and issues around codependency. Some bulimics may only vomit occasionally, but for many it happens on multiple occasions every day.
I’ve met people with bulimia who will spend literally hundreds and hundreds of pounds on food every week, all of which they binge on before making themselves throw up. While they’re in the act of bingeing they can experience an enormous rush of power and excitement. It’s as if they experience a high through the unbridled consumption of food, often in the form of sugary things like chocolates and sweets.
In extreme cases, the urge to continue eating is so overwhelming that people have been known to throw up into rubbish bins and then scoop out their own vomit in order to eat it. You can only imagine the feelings of shame and disgust that this causes them. Ironically, these feelings in turn continue to drive the process of bingeing, because bulimics deal with the distress through more comfort eating.
Inducing vomiting is a dangerous process that robs the body of vital vitamins and electrolytes, so even though they maintain a normal weight, bulimics often encounter other medical problems. In extreme cases the sufferer can be at risk from heart attack or stroke. Some bulimics develop the ability to throw up almost at will, without the need to put their fingers down their throats. When this occurs, the sphincter at the bottom of their oesophagus may stop working correctly, and the contents of the stomach are able to leak upwards, leading to foul breath that stinks of vomit.
A bulimic’s teeth become discoloured from constant contact with the acid contained in their vomit, and their cheeks become puffy and hamster-like. If a sufferer already has an addictive nature that’s characterized by low self-esteem, these side effects make them feel all the more traumatized.
A phenomenon that often exists alongside bulimia is overt self-harming, which may involve the sufferer deliberately cutting themselves. This is largely an attempt to substitute physical pain for emotional pain, because the former somehow feels more bearable. Typically, sufferers will cut their arms, sometimes with very deep gashes that require hospital treatment.
I’ve known young girls to attend treatment centres with their arms bandaged from wrist to shoulder. The girls’ upper limbs are left deeply scarred, to the extent that they refuse to wear sleeveless outfits. Other forms of self-harming might include inflicting burns to arms or legs, or attempting to harm the genital area by plucking out pubic hairs.
When somebody self-harms, the feelings they experience are very complex. The pain they feel from the act of cutting, for example, seems to release something within them, like a form of emotional blood-letting.
They describe the process as being like flushing out their negative feelings about their own self-worth and inner self-esteem. It’s as if the emotional pain that they feel in their lives is so great they’re willing to substitute it for the physical pain caused by self-harming. This physical pain is angry and raw – but it’s easier to deal with than the emotional agony that it masks.
The correlation between bulimia and self-harming seems to exist to a greater extent than it does in anorexics or overeaters, but they too may also self-harm. The way to treat the condition is to strip away the detail of the self-harm itself and work out what it is that’s causing the emotional pain that leads the sufferer to do it.
Overeaters – and by this I mean people with serious food addictions – are also seeking to change the way they feel about themselves. In the chapter about sugar addiction, I explained the process they go through in detail. It involves gorging on food in order to experience an emotional boost. In blunt terms, it is comfort eating that has run riot.
The sufferer’s weight can balloon to gigantic proportions – in some cases to the extent that they’re unable to even get out of bed unaided. When this happens, there necessarily needs to be someone who is enabling them by constantly feeding them. Often this person may be a misguided parent who is suffering from emotional issues of their own.
The process of overeating works in a similar way to other forms of addiction like alcoholism. If you’re an alcoholic and you feel crap or insecure, you go out and drink. Invariably this only adds to your problems, so sooner or later you repeat the process, with ever more dire results. A person who overeats feels like crap because they’re overweight, so they eat even more in an attempt to comfort themselves. They know they’re fat, but unlike anorexics or bulimics, they cannot develop any way of controlling their weight gain.
Overeaters think of themselves in very harsh terms and their fears about putting on even more weight become a self-fulfilling prophesy as the process continues to repeat itself.
Some people may dip in and out of problems with eating, depending on what else is going on in their lives. As a general rule of thumb, if a woman has had more than three or four different dress sizes during her adult life it can be a clue that she has issues around food, since it’s clearly causing her weight to yo-yo. The same applies to men, although it may be less noticeable, as culturally, people may be less likely to comment on a man’s weight.
Sadly, if someone is extremely overweight it may take many years before they’re able to start to tackle the causes of their distress. This is because if a person weighs 20 stone (and is 10 stone overweight for their height) it may take many years to get them back to their normal weight.
Unfortunately, until they manage to do this it’s very hard to get to grips with the emotions that are causing them to overeat, because their weight continues to be a distraction. In order to treat addiction it’s necessary to strip away the addictive process and get to the raw feelings that are causing the problem.
With some forms of addiction, alcohol for example, this can be a relatively quick process. If an alcoholic stops drinking then his or her raw emotions will begin to surface relatively quickly, often within the space of a few days or weeks. People with eating disorders, however, face a slow road to recovery.
But with help and support it’s possible to turn their lives around. The dietary regime they’re recommended to follow usually consists of three meals a day, with the avoidance of sugar and white flour (the two ‘high-octane’ food ingredients that I talked about in the chapter on sugar).
Of course, not everybody who has issues around food develops a fully fledged eating disorder. In my opinion most of us probably eat too much (or too little) than is good for our health on certain occasions. If the consequences of our relationship with food become negative then it can have an extremely adverse effect on our lives.