Shedding in Pounds, Gaining in Control: Exploring the Determinants of Anorexia Nervosa Through a Personal Perspective

Nuzhat Faizah

Sophomore

School of Life Sciences

Independent University, Bangladesh

September 15th, 2017

Apshara stood up from her bed and stretched in the direction of the sun just shining its warm golden light on the balcony. Her eyes barely open, she could see the sharp shadows cast by the neon street lamps gradually disappearing with the onset of daylight. As she went towards the balcony, the dew-laden Jasmine tree embraced her with its fragrance even as she felt the tightening grip of the immense expectations she was carrying within herself. The vibrant summer rays kissed the outline of her curves, and tinted her brownish hair orange while she was standing in front of her mirror and pounding on her abdomen with her wrists. She was standing at the edge of her teenage years and was disgusted to see her belly. Eventually she thought to make it disappear.

Apshara's elder sister had eloped with her boyfriend and gotten married five years ago, and since then her relatives have been taunting her and her parents about upbringing and moral values. On top of that, her parents regularly taunted her, predicting that she was going to follow her sister's footsteps and tarnish the remaining reputation her family has in society. Her relationship of seven years with her boyfriend had ended with betrayal and heartbreak which shattered all her hopes of having a perfect family with the man she loved in the future. Moreover, disturbing fights and daily quarrels between her parents had her convinced that she could never have a harmonious environment at home. Ultimately, all these experiences had a negative impact on her professional life. Her friends and colleagues, while fully aware of her circumstances, had still taken advantage of her emotional disturbances and eventually boycotted her instead of standing beside her and supporting her through these ups and downs. Apshara realized that she was losing everything, and little did she know that she was going to get addicted to losing soon.

She could not believe in God anymore, not even in her own worth. As days passed by, she began to be under the impression that she was cursed, flawed, and worthless. She was fed up while coping with the taunts, expectations and decisions her parents had imposed on her, losing her job and friends, heartbreak, and betrayal. She was surrounded by the daily hustle and bustle, clustering of known and unknown people but at the end of the day, she was completely alone, concealed by the shadows of her agony and depression.

In response, she began to take control of her body and mind, and began losing calories. She did not care much about her health, as she did not want to live anymore. Her body amazed her when she woke up every day and went to coaching centers to teach children after she lost her job. She did feel uncomfortable and exhausted as she had very little body fat and almost no energy. The skinnier she became, the harder it was to keep the people around her from noticing, though she did everything to hide her body. She stopped caring about what everyone thought and focused on living up to her own standards of starvation.

What remained of her social life took a toll. Visiting Burger Lab, Pizza Inn or any other fast-food shops became a nightmare. "You are fat! You have to lose calories again! You are a failure! A disappointment to your family! You should die!" -an inner voice recited to her, conflating her feelings of loss and alienation with self-esteem issues regarding her physical appearance.

By April of this year, her physical conditions had worsened so much that she could not cover it up with clothes. Her hands and feet were completely emaciated and she tended to lose her balance whenever she tried to walk. One day at the coaching center, she collapsed. Once taken to the hospital, the doctor told her that her right leg was paralyzed and gradually the most important organs of her body would give up if she kept going this way. Apshara was scared but she was unsure if she wanted to go back to the days before she had started starving herself. Sitting emotionally numb at the doctor's chamber, she got to know that she was a serious patient of Anorexia Nervosa and if she had the will to get better and live a normal life, she would definitely attain success one day.

What could cause a normal person like Apshara to intentionally starve herself to this extent? What external factors and influences contributed to trigger this behavior? Could she recover?

There are two sub-types of anorexia: the restricting type, which typically involves severe reduction of food intake but no purging (self-induced vomiting or misuse of laxatives and diuretics);  and the binge-eating/purging type, which involves relatively frequent episodes of excessive eating followed by compensatory purging. The latter is distinct from bulimia nervosa, which also involves binge-eating and purging, but affected individuals are usually of normal or above average body weight.

Eating disorders like anorexia are products of many risk factors which might be cultural, biological or psychological, and these can add to the probability of developing anorexia, especially during late adolescence or early adulthood.

Anorexia’s general physical symptoms include rapid weight loss, irregular menstrual cycles in women, decreased libido in men, dizziness, bowel problems, swelling of face, hands and feet, anaemia, osteoporosis (thinning of the bones), dental problems, feeling cold most of the time even in warm weather, and feeling bloated and constipated. Furthermore, anorexia can result in lethargy, low energy and insomnia. But anorexia nervosa, at its root, is a mental health disorder. Anorexic individuals exhibit obsessive behavior such as excessive fasting and counting of calories. They often isolate themselves, and can become suicida.

Anorexia Nervosa, according to American Psychiatric Association Practice Guidelines can be treated by nutritional rehabilitation, psychosocial therapy, and medication such as anti-depressants and antipsychotics.

Nutritional rehabilitation simply refers to attempts to reverse the starvation-associated symptoms of anorexia through feeding of energy-rich foods. It is important to note, however, that overly rapid intake of nutrients in malnourished patients can result in refeeding syndrome, which is characterized by metabolic disruption and electrolytic imbalance. Patients are often resistant to change, so nutritional rehabilitation is often coupled with psychosocial therapies, which can include education, individual and family psychotherapy, and counseling. Interestingly, studies have shown that family therapy works best for adolescents while adults respond best to individual therapy. The Maudsley approach, developed for the treatment of anorexic patients, is a family-based therapy where parents play an active role to help their children start eating again and gain weight according to their age and weight. At such a vulnerable stage in their development, it appears that adolescents need encouragement and positive reinforcement to properly recover. It can take up to years to fully recover, and relapses can occur. But those are no reasons to give up trying.

It is undeniable that women are more susceptible to anorexia than men (the ratio is roughly 10:1). As girls grow up, they are complimented more on their physical appearances than on any other qualities they have. A majority of them follow diets and become conscious of their bodies from a young age. It is hardly surprising, then, that girls respond to feelings of inadequacy through enforcing harsh control over their bodies. Low self-worth combines with society’s ideals of beauty. While short-term measures must involve accurate assessment of each individual patient’s experiences and mental health, society’s attitudes toward women must change to truly break the cycle.

Name of character has been changed to maintain anonymity.

Nuzhat is a Biochemistry second-year with a neverending passion for photography and birds. She likes to study about mental disorders.