More and more young people in Britain are being admitted to hospital with eating disorders. According to the government’s Health and Social Care Information Centre, between October 2012 and October 2013 hospitals took in 2,560 patients suffering from severe health problems resulting from eating disorders – “8 per cent more than in the previous twelve months” [1]. Of those admitted, a whopping 91% were female - a large proportion of whom were aged between thirteen and nineteen. Three in four of the admissions were for the disease which strikes helpless terror into the hearts of loving parents worldwide – anorexia nervosa. Perhaps the most worrying thing about all this is that in order to necessitate hospitalisation, the starvation must have got to a fairly advanced stage. This indicates by extrapolation that untold thousands are struggling with this disease outside the hospital system. Given the secretive nature of this disease and the ubiquity of weight-loss initiatives in our culture, anorexia is often only noticed by family and friends when adverse physical symptoms such as reproductive failure, the growth of a fine downy hair all over the body, and even organ decline start to manifest. By this time the condition can be worryingly ingrained and hard to combat. Here, therefore, are some of the mental aspects of the condition from which anorexics may be suffering. If you think you recognise any of these attitudes or emotions in someone who is also displaying a fraught relationship with food, it may be time to try and persuade them to contact someone who can help [2].

Depression - Concerning Co-morbidity

Depression and anxiety are often major factors in anorexia. Depression is a serious illness for which help should be obtained in any case – but it is particularly concerning when it is co-morbid with anorexia. A study by the American Psychiatric Association reached the worrying conclusion that “Someone with both anorexia and depression can be ill for longer and less likely to recover from anorexia than someone with anorexia alone, suggesting that depression is a severity marker for anorexia” [3]. What makes this even more worrying is that depression and anorexia are commonly co-morbid. As PsychGuides point out, “Depression and eating disorders often occur together in the same individual” [4]. Sometimes the depression may occur as a result of the anorexia (starving the brain never has positive emotional results), and sometimes it contributes to the commencement of the condition – whatever came first, the two seem to thrive in each other’s company. Both illnesses entwine themselves around each other and combine forces to keep the sufferer in a state of calorie-cutting self-loathing from which it is extremely difficult to recover. It is thus essential to ensure that any depressed person who displays other markers of anorexia should be persuaded to seek help before either condition progresses any further.

Exerting Control

A feeling of being ‘out of control’ is also often a strong aspect of the anorexic mindset. Many anorexics speak of using severe food restriction as a means of exerting bodily control over a life which seems emotionally chaotic. Marilyn Lawrence, author of ‘The Anorexic Mind’ [5] and a prominent figure at Bradford’s School of Applied Social Studies, has studied this aspect of eating disorders. “Anorexics are attempting to solve the problem of their own powerlessness and denigration as women by engaging in an internal struggle for self-control”, she writes in a paper on the topic, “The struggle takes the form of an effort to transcend the body which debases them, and to achieve self-respect through self-denial” [6]. Certainly feelings of ‘spiralling out of control’ and ‘helplessness’ are often cited by anorexics as a reason for their calorie restrictions. Young children in particular may manifest symptoms of anorexia if they become frightened about the prospect of growing up and experiencing bodily change. A thin figure with no womanly curves or masculine musculature is associated with children, so many children subconsciously attempt to stay thin in order to prolong childhood. The National Centre for Eating Disorders highlights this as an anorexic trigger relating specifically to children, pointing out that “It can be a way of avoiding sexual maturation in someone who feels they cannot cope” [7] .

Poor Body Image and Societal Pressure

Of course, one of the reasons why pre-pubescent girls in particular may want to stave off puberty is that a pre-pubescent style body – lean, no curves, and no body hair – is arguably idealised by our society. One simply cannot deny the importance of body-image factors in the development of anorexia nervosa. The unfortunate fact is that ours is a culture in which thoroughly unrealistic standards of physical attractiveness are worshipped. Images of stick-thin female fashion models, or male torsos which are all veined muscle and no fat abound on every billboard, and we are tacitly encouraged to emulate them. This often results in extremely poor body image. A Glamour magazine survey came in with the shocking results that an enormous 97% of women would have a ‘body-hating’ moment in any given day. According to Glamour, each day “young women recorded an average of 13 brutal thoughts about their bodies” [8]. For many this results in an obsession with eradicating perceived imperfections. Anorexics often start their downward spiral into starvation by expressing dissatisfaction with their bodies and undertaking weight loss programs. However, when they discover that healthy weight loss techniques are not extreme enough - responsible weight-loss groups like Weightwatchers promote “Eating smarter without eating less” [9] - they take matters into their own hands. This can swiftly lead to anorexia or other eating disorders. Social media and the rise of the internet appear to have exacerbated this phenomenon - in a report upon the subject the Guardian states that “blame is in part being put on the rise of social media which has helped to develop an obsession with image” [10] . There are a few vocal campaigners who insist that the media and fashion industry should be able to use whatever body type they choose in their images, and that eating disorders have little to do with societal factors. However, the undeniable truth is that, while anorexia and its compatriots have existed for centuries, they have only ever manifested in societies which place extreme positive value upon being lean.

A Complex and Dangerous Mental Illness

This is by no means an exhaustive list of the kind of attitudes and feelings experienced by an anorexic. The NHS has a comprehensive description [11]; of physical and behavioural ‘tells’ which will also be of use, while research is ongoing into the psychiatric and lifestyle factors related to the condition. However, those described above are some of the most common. If you have a friend who is depressed, has expressed a degree of anxiety about their body, and speaks of their life ‘spiralling out of control’, you should perhaps talk to them and attempt to aid them in their problems before any of these things develop into something far more dangerous. Anorexia can be lethal, and is extremely hard to cure. According to the BBC, “Anorexia is recognised as the most deadly of all psychiatric illnesses, killing more people than alcohol and drug addiction and depression” [12]. Once we learn to fully recognise that anorexia is as much a mental and emotional condition as it is a physical one, we will be halfway to giving it the proper psychiatric attention it deserves.

Contributed by Jenni Gannon

[1] Health and Social Care Information Centre "Eating Disorders: Hospital admissions up by 8 per cent in a year", January 2014
[2] B-Eat: Beating Eating Disorders
[3] Joan Arehart-Treichel "Premorbid Depression Associated With Poor Anorexia Prognosis", Psychiatric News, The American Psychiatric Association, April 2014
[4] "Eating Disorder Symptoms, Causes and Effects", PsychGuides
[5] "The Anorexic Mind" Marilyn Lawrence, , Karnac Books, 2008
[6] "Anorexia Nervosa - The Control Paradox" Marilyn Lawrence, Women's Studies International Quarterly 1979, Science Direct
[7] "All About Anorexia" Deanne Jade, , National Centre for Eating Disorders, 2009
[8] "Shocking Body-Image News: 97% of Women Will Be Cruel To Their Bodies Today" Shaun Dreisbach, Glamour.com
[9] "Eat What You Love. Just Smarter", Weightwatchers.co.uk
[10] "Rise in hospital admissions for young people with eating disorders" Sarah Bosely, The Guardian, January 2014
[11] "Anorexia Nervosa: Symptoms" NHS Choices, NHS.uk
[12] "Young with eating disorders 'missing out on vital help'" Liz MacKean, BBC News, July 2012