Anorexia nervosa psychosis is the technical diagnosis although it has now been shortened to Anorexia.  The original diagnosis included “psychosis” because the Anorexic does not appear to know that there is a problem.  The denial is so intense at times that it defies reason or reality.  I have treated adults who weighed 65 pounds and believed that they were overweight.  

To the Anorexic, starvation is a solution to a problem, which is the anxiety caused by eating.  The calmness s/he experiences with starvation becomes addicting.  

As crazy as that sounds, there is a scientific reason for this.  Starvation causes a chain reaction that intensifies anxiety when the individual suffering from Anorexia re-feeds.  

Anorexia: How It Starts

In my experience, Anorexia doesn’t just happen, it occurs for a reason, or a combination of reasons, often to correct something that is out of balance in the patient’s life; an injury that ended dreams of being an accomplished athlete, dancer, or skater. Maybe it was an obese childhood and the stigma of being obese which resulted in the determination that it will never happen again.  Or perhaps the individual felt abandoned figuratively or literally, and the eating disorder was a way to get the attention needed to feel safe.

Many people suffering from Anorexia have debilitating anxiety.  As we saw above, the anxiety may start out as a gut issue having to do with Serotonin levels that are out of whack.  Even if it starts that way, it will usually take on a life of it’s own.  The Anorexia provides such individuals with a focus, being as thin as possible, a strategy which is restricting, and a desired outcome, which is lose weight.

Extreme perfectionism also plays a role with most Anorexics, who aspire to be the best Anorexic ever.  To this end they feel ashamed when they are not restricting, or worse, when they are gaining weight, as it means that they are failing.

There is a myth that Anorexia is a disorder that only impacts teenage girls, but the latest research shows that it can begin at any age. Today it is affecting younger children, older women and more men.

 Primary Features of Anorexia

Whatever the cause, the primary features of Anorexia nervosa are:

• Refusal to maintain a healthy body weight

• An intense fear of gaining weight

• Distorted body image – called body dysmorphia, such that she may still see herself as “fat” at 60 pounds

How It Feels

Lonely. You have lost your friends. Your parents and/or your significant other go back and forth between begging you to eat and threatening you if you do not. They definitely do not have a clue about the “twisted” way your Anorexic mind is working. Your every waking moment is dedicated to the pursuit of thinness. You (or the vicious voice in your head) never stops. It is relentless. It makes every situation involving food a nightmare for you and your loved ones. But you have to keep all of this to yourself. No one seems to get it how afraid you are. They all think you are being “stubborn”. You are losing everything. But you cannot see a way out, or a way back.

What to Look For in Your Loved One

These are just some of the characteristics that accompany Anorexia.  Please understand that everyone is different and that this is not a One-Size-Fits-All sort of problem.

• Restricting food intake despite being thin – Following a severely restricted diet. Eliminating “fats” or “carbs”. Eating only certain low-calorie foods. Refusing to eat around others or in public places.  Having a “good” and “bad” food list where the “good” foods are fewer and fewer over time. It can get so extreme that the Anorexic is afraid to drink water.

• Food rituals –Eating in rigid, ritualistic ways, such as cutting food into tiny pieces; eating at certain times and if that time is missed, not eating; eating only with a particular set of utensils; chewing food and spitting; eating alone and if anyone enters the meal is over.

• Pretending to eat or lying about eating –Suddenly becoming vegan, always having stomachaches.  Hiding, playing with, or throwing away food. Making excuses to get out of meals.

• Preoccupation with food – Some individuals, especially those suffering from starvation syndrome, cannot stop thinking about food and may engage in food related activities such as cooking for others, collecting recipes, reading food magazines, or making meal plans while still eating next to nothing themselves.

• Obsession with calories, fat grams, and nutrition – Reading food labels, measuring and weighing portions, keeping a food diary, surfing the net for low calorie diets/foods.

• Dramatic weight loss – Rapid or drastic weight loss with no medical cause. It may start out as seeming completely normal, s/he was a bit overweight and went on what appeared to be a “healthy” diet. (Diets are never healthy.) But there was no end and s/he could not stop losing weight. What was once a diet, is now an obsession.

• Feeling fat, despite being grossly underweight – Many though not all individuals suffering from Anorexia or Bulimarexia suffer from body dysmorphia, or a belief despite all evidence to the contrary, that they are fat. Sometimes the focus is a particular body part, usually the stomach but it can also be legs, hips, or thighs.

• Fixation on body image – Most patients really believe that other people are harshly critical of the way they look. They may obsess about every aspect of their appearance or something specific such as body shape, or clothing size.

• Harshly critical of appearance – In some cases the individual spends so much time in front of the mirror that they cannot function. It may take hours to get ready. Others cannot bear to look in a mirror and must cover the bathroom mirror up in order to shower.  Some individuals do not apply makeup and where baggy even wrinkled clothes.  In either case, there is always something to criticize. You’re never thin enough.

• Denial – The denial is fierce. It is one of the reasons that this disorder is considered to have psychotic-like symptoms, because the break with reality is so significant. It is very sad to see how this plays out. Many people are frightened of Anorexia.  Unaware or unable to express their fear, they appear instead to be offended by the person who refuses to eat. But the Anorexic/bulimarexic misinterprets their fear as disgust and believes that they are disgusted with her for being too fat.