Anorexia is a complex mental illness

Voices of an eating disorder

Anorexia is a complex mental illness to treat

Sherri has two voices in her head.

One is rational and intellectual. It tells her that what she is doing to herself is abnormal, that other people don’t live this way.

“You will die if you keep this up.”

The other is cruel and heartless. It says she is worthless unless she is in control; that she can only be successful if she loses weight.

“You don’t deserve to eat.”

That’s her eating-disorder voice, and it wins almost every time.

Sherri (not her real name), who is in her early 30s, suffers from anorexia. She struggles with those two voices every day.

“It’s really harsh,” she says of the negative thoughts. “I would never talk to somebody the way this voice talks to me: ‘You’re a pig. You’re fat. Why would you eat that? You weigh too much.’ “

Sherri’s days are consumed with numbers: How many calories are in that item? How many minutes did I exercise? How many calories did I burn? How much did I lose? How much do I weigh?

She has goal numbers for everything, but won’t discuss them or her current weight because of the competitive nature of her condition. She says research has shown that dramatizing dangerous thinness can provoke other sufferers: “She is thinner than I am and she’s still alive. I should lose more weight.”

Sherri has struggled with her condition for most of her adult life, most severely in the last seven years.

“It’s not like I said, ‘I’m going to have an eating disorder’ … I don’t think you realize what’s happening. It just kind of sneaks up on you.”

She can pinpoint the start to her university years, when she was studying for a degree in a physically demanding field – which she has asked not be identified – and had to change direction because of severe persistent pain.

She had focused most of her life in this field and hadn’t thought about doing anything else. It was as if her whole identity had been erased.

She slid into a deep depression and was hospitalized when she became suicidal. Her life felt so out of control, but there was something she had some power over – what she ate.

Sherri began restricting her food intake and exercising more than the average person.

The behaviours tapered off for awhile, but they came back with a vengeance in 2005 and haven’t left. Every day is a challenge.

If she eats too many calories over the number she has arbitrarily chosen for herself, she might work out longer. She exercises every day, even when she is sick.

She avoids, as much as possible, social situations that involve food. Christmas is particularly difficult, when her family gathers for a big feast. Her anxiety is amplified as she tries to appear “normal” but feels like there is a spotlight over her plate and people analyzing what she is consuming.

She is often weak and has difficulty concentrating. She has been hospitalized numerous times, often for her depression, and this makes her eating disorder worse because she has no control over the food given to her. Sherri often deals with medical professionals who have little to no understanding about anorexia.

Once, when she was struggling to eat some hospital food, a nurse chastised her by saying, “There are other people that are starving in the world.”

Sherri’s closest friends know about her eating disorder, but she shields it from others because of the stigma. She has been through counselling and the St. Paul’s Hospital eating disorders program, but Sherri says the services are limited and she needs ongoing support.

For those reasons, Sherri has become involved in Advocacy for Adults with Eating Disorders in B.C., a new group that has already met with B.C. Health Minister Mike de Jong to discuss the need for improved services. She also hopes the group will help increase the discussion and awareness about eating disorders.

“It’s not something people choose. This is not how I envisioned my life to be at this stage,” she said.

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Anorexia is a complex mental illness with both environmental and genetic components, says an eating disorders specialist.

Hanif Mohamed, who is responsible for eating disorder services with Fraser Health, said there is no easy way to sum up what drives a person to severely restrict their calories and/or exercise compulsively to become dangerously thin.

“There’s always that interplay between one’s environment and one’s innate qualities,” he said.

Mohamed said anorexics’ intense fear of gaining weight – even when others around them say they are too thin – is often fuelled by a trauma they have experienced. Limiting what they eat and how much can be a way to feel in control of their life, particularly in a society that glamourizes a thin physique and equates it with power.

Mohamed said the disorder is often compounded by low self-esteem in which the person does not feel worthy of proper treatment. Negative, critical thoughts become overpowering.

“It gets to a point where they can’t control those tendencies within them. Those tendencies overtake their logical reasoning, and it gets to the point where it becomes an obsession.”

Mohamed said anorexics may also suffer from other conditions such as depression, anxiety or substance abuse. He said successful treatment is intensive and long-term, and includes several components – psychiatric consultation, counselling, nutritional support, and medical treatment.

In Hope, eating disorder support services are offered for youth (18 and under) through Child and Youth Mental Health Services (604-869-4900) and for adults through Hope Mental Health Office (604-860-7733).

Doctor referrals are required for most services. For more information, visit fraserhealth.ca and search “eating disorders.” For more information about the group Advocacy for Adults with Eating Disorders in B.C., visit advocacyforadultsedinbc.webs.com.