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Anorexia Nervosa
Five Anorexia Myths Exploded
You do get hungry; you don't see yourself as fat.
Posted August 23, 2009 Reviewed by Kaja Perina
So many people just don't understand what it means to want and need to starve yourself. Why on earth should they? Yet anorexia seems strangely appealing as a subject of media jokes, or magazine gossip, or off-the-cuff comments from acquaintances: ‘She's been looking really anorexic lately'. When I was ill and since I've been in recovery from it, the prevalence of myths and misconceptions has surprised me. They used to upset and infuriate me, now I can better understand them. So here I want to describe, and dissolve, the major myths about anorexia.
Generalising with complete confidence is impossible; there is always an exception. But (as I discuss here) the tendency to make oneself an exception to the general rule is an anorexic tendency too, and generalisations have the power to illuminate as much as exceptions do.
Myth 1: Being really thin equals having anorexia.**
You can be thin for all sorts of reasons: a persistent virus that makes it hard to keep food down; a terminal illness; frequent use of stimulants or appetite-suppressants like nicotine; endurance cardio training. It's often hard to tell the difference between these people and people who have anorexia, because simply being underweight has such systematic effects on the workings of the body and the mind. If you have anorexia, you may recognize in yourself some of these habits and characteristics:
a) Wearing lots of layers of thick clothing on a warm summer's day, and seeming to think it normal. (You're never warm when you have anorexia; you dream of heat almost as desperately as you do of food, and you watch winter coming with dread.)
b) Taking excessive interest in food, whether gazing in at the cakes in the baker's window as you pass, or eyeing up people's shopping baskets or their restaurant choices.
c) Looking secretive and/or detached from the rest of the world. Nothing much matters except your own life, especially when you can next eat, and especially keeping that eating absolutely private to the point of mystery.
d) Having no energy at all for more than the essentials. If you're walking, say, you might walk fast, but all your concentration will need to go into it; smiling is an effort; you don't even remember that you ever used to really laugh, with hilarity and abandon.
I used to think these qualities distinguished people with anorexia from those who are thin for other reasons, but the more I've read about the effects of simple starvation (especially from the Minnesota Starvation Study, which reduced robustly healthy young men to emaciated creatures who in almost every respect resembled sufferers from anorexia; see my discussion here), the more I understand that they are not so easily separated from each other. So if you're significantly underweight but don't consider yourself to have anorexia, maybe you recognize some of these traits of anorexia in yourself too? Maybe not the secrecy around eating, but the rest? Perhaps the most telling distinction is the question of whether you want to eat more, and be less thin, or not; their uncomplicated longing to eat was what showed the Minnesota volunteers to differ from people with anorexia. But even that desire may change and fade with lasting underweight - and does that fading at some point denote a shift into anorexia?
In short, I'm no longer confident about this myth. Anorexia seems obviously to be more than thinness, but pinning down qualities that distinguish the two categorically is not easy when we appreciate the complex feedback loops of the mind-body system. We can appeal to the current diagnostic criteria for anorexia, but I don't know whether that will always give us our neat distinction. More research is, as so often, still needed...
Myth 2: People with anorexia don't feel hungry.
Of course they do. They're only human, however much they like to pretend otherwise. For most people with anorexia, hunger is the point, after a while: it's the great tormentor and the great addictive high. You'll say you're not hungry (/ have had a big lunch, etc.) ad nauseam, but it's an excuse that wears thin when you're staring with eyes sunk into a skeletal head at the biscuit on someone else's plate, which you've just refused one of. Feeling hunger and resisting it is central to the illusion of power and control which anorexia revolves around (see Myth 5).
Myth 3: People with anorexia don't like food.
This is similar to Myth 2, but leads to different assumptions. In general, people with anorexia love eating as much as they love being hungry, if they dare to acknowledge that pleasure. (Not daring to acknowledge it can lead to a dissociation between liking food and wanting it which has been the subject of quite a bit of research on anorexia; see this post.) The eating, like the hunger, becomes the point: eating can only be as perfect as it should be if you're hungry enough, if it's late enough, if you've prepared the food meticulously according to your own immovable rules, if you eat it at the right speed, in the right order, without any danger of interruption. Only then has the day's hunger not been in vain, and the day held one small - or immense - pleasure after all the waiting. This is why rule-breaking is so much rarer for someone with anorexia from someone who is just dieting: there is so little else left in your life that to risk ruining the pleasure of eating by doing it 'too soon', or 'too much', would be devastating. For me, it was less the fear of getting fat that kept me ill than the fear of losing the grand pleasure of lots of chocolate in the dead of night.
Myth 4: Someone with anorexia looks in the mirror and sees a fat person.
Of course (s)he doesn't - not in the sense of hallucinating rolls of fat where they aren't. Anorexia is not body dysmorphia, though there can be an overlap between the two. Probably, you look in the mirror and see your ribs with their thinly stretched coating of papery skin; you see every hump of the spine if you bend over; you see the elbows thicker than the arms above them, and the dark hole between the bee-stings where your breasts might have been.
You see all this, but what you care about will be some tiny, specific aspect of your body that has always to be more and more pared away: the inner thighs must be more and more fleshless, say; or you have to be able to encompass your wrist with the other hand with more and more empty space to spare; or, as for me, your tummy has to be flatter and flatter, more and more concave, less and less like a tummy at all. The focus on minutiae is what lets you look in the mirror and be spurred on still further in your quest for a bodily ideal centered on thinness. (I explore the distortions of vision in anorexia in this post.)
In anorexia you see so selectively that when something does force you to see the whole, it can be shocking: one of the steps in my progress towards saying no to starvation was trying on a ball gown in a changing room and seeing the Dachau contours of my spindle arms and scrawny neck and bony bust emerging from the rich chocolatey shot silk of a dress I could never wear without horrifying anyone who saw me, nor could ever have any occasion to wear, since I never went out in the evening, because I needed all the evening hours for my bleak lonely routines of drinking and eating. It made me cry - and, eventually, helped me act.
Myth 5: Being thin is all that matters to someone with anorexia.
It might seem to contradict the previous myth, but being thin is in fact often only a minor matter compared to everything else that drives you. For many people, control is probably at the centre of it all: thinness is simply an effect of exerting control, a demonstration it to yourself and to others. (See my pair of posts on taking, losing, and letting go of control here and here.) Control of food and eating might be the most obvious anorexic behaviour, but the control illusion stretches its tentacles into all the rest of life: you have seemingly complete control over how much you work, say, and when; how much you spend; how many people you spend time with, how often, and in what context. And all of these things, being so controlled, shrink and shrink away as your body does, till going out for a drink on a Saturday night is as impossible as stopping work before your head is spinning, or spending anything without entering into your little expenses book, or going to bed before five in the morning, or not having the next day and week and month planned into nothingness. The whole constellation of ideals that clusters around the concept of control validates and reinforces all this: control equals strength, strength equals denial, denial equals simplicity, simplicity equals purity, purity equals perfection, perfection equals perfect control.
In fact, of course, it's the ultimate illusion: you're completely under the control of the twisted ideals and the routines that suffocate you, and make you inhuman.
Purity and self-denial and perfection are all equally inhuman. Gradually you lose your grip on what it means to live, and you delight in this (as much as you can delight in anything), because of that shining, unassailable edifice of ideals in your thin and tired and blotchy-skinned head.
Next week I'll talk more about how ‘life' is when you live it according to this illusory set of unspoken rules.
(**19 May 2017: update to Myth 1 to reflect my changed thinking on these mind-body questions.)
