Sustaining anorexia: why recovery is so hard
If your life has been unfortunate enough to have been touched by anorexia nervosa in some shape or form, you will know that it is far from the prevalent narrative of someone choosing to starve themselves. It is incredibly upsetting to imagine someone seeing such a devastating illness as a choice. Anorexia has the highest mortality rate of any psychiatric disorder from medical complications caused by the illness, such as cardiac arrest, as well as suicide. With this in mind, how anyone can think it is an illness you ‘choose’ is beyond belief.
The statistics are frightening. 5-10% of anorexics die within 10 years after contracting the illness and approximately 20% of anorexics will be dead after 20 years. What’s even more concerning is the majority of people suffering with anorexia do not get the help they need to recover. This is often because medical professionals view someone who does have anorexia as not ‘sick enough’ to warrant treatment. In the meantime, the person suffering with the illness loses even more weight and gets deeper into the torture of their illness. The longer a person suffers, the harder it is to recover.
The lack of treatment and support options being provided to those with anorexia is one glaring reason why it is so hard for someone to recover. There are numerous other reasons as well.
Control is a key feature in anorexia. A person suffering with the illness may feel like they are in control of their life as a result of the illness, but the reality is, the illness is controlling them. It may well have started with the person being in control, but it is a slippery slope and sadly, the illness takes over soon enough. It is relentless.
Anorexia causes physical and psychological changes due to starvation, which makes recovery challenging. The physical loss of weight can give someone with anorexia a ‘high’ feeling, like a sense of achievement. This can almost become addictive, as the sufferer continues to seek the high feeling through more weight loss, leading them again, deeper into the illness. Initial praise from others and comments about ‘successful’ weight loss can also feed this sense of achievement. The thinness ideal that is paramount in our culture, which is showcased prolifically through social media, is counterproductive in motivating someone with anorexia to gain weight. Society reinforces diets and weight loss – the things we are trying to help someone with anorexia to go against.
The psychological anorexic ‘voice’ or internal narrative that sufferers experience is one of the most significant aspects to the illness that sustains its existence. The more weight that is lost, the louder and stronger its presence. This bully that dominates a sufferer’s mind takes control of the person and it is extremely hard to fight. It is a constant battle in the sufferer’s head and as starvation continues and a person’s mental ability wanes, the voice keeps winning in telling the suffer not to eat, how worthless they are and that they must not gain weight.
People with anorexia can also experience emotional blunting, which can be very useful to the sufferer and so prevent recovery. Not being able to cope with emotions, such as sadness or anger, or even the overwhelming feelings of happiness, can make the anorexia valuable to the sufferer, as it enables a person to be numb to their emotions.
The core beliefs of someone with anorexia can further aid in sustaining the illness. If the sufferer believes that they are a bad person or that they are worthless, then they do not believe that they are worth fighting for. They do not believe that they are deserving of a life free from their illness and so are indifferent to recovery. The anorexic voice will also reinforce these negative core beliefs. Such beliefs are associated with rigidity and obsessiveness, which are consistent with perfectionism – a highly common trait in those with anorexia. The rigidity and obsessiveness displayed in someone with anorexia is extreme and leaves them very much set in their ways in their eating disorder, so change and trying to make steps towards recovery seem impossible. The Ancel Keys starvation study highlights the emotional changes that occur as a result of starvation, including obsessiveness around food and eating.
The above should give some indication of why it is pointless to tell someone with anorexia to ‘just eat’. Recovery is notoriously difficult and takes a long time – sometimes years. Despite the odds seemingly being stacked against the person with anorexia, recovery is absolutely possible, even when the person has lived with the illness for many years. Having a support system in place is crucial in helping the sufferer to fight their illness. Eating disorder specialists, counsellors, doctors, nutritionists, family and friends are all important in helping a person to fight for a life free from anorexia. Relapses are frequent but they are a normal part of recovery.
You can live without anorexia calling the shots. Never lose hope, and definitely never give up.