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Understanding anorexia
KalTorak
One way or another, they all end up inthe Undercity.Registered User regular
One way or another, they all end up inthe Undercity.Registered User regular
My girlfriend is a former/recovering anorexic.
Now, I know what it is, what the symptoms are, sort of what causes it. I've researched the fuck out of it. And yet I still can't wrap my mind around it. My girlfriend is otherwise very successful, does very well academically at a prestigious university (we're both 21), is talented, all that. She says that it comes from her being a perfectionist rather than having low-self esteem.
We don't talk about it very often; when it comes up I try and be helpful but i simply cannot understand why someone would do these things. We were looking at the wikipedia page for it, specifically the symptoms, and she says "i cringe reading it, but at the same time it's a sense of satisfaction... because you're accomplishing something. It's like proof that you're not going to gain weight."
Obviously I find this really scary (some of the symptoms she was referring to included "constantly feeling cold, bruise easily, dry skin, excessive exercise and food restriction"). I try and step logically through the theoretical thought process of how these could be perceived as good, trying to understand it. Usually when I do this she'll go some of the way with me before asking that I not argue with her anymore, or saying that it's irrational.
Now, logically, when something is irrational I figure it should be dumped. She says that she agrees but also says that if I argue it with her then it'll just make her stand firmer. Now the last thing that I want to do is persecute her or act like a pompous asshole, which I think is how it comes. But I honestly do not know how to respond to her when she talks about it - I try to understand it but she always stops the argument. Not to throw stones but it reminds me of trying to argue religion with people. It's frustrating because I want to understand it and help her but I don't think the way I'm going about it is helping at all.
tl;dr: My GF is a recovering anorexic, I don't understand it and don't know how to help.
How can I be supportive without attacking or condoning her behavior?
Now, I know what it is, what the symptoms are, sort of what causes it. I've researched the fuck out of it. And yet I still can't wrap my mind around it. My girlfriend is otherwise very successful, does very well academically at a prestigious university (we're both 21), is talented, all that. She says that it comes from her being a perfectionist rather than having low-self esteem.
We don't talk about it very often; when it comes up I try and be helpful but i simply cannot understand why someone would do these things. We were looking at the wikipedia page for it, specifically the symptoms, and she says "i cringe reading it, but at the same time it's a sense of satisfaction... because you're accomplishing something. It's like proof that you're not going to gain weight."
Obviously I find this really scary (some of the symptoms she was referring to included "constantly feeling cold, bruise easily, dry skin, excessive exercise and food restriction"). I try and step logically through the theoretical thought process of how these could be perceived as good, trying to understand it. Usually when I do this she'll go some of the way with me before asking that I not argue with her anymore, or saying that it's irrational.
Now, logically, when something is irrational I figure it should be dumped. She says that she agrees but also says that if I argue it with her then it'll just make her stand firmer. Now the last thing that I want to do is persecute her or act like a pompous asshole, which I think is how it comes. But I honestly do not know how to respond to her when she talks about it - I try to understand it but she always stops the argument. Not to throw stones but it reminds me of trying to argue religion with people. It's frustrating because I want to understand it and help her but I don't think the way I'm going about it is helping at all.
tl;dr: My GF is a recovering anorexic, I don't understand it and don't know how to help.
How can I be supportive without attacking or condoning her behavior?
KalTorak on
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There's also a certain fixation that goes along with it that's similar to obsessive-compulsive disorder. They often become fixated on body image and food. They may still eat, for example, but they'll eat meticulously measured proportions at specific times of day. Or they may hoard food, partly to give the appearance to family that they're still eating but partly because the hoarding behavior itself is satisfying in a way similar to OCD.
Consequently, the worst things a loved one can do are to be controlling or to fixate on the disorder. Talking about the anorexic's weight or eating habits, even in a positive way, can reinforce the anorexic's fixations on food and body image. The family of an anorexic may try to manipulate or control the anorexic's eating habits, punishing the anorexic if she refuses to eat or using emotional manipulation (withdrawing love and support as the anorexic gets worse).
In contrast, the best thing you can do is let the anorexic deal with the problem herself, but encourage her efforts to find healthy ways of exerting control over her life. Reminding her that you love her regardless of how much she weighs or how much she eats is good, just don't bring it up too often. But it really is a question of what not to do rather than what to do. Don't control, manipulate, or obsess over the issue. Save attempts to intervene until/unless she's in danger of seriously hurting herself. That's not to say that you should ignore the problem - it's okay to express concern and to communicate about the problem openly. Just be aware of the line seperating concern and manipulation.
* - Men can have eating disorders too, of course.
the "no true scotch man" fallacy.
I've no doubt that a range of reasons can induce such a problem but I myself liken practicing anorexics to body builders who, seemingly out of compulsion, continue to induce muscle growth. It's from an (often) irrational desire for their warped idea of perfection that these compulsions arise and because the target is an unattainable one the drive for it continues. It's from here the associated problems are derived as the individual continues to reach for progression into something that they may well know is doing them harm yet continue to ignore.
Once it is understood that you can't superimpose your idea of what is ideal onto them it becomes easier to understand any motivation involved. One of my friends was once anorexic because she was of the firm belief that being thinner meant being more attractive. It turned out that her target was to be grossly underweight because that what was percieved to be perfect. Just because their opinion doesn't coincide with your own doesn't deprecate the strength of their belief, no matter how unhealthy it may be.
You can be infinitely more helpful by simply letting the subject drop and supporting your girlfriend in whichever way is necessary. It's certainly the case that discouraging that behaviour will seldom have the desired effect so the best way is to encourage growth in new directions rather than to attempt to stamp out any belief system.
Apologies if this doesn't read well, I'm really tired and my language doesn't seem to be up to scratch from what I can glean by glancing over my post. Edit due tomorrow.
You say she's a recovering/former anorexic. She's not doing it now? So really your role is to help her continue on her recovery.
You should accept that she's irrational about food. To be honest, it sounds like you have a little bit of a problem with illogic in others (something I suffer from myself). If she's illogical, so what. People are often irrational, and the fact that she's aware of this is excellent.
If she talks about it, ask her questions designed to let her express her feelings more, and to explore those feelings with her. Take the basic assumption that she's trying to get better, and incorporate that into the conversation, e.g. ask her if the feeling she had is something she can deal with or something that she is worried about.
Having said all that, there are two things in your post that worry me - firstly is she really a former anorexic, and secondly that there is 'arguing' about this going on. What's to argue about?
Being fat or unnattractive is often demonized to the point where it starts to carry some really hateful sentiments. OMG that girl is so fat! Can mean plenty of things, and not any of them are generally intended to be nice. Because this attitude or belief about fat is so prevailent, it carries forward to those who don't really have a problem that way with an almost cult like charisma.
Charisma is way of making people believe things that aren't exactly true through a series of associations, rather than actual evidence. This isn't to say that it is not a real force, or that it's conclusions are less real to the people that believe. It's just something different.
So when looking at something like anorexia, it's important to spell out and recognize the associations made with being fat.
Does it mean unpretty?
Does it mean unhealthy?
Unliked?
Not in control?
Made fun of?
Less of a person?
Unworthy of being loved?
So really, when you get down to it, a great deal of anorexia, or really any eating disorder, is about fear. Fear that 'calories' will do unspeakable things to you. Make you unpretty, make you unworthy of love. Calories may as well be a strain of flesh-eating bacteria (as ironic as that is), in the way they are perceived as potentially damaging to the things that person values. The more that person has to lose, the bigger that fear can become - counter to most understanding. Lots of people think that anorexia is simply a case of low self-image or esteem, and so it becomes hard to imagine why pretty people, lovely people, brilliant and popular people would fall prey to this kind of thinking.
Really, its quite the opposite - these people have an intimate understanding of the value and power of those things, and they recognize that much of what they have has been, at least in part, gained by those attributes. They know what is at stake, they know personallly and deeply just how close to the truth the issue cuts.
Now it probably wont feel like fear, more like pressure. Pressure that they'll be letting themselves down if they allow themselves to go down this road. This road has something 'bad' or 'wrong' at the end of it, so they don't like to take that trip. Sooner or later, they don't even like to drive anymore. It's hard to get out from under this kind of pressure, a lot of it is about what kind of messages they are getting from outside themselves and how they apply them on the inside. No magic bullet or cure for this one, I'm afraid. Certainly not much an outsider can do.
But, as it is with all things fear related, the key things involved to overcoming it are exposure and positive associations. Expose the lies, the unknown, the guesstimates. Shine the light in the darkness so those little dark shadows run a'scurrying away. Expose them to a healthy life, create positive experiences around the changes in their body. Reassure them that no matter what, you are going to be there. You can't force someone to not be afraid, you can only provide a situation which is safe and secure. It takes time, it takes patience, and there's going to be little bouts of backsliding. It's just the way things are. Keep at it though, and hopefully truly healthy will win out over an exaggerated idea of healthy.
If you want to justify aneroxia logically it's simply put that the desire to starve oneself and look thin outweighs the damage to your body that it may cause. It's purely a risk reward thing to why people do anything. (Why use the stairs? You can jump out of the window instead, reward shorter travel time, risk death). Since she thinks these things such as dry skin/bruise easily are acceptable side effects of being aneroxic, when she does get them it becomes proof that she is being anorexic, therefore have the dry skin is in fact good because her "diet" is "working"
Note, diet and working are not the right words to use in this situation but you know what I mean.
Satans..... hints.....
Not having had any personal experience with the phenomenon, I guess I fall in the category of people who think that it's (largely) a case of low self-image or esteem, and so I'm curious to see why you think this isn't really the case.
It would seem, from a complete outsider's perspective mind you, that anorexia (and bulimia, and plastic surgery addiction, and many other things) are symptoms of a person's tying the perceived value of themselves to some particular attribute - in this case, appearance. If you truly believe that your value as a person is directly related to your appearance or weight, then any effort to improve your weight/appearance increases your worth. Love, acceptance, happiness, a feeling of being at peace with the world are all side effects of having self-worth, and so hey, bonus.
Let me take a seemingly unrelated example. My grandmother is obsessed with family history. She will go on and on for hours about the centuries-long storied history of our family, and point out in no small way that having such a long and distinguished history makes our family (and by extension, her as a member) better than other people whose family histories can't be traced back umpteen generations. Any implication that this is otherwise is not just wrong, but personally offensive to her.
Obviously, this obsession is ridiculous. However, I firmly believe that (among other obsessions we have) this is just a symptom of the same root cause: low self-esteem.
We all desire self-worth, for the above very practical reasons. I believe that a lot of the challenge of life is acquiring and maintaining intrinsic self-worth. We are constantly subjected to extrinsic evaluations of our self-worth: by the public, friends, family, work colleagues, etc. Intrinsic self-worth is a resource pool from which one can draw to normalize these extrinsic influences. It allows us to take criticism in proper perspective, and to look at ourselves objectively, without falling into the obsessive trap. For example, I'm fat. I don't need a crane to get out of the house, but I'm not thin. I know this objectively. I'm reminded of this every time I go into a clothing store. I was especially reminded of this when my last girlfriend broke up with me because of it. However, these events don't send me into a tail-spin or depression. Why?
For me, it's because in my life I've set many goals and achieved them. I have taken risks and failed hundreds of times before succeeding. I have pushed beyond my own limits in every way and survived. These experiences have all bolstered a sense of intrinsic self-worth that lets me say "yeah, I'm fat. Hrmph. Have to work on that."
I know, on the other hand, that my grandmother has had no such experiences. In her life, she was coddled and isolated herself from the vagaries of the real world. She never pushed beyond her own limits. She never had to try and fail at anything that mattered or was hard. In her dotage, she now desperately needs to find things (as we all do) to make her life meaningful and valuable. And so she clings to stupidity - family history, the quality of her jewelry collection, and making up stories about her late husband that make him out to be a superhero on par with Superman, making her Lois Lane.
Many people have pointed out "society's obsession with weight" and the countless media images we're exposed to every day that equate low weight with individual value. As true as this is, I see this as a secondary problem. Society will (and always has) provided people with any number of stupid ways of evaluting one's own worth extrinsically. Wealth, caste systems, secret societies, and the size of rims on your car. These have existed throughout history and in perpetuity. They will never go away and cannot be controlled.
I feel strongly that overcoming obsessive behaviors is a result of developing a sense of intrinsic self-worth. That is, it requires people to really believe that they have value, independent of the rest of the world. This does not mean ignoring what the world has to say, it just means tempering it with perspective. I know how I've done this, and it's certainly a repeatable (but not easy) process. It involves, above all things, hard work, perseverance, and pushing beyond your own limits. The difficult thing is that I have never figured out how to best help other people do it. My girlfriend, for example, is a wonderful person with tremendous potential. And she does not believe that one whit. Nothing I can do or say seems to change that perception - only her own experiences have been able to do that (and at the pace of a crippled snail, at that), and only with constant urging and pushing from me and others.
I'm curious to hear what your opinions on this matter are, then. Is it more than this root cause, or is it symptomatic of it? How do you help someone without intrinsic self-worth achieve it?
This is very typical thinking really. Certainly it is true that some overweight people starve themselves because of low-self esteem issues.
But anorexia the illness is more about controlling things, one's self, one's dedication, one's self-dicipline etc. You can have a very high sense of worth about yourself and still want to control yourself and the things around you. In fact, its the measure of control itself one has over themselves that often provides one with a sense of accomplishment and self-worth. It has much less to do with achieving self-esteem and more to do with maintaining self-esteem.
That's why anorexia can't be fixed with a big hug and some personal acceptance. They are not looking for additional positive attention, in the way many overweight people want to become thin for. Rather they are looking to prove something to themselves, or exert the same level of control they have over other things.
The trick of it is to focus that need for control on other things about themselves instead of just calorie reduction. They need to eat right, and worry about maintaing a healthy weight, not just a low weight. It's harder than it sounds, once you break your addiction to food, you really just don't need as much of it anymore. You don't really get the same signals to tell you when you're hungry, and your body hits an energy rush - almost a euphoria. It gets easier and easier to eat less and less, and if you put too much trust in what you think your body is saying, you can tip over the edge because it's just not saying anything anymore.
Its not at all like losing weight when you're fat, where it's all effort and exercise and muscle burn. The routine and habits for gradual loss are already in place and being taken for granted. One pulls their weight uphill when getting to trim condition, you glide down the other side once you get there.
And really, there aren't any messages out there telling them to stop. There''s just one or two about eating disorders and the rest of the world says thin is beautiful. Thin to a certain extent, and to a great many people, is beautiful, which can be an addictive blend of power and control all on its own. It is one reason why truly attractive people often display eating disorder symptoms - once you have tasted that kind of power, that kind of random effort and appreciation directed at you, it can become very important, and one tends to ensure it doesn't slip away.
I not saying self-worth doesn't have a part to play in all this - obviously if one could find complete and total acceptance of one's self within themselves, they would probably stop trying to control and manipulate thier bodies so much. But that is true of anyone, so it doesn't really target the anorexic all that well. Typical self-esteem building exercises (creating stepping stone goals and meeting them, for example) won't do much, because in most cases, the esteem is already there. They're tough, they're motivated, they're proud of who they are. They just feel a need to stay that way.
They only real way is to have a healthy image gradually accepted as ideal and perfect rather than a rail thin one. Healthy bodies have muscle and a body fat percentile. Let them obsess over that, let them body sculpt that, etc. You can throw all the attention into your own body you want, and as long as you are working towards a healthy ideal, no real harm is going to come of it. In fact you'll probably end up smokin hot. Encouraging and directing that drive and energy into something good, instead of something potentially harmful, seems the way to go. IMHE, anyways.
That's definitely true; i'm coming to realize that I have a real problem dealing with people who don't think the way I do - that's something I'll have to work on.
The thing is, I can't really be sure how much she's recovering or not. We're in an almost constant long-distance relationship (we go to different schools) so I can't really say how well she's recovering. She says that it only comes up once in a while, the rest of the time she's fine (this most recent one was brought on by her classmates talking about how they had put on a lot of weight while they were all abroad).
During the time that we do get to spend together she eats normally most of the time... i think. The past few visits she's been eating pretty much the same sorts of things I eat anyway. She still has some food quirks that I can't tell if they're just genuine food dislikes or if it's a symptom; like, she'll almost never eat anything that's been fried, or has come into contact with hot oil. She used to just order salads but from what i've seen she's been getting more substantial meals. I don't want to ask her about these things because i'm trying not to focus on it.
The "arguing" that goes on is basically her trying to explain the thought process to me. Unfortunately when she does this I try and break down the things that don't make sense to me, which I don't think is helpful to her. My problem is that when she does want to talk about it (rarely), I want to be supportive and listen, but other than nod and say "ok" a bunch of times I can't see what I can contribute that's not judgmental. I just feel like such an idiot sitting there listening to her and not being able to say anything helpful other than "i love you."
We'll be living together over the summer which will probably let me get a better picture of things. I also cook a lot, so i'm trying to come up with recipes that she'll find acceptable but are also healthy and substantial. Would this be constructive?
Nodding, saying 'OK' and finishing with 'I love you' is fine. This isn't a test of your intelligence - rather your empathy, self-control and patience. Do you tell her that you worry about her?
If you do want to do more, questions are what you need - by asking questions to understand her, you may help her to understand her own feelings.
Obviously, be careful about being too much with the 'healthy eating' - I can imagine that could be irritating. Probably much more sensible to decide on meal plans with her, to make sure she feels in control of what she's eating, and that compromise with you keeps her eating healthily.
Also, this may be something that will be part of her for a very long time - that she will continue to sometimes have problems with food.
If you have a chance, read Men are from Mars, Women are from Venus. I know it sounds very cliche, but the diferences between men and women in general are mental as well as physical. The book does a lot of stereotyping, but you will likely find that many of its observations are spot on for you as well as her.
As far as I know we have a thread on low budget and (mostly) healthy food http://forums.penny-arcade.com/showthread.php?t=737 here. Plenty of decent recipes there. If you're looking for recipes around a different theme then I'd recommend getting a book on it. Without more information on exactly what kind of stuff you're looking at making I can't help you.
I can certainly understand your frustrations and questions, even though she's physically recovered she still struggles daily with the mental aspects of the addiction.
There was a book I read that really helped me understand the disease called Anorexia Nervosa: A Survival Guide for Families, Friends & Sufferers. You can find it on Amazon.
I've also joined a forum for friends and family of sufferers. There is a lot of support there for everyone else, because it is a stressful and heartbreaking thing for everyone to deal with. I've found though that many of the "boyfriends" there are in high school since Anna tends to affect younger women more than older ones, so I can't reflect as much on other's experiences as I'd like.
The one thing I have learned is never, ever to try and control my wife. She will rebel. Trying to control her eating habits is probably the worst thing I could do. She knows how she has to treat herself and she's good about it now. I just need to be there to support her and let her know I love her when she gains weight.
]Feel free to PM me if you'd like to talk/vent about anything.
My biggest advice though is to read the book, it really helps.
I'd strongly suggest the same thing. Wikipedia just does not cut it for something as complex as anorexia.
I also recommend Treating and Overcoming Anorexia Nervosa by Steven Levenkron. The author is a therapist and you'll get a feeling of how you're supposed to act and react around your girlfriend.
Have patience, a lot of patience. Good luck.
What is she doing to maintain her recovery? Therapy? Support groups?
You should try to avoid either/or thinking. The important thing is to what degree she takes it. A lot of mental illnesses (anorexia included) involve behaviors that would be perfectly normal in some people but the mentally ill person takes the behavior to an unhealthy extreme. For example: not liking fried foods is normal; not eating anything cooked at a restaurant because it might have come into contact with some oil on the grill would not be normal.
What questions are you asking, and how are you asking them? Can you describe the way you phrase your questions?
By the way, helping couples communicate better is one of the biggest goals of couples therapy. You might want to consider getting some while you guys are living together.
the "no true scotch man" fallacy.
All the things you mention, excessive excercise, controlling food to a ridiculous degree, denying yourself food - all this feels so great when you are seeking control in your life. Most people do this subconsciously, as I did. That is, you don't realise until you are out of it how strange and unhealthy your behavious was.
For me it was caused by a very stressful time - moving to uni miles away from home, having to live on my own for the first time, horrible anxiety caused by untreated OCD (yes, there is a link between OCd and eating disorders).
This is something your GF will probably always struggle with, I have to say your attitude towards her problem, that she is totally illogical for acting this way, will not help anything. You have to accept you probably will never understand it, thank goodness for your health, but its still very much prominent in her mind/ psyche. But kudos on looking up the condition and being there for her.