What happens when denying yourself food becomes a self-harming addiction?

It is my belief that anorexia nervosa is not only a serious mental illness, but also an addiction to starvation and restriction. It is in light of this that I say that anorexia is not about the food. It is about what the food represents.

Anorexia has the highest mortality rate of all psychiatric illnesses. It is believed that five to 20 percent of anorexics die. Studies also indicate that only one third of the anorexic population is likely to fully recover, while another third reaches a level of maintenance, and the remaining third (many of whom never seek treatment) remains chronically ill or dies. I can now say that at the moment I probably fall somewhere in the third of anorexics that reaches that ever-fluctuating level of maintenance.

There are usually a number of reasons that contribute to an eating disorder. I think it would be safe to say that there are probably as many possible causes as there are eating disordered individuals. Each case is unique and each person develops different coping mechanisms in reaction to different, often traumatic experiences. Some of the major risk factors for anorexia include body dissatisfaction, dieting, low self-esteem, perfectionism, childhood sexual abuse and a family history of eating disorders.

For many people, an eating disorder will start with ‘healthy eating’, says Johannesburg-registered dietician Loreine Saunders. “One’s scope of food gradually becomes narrower and eating ‘healthily’ pushes over into a fully-fledged eating disorder. At first it may not be classified as an eating disorder, because it hasn’t developed into a medical condition.”

However, this does not mean it’s not potentially dangerous. In fact, there exists a group of ‘Eating Disorders Not Otherwise Specified’ (EDNOS). In this category lie syndromes that resemble anorexia or bulimia, but fall short of an essential feature or are not of the required severity. Other EDNOS include anorexics who still menstruate; anorexics who despite significant weight loss are in the normal weight range, purgers who don’t binge and individuals who chew and spit out food.

Eating disorders such as anorexia and bulimia have long been associated with the youth. However, experts say that in recent years more women in their 30s, 40s, 50s and older have been seeking help. “It may not be as prevalent as it is among younger age groups, but may also present with different forms,” says Professor Christopher Szabo, head of clinical psychiatry at the University of the Witwatersrand. “Older women who have suffered chronically with the illness become tired and exhausted by the eating disorder,” says Saunders.

Is there hope?

“When treating a patient, there isn’t one recipe that fits all patients – that’s really the problem,” says Saunders, who suggests taking a multi-sourced approach to treatment. “Moving through therapy is an integral part of the process. This often involves trying different disciplines of therapy, and perhaps different therapists over time. ”

Personally, I hesitate to say that one can recover from anorexia completely. In the words of Professor Szabo, “Recovery is different things to different people. I think that sufferers can get better. The focus should be on improvement, and building on that.” Saunders states that you may recover in as much as you may achieve and maintain a normal weight and eat fairly normally, but that anxieties around food are likely to remain.

Slowly cultivating supportive relationships is what I have found to be the most healing. It has also been the most difficult. Getting support has also been significant, because anorexia is such an isolating disease. Perhaps anorexia is one of the most difficult illnesses to treat due to the intangibility of its treatment. With most addictions there is a tangible substance that needs to be taken away to aid recovery, for example drugs, alcohol, etc. With anorexia however, something needs to be added. This ‘something’ is not just food. It is a ‘sense of self’ that needs to be restored.

Getting help

Johannesburg

Houghton House: (011) 728 0850

Tara Clinic: (011) 535 3000

Cape Town

Groote Schuur Hospital SADAG: (021) 404 2151

Tygerberg hospital SADAG: (021) 938 4571

Eating disorders unit: (021) 763 4535

Durban

Eating disorders support group: (033) 260 5209

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