Anorexia and bulimia ? three superstitions about our bodies

Who is slim and who is already fat? How much should one weigh „to look well“? How has it all started? Feelings of dissatisfaction with one´s look, foremost one´s weight, maybe a remark by classmates or parents on one´s figure, a desire to lose some kilos, to prove everybody that I can control my body… In psychology, there are theories claiming that the main activity of our reason in everyday life is evaluation. We evaluate the world around us, our close environment and also ourselves. According to our evaluation we then anticipate what can be expected from others and ourselves, too. When evaluating, we are biased by our own past ? experience, our mood, fear and also by a reaction of our environment. Sometimes we can agree with it, sometimes not. Most of us tend to achieve an agreement ? at least with someone. Self-evaluation runs by the same rules as evaluation of anything else, it only concerns us more. It involves also our relation to our body ? and it can be said vice versa: we evaluate our body with regard to how we perceive ourselves ?as a whole?. This is quite interesting because it can help us understand those who devote all their attention, will and time to their bodies. Body and soul are two connected vessels and even Western medicine has reconciled with this fact. The relation to one´s body, its evaluation, perception of what is pretty and ugly, all this is a work of soul lead by the spirit of the age or simply said by social norms. Everyone can see with their own eyes that the spirit of the age exists. It is enough to visit a picture gallery or a sculpture exhibition and to watch beauty ideals in the history of world cultures. Apart from getting aesthetic impressions, we can also rise above today´s norms and see their relative validity. The first superstition is that a beauty ideal is an objective reality that is worth devoting a whole life to. I cite from a letter: „I started watching my weight some 4 years ago. I was 13, my breasts and buttocks started growing and I felt sort of plump. I couldn´t integrate among my classmates the way I wanted and I thought it was because of my overweight. I started restricting food, weighing myself and counting calories. Today I am 165 cm tall, my weight varies – now I have 43 kg. I may be sick, everyone says so but I still have the feeling that I have won over the kilos. It is the only thing that I have really mastered in my life ? to lose weight.? This is one of many stories the heroine of which set on the journey of fight against her own body in the effort to improve her self-evaluation (of which she was not aware at the beginning). It is a journey of askesis (sometimes alternating with binges of ?indulging in everything?), constant watching and counting, everything else stops being important. The people she cared for in the beginning, she wanted to be with, slowly disappear and their place is taken by a personal scale and a mirror. Fear of food and fear of weight. Every meal carries a potential danger of higher value on the weight and its taste stops being important for our heroine. The word ?fat? becomes even bigger threat. She considers it to be the utmost unhealthy thing, a surplus in the body that makes it ugly and thus brings about unpleasant feelings. Everything she dislikes in her life, she considers unacceptable and wants to get rid off at any cost, is projected into the body fat. Here I pose a question to a reader: What can we put as a replacement for fat symbolising the blameful things in our life? What is so unacceptable and yet so easy to reach? The second superstition says that fat has nothing to do in our bodies! Yet an adequate amount of fat has vitally important functions ? it helps maintain body temperature, absorbs impacts on joints, protects organs, stores vitamines, and provides the body with energy during a lack of nutrition. An increased level of fat may of course harm our health but we are certainly not in this field when looking at the story of our heroine. Most people think thay they may objectively monitor the level of fat by means of their weight. Our heroine, too, had thought that less kilos meant more beauty and better health. However, the body weight is composed also by other components of body ? bones and muscles. We may have a skeleton of different growth and thus different weight than another person of the same height. Likewise we differ in the amount of musculature. This is why all numbers based on measuring body weight and height are just approximates. The example is a calculation of Body Mass Index (BMI). By means of a simple formula we calculate a figure that compared with normative tables indicates how our weight stands against the norm. This is alright but if we take BMI for a precise value expressing the measure of our fatness or thinness, we are grossly mistaken. The third superstition is that the number on a personal scale precisely indicates our fatness or thinness, that it precisely testifies on the amount of fat in our body. But this cannot be said even about BMI or other calculations. Weight is just an orientation value that often changes. I started with ideals, I will end more prosaically with kilograms. There are many more superstitions. I will add one more ? many people who have limited their world to the care for their bodies and namely their kilograms think that this is the only world they can live in. A man has received a great gift from Nature and that is the ability to change. Our letter heroine also has it. Maybe she could start the adventure of change by distinguishing superstitions from reality. But she must overcome her fear of the new. And I wish her that.

My friend is ill ? what shall I do?

Thoughts, worries and confusion on one side: 1. My friend has anorexia, I cannot leave her alone, I must get her out of it somehow! 2. She should go to a doctor. Shall I drag her there even when she does not want? 3. She said several times that she would kill herself, she was good for nothing and she would finally be in peace. 4. She must eat otherwise she dies. I can´t let her die! 5. I am worried to ask her about food. She eats nothing and keeps making up excuses! 6. I´ve found food in a litter bin even though she swore she had eaten it. 7. I yelled at her horribly because of food. Now I feel sorry but it can´t be taken back. 8. It is strange to eat when she doesn´t eat. I feel ill at ease when I eat. I never know if she will eat with me. Shall I let her eat as she wants? 9. I had an idea to stop eating too. Maybe it would bug her and she would start eating because of me. 10. Sometimes she wants me to tell her boyfriend that she ate when she didn´t. What shall I do? If I say the truth, she´ll get angry at me, if I lie I sustain her disease, don´t I? 11. Shall I tell her parents? She´ll get angry at me but I worry about her so much that this might help. 12. Her boyfriend asks me what to do but I have no idea. He is desperate what to do. 13. Her mother called me. Shall I tell her what I know or better not? 14. She doesn´t want to talk to me, is horribly sad, enjoys nothing, goes nowhere, locks in herself. 15. Why doesn´t she call or at least write that she is OK? Why has she so changed that she doesn´t care for me? 16. Her disease is to blame for all the trouble. It seems to me that I can´t be cross with her when she is ill and cannot be blamed. 17. She hardly talks to me. I feel silly and shy to tell her about my troubles when she has bigger ones than I do. 18. How long will it take until she is again like she used to be before? 19. Sometimes I have no strength to be with her, keep writing her, beg for contact. But I can´t betray her! 20. The main thing is that she is alright, nothing else matters! Ideas, suggestions and solutions on the other side: 1. I know that the only one who can help is herself. I can only offer my support and friendship. 2. I can offer her the option to see a doctor or a psychologist, to make a contact together, to accompany her there, but I can´t force her. It is her decision, violation is no good in this regard. A treatment requires compliance, not resistance. 3. If she starts talking about end of life, I can ask directly whether she means suicide and try finding out how real are her plans. I try offering a contact to a crisis centre or a help line and I take seriously what she says. But I am not an expert. Making a taboo around her suicidal thoughts could be dangerous. 4. She must eat but only she can decide about her life and health. I can help her with food when she cares about it, when we agree on it and she wants to know what is a normal serving or she wants to eat together etc. 5. I tell her about my uncertainty around food and we try agreeing on rules we will both respect. 6. I will again try establishing sincerity, a way of communicating without lies. We will try finding together how I possibly make her lie and how this could be changed. 7. I have the right to be angry. When I calm down, I try seeing her and telling her how I felt, why I was so cross with her. I ask her how she saw it and how she felt. 8. I must eat normally as I am used to in order to show her that I eat regularly, am adequately active and yet I maintain a physiological healthy weight. She will also see a normal serving and comprehend that it is normal to eat, not vice versa. When I go shopping or prepare a meal, I ask her what shall we buy or have to eat. I don´t play her game by a priori expecting that she won´t eat at all. 9. It isn´t a good idea. I must eat normally. She must eat because of herself not someone else. 10. I mustn´t assent to any such request. I explain her why I cannot and will not do it. I shouldn´t interfere in her relationships with her boyfriend, mother on any other close people of hers. 11. I shall talk this through with my girlfriend first. I tell her about my fear and idea to tell her parents. I will not act beyond her back so that she doesn´t feel threatened by the disease plus her environment. 12. I can tell her boyfriend about my stance, we can mutually listen to each one. I can advise him to try telling all this directly to his girlfriend, to let her know he is worried about her. I can´t solve it with him, I don´t want go between them as it would harm both their and my relationship with my friend. 13. I can listen to her mother and let her know how I talk to her daughter. I can share her fear and tell her about mine. If she cares, I can advise her what literature on eating disorders has helped me and I may offer contact with experts. 14. I try offering her various activities and events we can attend together. I ask her about her wishes, what she thinks about, she desires etc. 15. I know that it is hard for her to communicate. I try agreeing on common rules. I let her know how stressful it is when she cuts off. We try finding a way of communicating so that I needn´t worry either. 16. I have the right to be angry even if my friend is ill. To express feelings including anger is natural. If I excuse everything by her illness (that she doesn´t call, come to agreed place, open the door when we have agreed on my visit etc.), I only sustain its symptoms. My friend is still a person who must respect me as well despite her being ill. 17. In a friendship, both parties have the right to talk about their troubles. Moreover, speaking only about her disease destroys the relationship. It is necessary to get a shared experience, to share everything as before even though it may be more difficult for my friend at times. 18. I try to orient myself in related issues, I read books on eating disorders, I search for basic information on the internet, and I arm myself with faith and patience. 19. I live my own life, I care for my needs, my interests, my close ones! Only if I can live for myself, I can provide support to my friend at times when I am strong enough and when she wants it. I am entitled to look for expert help and advice, too. 20. Other things matter! It does matter how I feel, how am I doing, how I live. I am not less important just because I am healthy!

How can the close people help

It might be better to ask first: ?When can the close people help??. I also count among the close ones of a person who struggles with an eating disorder. And I thought that I could help immediately, that I must help immediately. I begged, cried, blackmailed, persuaded, yelled, cursed but all this lead to just the same thing ? my feeling of despair, helplessness and hopelessness. When I had come to the understanding that only my friend could decide when and how she would recover, I felt relieved. Now I know that I need to wait close by so that when she reaches for a helping hand I could be one of those who catches her and pulls her back to healthy life. Until then I must and want to live my own life; my strength will be needed when the day comes. The self-help group of people close to those with eating disorders repeatedly hears questions like ?She wants no treatment, wants to do nothing but I cannot leave her so. What shall I do??, ?Shall I ask her what she ate??, ?Shall I ask if she vomited??, ?Shall I control her eating?? Eating disorders disrupt human communication, isolate, endanger patient´s relationships, form taboos in communication. Our task is not to play by rules of the disorder but to disprove their logic. If it is at least a bit possible, try asking the patient about things that are not clear to you, where you need advice. Maybe she refuses your first attempt, gets angry or denies any such effort but believe me, she will think about it. She in fact cares for your interest. She does, the disease does not. Do not make the eating disorder the topic of the day, do not make a drama, do not let the disease have such privileges. Give the questions listed above directly to your close one, she knows best how and where you can help her. You can express your fear about her, uncertainty in how to behave. Be sincere and do not lose faith in the ability of your close one to recover. Overprotection and taking responsibility over the patient only slow down the recovery process. Do not override her autonomy, do respect her, do not let yourself get into the position ?You are ill and only I and doctors know what is best for you?. In short term you may know but you cannot live the life instead of another person. Everybody has to stand on her own feet. There are things to offer against the life with disease and our task is to outline the other shore so that the patient herself desires to live a full life. And so that she does something herself to get there. Only on such a condition she will be able to live with us on this other shore and she will not want to go back.

Orthorexia, bigorexia, drunkorexia

Nowadays we can often read or hear that our culture is affected by an easy access to food and a lack of active movement, both resulting in growing numbers of overweight people. At the same time, there is an increasing number of those who have various ?problems? with food or their figure, are markedly unhappy with their own bodies and/or have abnormal eating patterns. When coping with food and their body, they may get into extremes that endanger their health or even their life. Orthorexia, bigorexia and drunkorexia are relatively new types of eating disorders that are equally dangerous as anorexia nervosa, bulimia nervosa or compulsive overeating when they reach extremes. We are now going to search for the border between a life style and a disease that poses a severe risk to one´s health condition and turns her life into hell. Orthorexia is a pathological obsession by healthy food. The term is composed of two Greek words: ?orthos? – correct and ?orexis? – taste. The disorder manifests so that the initial orientation on healthy food, stores that sell it and search for information how is such a food processed turns into obsession and main life activity. The fear of ?unhealthy? food grows, the healthy food is investigated in more depth and gradually stops being healthy enough, i.e. safe. The diet thus reduces to a minimum, the patient loses weight and becomes underweight. Moreover, s/he must think about food very frequently (like in anorexia nervosa), is bothered by anxiety and depression that lead to a feeling of loneliness and real isolation. The patient has nothing to share with others in such a condition. The problem appears mainly in women, even though it is less prevalent than anorexia or bulimia. Orthorectic patients are radical objectors to artificially fertilized, genetically modified food, that is chemically preserved and coloured. They orient themselves exclusively to organic food from special stores. The pathological issue is the extreme refusal of everything else, not the mere idea that food should be maximally natural and thus healthier. The list of ?approved food? becomes shorter in time as even organic food may be unsafe ? it depends on producers and whether they really complied with all ?organic procedures?, if the food was not contaminated by polluted air … At the same time ?unhealthy food? turns into poison that if ingested by the patient would certainly cause poisoning or another severe disease. I think that the difference between preference of healthy food without additives (E agents) and obsessive ?organic fanatism? is really evident. Definitely, the issue is not to make a healthy life style pathological but to describe a condition when things get out of control. The term orthorexia was first used to describe a fanatic obsession by health food in the book ?Healthfood Junkies? by Steven Bratman, an American physician. He had himself founded a community of people concerned with healthfood but over time he found out that excessive concern with it leads to extreme changes in eating patterns due to obssesive limitations and to significant negative consequences on physical and mental health. So he later dissolved the community. Bigorexia on the contrary concerns body proportions in the sense of obsession by one´s looks. There is a disorder in perception of one´s body when the patient strives for achieving often unreal values of body fitness or body proportions. The literature also refers to this mental disorder under the term ?dysmorphophobia? (excessive concern with fictitiously defective look in a normally looking person) or it can be found under ?Adonis complex?. Bigorectics consider themselves weak, with insufficient musculature, they are much bothered and willing to do a lot to achieve the looks of stars from body building journals or action movies. They are often dependent on body building, abuse protein food supplements, and substances enhancing muscle growth and modifying metabolism (anabolics). The main risk of the disorder is so-called ?overuse syndrome? – a damage to locomotor system due to long-term overload. A totally unbalanced diet and overuse of ergogenic substances (supplements with high protein and aminoacid content) also pose excessive burden onto digestive tract, kidneys and liver. Bigorectics suffer from overweight that they intentionally develop by means of high energy intake to enhance muscular growth. A substantial risk to mental health is brought by social isolation; like in other dependencies, the patients lose common topics with other people and they prefer going to fitcentres to socializing. Mental problems may develop also as a result of insufficient financial resources (fitcentres, food and supplements cost quite a lot and at the same time there may be problems at work or even a loss of job). Drunkorexia refers to repeated reduction of food intake in order to reduce calories and allow oneself to drink more alcohol. This obsession is based on the fact that alcohol, namely spirits, contain a lot of calories. The main role is again taken by dissatisfaction with one´s figure and fear of weight gain. Drunkorexia also includes intentional increase of energy output at parties or discos by combined drinking of spirits and energy drinks. This disorder affects more women but men are not immune either. Statistical data from American population say that 30% girls at the age 18-24 years skip food in order to drink more alcohol. The main danger of such a behaviour is that alcohol gets absorbed much faster on empty stomach and may reach liver in less than 15 minutes. Its effect is thus stronger and more dangerous ? the body absorbs it worse, moreover it often comes in a higher dose as ?eating less means drinking more!? Besides, it is very dangerous to mix alcohol with energy drinks. Such a combination markedly raises blood pressure and heart action, at the same time it reduces the ability to perceive tiredness. So a sudden collapse threatens not only those with a heart defect or hypertension but healthy youth as well. There are numerous cases of sudden deaths ascribed to such a behaviour. Drunkorexia threatens mental health as any other eating disorder – patients experience anxiety when trying to control their proportions, dissatisfaction because it does not go according to their often unrealistic ideas, and ?after-party depressions? from the amount of alcohol drunk and also of food consumed (when tipsy or drunk the patients simply satisfy their hunger). The patient gradually suffers on social level ? repeated irritation due to hunger or quick drunkeness on empty stomach markedly diminish social attractivity of such a person and may lead to feelings of strangeness, loneliness, isolation.

Recording food intake ? a diet under control?

All those who are bothered by an eating disorder know well how unpleasasnt it is when life gets limited to a constant control over body weight and calories. Whether we try solving our trouble ourselves or we seek an expert help, following questions will emerge sooner or later: „Why am I still underweight despite consuming a seemingly large amounts of food?“, „Why some days are alright and other days I have several bulimic binges?“, „Why do I so often feel a desire to eat and overeat after 10 pm?“, „Why after having eaten a sweet or fat meal, I keep a diet for several days or I eat too much on the other side?? It is an old proven truth that when looking for a problem solution, we should try an easier one first and only in case it doesn´t work, we shall try a more complicated one. The easier and at the same time very practical and comprehensible way of knowing one´s eating habits and vices is to record one´s food consumption. The records should then be studied with the expert on eating disorders or with a self-help manual and learned from. Examples of food intake records can be found in tables in „Download“ section. If you decide trying this method, you can download and print the tables. Every day you have to thouroughly record all food and drink you consumed, and additional information on important facts like time of eating, feelings during and after meal, place of eating, vomiting or exercise following the meal etc. Such a record is a very private matter, everyone writes it only for him/herself, sometimes also for the therapist if agreed on. It is important not to hide away or change any facts, simply be frank. To give you an idea how is the record used, I will describe three examples: 1. In anorexia nervosa, there is often a problem of feeling very full after a meal. Such a feeling leeds to a fantasy that we have eaten too much and so will put on weight uncontrollably. Yet our weight may be deeply under the norm or keeps falling and we are threatened by severe health problems. The food intake record helps us see more realistically what we have really eaten and thus make a distinction from unpleasant feelings rather due to fear. The food record can be compared to a recommended diet in the ?Diet? section. 2. In bulimia nervosa, the food record may tell us for example that if we eat outside a kitchen or dining room, e.g. by TV or in bed, we often eat more and then we have to go vomiting. The problem is often that if we do something else while eating (watch TV, read a book etc.) we lose control over the amount of food we consume, we can exceed it easily and then it makes no difference… 3. In binge eating we may find out that our irresistible appetite after 10 p.m. may relate to the fact we have supper at half past five and we restrict this meal. This leads to a natural feeling of hunger and besides we subconsciously know we have cheated our body. It has been proven that such feelings increase the risk of overeating. This article did not aim at all-encompassing description of food intake records, rather at stimulating your curiosity and possible interest to try it out. More information can be found in ?Literature? section or gained in a consultation with an expert.