Anorexia nervosa is an eating disorder we describe as addiction to starving. The term is a psychiatric term, and it has the highest fatality rate of all psychiatric disorders — about 20 percent die of the disease. It is usually treated as a psychiatric illness, often focusing on family dysfunction. Usually the addictive aspect is ignored.
Anorexia nervosa is an eating disorder in which the individual struggles to maintain a low food intake, with occasional ventures into what most of the rest of us would call moderate eating. Because of the body image distortions of anorexia nervosa, these ﬂuctuations are viewed by the anorexic as inexcusable, terrible binges, rather than moderate eating, and most anorexics will purge if they can following such a “binge.”
In the Diagnostic and Statistical Manual of the American Psychiatric Association, fifth edition, revised in 2013, the diagnosis for anorexia nervosa is summarized as follows:
- Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
- Intense fear of gaining weight or becoming fat, even though underweight.
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
There is a type of anorexia nervosa that seems much more psychiatric than addictive in nature. In these people there is more dysfunctional thought and behavior, which may involve many areas not directly connected with eating. Often the family is very controlling, overprotective, and may have many problems that cannot be explained by addiction in the family. Roughly half of all anorexics do not respond well to an addiction model, even with good treatment.
Addiction to starvation Starvation inﬂuences many neurotransmitters and other biochemical agents. The anorexic can, of course, become addicted to the body’s own chemicals.
Avoiding overeating Most anorexics have a strong fear that if they begin eating, they will overeat. This fear may come partially from their history of being overweight, or of obesity in the family.
Restricting vs. purging Many anorexics do have binge/purge episodes besides their extremely restrictive eating. You can be anorexic and bulimic simultaneously. In fact, anorexics are often categorized into restricting anorexics and purging anorexics.
Starvation disrupts many bodily functions and changes neurochemical balances. These changes seem most similar to those we see in stimulant drugs.
Ketosis Starvation depletes the glycogen supply, and the body does not have enough blood sugar to metabolize fats properly. Ketone bodies are produced, which supply enough energy to the brain to keep it alive, but they also suppress the appetite and make you smell funny, due to the acetone (like nail polish remover) produced when fats are burned without adequate carbohydrates.
Malnutrition Starvation means an inadequate amount of protein, fat, and other nutrients that produce hormones, especially female hormones. The body shuts down the reproductive system, partly because it is unsafe to bring a child into what seems like a famine outside. Menses (periods) become irregular and stop altogether.
The body needs protein to live and will take it from muscle tissue, like the heart. There is often hair loss, a downy growth of hair all over the body, and loss of sex drive.
The body gets addicted to these biochemical imbalances. To get this high, which resembles an amphetamine or “upper” drug, requires more weight loss as tolerance increases. This may be the most cruel addiction: consuming your own body to get high.
The “nervosa” part of anorexia nervosa refers to the mental part of the disease, as obsession and perceptual disturbances become extreme.
Fear of fat The body image becomes distorted to bizarre levels. Even if there is some basis for the fear (like a tendency to overeat), the response to this fear is exaggerated, inappropriate, and destructive. This extreme distortion puzzles and frustrates family members and others trying to help the anorexic.
Control illusion Most anorexics report a tremendous feeling of power and control, which is usually reinforced by comments (even admiration) from others. Control is an illusion, but this illusion is critical to the functioning of anorexia. It focuses on control of food, eating, fat, weight, and through these, other people.
Anorexia nervosa, see also: Adolescents, Bingeing, Biochemistry, Body image, Bulimia nervosa, Constipation, Control, Crisis, Defenses, Delusion, Dichotomous thinking, Diet mentality, Eating addiction, Eating plan, Exercise & activity, Family, Fats, Higher Power, Hunger & appetite, Intervention, Magical thinking, Moodifiers, Nutrition, Purging, Sabotage of recovery, Sanity, Self-image, Sex, Stinking thinking, Stress & strain, Therapy & treatment, Unmanageability, Weight.
Updated 6 Sep 2015