Eating Disorders - Connecting the Dots : Part 7

Gaining: The Truth About Life After Eating Disorders
by Aimee E. Liu

(Page 7 of 7)

Cultural influence, I assumed, meant the usual culprits: Shape magazine, weight-conscious parents, size-2 celebrities, and school yard fat jokes. But what exactly did he mean by inherent risk?

Strober reeled off a list of typical anorexic qualities: "perfectionistic, cautious, highly regimented, and disciplined; and they suffer from inadequacy that is entirely self-perceived. These traits are largely inherent - not exclusively so, but it's well documented that anorexia nervosa has the strongest correlation to temperament of any psychological illness. Bulimia nervosa also has a correlation but less so."

This was research speak. I needed plain English. "Inherent," I repeated. "Are we talking DNA?"

"Our research suggests that anorexia has a strong genetic component. Yes." Since 1996 Strober had been working with a multinational team, led by Dr. Walter Kaye at the University of Pittsburgh School of Medicine, to search for possible genetic links. By analyzing genetic samples from across the United States, Canada, England, and Germany, they so far had identified "susceptibility genes" for restricting anorexia nervosa on chromosome 1, and for bulimia on chromosome 10. Strober told me that identical twins of anorexic subjects have a 50 to 60 percent likelihood of developing the eating disorder, even if raised apart, whereas fraternal twins of anorexics have the same 14 percent risk that their other siblings have. Girls in families with no history of eating disorders, meanwhile, run less than a 3 percent chance of becoming anorexic."

I thought of my own family. I mentioned that several of my nieces had struggled with bulimia.

"Not surprising," Strober said. He'd found that immediate family members of anorexics were twelve times more likely to develop anorexia than people without a family history of the disorder, but they were also four times more likely to suffer from bulimia. "What's interesting about these results is that they suggest several different eating disorders may link to a common genetic source." Compulsive overeating and binge eating disorder may also have genetic roots. Prader-Willi syndrome, for example, is a chromosomal disorder, affecting both sexes, that causes an insatiable appetite for food, beginning in early childhood. However, Strober cautioned, the temperamental and physical profiles of compulsive and binge eaters tend to be much more varied and variable than the profiles of individuals with anorexia and bulimia. Overeaters are nearly as likely to be male as female and may be overweight or of normal weight, which suggests that genes play a less consistent role than they appear to in anorexia and bulimia.

The latest research did, however, point to links between anorexia nervosa and obsessive-compulsive behavior, anxiety disorders, and depression - all of which tend to persist long after the eating disorder. At UCLA, Strober said, anorexic and bulimic patients are considered recovered when they maintain a healthy weight and no longer obsessively count calories, binge or purge or manically exercise; yet even years later these recovered patients will show abnormally high rates of anxiety and obsessive thinking, especially perfectionism. "The solution is not to eliminate these traits but to learn to manage them. So in treatment we try to move patients to a new framework, to enable them to accept growth and change." The problem is that growing and changing run directly counter to the craving for order and familiarity that typifies anorexia nervosa. Carefully constructed rituals and disciplines protect an illusion of emotional safety. By challenging those rigid patterns of behavior and thinking, treatment threatens to expose "unacceptable" emotions like fear and grief and despair. "That's why anorexia nervosa in particular is so difficult to treat and why there are some patients who will never get well. Bulimic individuals, while also typically perfectionistic, are less restrained and more impulsive. And they generally respond better to treatment."

I pictured a scale of temperament with extremely compulsive restricting anorexics at one end and extremely impulsive bulimics at the other. "Do some recover, then, only to shift that rigidity - or impulsivity - to anxiety-reducing habits that have nothing to do with food?"

"It's possible."

Connect the dots. I asked Strober one last key question: "Has anyone studied the daily lives of people who've recovered from eating disorders?"

"Outcome studies. Rates of recovery, suicide, relapse -that sort of thing, but not much on subjective experience. Work, marriage, parenting styles. Is that what you mean?"

I nodded.

"It's a wide-open field." He smiled and extended his hand.

"Let me know what you find out."

If Strober was right, then much of the blame that had long surrounded eating disorders - and that shaped my own assumptions in Solitaire - was misplaced. Perhaps no single factor was at fault. Perhaps the impulse to blame, in fact, diverted essential energy and attention from the real business of recovery. Mothers who subscribed to Vogue might play a hand in some cases of anorexia, but according to Strober they no more "caused" the problem than chilly temperatures caused pneumonia. Nor did anorexics "choose" this infuriating and dangerous behavior - any more than they could snap out of their genetics on command.

To escape an obsession, I'd wanted to believe when writing Solitaire, one had only to recognize its pointlessness, and I had done that. But more than two decades later I realized that recovery was in many ways more complicated than the eating disorder itself. To make sense of it in my own life, I needed to go back to the turning point of my illness and this time search for the truth.

Copyright © 2007 by Aimee E. Liu

About the Author

My past lives include early childhood in India; middle childhood, adolescence, and anorexia in the Connecticut suburbs of New York City; three years of teenage modeling through the Wihelmina agency; a major in painting at Yale University followed by turns as a waitress in New York and a flight attendant with United Airlines. Between flights I wrote my first book, Solitaire, a chronicle of my passage through anorexia, which was published in 1979, when I was twenty-five.