Imagine yourself as a young child. Your entire world depends on your parents, teachers, and other caretakers. Before your earliest memory, you developed the ability to grasp what adults expected from you, and then you did what was expected. You've become a star at following the rules, getting the grades, being popular, and generally making everyone feel proud of you. You don't worry about your own feelings very much, because you can see from everyone else's attitude that you are successful. Your parents, teachers, and friends admire and reward you, so you must be successful. You feel sure that the stage is set, because you have refined your ability to read the rules and achieve excellence.
How Anorexia Develops
You can adjust to anything, until you start to hit puberty. This is foreign territory. All your life, you could rely on other people to set the standards for you. Now you have all sorts of feelings and messages coming from every direction, and you start to be afraid. How can you manage to succeed and please people if the rules keep changing? The adults in your life always told you what to expect. Now they're asking you. What do you want to do when you grow up? How are you going to handle the pressure of dating? How will you cope with all the different opportunities available to you?
Your parents and teachers may tell you that you're lucky. You have opportunity! The world is wide open for you. With your ability to achieve, you can make anything happen. But inside yourself, you start to feel consumed with doubt. All your past achievements were accomplished because the rules were clear and your options were limited. Now they are limitless. Now, after a lifetime of never having made a decision that was not first made by an adult, you have to make choices about school, work, socializing, sexual impulses and pressures, and the opportunity to take drugs that are available from every direction. In the middle of all this external change, your body is different, inside and out. When you look in the mirror, all you see is change. And when you sit in class, go to a movie, or sit at dinner, you're aware of restless, confusing feelings that are unfamiliar and decidedly unwelcome.
At this point, you may decide, consciously or subconsciously, that you have to get a handle on the situation. You were successful before; you'll be successful again. All you have to do is focus on an important, respected goal that other people will recognize and that you know you can achieve. You don't want to defy your parents or teachers openly, because they may withhold all that affection and approval they give you when you are cooperative and compliant. So you have to come up with some way of getting control over the situation without doing anything that adults would find totally upsetting. If you can find that route to control once again, you can duplicate those comfortable old feelings of safety that made your childhood such a success.
You start to search for some sort of strategy that will make life more predictable and concrete for you, the way it was while you were in elementary school. At that point, you may decide to take control over the one territory you have to make safe: your own body. By focusing on taking control over your body, you can ignore all those complex, conflicting, and confusing changes that take place when you become a teenager.
But you don't even make that decision on your own. You seek "permission" from someone important to you. It could be your mother, father, sister, brother, teacher, coach, religious leader-anyone you respect and want to please. You won't go through the pain without that permission, because you have no experience with decision-making, and you feel the need to get approval from someone who cares about you.
That permission does not have to be spelled out in so many words. A coach may comment that you might want to lose some weight, or a boyfriend might say that you would be really perfect if you could just lose a few pounds. Your mother or father may be letting you know that this is the time in your life when you have to start being careful about what you eat and when you eat it, because weight gain may creep up on you silently, without warning. Someone important to you may tease you about how your hips or breasts are getting big, or how your belly is sticking out a little more than is desirable.
Yes, people tease and talk with each other about these things all the time. But if you are a teenager who is looking for permission to take control over your body by setting weight goals and suppressing all that physical and emotional change, then you may take those comments to heart and keep them in your heart as you set, achieve, and redefine weight-loss goals that eventually will make you skeletal.
That is how anorexia nervosa can develop in a young man or woman. It does not have to develop at puberty. It can develop later in adolescence or young adulthood, but it generally begins before the young man or woman is 25 years old. The one thing that you can say with confidence about anorexia is that it is different with each person. Some people who develop anorexia have a history of weight problems, and some do not. Many anorexics are white middle or upper-middle class young women in their teens or early twenties, but some anorexics come from entirely different backgrounds. An increasing number of male and nonwhite adolescents and young adults are diagnosed as anorexic, and the disorder can remain entrenched long after a person reaches the age of 30.
There are a few basic conditions that anorexics do share, however. They all starve themselves, and they all have a profound fear of fat. They will focus so relentlessly on weight loss that they will eventually lose at least 25 percent of their normal body weight. They are not suffering from any other medical disorder or social problem that could be associated with loss of appetite, and they deprive themselves of food despite their constant, gnawing hunger.
As you might well imagine, starvation is not a fact of life that you can live with indefinitely. In fact, up to 15 percent of all anorexics die as a result of medical complications that develop because they are starving. If this surprises you, take a moment to think about all the news reports and TV specials devoted to telling you how starvation kills people in areas of the world where hunger is a persistent fact of life. Starvation causes the same medical problems for people who live in an environment where food is available but remains untouched-the one aspect of the environment that can be managed totally.
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