‘Almost Anorexic’: Determining if your relationship with food is a problem

Jennifer J. Thomas, PhD and Jenni Schaefer provide a helpful guide to recognizing unhealthy eating patterns and getting to the root of eating disorders in “Almost Anorexic.” Here’s an excerpt.

A Touch of Anorexia

“I wish I had just a touch of anorexia.”

A young woman whispered this to me after I shared my eating disorder recovery story in her school’s auditorium. She had waited patiently to talk with me until most of the crowd had dissipated into the humid evening and I was packing up my guitar.

“Jenni, I never had the problem you had,” she continued before I could respond. “I’ve struggled with overeating my entire life.” Her eyes darted quickly behind her to confirm that her next statement would be out of public earshot. Then she looked back up at me: “If only I had your willpower, I know I could lose this weight.”

You might have heard someone say this before. Or maybe you’ve said (or thought) something like it yourself. Countless people want to “eat better” and “lose a few pounds.” But, unlike what some may think, anorexia nervosa is not simply a diet gone wrong, and it has little to do with willpower. Why, then, does a serious, life-threatening illness with one of the highest mortality rates of any psychiatric disorder inspire such cachet?

A superficial response may lie in the current high rates of obesity. With one-third of adult Americans overweight and yet another third obese, the ability to achieve a low body weight by controlling food intake is exceedingly rare. But you’ve probably never heard people say they wished they had a touch of cancer or depression, two other illnesses that can also lead individuals to eat less and lose weight.

A not-so-obvious—but perhaps more accurate—explanation of anorexia’s pseudo-prestige lies in the definition of anorexia nervosa itself. The criteria listed in DSM-5, the Diagnostic and Statistical Manual of Mental Disorders (5th edition) ,which health care professionals use to diagnose psychiatric disorders, are quite strictly defined. For some, meeting such select criteria can feel like earning a badge of honor. Of course, developing a life-threatening eating disorder is nothing of the sort. The hallmark feature of anorexia nervosa is a significantly low body weight due to self-imposed food restriction. Accompanied by an intense fear of fatness or relentless behavior that interferes with weight gain, anorexia is also characterized by body image disturbance. Not only do individuals with anorexia typically “feel fat” despite being thin; they may also base their self-worth almost entirely on their ability to control their eating and weight.

'Almost Anorexic'

Anorexia is not just a cry for attention; it’s a serious mental illness caused by biological, psychological, and environmental factors. A common misconception is that someone with anorexia can “just eat” but is simply choosing not to. Nothing could be further from the truth. Once a person becomes dangerously underweight, powerful psychological and neurobiological changes lock the symptoms in place. Some with anorexia nervosa even begin bingeing and purging, in part, as a result of these physiological changes. Another myth is that anorexia only affects the lives of young white females. Although research suggests that anorexia is more prevalent in females, many males also develop the disorder. Similarly, although the illness typically begins during adolescence with peaks at ages fourteen and eighteen, people of all ages struggle. As a matter of fact, eating disorders do not discriminate by age, gender, culture, ethnicity, sexual orientation, or socioeconomic status.

The truth is that the majority of people with eating disorders do not fulfill anorexia nervosa’s diagnostic requirements, nor do the countless others who loathe their bodies and struggle to eat normally. We know from clinical and personal experience that the gray area between normal eating and anorexia nervosa is home to a great deal of pain and suffering for many people. Their lives can be just as out of control, unmanageable,and miserable—if not more so—than those with anorexia. That’s why we wrote this book: to identify and provide guidance for people who struggle with forms of disordered eating that are not officially recognized and often go untreated—what some clinicians have termed “diagnostic orphans.” We call this once-overlooked category almost anorexic.

Excerpted from “AlmostAnorexicby JenniferJ. Thomas, PhD and Jenni Schaefer. All rights reserved. No part of this book may be used or reproduced without written permission from Hazelden.