Anorexia and Pro-ana:
Anorexia is both a physical and psychological illness. It can be very severe and can result in death. Most anorextic women before, during, and after the illness are serious, well-behaved, orderly, perfectionist, hypersensitive to rejection, and inclined to irrational guilt and obsessive worry. It is especially common among girls committed to the demanding disciplines of ballet, cheerleading, competitive swimming, and gymnastics. But the common belief that high social status raises the risk for eating disorders may no longer be correct.
The anorexic sufferer is typically female. Ninety-percent of all cases occur among adolescent or young women though the number of males with the disorder is on the rise (Blackman, 1996; Carlat, 1997; Kinzl, 1997). Studies have shown that 75% of American women are dissatisfied with their appearance and about 50% are on a diet at any one time. Even more alarming is that 90% of high school women regularly diet, even though only 10%-15% are over the weight recommended by the standard height-weight charts (Council on Size and Weight Discrimination, 1996). Though the majority of these women do not develop eating disorders, 1% of teenage girls and 5% of college-age women do become anorexic or bulimic (Council on Size and Weight Discrimination, 1996).
Anorexia is characterized by extreme weight loss. The disorder usually starts with a pattern of dieting or particular food choices (avoiding certain foods which are seen as fattening). The weight loss often provides a short-lived confidence, which the anorexic craves and strives to re-experience. It is further believed that a feeling of accomplishment from weight loss produces a euphoric sensation similar to that of a “runner’s high.” As the feeling becomes an addiction, the anorexic continues to lose weight in order to reproduce the euphoric feeling. This cycle continues until someone convinces the anorexic to seek help; which can be difficult as the anorexic is usually in denial and suffering from a distorted body image. As the disorder progresses, anorexics become resourceful in hiding their behavior and may avoid eating with in front of others. They may attempt further weight loss by compulsive exercising. The condition can become well advanced before anyone notices.
Symptoms are dry skin, brittle nails and hair, “lanugo” (fine downy hair on the limbs), constipation, anemia, drowsiness, and swollen joints. The level of female hormones in the blood of an anorectic woman falls drastically, and her sexual development may be delayed. Her heart rate and blood pressure can become dangerously low, and loss of potassium in the blood may cause irregular heart rhythms (Bower).
In many cases, the trigger of the disease begins with a remark by someone important to the person (i.e. a coach or a friend). They may suggest that the person is getting fat, clumsy, or that their performance (if they are athletes) is suffering (Blackman, 1996). These remarks, as unintentional or innocent as they may seem, only serve to reinforce society’s attitude that gaining weight is unacceptable.
Theories:
In the vast psychological and sociological literature on eating disorders, a wide variety of influences have been suggested, from peer pressure to sexual anxieties. Many recent theories of anorexia focus on psychological trauma, unsympathetic and overly domineering mothering, or as a reaction to sexual abuse or assault.
The psychodynamic approach speculates that an anorexic simply cannot separate, individuate, and/or develop an independence from the primary caregivers. Families of anorexics have been described as enmeshed, dithering between over protectiveness and abandonment.
Some theories view anorexia as a method used as a cry of help for a conflicted and dysfunctional family. Minuchin noted that the maintenance of the symptomatic child often defused parental conflicts, and when the symptomatic child matured, the balance of the family became disrupted (Minuchin S, Rosman BL, Baker L., 1978).
Psychoanalytic theory proposes that the symptoms serve as a defense, masking an underlying core set of more primitive issues and dynamics. One such central issue is a fear of and resistance to growing up.
Cognitive-behavioral theories suggest that anorexia is conceptualized as a learned behavior maintained by positive reinforcement. The individual, through excessive dieting loses weight, which is reinforced by peers and society. An overweight person, on the other hand, is the recipient of disapproval and sometimes ridicule. Reinforcement for weight loss can become so powerful that the individual maintains the anorexic behavior despite threats to health and well-being.
Some believe that anorexics starve themselves to suppress or control feelings of emotional emptiness. They struggle for perfection to prove that they need not depend on others to tell them who they are and what they are worth.
Culture
A major contributor to the anorexia is society and its values. Cultural changes have led women to devalue relationships and focus instead on females’ own independence. Steiner-Adair proposes that the incidence of eating disorders has erupted due to an unrealistic emphasis on independence in women.
Additionally, western culture has an obsession with looks, making the American ideal of thinness a contributor (though the extent of its contribution is largely uncertain). This creates a vulnerability for people who are especially concerned with meeting this ideal. Slim, attractive people are linked to beauty, success, and happiness, therefore self worth is equated with a desirable slim appearance.
Our society teaches us to value such superficial standards and bombards us with images of the idealized female body through mediums such as magazines, films, and television (Blackman, 1996). Books and magazines provide the essential keys to caloric counting and the fashion industry promotes excessive thinness. (Brumberg, 1988).
Interestingly, anorexia is now being seen in non-western countries that receive American television, so it may be that a cultural ideal of thinness is a potent catalyst. One only has to watch television or read the latest magazines to realize how few overweight or average looking people appear in advertisements.
Males:
A group that often gets overlooked in the studies is males. Eating disorders are growing among males who are now being studied more frequently to determine whether they differ significantly from females with respect to eating disorders.
Males share some similar central features as females who suffer from anorexia; but have their own unique issues with regard to social pressures and vulnerabilities (Carlet, 1997). Males are often obese to begin with and are more likely to diet to attain goals in a particular sport like wrestling or swimming. Males also diet to prevent themselves from developing medical complications witnessed in other family members such as cardiovascular disease or diabetes (Blackman, 1996).
In many cases, profession was found to be clearly related to the onset of the eating disorder (Carlat,1997). One patient (studied by Carlat et al.) reported taking appetite suppressing pills in an effort to keep slim for acting roles and within several months he began a pattern of binge eating and self-induced vomiting. In the same study, which involved 135 males with eating disorders, 22% had anorexia nervosa, 73% were single and 131 were Caucasian.
Homosexuality was found to have a 27% prevalence among male patients with eating disorders. Recent data estimates 1%-6% of healthy males are homosexual (Carlat, 1997). Anorexic males in particular were also found more likely to be asexual (defined as having a lack of interest in sex for a year prior to assessment)(Carlat, 1997; Murnen, 1997).
Familes:
Having a child in crisis with an eating disorder impacts on the entire family as well as the child. The support mechanisms that parents may have come to depend on at work or in their leisure may no longer be helpful, thus causing disruption to these patterns and to family relationships. One study’s findings indicated that there is a significant impact on relationships associated with age of child, personal leisure and level of confusion in the family. The findings also showed contrasts in the way families cope with having a child in crisis, either very negatively or very positively. The qualitative anecdotes describe the tremendous strains and changes in patterns within families particularly during the initial period of diagnosis. (Gilbert).
Today, seven million women and one million men suffer from anorexia and bulimia. Almost nine in ten individuals with eating disorders (86 percent) report the onset of their illness occurring by age 20. Three in four (77 percent) report that the duration of their illness ranges from one to 15 years. Fifteen to twenty percent of anorexics die prematurely due to complications related to their illness (Dolan, B., l99l)
Lasting effects:
Anorexic patients are often found to suffer from osteoporosis, anemia, and hypotension (Carlat, 1997). Chronic starvation due to anorexia has also been linked to seizure activity and fainting attacks (Blackman, 1996). The anorexic often looks pale, tired, and wasted; bradycardia (slow heart rate) may be present and the skin is cold to the touch. Laboratory results often reveal quite abnormal values. These values are often caused by dehydration and severe electrolyte imbalances which can be life threatening. Starvation as been shown to induce many hormonal changes in the body as well as inducing mental states such as anxiety, depression, and even psychosis (Kershenbaum, 1997). These are just a few of the consequences associated with anorexia nervosa. There are many others ranging from things as obscure as bilateral foot drop, (Kershenbaum, 1997), to something as serious as sudden death or even suicide (Neum�¯�¿�½rken, 1997). Some anorexics who died suddenly did show abnormalities in ECG recordings days prior to death. As well, upon autopsy, changes in brain structure and cardia muscles (such as atrophy) were sometimes found (Neum�¯�¿�½rken, 1997).
Treatmemt:
Treatment of anorexia can be frustrating, and recovery is usually prolonged and difficult. Even women whose most serious symptoms are relieved often relapse or suffer from various residual effects and chronic troubles. In long-term studies covering periods from 4 to 30 years, 50% to 70% are found to be no longer clinically anorectic: they are menstruating and maintaining a weight in the normal range. About 25% show some menstrual irregularities, and their weight is sometimes low. The outcome is poor for another 25%; they are not menstruating and their weight is far below normal. Whether they recover or not, many of these women are still preoccupied with weight and dieting. Women with personality disorders and those who have symptoms for a long time before seeking treatment are least likely to recover.
Evidence on the effectiveness of treatment is limited. Many women with anorexia or bulimia are never treated, and in long-term studies many drop out possibly those who are doing worst.
Experience has shown that the more distorted body image the victim has of herself, the more difficult the cure, and the longer the condition goes untreated the more uncertain the outcome. Spontaneous cures rarely happen because the victim takes a positive pride in sustaining her hunger.
Since women with anorexia are usually living with their parents when the symptoms develop, “psychotherapists” have often found it helpful to work with the whole family. The resulting discoveries and speculations are an important source of family systems theory, in which the family is conceived as a social unit with internal structures and processes that have a life of their own.
Treatment comes in the form of psychotherapy, nutritional education, and re-feeding. Nutritional education takes time however as the farther a person is below their healthy weight, the more their cognitive ability is impaired (Merriman, 1996). The nutritionist then must carefully plan nutrition education sessions to make them as meaningful to the person as is possible. Re-feeding is also not a straightforward process as anorexics often find it quite difficult to gain weight. This is due to an increased diet induced thermo-genesis and a lower metabolic efficiency. Anorexic patients can waste about 50% of the energy of their food due to this inefficient metabolism at the start of re-feeding, making the maintenance of any gain in weight difficult (Moukadden, 1997). Another study concluded that even with weight gain after 3 months to a year, it was not enough to maintain a desirable nutritional status. This was because patients did not reach an adequate body mass index and their immunological indexes were lower than in control subjects during an entire one year follow-up (Marcos, 1997).
Conclusions From the information presented, one can only imagine just how complex the issues really are that the anorexic attempts to deal with via dieting. The anorexic may be dealing with substance abuse, depression, sexual abuse, confusion about their sexual orientation, or bodily dissatisfaction to name a few.
The road to recovery is difficult and the body seems to resist any weight gain during the initial re-feeding period. Even after an entire year of treatment, evidence suggests that recovery has not been achieved and many anorexics continue to suffer from their disorder. There are so many complications that anorexia can be attributed to that it would appear that the quicker a person complies with treatment and can be recovered, the better. It is quite obvious that anorexia is a complex disorder that partly involves how one perceives his/her self and what physical standard society dictates they should live up to. The topic has many areas that require further research as society has been shown not to be the entire causative factor for the development of the disorder. It has been shown to be one of them however; so until society becomes more realistic in the ideals it endorses, it is responsible, at least in part, for the prevalence of this disorder.
Pro-ana
A relatively new development in the area of anorexia is “Pro-ana” or Pro-anorexia. This is an extremely controversial topic. Not much has been done in this area as far as research, theories, or even an attempt at analysis or understanding. Many argue that it should not be considered as a psychological issue as it is simply anorexia with a spin. A plethora of “ana” websites have been censored and shut down because the pro-ana ideology is seen as “the world’s deadliest secret society.”
The idea of pro-ana emerged within the last five to ten years and is successful largely due to the popularity and accessibility of the Internet. The pro-ana concept was introduced through websites that support anorexia and provide a place that anorexics uninterested in recovery could gather to learn tips and tricks.
These sites contain “thinspirational” pictures of waif-thin models and actresses, as well as pictures of the grossly obese, to inspire readers to lose weight. They include quotes, stories, and message boards, which provide an incredibly strong, dependable support system. In addition, they offer comfort and serve as a reminder that there are other people living the pro-ana lifestyle. Many talk of anorexics as “the elite”, and present the anorexic lifestyle as a rejection of conventional, “weak” values.
These sites also contain information on issues surrounding anorexia. They provide safety information for fasting; they strongly discourage the use of diet drugs (which many anorexics die from). They include topics on everything from “how to avoid lanugos” to the “risks of purging and how to keep your electrolytes in check”. They provide BMI (Body Mass Index) calculators and listings of the calories and fat content in foods.
Pro-anas regard anorexia as a lifestyle and a choice, not as an illness or disorder. It is felt that volitional, proactive anorexia is not to be confused with ED-anorexia (or anorexia as an eating disorder). It is not something invasive, which one “suffers from.”
“Pro-ana” is short for proactive, volitional anorexia, referring to the desire to actively embrace anorexia as a lifestyle choice rather than an illness. It involves control over oneself: denial of appetite, restriction of food intake, and discipline in exercise. A “pro-ana” does not feel like a victim and thrives upon the challenge and competition.
This new ideology makes pro-ana especially hard to treat, understand, and research. Despite widespread media attention, the phenomenon of pro-anorexia has not yet been examined in the scientific literature. Perhaps this is because it is difficult to break the close ties of the secret society surrounding the pro-ana lifestyle; outsiders are generally not allowed in. The overall feeling of these communities is of an “us versus them” relationship. The “them” is considered as a threat, misunderstanding the pro-ana ideologies, and trying to dispose of ana.
Pro-anas have their own language, their own terminology, which throws around terms such as rexie, ana (nicknames for pro-anorexia, or anorexia), ED-ana (eating disordered anorexic), mia (bulimia), “confessing” (purging), BMI (Body Mass Index), and thinspirational (something, such as quotes or pictures, that inspires the desire to lose weight), to name a few. Girls reaching a certain goal weight earn their red bracelets, which declare their commitments to ana and announce their achievements of their goals. The bracelets also function as a way to unite “anas” across the world and identify a fellow “sister.” In addition, they serve as a reminder of future goals and past (met) goals.
Eating disorders are a cause for serious concern from both a psychological and a nutritional point of view. They are often a complex expression of underlying problems with identity and self-concept. There is still much research to be conducted, especially in regards to the pro-ana mentality, male anorexics, and the treatment of anorexia.
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