Anorexia nervosa is a disorder that reveals itself in obvious and physical ways, but the psychology of anorexia is the driving force behind the behaviors. There are many personal memoirs about the struggle with anorexia that let the reader see inside the mind. Here are a few quotes from those who battle the disorder and some thoughts from research (and personal experience with clients) regarding what is likely going on psychologically.
The Motivation: Shame in the Psychology of Anorexia
I often went entire days without speaking -- unable to get a word in over my inner taskmaster, who never shut up: "You fat, disgusting slob, you'll never be thin enough, good enough, smart enough, tough or talented enough...." -- Aimee Liu, Gaining: The Truth About Life After Eating Disorders
At its core, anorexia can cause a deep sense of shame. It can come from one or more of a host of influences. Liu's account of the thoughts that plagued her are also often present in bulimia.
The Counterweight: Pride in the Psychology of Anorexia
Inside, that little kernel of pride sprouted, watered by the attention and by what I understood to be envy; without even trying very hard, I could do what others tried and failed to do. -- Caroline Knapp, Appetites: Why Women Want
For Knapp, this moment occurred as she began to lose weight and consciously avoided eating when with friends. This arrogance is always present, but usually well hidden. Revealing it would give away an internal hardness. But not thinking it would deny the person the sense of power that anorexia offers. Note also that the massive failures of the practice of dieting allow those with anorexia to evoke envy and a sense of being special very easily.
In Gaining: The Truth About Life After Eating Disorders, author Aimee Liu quotes Marya Hornbacher, who explains the resulting internal battle accurately: "It's hard to describe how these two things can take place in the same mind, the arrogant, self-absorbed pride in yourself for your incredible feat, and the belief that you are so evil as to deserve starvation and any other form of self-mutilation. They coexist because you've split yourself in two..."The Veneer: Bland Self-Protection in Anorexia
I think I look okay. I'm sure you mean well, but you're mistaken, just like the doctors here. I don't look too thin nor is my weight too low. -- "Greta," from Steven Levenkron's Anatomy of Anorexia
A psychotherapist, Levenkron is taking this quote from a conversation with a young woman just hospitalized; her heart, kidneys, and liver were failing. She was too weak to lift a telephone receiver. She had just threatened to sue her doctors for saying that they needed to feed her intravenously to save her life. But notice her politeness and her bland way of speaking in this quote. It shows a numbness to the reality of her skeletal appearance, to the urgency of the situation, and to the kindness of the author...that is, until Levenkron told her she would be declared psychiatrically incompetent if she didn't cooperate. Then her response was, "I'm scared. I don't want them to make me fat!"
Numbness, blandness, niceness, and a certain level of vacancy are common in anorexia. Even at the brink of death, a person will choose to try to "help" someone else rather than receive life-saving care. Since the other person (parent, therapist, friend) can feel desperate as a result, the patient's attitude doesn't help anyone at all.
The Response to Challenge: Contempt
If you look at my fashion magazines, you'll see I don't look any thinner than those models. You'll always be a worrier. I'm just getting in style is all. -- "Amy," Anatomy of Anorexia
This comment, from a 15-year-old girl, effectively shut down her mother's questioning. It is dismissive. In these situations, the girl feels enormously powerful compared to her mother, who feels inept and helpless. It's a comment designed to protect the eating disorder from further challenges.
The Fear: How Anorexia Delays Tough Changes
I feel like I want to grow up, but if I do, I'll be doing something terrible to you. -- "Lena," Anatomy of Anorexia
Lena feels ambivalence -- two emotions at once. She perceives that her mother needs her to stay close to her, but if she grows up, she'll separate from her (a part of growing up). Anorexia lets Lena feel as strong as an adult (since she's dominating her parents) while maintaining a body that makes her feel small and young. The "small and young" (and often ashamed) part is generally the real self. It's the part that gets protected.
The Love Affair: How the Psychology of Anorexia Offers a False Intimacy
I know that it's a good thing that I got my period, but it's also sad for me because it means I officially don't have anorexia nervosa anymore, since it's one of the criteria. -- "Shelly," Anatomy of Anorexia
Anorexia can feel like the best friend a person has had, at least in some ways. When leaving the disorder behind, there are still parts of it that linger in the memory as enjoyable. The enjoyable parts are not nearly as pleasurable as the parts that come from overcoming fears and dealing with the world. But there is a big feeling of nostalgia.
Hope in the Midst of Complexity in Anorexia
Anorexia is more than a battle between a spoiled, control-seeking child and her parents. The psychological relationship between the disorder and the person it inhabits is complex. A shrinking body is the visual indicator of the struggle within and how it literally eats away what is good.
But anorexia is not a hopeless problem. Treatment is available, and we learn a little more about what works and what doesn't all the time. If you have a loved one with an eating disorder, you can take steps to gently and firmly invite her (or him) to acknowledge reality and enter treatment. You can't save your loved one by yourself (and it's self-defeating to try). But you can be a part of the path to recovery.
Sources:
Knapp, Caroline. Appetites: Why Women Want. New York: Counterpoint Press; 2003.
Levenkron, Steven. Anatomy of Anorexia. New York: Norton and Company; 2001.
Liu, Aimee. Gaining: The Truth About Life After Eating Disorders. New York: Warner Books; 2007.
