It’s time we revisited the generic definition of anorexia in the spirit of facing that denial up-front. You can read this and not even think it’s you, when it is. Your friends and family can see it, but you can’t.

“Anorexia nervosa is a psychiatric diagnosis that describes an eating disorder characterized by low body weight and body image distortion with an obsessive fear of gaining weight. Individuals with anorexia are known to commonly control body weight through the means of voluntary starvation, purging, vomiting, excessive exercise, or other weight control measures, such as diet pills or diuretic drugs.”

When you block out food and deprive your body of essential nourishment, the physical changes are immediate and quickly turn severe. The body signals damage and need very clearly, and it is these signals that must be overridden and resisted. The first stage is malnutrition, which becomes a state of starvation over 5-7 days.

Of course, none of this will happen to you, because unlike everyone else you’re in control of it. You’re just doing it for a little while to get to that target weight and then you’ll start eating healthily again.

It’s a common perception amongst those who suffer with eating disorders that this suffering is temporary and the body is dynamic enough to repair itself and adapt. There is a certain amount of truth to that, but going into a state of denial that is so intense as to ignore the very dramatic signals the body gives out is something else. The trouble with anorexia is that starvation denies you the basic nutrition that enables you to think properly, and because of that actually enables denial.

All of this happens within just 2-3 days of food blockading, or when less than 800 calories has been adsorbed per day over 48-72 hours.

The first thing that happens is a change in the body’s electrolyte balance - electrolytes are salts that conduct electricity and are found in the body fluid, tissue, and blood. Examples are chloride, calcium, magnesium, sodium, and potassium. You start feeling weak, heavy, achy and slow. If you’ve felt the pain of a hangover, that pain is from dehydration, which is an electrolyte imbalance. You will start experiencing regular headaches all the time and being over-tired. In the case of anorexia, phosphate deficiency tends to suffer most. You will want to sleep more than usual, and will find it harder to get up.

Secondly, your brain structure and function will change, but you won’t notice it – only the people around you will. The ventricles of your brain will enlarge, and blood flow to your temporal lobes will slow down. Because your eating has slowed, your body will compensate by slowing your metabolism, making you feel slow and lethargic. It will try to conserve energy by preventing you from expending too much of it. Occasionally you will go jittery and hyper because your body has flooded you with adrenaline, which is emergency mode reducing appetite and compensating for an inability to derive energy from normal sources.

Your normal level of sex hormones, such as oestrogen, cortisol and progesterone will decrease, making you feel less womanly in yourself. You will rarely feel horny and it will be hard to get turned on as your libido has shut down. It will take longer to have an orgasm and your arousal will disappear quickly. Because your endocrine system is unbalanced, your periods will take longer to arrive, become lighter and less frequent, and eventually stop. The stress you put on your fragile reproductive system means it starts to behave erratically and fertility becomes unstable. Your body will shut it down to protect it.

Your hair will lose its shine, so you’ll need to use more conditioner. It will take forever to grow. When you rush your hands through it, lots of individual strands will be left on your fingers. It will be dry because it will stop providing natural oils and does not have the minerals to look good. You’ll need to use more and more concealer because you will have noticeable black bags under your eyes that are too severe to just be from being tired.

You’ll feel freezing cold all the time – more cold than you normally would. Your hands will become white and numb very quickly and you’ll find yourself with pins and needles. You will notice bruises appearing everywhere in strange places when you can’t remember hurting yourself. Your vision will be blurry and you won’t be able to concentrate for very long, meaning you will get frustrated and bored easily. You will ache a lot and not know why. Your joints will crack and be sore. Sitting in one position for too long will be painful.

Because your iron intake has stopped, your skin will stop looking full-blooded and radiant, making you pale. Less oxygen will be carried to your brain, meaning you will be more tired than normal and need to breathe faster and deeper. Your skin itself will stop making its natural oils, and become dry and flaky, and your complexion will be more unstable, with subtle red and white patches, meaning you need to use more foundation. Sebum will collect under your skin and increase the number of spots you get because your natural skin oils aren’t flushing your skin.

The worse it gets, the more make-up you will need to put on.

When you go to get your nails done, the varnish won’t set as well. They will break easily from being brittle and have small marks. You will need to use more and more lipsalve and lipstick because your lips will lose their natural lubrication and become dry and chapped. Not having enough calcium means your teeth will stain easier from tea/coffee or cigarettes, so you’ll have to use tooth-whitening toothpaste. Your teeth will ache after you’ve eaten and feel hollow and sore. Things will taste different once your zinc intake is below normal.

After a while you will notice small soft hair appearing on your skin, often in patches, because your body is trying to compensate for insufficient natural fat levels. It is the same hair that a foetus has in the womb. You won’t go to the toilet as much, and your urine will be darker and fouler-smelling. As your food intake is poor, you’ll be straining hard to take a crap because a lack of fibre and carbohydrate means your poops won’t have enough substance to pass through you easily.

And then there is the smell. Your sweat levels will go up because your body will try to raise its core heat and circulation, and as your electrolyte balance changes your body smell will become more noticeable and obnoxious. Your breath will be sulphurous and sour, your armpits, teeth and backside will be emit more odour due to higher bacteria levels, and because the Ph of your vagina has changed, your lady parts will take on a smell of strong urine or rotten flesh (bacterial vaginitis, or BV). You won’t be able to notice it, but it will come through your clothes to be obvious to your workmates when you walk past them, and your partner won’t know how to tell you.

Other interesting things you will notice are that your ankles will swell during the day, and your eyes will puff up at night, and because your immune system is depressed, you will get ill more than usual and pick up everyone’s colds. It’ll hurt more when someone smacks you on the arm. And of course, your stomach will feel empty and the hunger will be intolerable, as nature designed it. Your immediate desperation will be for carbs for basic operation – bread, toast, chips, crisps and nuts.

But that’s just some of the physical signs.

Mentally, the first symptoms will be that you sink into depression (not sadness, a “numbness”), as your body is depressing itself to slow down. You won’t feel anything at all emotionally. You’ll be tired all the time, and stop/slow down moving physically. Not eating will make you restless, nervy and anxious, meaning you worry about things more than you normally would. You will be defensive and paranoid, and unable to rationalise as you normally would. Because your blood sugar levels are perpetually low, your eyesight will be affected and you’ll be grumpy as sin.

Your moods will drive you mad. One minute you will feel strong, the next you will be wanting to collapse. Your strength of will and sense of hope will fade. You will feel apathetic, uninterested and lazy. Everything will seem like a hassle, and everyone grey, tired and threatening in some cases. You will lose your temper easily, and will clam up and become withdrawn. Everything will feel pointless. You’ll do things because you have to, not because you feel like you want to. That means you’ll be spending most of your time on your own, watching TV, listening to music, or finding some kind of entertainment on the Internet to relieve your boredom. You won’t have as many texts on your phone and you’ll notice it’s been a while since you got phone calls from friends.

As you become more withdrawn, you’ll notice you actually try to create more physical barriers around yourself. Mostly this will mean that you stop talkng face to face and put a machine (PC, mobile phone) in the middle, or simply cross your arms, sit sideways and have an object (e.g. cushion) between you and other people. You’ll be confused because you feel better for feeling thin, but you still feel like a piece of shit that’s not worth anything.

You won’t notice that you are drinking more alcohol, and smoking more. Alcohol is a source of carbohydrate and reduces appetite, as well as warming you up – just like a tramp. You’ll see more empty bottles of wine lying around and go to the pub to keep away from the kitchen and the food in your house. You’ll find yourself drinking more tea and coffee, as the caffeine in them also reduces appetite. All of these things feel “warm” in the chest and give a strange sense of comfort. You have no comfort but will get it without realising you are doing it.

And once you’re down there, you won’t want to come out. You simply won’t have the energy or will to climb out. Self-pity will take over and your thinking will be negative. You won’t remember the last time you didn’t feel your cheeks so heavy when you smiled.

But it’s worth it! It will eventually make you thin, perfect and beautiful! If you just be strong!

The more you starve, the less attractive you get. It’s a bit like an alcoholic drinking himself stupid every day in an attempt to get sober. The more you shut down, the more isolated you get. The more unattractive and isolated you get, the more you want to starve and withdraw. A spiralling cycle – getting the picture yet?

Take a look at the following definition. I know i’ve featured it before but it’s a powerful concept.

paradox [par-uh-doks]
–noun

1. a statement or proposition that seems self-contradictory or absurd but in reality expresses a possible truth.
2. a self-contradictory and false proposition.
3. any person, thing, or situation exhibiting an apparently contradictory nature.
4. an opinion or statement contrary to commonly accepted opinion.

The objectives and desires that drive anorexia are self-contradictory and impossible by definition, which means it always ends in failure, all the time. Every single person who suffers with thinks it won’t be the same for them. The goals are hopelessly unreachable. It is a trap.

Now let’s take a look at just how eating disorders make you beautiful by comparing a sign/attribute of beauty with the equivalent result of shutting out food.

Beauty	Blocking out food….
Athletic body	Boney, pale and skinny body
Proportioned body	Disproportionate body from rapid weight loss
Feminine shape	Boyish/androgynous shape
Flowing silky hair	Thin/flaky hair
Smile	Expressionless/frown
Glowing skin	Pale, dry, gaunt skin, poor circulation
Tanned	Pale, anaemic
Long legs	Boney disproportionately shaped legs
Bright full lips	Pale chapped lips
White teeth	Brittle calcium-deprived teeth
Small bum	Boney disproportionate bum
Curvy hips	Boyish hips
Sparkly eyes	Dull sunken eyes
Blushed cheekbones	Pale prominent cheekbones
Flat Stomach	Stomach pouch raised
Big boobs	Small hanging boobs
Shiny nails	Brittle broken nails
Long eyelashes	Eyelashes fall out
Prominent collarbones	Heavily raised collarbones
Alluring cleavage	Boney chest
Odorless lady parts	Changed Ph, rotten flesh
Clear complexion	Pale mineral-deficient complexion
Little body hair	All over body Lanugo hair
Small calves	Emphasised calves
Sweet smelling	Increase in body odor
Tight figure in jeans	Disproportionate/lacking shape
Raised shoulderblades	Over-prominent bones
Rounded knees	Nobbly/boney knees
Odorless breath	Halitosis, dehydration
Small arms	Boney arms, hanging skin
Beautiful without make-up	Ill
Happy/Fun	Miserable, headaches
Energetic	Weak, Exhausted
Mature	Childlike
Confident	Anxious, self-conscious
Relaxed	Intolerable hunger, irritation
Social life	Drink heavily, can’t eat out
In control	Controlled by eating disorder
Stands out	Trying to fit in
Sharp thinking	Impaired thinking and insight
Self-assured	Obsessed with perfection
Outgoing/open	Closed, withdrawn

Well it’s obvious. If you shut out food, you lose weight quickly and that makes you thin, which solves all your problems. Thin is beautiful and perfect. Being able to shut out the hunger makes you feel strong.

If you’re in control, why can’t you stop?
if you’re in control, why isn’t your body healthy?
If it will make everything ok, why are you so miserable?

The simple fact is this: eating disorders might help you cope, but they also make you ugly.

Perhaos instead of carrying out with the gentle silliness, we should look at a few other paradoxes in life that involve similar thinking.

You cannot become thin and beautiful by ruining your body.
You cannot become full and complete by emptying yourself.
You cannot become happy by doing things that make you miserable.
You cannot overrule nature without your body adapting and reacting to you abusing it.
You cannot be perfect when everyone finds different things attractive.
You cannot empathise with others if you do not have faults.
You cannot get your self-worth from other people.
You cannot get love by denying others your love.
You cannot get support by shutting down and pushing people away.
You cannot be understood by being silent.
You cannot cope with things by behaving in a way that makes it impossible to cope.
You cannot win a battle if you admit defeat before you start.
You cannot feel protected by isolating yourself.
You cannot get yourself out of a hole by refusing to come out.
You cannot move on with your life by just standing still.
You cannot receive affection if you surround yourself with barriers.
You cannot avoid pain if you act in a way that causes it.
You cannot calm someone’s anger by running away from it.
You cannot feel strong by weakening yourself.
You cannot be close to others by holding them at arm’s length.

Eating disorders have a mind of their own and encourage you to do things that keep them alive and going. The behaviour gets you the opposite of what you want and need.

The hardest thing for loved ones, other than watch the girl they care about totally isolate herself, fall into denial and depression, and ruin herself for martyrdom, is not knowing how to help. The first response you have is to control the situation - get mad, make demands, force-feed, make more demands and so on. Then you give up and go silent. You try to understand and help by making excuses. You try everything.

We can love a person’s being and still protect ourselves from their behaviour if that is necessary.  To think that loving someone means we have to accept being abused by them is dysfunctional - and it demonstrates a lack of love for our self.  If we do not know how to be loving to our self, then we cannot truly love another person in a healthy way.  If we do not honour our self, show respect for our self, by having boundaries - then the other person is not going to respect us.

Does any of this sound familiar? It should do, as it’s exactly what happens with alcoholics and drug addicts. By medical definition, eating disorders are an addiction. They are a way of coping, and a way of avoiding problems and responsibilties.

The worst possible thing you can do is to enable the eating disorder.

The most loving thing friends and families can do for a girl with an eating disorder is to stop enabling her by rescuing her from consequences. Enabling is doing for someone things that they could, and should be doing themselves. Simply, enabling creates a atmosphere in which the sufferer can comfortably continue her unacceptable behavior. It takes many forms, all of which have the same effect - allowing her to avoid the consequences of her actions.

A person who is acting out self-destructively has no reason to change if they do not ever suffer major consequences for their behaviour.  If they are rescued from consequences, they are enabled to continue practicing their addiction.

When you stop enabling someone, or refuse to enable them, their immediate reaction will be one of pain and outrage. They will see it as an outright act of hostility and/or withdrawal where you are screamed at that you are not being supportive. There is a very distinct difference between giving support and enabling an eating disorder. You are not required to give support if that “support” helps the disorder to continue.

A person can and should communicate their feelings, be open and state their needs. A person can and should be able to face up to difficult problems and deal with conflict. A person can and should be able to maintain their health, ask for help and be emotionally available. They should be able to cope without the use of an eating disorder. It is their responsible to stop these behaviours, find help and seek out new ways to cope.

How do you know the difference between helping her and enabling her?

Helping is doing something for someone that they are not capable of doing themselves. Enabling is doing for someone things that they could, and should be doing themselves. Enabling says someone else takes the responsibility away, whereas help/support requires her to take responsibility.

• Immediately cease doing anything that allows them to continue their current harmful lifestyle.
• Do nothing to ‘help’ the person that she could or would be doing herself if she were not starving.
• Stop lying, covering up, or making excuses for them, such as ‘calling in sick’ for her.
• Do not take on responsibilites or duties that rightfully belong to the person with the eating disorder.
• Don’t ‘rescue’ the person by carrying her physically, making her eat or mopping up in the bathroom after her.
• Do not scold, argue or plead with her. You will not win a control battle.
• Stop making rationalizations for their irresponsible behaviours.
• Do not react to her latest misadventures, so that she can respond to your reaction rather than her actions.
• Do not try to starve with the sufferer.
• Do not make excuses or try to avoid discomfort at mealtimes.
• Set boundaries, don’t make threats, and stick to them.
• Carefully explain to her the boundaries that you have set, and explain that the boundaries are for you, not for her.
• Stop ignoring the problems caused by the eating disorder (health, arguments, withdrawal, social problems, financial, employment, legal)
• They will also need someone to talk to, as most anorexics keep their feelings to themselves (for various reasons, common ones are fear and rejection).
• Encourage them to be more open with their feelings and don’t judge.
• Recognize their efforts to recover.

In some cases, that may involve ending the relationship. If a person’s behaviour is so destructive that it means that the obvious consequence in a normal situation would be the ending of the relationship, you  prepared to end it. Not enforcing boundaries and allowing yourself to be taken advantage of provides a consequence-free environment where the sufferer feels comfortable with continuing with their eating disorder.

Do not save them or try to find ways around not ending the relationship when the situation may necessitate it. They are responsible for their own feelings and behaviour, and there are nagative consequences that result from using eating disorder as a means of coping which they should be allowed to suffer. If they lose their relationship because of their eating disorder, so be it. You must not save them from that consequence or respond to their pleas for the consequence-free environment to continue.

It may be a long road to recovery. It may be hard. It may be something you have to do if you want to have a baby. It may be scary. It may seem impossible.

If you carry on, your daughter will suffer this too. You will lose the people you love. You will be alone. You will always be scared and isolated. You will always be a victim. It is your eating disorder that causes all of it. It is not the thing that saves you, it is the thing that keeps you ill and paralysed. It’s up to you to take control of the thing that has control over you. It is your enemy, not your friend. You think you’re alive, but you’re dead. It is the illness that is sucking your energy. It is the illness make you feel numb. It is the illness that makes you so weak and needy.

It is shutting down that makes you feel alone. It is not eating that makes you feel weak. It is running away from your problems that makes them become so bad. It is not setting bounraries that makes people run rampant over you. It is trying to control that makes you vulnerable. It is making yourself weak that stops you from being strong.

If you can train yourself to starve, count calories, purge, fight and resist the pain of hunger, you can train yourself to resist the need to shut down, block out and refuse food. You must save yourself. Opening up takes practice, and needs baby steps. But you have to do it, not just hope you will in the future. You have to research and learn new ways of coping. All that coping means is that instead of clamming up, you override that feeling and deliberately reach out to a friend. You tell them how you are feeling and ask for a hug. That’s it.

You work out who you can trust, and who you can rely on. And who you can’t.
Everyone has different levels of trustworthiness and reliability, so you treat each person differently.
You only share with loved ones you know won’t ignore you, humiliate you, or attack your vulnerability.
If you feel sad, you tell a friend and ask for a hug.
If you’re frustrated and resentment, you explain your wants and needs.
If you’re nervous or insecure, you ask for reassurance.
If you’re lonely, you invite someone out with you for the evening.
If you feel happy, you ring someone and tell them why, then jump around and smile.
If you’re scared, you ask someone to protect you.
If you’re bored, you find something to do that will entertain you and someone else.
If you’re angry, you learn how to confront someone assertively.
If you feel vulnerable, you set a list of boundaries and make people aware of them.
If you are struggling, you ask for help instead of trying to do it all yourself.

But as my sister so rightly put it, having been down in that hole.

“The battle is over when you decide it is over.“