Response to Newsweek's Anorexia Cover Story
> 11/30/2005 3:14:04 PM

It’s not surprising, with the media’s obsession with turkeys, hams and yams at this time of year that their attention focuses on eating disorders.  The Dec 5th Newsweek cover story on anorexia is an informative, and yet, not particularly earth shaking article. A mental disease, anorexia has self-inflicted starvation, distorted “fat” self image, over exercise, high anxiety and the good girls syndrome as its predominant features.  While it is important to remember that this is a heinous, disastrous disease for those that if afflicts, its importance can be inflated by the media at the expense of other mental illnesses that are far more pervasive and damaging to the overall public.

The epidemiology of anorexia was known to predominantly afflict white middle to upper class girls of 12-16 usually before entering and during puberty.  Later studies identified another at risk population, including mid- to upper-class women in their late twenties and early thirties, usually before or after pregnancy.

Lately boys and men, though rarer, have gotten into the picture. According to the Newsweek article the newest evidence shows girls as young as ten are being reported with the disorder, as well as Asians and blacks. For some reason these new groups come as a great surprise to professionals. Why, I don’t know. Girls are maturing faster, menstruating earlier and assimilating the culture of thinness and beauty at a much earlier age, so it becomes perfectly reasonable that eating disorders would start earlier too.  Anorexia has to be an affluent cultural phenomenon since it does not exist in starving nations (unless we consider the few political and religious leaders who are lauded for fasting to get attention and their point across). Ethnic minorities are rapidly assimilating in to this society, adopting the majority values and customs, so why shouldn’t they adopt the same neurosis as well?

 Anorexics suffer from high anxiety and depression which often is masked by the starvation induced euphoria, release of encephalin (aka- endorphins) due to over and constant exercise, and compulsive behavior and obsessive thinking.  The anorexic behavior like most neurotic behaviors has a mind of its own and creates a self-perpetuating cycle that is difficult to stop.  Now that the psychological profession has accepted the notion that little children suffer from depression and anxiety, early age onset of anorexia should not be at all surprising.           

Successful anorexics die, not because they want to but because it is inherent in the disease. Their goal is less about weight loss and more about a desire to gain control when they feel they have none—and they will strive for this at any cost.  When you don’t feel you can have any control over anything, at least you can control what goes in your body. Think of a little baby, helpless by all standards, which can still manage to confound adults by refusing to take a bottle or nurse.

 Unsuccessful anorexics often become bulimics, exercise fanatics or obese. They are unable to maintain the discipline and concentration that anorexia requires so they start taking shortcuts: vomiting, ipecac, diuretics.  Then they weaken and begin their binge or exercise regime, which leads them into the next cycle.

  Understanding and recognizing Anorexia is one thing, but treating it another story. In-patient treatment is necessary in many severe cases. It usually consists of a multi-discipline approach. Medical health is treated immediately. Often anti-depressant and anti-anxiety meds are prescribed. A strict behavior modification approach is instituted, which involves taking over total control from the patient and then slowing allowing her to gain control by earning it.  And, you earn it by eating.  Food is monitored down to the last crumb and if you eat you get to do something you want: exercise, watch TV, leave on a day pass, etc. In addition to this, family and patient undergo therapy.   Individual therapy consists of encouraging the patient to experience feeling, and understand their behavior. Family therapy is designed to understand the dynamic of the family, how they interact with each other and what role each person plays in the family. 

 Peg Tyre, author of Newsweek’s piece, describes method of treating this disorder called the “Maudsley approach” which incorporates the family in the treatment.  This is not as new as the writer initially makes it seem.  Back in the 80’s an Argentine  psychologist named Dr. Salvatore Minuchin and Dr. Jay Haley,  who some say were the fathers of family theory and therapy, distinguished two types of families, the overly enmeshed  (chaotic and tightly interconnected) and the disengaged.  Those who suffered from anorexia fell into the former category. Mothers were seen as controlling and very demanding, giving the children no autonomy. Fathers were passive and tools of the controlling mom.  The children, being “the ultimate good little girls,” instead of rebelling overtly to this over-control and high level of expectation become totally compliant in every aspect, except for a “volitional” though passive refusal to eat.

 The dinner table becomes the war zone, the weapons, the peas and carrots.  As in all neurotic behavior, there are also many secondary gains from this behavior.  The daughter makes mom look bad because, what kind of mom lets her daughter starve?  The “good little girl” get all sorts of sympathetic attention that an overtly rebellious, bratty child would not get and everyone, doctors, nurses, teachers, etc., are completely confounded and rendered powerless by this good little child.  What an incredible feeling of power in such pathetically frail little hands. 

Family sessions took place at the dinner table and at first, the interaction would be noted and identified. Things would start out fine; mom and dad would beseech the anorexic to eat, “just a little,” “take a taste.”  As patience thinned things would degenerate.  At first mom and dad would scream at the child then they began to scream at each other, laying blame on the other for any number of reasons: spoiling the kid, not making enough money, out of the home too much, working, not working… the usual. Meanwhile, the anorexic still wouldn’t eat and got lost in the shuffle.  Finally, Dr.Salvador Minuchin or a member of his team would step in and point out the dynamics and get the family to adjust their behavior.

 The “Maudsley approach” doesn’t banish the parents from the treatment and neither did the family method.  Both were started in the eighties and probably pulled from each other as they developed this “family centered approach.”  Out-patient treatment can often be tricky if the parents or spouse have chosen to see the disorder before it has gotten out of hand.  In these cases family, as well as individual, therapy is required.  But, it is most important that the therapist providing treatment to the individual not be the same therapist treating the family.  Although a seemingly easy distinction to make, in reality this practice can be quite difficult.  Invariably as the anorexic patient begins to get better, the family demands to come into the individual session so that they can plead their case and overpower the patient and the therapist.  Both the individual and family therapies are long and exhausting and slow to respond.  Perhaps the most important point in treating anorexia is to allow the patient to determine their treatment: at their pace, in their time, as long as they stick to a mutually agreed upon weight gain regime.     



I do beleive anorexie is the desire to go back to child like vulnaribility, to become like light like an angel feather and to be just like a drop a water under the sun : I will evaporate n the univers.
Posted by: Marie-France 6/14/2006 10:47:18 AM

That's just the most hidiouse thing I've ever seen. That's just outragouse... an undead skeleton.
URL: http
Posted by: Rolf 3/2/2007 2:59:47 AM

Rolf. Dont b such an idiot. these people hav a disease if u saw sum1 with a shaved head because of cancer would u say tht? no. (well i hope u wudnt) so dnt say it bout them.
Posted by: Chloe 3/9/2007 9:11:34 AM

Posted by: crystal 4/10/2007 9:35:13 AM

that women needs MENTAL REHAB!!!
Posted by: Fat lard 4/23/2007 9:19:40 AM

i think that this is so sad for her to do her body that way and dont even care if she dies
Posted by: saquanya 5/31/2007 1:44:28 AM

She looks like she's modeling or something...and if she is, that is such a negative image to be marketing about...especially for the young crowd...
Posted by: 6/5/2007 6:23:54 AM

i suffer with an eating disorder at the moment and have for years now. i am nothing like that. i used to make my self sick after i pigged out, now when ever i eat i feel sick and am somtimes sick automaticly its horrible and i cannot wait till i am completely clear. it all starts from seeing skinnyer girls than you.. dont be lead by the size curves look better deffently! when i look at the picture i would rather be a size 18 than a size 0!
Posted by: pippa 6/24/2007 4:53:43 AM

This is crazy! She has scared my sister!
Posted by: Aliyah 7/21/2007 5:17:46 AM

anorexia is so stupid and whoever has it needs serious help!!!!!
Posted by: 10/25/2007 11:01:35 AM

I would love to drop from a 135 to 115. But going to the extreme that this model has,I feel bad for this her. I mean what is she going to be like in another 6 months or even a year.
Posted by: Carrie 12/4/2007 1:43:30 AM

being skinny is nice but this has girl has gone too far she looks disgusting
Posted by: maria 2/11/2008 4:43:38 AM

she loooks sooooo ugly and horrible
Posted by: jessica 2/14/2008 4:59:46 AM

I used to be anorexic, it never really goes away mentally. Professional help works, otherwise you mask your problems with something else, drugs, booze, etc.
Posted by: linda r. 4/2/2008 8:07:51 AM

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