​First published in the journal of Psychic Healers
Volume 14, 1995

INSIDE ANOREXIA
_________________________ Sivan McGarry


Aetiology
 
Many psychologists (Bemis 1988, Crisp 1990, Monte 1990, etc.) consider that Anorexia is an eating disorder, and feed the media including women's magazines (e.g. Vogue Sept. 1995) faith hype to be disseminated to the general public.

The truth on the contrary, is that Anorexia Nervosa and Anorexia Bulimia are NOT eating disorders.

In fact, they have nothing to do with food. Anorexia is a  psychological disease centred around control.

Anorexia Nervosa and Anorexia Bulimia are the same disease with different manifested symptoms, although a Nervosa sufferer may go on to develop Bulimic symptoms at a later date (Davidson & Neale 1982).

Overwhelmingly, Anorexia sufferers are female. Crisp, Palmer and Klucy (1976) report a ratio of 20 females to each male and further claim that one in every 200 school age girls is Anorexic. Brett Thomas claims that this last figure is higher in Australia in 1995.

A Nervosa sufferer will deny herself food for long periods of time. This is not something that she makes a conscious decision about. Sufferers don't sit down and decide, “Today I'm going to start starving myself to death”. It tends to happen gradually. They may start by skipping one meal by accident, realise that it wasn't so devastating and then try deliberately missing a meal.

From this point on it becomes a challenge to see how many meals can be missed. Suddenly they have control over something in their lives. And the bathroom scales show a loss of weight during this time so that a reward is added to the equation.

Eventually they can go two or three days without eating. This gives them a great sense of mental euphoria because at last they are in control. An anorexic feels the need to have this control over her body because it is felt that they have no control over the rest of their lives.

A Nervosa sufferer may then go on to develop Bulimia at a later date. Often there is a feeling that they are in control enough to allow themselves some food. But after they've eaten it is common to feel so disgusted with themselves, and depressed because they gave in - because they gave away some of that control.

The next step in the sufferer's development of Bulimia is to try to purge the food from their system, either by making themselves vomit or by abusing laxatives, or both.

These methods of purging may be discovered by accident: a finger down the throat because of an inability to burp; a need for a laxative because of the constipation caused by not eating for long periods, which the Anorexic personality then takes to extremes.

The discovery that, while trying to burp most of their dinner came up as well - and considering that therefore that meal doesn't count - can then become: "I can eat three quarters of a meal and then go to the bathroom and get rid of it. Then if I come back to the table and eat the other quarter everyone will think I'm eating normally. And later I can have four laxatives to get rid of-the last quarter of the meal".

What must be remembered is that all of these manifestations of the disease are symptoms, they are not the disease.

So what causes an Anorexic personality? Usually we can trace it back to the Anorexic's childhood which specifically and generally is not happy. The Anorexic often feels unwanted and unloved from an early age. The father is usually absent, if not physically then certainly emotionally, and the mother may be the opposite - she totally swamps the child with emotion, unfortunately it is usually conditional and manipulative. She likes the sense that the child is dependent on her and that she has total control over the child's life. Even when the child is no longer a child but a teenager or even an adult this mother will not readily relinquish control.

The Anorexic therefore tends to be emotionally arrested. They may physically be an adult but emotionally still be a child - and still subject to the manipulations of the mother.

In many case studies the Anorexic has an older sibling who can do no wrong in the parents' eyes, and who may quite often be successful in a career or business.

This may be perceived by the future Anorexic as an impossible ideal to live up to.

Since Anorexics have little or no self-esteem to begin with, and therefore don't have the confidence to stand up for themselves and gain the control they so desperately crave over their lives, they turn to the one thing they can control, their bodily functions. They feel that if they conform to society's ideal of thin and beautiful then somebody will love them and their depression about themselves and their worthlessness will disappear.

Fashion magazines and the fashion industry as a whole has been blamed for causing young girls to become Anorexic (Kurtz and Prestera 1985). This is simplistic at least and largely is not true. Magazines present what society's ideal of beauty is perceived to be and the Anorexic personality seizes on that image and tries to confirm to it in a bid to be loved.

It has been claimed that if magazines showed models with two heads then Anorexics would forget about starving and try to grow another head (Levinson 1995). In other words it is the attempt to conform to an ideal that is the problem.

There are many professions and sports where Anorexia develops as a result of that activity, for example in gymnastics. Here the coach and Federation officials take the place of the overbearing parent and Olympic gold provides the impossible ideal.

Anorexia is not however totally confined to teenage girls. Ballet dancers, jockeys and models all fall into this last category. However the majority of these Anorexics revert to normal eating patterns after they leave the sport / profession. The few who have had an Anorexic personality since childhood may not recover and so will continue with Nervosa or Bulimic symptoms for years after they've discontinued the activity, or until they die from the disease.

Because Anorexics don't consider their behaviour to be abnormal, and because the symptoms of Anorexia manifest so gradually, it can take up to ten years for full-blown symptoms to be noticed by relatives or friends.

However with all the publicity about Anorexia in recent years and the advertising of symptoms, this period may become much shorter as the potential sufferer is virtually given instructions on how to be an Anorexic.

Unfortunately, the first person an Anorexic is usually taken to see is a medical practitioner. The medical profession's usual treatment for full-blowm Anorexia is hospitalisation and forced feeding. This is totally barbaric. To force feed an Anorexic is to take away the only degree of control that they perceive themselves to have and which they've worked years to achieve. It's little wonder that it doesn't work.

Of course forced feeding may have an effect in the short term because a lot of Anorexics work out that if they put on a little weight they'll be let out of hospital and then they can go straight back to starving (Hsu 1980 ).

Getting an Anorexic to put on a few pounds and then releasing them as cured is as silly as a doctor putting make-up on a melanoma and saying "Oh look, you can't see it anymore - so it must be cured". Meanwhile the real action is going on under the surface and quietly killing the person.
 
Prophylaxis and Treatment
The first and most important thing that needs to be done when treating an Anorexic patient is to separate them from the family for at least six months. This will not be easy, especially if the patient is a teenager and still at school.

There may be relatives or friends who can fill this need but you must make sure that they are suitable, i.e. not the same personality make-up as the parents. If the patient is an adult already living away from home it is a little easier.

During this six month period they are to have no contact with the family at all, no phone calls, no letters, nothing. In order to achieve this you will have to call the family in and tell them very bluntly that they are not to contact your patient in any way. Do not expect this to be pleasant. The father will probably stare at the ceiling or floor (being incapable of expressing emotion), the mother will burst into tears and the older siblings will probably become argumentative and aggressive.

Your response to this behaviour should be very blunt. You must tell them that, "This is your daughter's life we are talking about, lf you don't do this you will kill her!"

After all an Anorexia sufferer is trying to commit suicide. It's a very slow method but suicide nonetheless.

The reason for this 6 month break is for the Anorexic to gain some control over the rest of her life, so that she can make her own decisions. Since she is emotionally arrested her emotional age is much younger than her biological age.

By taking away the safety net of the mother who has always made her decisions for her, and allowing no contact, the Anorexic starts to find that she is quite capable of making her own decisions. This gives her confidence and a sense of independence i.e. control.

The rest of the therapy should involve both Psychophysical Healing and Hypnotherapy. The Psychophysical Healing is necessary to remove the emotional blocks and traumas from childhood, and there will be many of these. Be gentle with physical touch - the skin integrity will become more compromised as the patient starves to death.

During the Hypnosis sessions you will need to address firstly the patient's safety and physiological needs, a sense of privacy is also important and is the precursor of self-reliance. In order to establish this in the patient both imagination and regression to times when she felt strong about standing on her own feet will help to reinforce the idea that it is possible to be independent. In practice she may not have any memories of independence, so use of imaginative techniques designed to create such a feeling and then implantation of it in the past are valuable.

Then work on her sense of belonging, in other words, give her a feeling of being in the world and a sense of it being O.K. to take up space in this world.

Interaction with non-threatening people is important. Joining clubs or groups who share a common interest with the patient are a useful stepping stone - sporting clubs, gardening, painting, dancing groups etc - not an Anorexia support group which will tend to reinforce the problem. This will also serve to reduce the sense of isolation felt by most Anorexics whilst at the same time offering an opportunity to develop social skills which are usually missing for lack of opportunity and practice.

And finally building up the self-esteem. Only when these preliminary steps have been taken is there a solid foundation on which to build a long lasting belief in the patient's self-worth. At this stage in addition to the development of self-hypnosis skills the patient should be given homework which is challenging and of a kind that gives feedback about her ability to operate well in the world e.g. undertaking a study course in a subject she is interested in.

These general principles will of course have to be tailored to the individual patient so detailed scripts are not possible - the same suggestions would not work for everybody. So weave imagination of both yourself and your patient around this framework - use it as a guide to keep your goal in sight, lf at any stage of this process you choose to concentrate on the weight of the patient or her eating habits you will lose her. She doesn't have an eating disorder and will react negatively to any suggestion that implies that you think that she does.

The prognosis for patients treated as described here is positive and they can be expected to not only not die but to live a happy, productive and largely healthy lifetime.


  © Copyright Sivan McGarry 1995. All Rights Reserved.                                                                                                 

  References

1. Bemis, K. M. "Current approaches to the etiology and treatment of Anorexia nervosa". Psychological Bulletin, 85, pp593-671, 1988.
2.Crisp, A. H.  "The possible significance of some behavioural correlates of weight and carbohydrate intake." Journal of Psychosomatic Research, 11, pp117-131, 1990.  
3.Crisp, A. H., Palper, R.L, & Klucy, P.S. "How common is Anorexia nervosa? A prevalence study." British Journal of Psychiatry, 128, pp529-554, 1976.  
4.Davidson, Gerald C. & Neale, John N. "Abnormal Psychology - An Experimental Approach 3rd Edition- John Wiley & Sons, New York, 1982.  
5. Hsu, I.K.G "Outcomes of Anorexia nervosa." Archives of General Psychiatry, 37, pp 1041-1046, 1980.
6. Kurtz, Ron & Prestera, Hector. "The Body Reveals" Harper & Row, New York, 1985.
7. Levinson, D Myra, "7.30 Report". ABC Television, 22 June 1995.  
8.Monte, Christopher, "Beneath the Mask", Holt, Rhinehard & Winston, New York, 1990.  
9. Thomas, Brett, “Legal Child Abuse.” Sydney Sun-Herald, July 16, 1995.
10. Vogue “Cracking Up”, Health Report,  September1995.