Starving for control:inside the world of anorexia nervosa

The frail, emaciated 11 year old Victoria* enters her daily battlefield — her family’s dining room —  and takes a seat at the table. She stares with both fear and disgust at the hearty plate of food in front of her. Anger boils inside her and tears fill her eyes. Her stomach growls painfully in hunger, but her mind convinces herself otherwise. She frantically tallies her day’s caloric intake in her head, trying to remember every crumb…every sip…every spoonful that she has placed inside her body.

Her parents, sitting across the table from her, watch anxiously. She glares back with fury. “Stop staring at me!” she shouts at them inside her head. They don’t hear her. “I HATE you. Leave me ALONE!” All of a sudden, she loses all interest in eating, and pushes her plate defiantly away. She sits, feeling a little bit stronger and empowered while she watches the rest of her family indulge themselves. She smirks to herself. And just in that moment, Victoria feels on top of the world.

It is difficult to understand why a person, especially a child, would willingly starve themselves to the point of jeopardizing  their life. Despite the overwhelming coverage of anorexia nervosa in the media, a disease synonymous with the pursuit of thinness, this eating disorder is still very much a misunderstood psychiatric illness. Dismissed as simply being an extreme form of extreme vanity, many fail to recognize its detrimental psychological causes and effects.

According to Mandy Lee, a social worker who has worked 8 years at the Hong Kong Eating Disorders Association (HEDA), many in Hong Kong are still very much ignorant about the intricacies of anorexia nervosa. The Hong Kong government has yet to develop a specialized plan for the treatment of anorexia nervosa. Thus, there are no official statistics on the number of individuals who suffering from it.

Anorexia nervosa has dramatically increased within the past 10 years in Hong Kong,” says Lee, “I definitely think Hong Kong’s cultural obsession with thinness has contributed to this rise.”

The Hong Kong Eating Disorder Association was established in October 1999, by a group of patients and their family members. The charitable organization has a professional advisory team of psychiatrists, family doctors, psychologists, social workers and dietitians to assist the anorexic sufferer in their recovery process.

The concept of anorexia was first sprung into the consciousness of Hong Kong people in 1994, when a skeletal 14 year old girl collapsed and died in a busy street in Hong Kong. In trying to identify and understand the cause of her death, Chinese reporters searched into Western medical records to explain her mysterious death. The notion of anorexia nervosa in Hong Kong was thus born.

‘A cry for help’ or ‘extreme self-punishment’, these are just some of the expressions that reveal the true nature of self-induced starvation, says Philippa Yu, a clinical psychologist who has practiced 7 years at HEDA. Food becomes a tool with which anorexics voice out their inner feelings… feelings of worthlessness and self- hatred. Denying their bodies nourishment becomes a coping mechanism to deal with stress and anxiety in their lives.

In the case of anorexia nervosa in children and adolescents, starving themselves may be a means to gain the attention and affection of their parents. In the grips of entering puberty, a child might feel ashamed and embarrassed about their physical and physiological changes, and resort to extreme dieting measures in hopes of regaining a pre-pubescent body. Self-induced starvation may also be a means for the child to fight back and gain control of their parents during a time in life where they are trying to establish their own identities and break free from parental control.

How extreme dieting plunges into a full-fledged eating disorder, however, lies in the distortion of reality in the mind. Anorexia develops when the stark deprivation of nutrients from a long period of starvation causes the brain to perceive things in a distorted manner. Instead of seeing skin and bones, the anorexic sees an overweight person in the mirror.

The sight of an anorexic sufferer, especially that of a child, is no laughing matter.

“As a psychologist, I really struggle every time I meet with a patient. It’s never easy. But I have to suppress my feelings, or else the anorexic patient may never come back in for treatment,” Yu says.

It is interesting to note that those who suffer from anorexia nervosa share similar personality traits. Many are high achieving and creative individuals, with a sense of idealism beyond the comprehension of the average person, a characteristic which makes Yu enjoy conversations with her anorexic patients. Their sensitive nature makes them highly emotional beings, experiencing emotions at a very deep, intense level, a trait which makes them prone to experiencing extreme discomfort when their external world is dramatically altered, says Yu.

Feeling a sense of hopelessness and loss of control over their lives, they resort to the only thing they believe is within their power of control — what they put inside their bodies.

“Anorexia is all about control,” states Yu. “People don’t really know that. It is also about avoidance…a lot of anorexics use their illness as a means to escape realities of life. Some of my patients deliberately remain at a dangerously low weight just so they can stay inside their hospital bed.”

Contrary to popular belief, anorexic sufferers cannot be cured by simply eating again. The recovery process may take years to undergo.

“As of date, there is very little evidence based treatment for anorexia nervosa, because it is such a multifactorial disease. There is no Golden Rule on how to cure an anorexic.” says Yu. “Therapy is like peeling an onion. You have to peel through all the layers to get to the root cause of the disease.”

Patience, understanding and sincerity on the part of the psychologist are extremely important during the anorexic’s recovery process.

So what does it truly mean to be ‘recovered’ from anorexia nervosa? According to social worker Lee, the key lies in how you learn to cope with life issues.

“It is very easy for an anorexic patient to develop bulimia later on in life if they haven’t learnt how to deal with problems in a constructive manner. It’s only when you change your mindset, then you can change your behavior,” says Lee.

Aside from providing psychotherapy, The Hong Kong Eating Disorder Association hosts various forms of group therapy and support group sessions for both patients and families of anorexia and bulimia nervosa. These sessions aim to aid patients in building up self-esteem and confidence, as well as to educate parents and loved ones on how to assist the sufferer in their recovery process.

Anorexia nervosa is curable. Previous sufferers of the disease have gone on to lead happy, meaningful and productive lives.

Today, Victoria* is a confident, healthy, 23 year old student studying at the University of Hong Kong. She is pursuing her dreams of becoming a writer and a mentor for young girls. She hopes to use her story as an inspiration for those currently struggling with anorexia, making a difference in the world one small step at a time.

*Names have been changed

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