Anorexia Nervosa

The Clinical Picture

Medical Problems

Bulimia Nervosa

Binges

Compensatory Behaviors

Bulimia Nervosa Versus Anorexia Nervosa

Binge-Eating Disorder

What Causes Eating Disorders?

Psychodynamic Factors: Ego Deficiencies

Cognitive Factors

Depression

Biological Factors

Societal Pressures

Family Environment

Multicultural Factors: Racial and Ethnic Differences

Multicultural Factors: Gender Differences

How Are Eating Disorders Treated?

Treatments for Anorexia Nervosa

Treatments for Bulimia Nervosa

Treatments for Binge-eating Disorder

Putting It Together: A Standard for Integrating Perspectives

Shani, age 15: While I was learning to resist the temptation of hunger, I walked into the kitchen when no one was around, took a slice of bread out the packet, toasted it, spread butter on it, took a deep breath and bit. Guilty. I spat it in the trash and tossed the rest of it in and walked away. Seconds later I longed for the toast, walked back to the trash, popped open the lid and sifted around in the debris. I found it and contemplated, for minutes, whether to eat it. I brought it close to my nose and inhaled the smell of melted butter. Guilty. Guilty for trashing it. Guilty for craving it. Guilty for tasting it. I threw it back in the trash and walked away. No is no, I told myself. No is no.

… And no matter how hard I would try to always have The Perfect Day in terms of my food, I would feel the guilt every second of every day. It reeked of shame, seeped with disgust and festered in disgrace. It was my desire to escape the guilt that perpetuated my compulsion to starve.

In time I formulated a more precise list of “can” and “can’t” in my head that dictated what I was allowed or forbidden to consume…. It became my way of life. My manual. My blueprint. But more than that, it gave me false reassurance that my life was under control. I was managing everything because I had this list in front of me telling me what—and what not—to do….

In the beginning, starving was hard work. It was not innate. Day by day I was slowly lured into another world, a world that was as isolating as it was intriguing, and as rewarding as it was challenging….

That summer, despite the fact that I had lost a lot of weight, my mother agreed to let me go to summer camp with my fifteen-year-old peers, after I swore to her that I would eat. I broke that promise as soon as I got there…. At breakfast time when all the teens raced into the dining hall to grab cereal boxes and bread loaves and jelly tins and peanut butter jars, I sat alone cocooned in my fear. I fingered the plastic packet of a loaf of white sliced bread, took out a piece and tore off a corner, like I was marking a page in a book, onto which I dabbed a blob of peanut butter and jelly the size of a Q-tip. That was my breakfast. Every day. For three weeks.

I tried to get to the showers when everyone else was at the beach so nobody would see me. I heard girls behind me whispering, “That’s the girl I told you about that looks so disgusting.” Someone invariably walked in on me showering and covered her mouth with her hand like I was a dead body. I wished I could disappear into the drain like my hair that was falling out in chunks….

While everyone else was out there swimming, tanning, making out, playing sports, volunteering and team building, I hid in my tent and wrote letters to my mother reassuring her that I was eating. I told her that I ate peanut butter and jelly sandwiches every morning for breakfast….

[Upon returning to school] I was labeled the “concentration camp victim.” On my return, over the months everyone watched my body shrink as though it were being vacuum packed in slow motion…. At my lowest weight my hipbones protruded like knuckle bones under my dress and I had to minimize the increments of the belt holes until there was so much extra belt material dangling down that I did away with the belt completely. My shoes were too big for my feet; my ankles were so thin that I wore three pairs of socks at a time and still my shoes would slide off my heels. And my panties were so baggy I secured them with safety pins on the sides so they wouldn’t fall down….

On the home front things were worse than ever. I moved to the downstairs room, which had a separate entrance and bathroom, and I locked my door and forbade anyone from entering. Even so, my mother and I had screaming matches every day, with her trying to convince me that “your body needs food as fuel” and me retaliating with “I’m not hungry.” But the more she tried to appeal to my rational side, the more stubborn I became in my conviction….

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For nine months my mother stood by, forbidden to interfere, while I starved myself. She had no idea what was going on, nor did I. All she knew was that I had changed. She watched me transform from an innocent, soft, kind, loving girl into a reclusive, vicious, aggressive, defiant teenager. She had lost her little girl. And there was nothing she could say or do to stop me. She knew that if my weight continued to drop radically that she might lose me. But despite all her desperate attempts to reach out to me … she had no way of getting through to me, let alone helping me because, like with food, I slowly banned her from my life….

(Raviv, 2010)

In Their Words

“Girls should be encouraged to take an interest in their appearance when they are very young.”

Ladies’ Home Journal, 1940

Are girls and women in Western society destined to struggle with at least some issues of eating and appearance?