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Dear Kellen,

Thank you for this accurate description one of the many physical dangers created by anorexia.
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You conclude by saying, "Until one is able to regain a safe body image and reintroduce nutrients the body has been deprived, the body will not be able to rebuild itself, keeping it strong, healthy, and nourished."
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This is the terrible "catch 22" of eating disorders. Taking in high quality nourishment in a timely fashion and in amounts appropriate to body needs is basic to restoring and maintaining health. But the person with anorexia cannot eat. The lack of nourishment affects not only her weakening body but also the ability of her brain cells to function normally. Her perceptions are distorted. Her thinking, impaired by lack of nourishment, is based on distortions. Her conclusions are not reality based, but she believes her conclusions are obvious and make sense.
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So out of the thin boney mouth of an emaciated person in the hospital on feeding tubes we hear the words, "Yes, I know I'm dying. Yes, I know I have to eat. But those doctors want to make me fat. If I eat I'll get fat. Please help me."
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I've had patients who run for hours on treadmills in desperation, truly running as if wolves were at their heels. They will run on broken bones, twisted ankles, and dislocated knees. Anyone who suggests that they pause for a few weeks to give their bodies a chance to heal are met with, "Oh no. I'll get fat if I don't run."
or, "You just want me to get fat."
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Providing nourishment is essential to people suffering from anorexia to help establish healthy brain cells so they can think more clearly and cooperate with their own recovery process. But they resist eating.
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Giving people information about the physical consequences of their behavior can help inhibit risky or dangerous behavior IF they are clear headed enough to understand the validity of the information. If their brains are starved they will discount the information or not hear it at all or be certain it doesn't relate to them (It can't happen here or to me syndrome). Or they will believe that the information is not true and that the message is part of a ploy being used by someone who wants them to get fat.
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How to intervene effectively in this tenacious pattern is the challenge of parents, siblings, spouses, children and all in the mental health professions who sincerely want to help the anorexic person be well. It seems so simple. Stop starving and running. Eat and be kind and appropriate to your body.
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But I think most of us touched by this disorder in some way know that the simple path to health - appropriate food and appropriate exercise - is far beyond the grasp of an anorexic person. In fact, if she does move in this healthy direction it is evidence that she has done considerable healing and is well on her path to recovery.
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Getting on that path is the challenge. Creating as many open gates, doorways, tunnels, flight decks, crawl holes that might give an anorexic person a glimpse of her way to her recovery path is what we in the field of eating disorder recovery do as much and as well as we possibly can.
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The anorexic woman needs to feel a "wolf free" environment so she doesn't need to run as if the pack were on her heels. She needs to feel safe and loved in a trustworthy environment so can take one bite more of nourishment, swallow it and allow herself to digest and use the nutrients.
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How we accomplish creating that environment for her is the great challenge that must be met for anorexia recovery to take hold.
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Thank you for you article, Kellen.
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warm regards,
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Joanna Poppink, MFT, psychotherapist specializing in eating disorder recovery
http://www.eatingdisorderrecovery.com

December 10, 2009 - 1:35pm

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