In 1978 information
about anorexia nervosa was mainly descriptive. We spoke about the
obsession with weight loss beyond normal low-weight limits, the
biological changes in the starving person's body: thinning scalp hair,
lowered blood pressure, poor circulation, lowered body temperature,
diminished sex drive and capability, loss of menses, osteoporosis, and
other changes which can produce premature aging and death.
Today we know much more about the bio-psychological changes that
describe the mental state, and the deterioration of that state,
resulting from weight loss. These changes deepen the disorder and reduce
the chances of recovery as time goes on.
We understand that anorexia nervosa begins as an attempt, mostly by
girls and women, to gain a sense of achievement through weight loss.
Those who are obsessive by nature, rigid, and have difficulty with
personality issues of trust, dependency, attachment, identity, and
femininity, are at extremely high risk to develop anorexia nervosa. They
are the ones who will become attached to the ideas that losing weight
means adequacy, and maintaining or worse, gaining weight, is
catastrophic. They will lessen their ties to family and friends while
they become drawn more deeply into all the techniques, healthy and very
unhealthy, to lose weight. They will become obsessed with infinite ways
of measuring their weight and the dimensions of their abdomens and
limbs. Their perceptions become distorted - adding pounds and inches to
their bodies. They turn inward away from others until they are very
difficult to connect with emotionally.
This is a treatable illness and over the last thirty years since I
treated my first anorexic patient I have seen 90 percent of them recover
and have a desk drawer filled with pictures of the children of my former
anorexic patients. Some who have also contacted me years after treatment
have requested that I talk them through their first pregnancy. They
state, "I don't have to be skinny any more but the idea of a pregnant
woman's figure is frightening to me." I have seen them through these
pregnancies and enjoyed the phone calls announcing the births of their
babies. There are lots of happy endings possible and I have been
rewarded by this self-reported, long-term follow-up information.
The latest perspectives I have developed can be found in
of Anorexia, (2000, W.W. Norton), as well as my earlier
and Overcoming Anorexia, (1982, Warner paperback), which
is more case-study oriented. The novelized case studies include,
Little Girl in the World, (1978, Warner Books), and Kessa,
(1985, Warner Books), a sequel to the first book.