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Sunday, May 19, 2024

Redefining Anorexia

Every time I got into an Ivy League school, I allowed myself an apple.

Plus 90 calories.
* * *
The beautiful Kate Upton, airbrushed to perfection on the cover of Vogue, never bothered me. Nor did the ubiquitous tabloid articles about how thin Mary Kate Olson was getting. I never stared naked at my imperfections in the mirror or griped to myself about being “fat” or “ugly”—at least, no more than any other teenage girl did.
Yet there I sat on my living room couch in early 2012, feeling an overwhelming sense of accomplishment that I had made it to 7 p.m. without even the slightest desire to eat. I had attained complete control over my body, even its most basic instincts. In triumph, I grabbed my sneakers and headed out to the Y for my daily hour-and-a-half workout on the elliptical (which, according to an extensive spreadsheet I had created, burned slightly more calories than the treadmill).

Minus 1,000 calories.

As I headed home, I was still enthused by my extraordinary lack of hunger throughout the day. My pride was compounded by watching the other Y members start and finish their workouts while I was still going strong. I indulged in my usual post-workout meal, my only food for the day: Lean Cuisine herb roasted chicken, the lowest-calorie of any of the frozen dinners sold at my local grocery store.
I ate not because I was hungry, but because it was routine. And I, if anyone, had the discipline to stick to a routine.
Plus 180 calories. 

And then to the scale, the only way to objectively measure my self-control. I weighed myself compulsively, about fifteen times each day. On my worst days, I weighed myself before and after I peed, hoping the loss of liquid would bring down the number on the scale by a tenth of a pound.
This daily routine of massive calorie deficits and incessant weigh-ins continued ad nauseam for six months, with almost no deviation. I was addicted to the control. I was addicted to the pride.
* * *
My story may read like a classic case of anorexia (it still feels weird to use that word to describe myself), but it felt like anything but that. How, in the age of the Dove “Real Beauty” campaign and Jezebel repeatedly defending Lena Dunham’s nudity on Girls, with such a strong movement against eating disorders and toward female bodily empowerment, could I have slipped through the cracks so badly—without even identifying myself as a victim?
The problem for me was that these movements made eating disorders almost synonymous with poor body image. The image of a thin young girl looking into a floor-length mirror with a fatter version of herself staring back simply bore no resemblance to my experience. I had a fairly normal body image, so I never thought my tendencies qualified.
I was driven to these extremes not by body image but by a desire to exhibit ultimate control and discipline over myself—a desire to be the best.
In my senior spring, with college application season behind me and the drive to achieve on my high school coursework a distant memory, I refocused my Type A obsessiveness on food. I had already gotten what everyone else desired academically: a perfect SAT score and a ticket to Harvard. Why couldn’t I do the same with diet and exercise?

I never considered what I was doing to be a problem, much less a disease; everyone else wished they had the discipline to exercise and to resist food to the extent that I did. It wasn’t until a full year after I returned to normalcy that I even realized I had been anorexic.
* * *
High school graduation came and went, and a summer of world travel ensued. Amidst all the new sights and sounds of the Eastern Hemisphere, I was overwhelmed by the opportunities. I focused diligently on mapping out public transportation, scheduling sightseeing, picking up the language—working to make the most of my limited time abroad. Just as I had transitioned from obsessing about schoolwork to obsessing about food six months earlier, my Type A gradually shifted focus from food to my travel.
The habits began to fade away. I didn’t even notice that I had stopped.
Twelve months later, I was still without relapse. My freshman year provided more than enough moving pieces to control, so denying myself food was, like over the previous summer, unnecessary. It was only during the summer after my freshman year that I even realized I had ever had a problem.
I picked up a copy of Unbearable Lightness, a memoir by Portia de Rossi, for no other reason than that Portia was one half of each of my two favorite celebrity couples (Lindsay and Tobias Fünke in Arrested Development, and Ellen DeGeneres and Portia in real life). The book details her struggles with closeted homosexuality and anorexia, the latter brought on by a combination of body image issues, the need to control, and a desire to excel.
As I read and re-read the book, I gradually began to recognize Portia’s thoughts as my thoughts, her tendencies as my own. Near the end of my third or fourth read-through, it hit me: Oh shit. What had I done? This whole time, I had been striving to be the best, yet “achievement” and “disease” are not exactly synonyms.
Once I had recognized this diagnosis, I knew that controlling my eating habits could no longer fulfill my need to be disciplined and high-achieving. One does not exercise discipline in hopes of becoming diseased, nor mark that diagnosis as an accomplishment. One does not garner pride from a practice that sends people to therapy, or worse. And without the fulfillment of those needs, my self-destructive habits were worthless to me.
With this realization, I knew I could never go back.
* * *
Had anorexia been portrayed as an issue of control and achievement, in addition to one of body image, I might have recognized my disorder earlier. Perhaps my family or friends would have recognized it. Had someone recognized my disorder, it might not have lasted as long as it did and might have done less harm to my body and my mental health.
We as a society need to expand our recognition of eating disorders. It is not always a young teenage girl who wrongly thinks she’s too fat. It can be a wrestler trying to make weight, a military brat looking for a sense of control as he keeps moving around the country, or a student plagued with depression, anxiety, or a desire for self-harm. Or, in my case, it can be a highly-disciplined high school senior who needed a new domain to fulfill her obsessive desire to achieve.
It is not the cause that defines the disease, but the disease itself. All of these people can experience the hours lying awake in bed counting the day’s calories, the detachment from family and friends out of necessity to hide the new habits, shrugging off the “you look so good!” comments because they know it’s not good enough. Only when the movement against eating disorders portrays all causes of the disease as legitimate will these other victims and their loved ones begin to recognize their disorders and get help.
As with many of society’s ills, education is the key to achieving this progress. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the widely-recognized authority on mental illness diagnostic criteria, does not require poor body image in order to diagnose anorexia. Rather, a diagnosis of anorexia is based on “restriction of energy intake,” “persistent behavior that interferes with weight gain,” and “lack of recognition of the seriousness of the current low body weight.”
Although the DSM-5 does make allusions to body image—for instance, offering “disturbance in the way one’s body shape or weight is experienced” as an alternative to the third criterion—it is not portrayed as a requirement for the diagnosis, as our school curricula would have us believe. Every health class I ever took featured the stereotypical image of the thin girl staring into the mirror as the face of anorexia—portraying her body image issues as the disease itself, not even as a cause thereof. And there was barely a word spoken about any other possible circumstances: “Well, boys can get it too … I guess.” So, why are we filling our textbooks—and our children’s minds—with the idea that body image is inseparably tied to eating disorders, given that the leading psychiatric authority doesn’t even think that is the case?
We must shift our message; rather than teaching children that distorted body image is anorexia, we must teach them the causes are as numerous and diverse as the victims, and that distorted body image is just one of those causes. Once our children begin to recognize this, the body empowerment movement will adapt. Eventually, other victims will be recognized, and the healing process can begin.
* * *
I still find myself checking the clock each day when I get my first pang of hunger. I still occasionally skip a meal and bask in the glory of what my peers didn’t have the self-control to do. I still think about how easy it would be to go back, to regain control when the papers, problem sets, and exams make me feel like I’m losing it.
And yet, I don’t.
The recognition of my disorder has allowed me to overcome it, at least so far. And it is my hope that greater recognition of all causes of the disease—both those that are driven by body image and those that are not—allows all afflicted by it to recognize their disease and begin their recovery.
“Shame weighs a lot more than flesh and bone.” —Portia de Rossi 
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