Let’s actually take a look at this. I’ve been talking about my experiences over the last 10 days, but haven’t actually gotten down and dirty with the reality of what exactly Anorexia Nervosa is. So, knowledge is power, what exactly is Anorexia Nervosa?
Anorexia is a mental illness, generally characterised by excessive efforts to lose weight, through restriction of food, over-exercising, purging meals, taking excessive amounts of laxatives or a combination of the above, with restriction being the primary method employed to control lose weight, often to the point of starvation.
The DSM recognises two subtypes;
· Binge-eating/purging type: the individual utilizes binge eating or displays purging behavior as a means for losing weight. It is different from bulimia nervosa in terms of the individual's weight. An individual with binge-eating/purging type anorexia does not maintain a healthy or normal weight but is significantly underweight. People with bulimia nervosa on the other hand can sometimes be overweight
· Restricting type: the individual uses restricting food intake, fasting, diet pills, or exercise as a means for losing weight; they may exercise excessively to keep off weight or prevent weight gain, and some individuals eat only enough to stay alive.
The DSM-5 uses Body mass index (BMI) as an indicator of the level of severity of anorexia nervosa. The DSM-5 states these as follows;
· Mild: BMI of greater than 17
· Moderate: BMI of 16–16.99
· Severe: BMI of 15–15.99
· Extreme: BMI of less than 15
I’m not going to give the number, but what on my admission my BMI was a number below 15. I still didn’t think my diagnosis was “extreme” and my BMI is still below that number and I can’t quiet see what’s so “extreme” about it. That of course in itself is a symptom of the disorder. No matter how think an Anorexic becomes, he or she cannot see what the rest of the world is seeing. Even though they are experiencing extreme fatigue, dizziness, hunger (though they probably don’t recognise the sensation), joint-pain, hyper-vigilance, anxiety, headaches, even an absence of periods in women; still they do not think anything is really that wrong. Things are maybe a little wrong, but it’s nothing you can’t handle. Because you’re different to other people, you don’t have the needs other people have. You can live of an apple, a low-fat yoghurt and a banana a day because that’s all you need, because you’re not like everyone else, they need three meals a day and some snacks, and that’s ok, but you’re just not like them.
Complications associated with Anorexia can include;
· A comorbid (also occurring or present) mental illness or illnesses such as Obsessive Compulsive Disorder, Anxiety, Depression, Alcoholism or other addiction, Personality Disorders, Attention-Deficicit Hyper-Activity Disorder, Body Dysmorphic Disorder and Orthorexia (Compulsive Exercise Disorder)
· Gastrointestinal diseases such as Irritable Bowel Syndrome and Inflammatory Bowel Disease. Further issues include poor gut motility, recurrent heartburn and indigestion, chronic constipation, flatulence and incontinence.
· Low or fluctuating levels of electrolytes such as potassium, chlorine and sodium, which are critical in maintaining effective heart activity. Complications with the heart can include arrhythmias, abnormally slow heartbeat, low blood pressure, decreased size of the heart muscle, reduced heart volume, mitral valve prolapse, myocardial fibrosis, and pericardial effusion. (I don’t even know what those last three are…)
· Either an under-active or over-active thyroid gland.
· Osteopenia and Osteoporosis
· Seizures and tremors
· Constant pain in bones due to insufficient body fat, resulting in a frequent need to move around.
· Increased chance of developing arthritis and other bone-related diseases in later life.
Relapse occurs in a third of people who receive treatment for the disorder, and is greatest in the first six to eighteen months after a release from inpatient treatment. Clodagh strikes again! Not only am I one of those 1 in 3, I was also in recovery for two and a half years before my relapse hit me. It snuck up on me; anorexia is like the Ninja of mental illnesses. I didn’t realise I was back under its’ thumb until I was actually suffering severely from many of its’ symptoms; extreme fatigue, dizziness, weakness, unsteadiness on my feet, headaches and joint-pain, mostly. But I still, I would have described myself as “moderately” unwell. Your own brain works against you, once you are past a certain point of weight loss, your sense of perspective becomes totally skewed. It’s like it isn’t even your voice coming out of your mouth anymore, the anorexia is speaking through you, assuring onlookers that you are fine, convincing yourself of it in the process.
The term anorexia nervosa was coined in 1873 by Sir William Gull, one of Queen Victoria's personal physicians.
The earliest medical descriptions of anorexic illnesses are generally credited to English physician Richard Morton in 1689. Case descriptions fitting anorexic illnesses continued throughout the 17th, 18th and 19th centuries.
In the late 19th century anorexia nervosa became widely accepted by the medical profession as a recognized condition. In 1873, Sir William Gull, one of Queen Victoria's personal physicians, published a seminal paper which coined the term anorexia nervosa and provided a number of detailed case descriptions and treatments. In the same year, French physician Ernest-Charles Lasègue similarly published details of a number of cases in a paper called De l'Anorexie hystérique.
A major, though tragic, event was the death of Karen Carpenter in 1983, which was the first event that prompted widespread ongoing media coverage of eating disorders as legitimate illnesses with potentially life-threatening consequences.
Out of all mental illnesses, anorexia nervosa holds the number one spot in when it comes to mortality rates. Only about 50% of those who receive treatment actually recover, while the remaining 50% will continue to exhibit sufficient anorexic behaviour to result in damage to major organs, which could lead to a tragic and untimely death. Those with AN are 56% more likely to commit suicide than those without. The average number of years from onset to remission of AN is seven for women and three for men. It’s a disease that takes over your life, it’s insidious in every facet of your day because everything you see and do is through the filter of anorexia. It isn’t a simple case of reaching a healthy BMI, it’s learning to rewire your brain, to learn from scratch what it’s like to feel the sensation of hunger and know that your body needs fuel and to feel the sensation of satiation or fullness and recognise that you are full, your body has enough for now.
***Now, at the beginning of my second week as an inpatient I am beginning to feel more comfortable on my Amber Meal Plan- a lot of the side effects of the increased food intake are beginning to ease. The overwhelming sense of fullness is now far more tolerable. I still feel extremely bloated and my belly is sticking out like I’m six months pregnant, but I don’t feel the same anxiety surrounding this as I did in my first admission. I know that this is part of the process. In weight restoration the dispersal of weight is extremely uneven, the majority of it going immediately to your belly in order to protect your vital organs. I know that this will even out over time. Every gram I out on is a little victory, a step closer to “recovery”. I feel confident in myself this time round, I feel ready to take back my control from the anorexia, to be ruled by my own authentic emotions and feelings. Also, importantly, I don’t care if I look 6 months pregnant. I care about the fact that I’m going to be able to sit without my bum hurting and that I’ll be able to sleep without a pillow between my thighs to keep my hips from hurting. I’ll be able to bound up and down stairs again. With time I’ll be able to get back to the gym and get back to squatting and lifting more than my bodyweight, as opposed to struggling to open a heavy fire door. While I haven’t lost too much of my flexibility, my yoga practise has suffered greatly by my lack of physical strength. There are postures that I would have like to have been working on in this time that I simply didn’t have the strength, mentally or physically, to work on. I am so looking forward to the challenge of what the next few months is going to bring in terms of reclaiming ownership of my body. This short term pain and discomfort isn’t comparable to the long-term promise of health- healthy eating, a healthy outlook, a healthy body and a happy, healthy, wholesome life. I can totally face another few weeks of bloating and flatulence for the promise of something better.
So here I am, Day 1 of Week 2, very full, of food but also hope and anticipation. A little bit of reluctance and worry too, but I know that that is normal and I am at peace with it.
As always, ask me anything, if I can help you in any way I will. Thank you to all my amazing Yogilateral Warriors that have sent me so many messages of support and encouragement! You are all so beautiful and so amazing, you keep me going every day!
So, technological magician that I am, I managed to somehow delete my blog. Panic stations!!! So this is being posted today, on my fifth day of week two, as opposed to my first. The only (but uber impressive IMO) thing of note that I really missed out on blogging about was my second official weigh-in, which was yesterday. I have put on 2KGS IN 2 WEEKS! I am so proud of myself. I'm surprised not to be feeling more negative feelings about it, but I honestly feel really good, like I'm really on-track with the plan and with my recovery journey. Feeling very positive heading into the weekend, I'm like an eating disorder ass-kicking ninja warrior queen!
Shoutout to the amazing Jamie Cullinane, (whose name is in the footer of this page and will give you his details if you click on it) for managing to fix the absolute mess I had managed to make of my site!! He is my angel of the week! Thanks, Jim! x