The medical implications of being paper-thin

Understanding anorexia

TERRY WUERZ VOLUNTEER STAFF

Medically speaking, I know the condition known as anorexia nervosa perfectly well. In the psychiatric textbooks such as the DSM-IV, it is described as an eating disorder, the diagnostic criteria of which I am able to list by rote. These are: refusal to maintain a normal body weight, an intense fear of gaining weight, disturbance in selfperception of body weight, and in women, the absence of at least three menstrual periods. I understand, too, the hard statistics of the disease. Much more common in Western, developed countries, more than 90 per cent of those who suffer from anorexia are female, often adolescent. The treatment of anorexia is also wellestablished in the medical literature: immediate weight gain is indicated, often requiring hospitalization and close monitoring of the re-feeding process.

As with many things I learned in medical school, anorexia can be neatly broken down into a package of epidemiology, diagnosis, complications, and treatment. Realizing what the patients I was seeing in the hospital were going through, and why, took a deeper understanding of myself and my own concept of body image.

In the summer of 2004, I spent several languishing months soaking Brazilian sun and culture into my bleached Canadian bones. What struck me most about Brazilians, or more specifically, the women of Brazil, was not their fabled beauty, although they certainly were not scanty in that department. Exotic and exuberant, their most memorable quality remains the seeming lack of regard for what in North America might be politely termed modesty.

From a country famous on beach circuits for their small swimwear and body wax, perhaps this comes as less than a surprise. Contrast this with the well-known fact that Brazilians boast the world’s highest plastic surgery rate, and it becomes somewhat baffling. Nevertheless, it became clear that I am much more conservative than I had thought when it comes to public apparel. It was strange to see a 300- pound woman wearing little more than a string bikini, or a man in his late 70s donning an unthinkably small swimsuit. Although at first shamefully repulsed by this unabashed display of unattractive flesh, I later came to deeply admire the shameless bravado of the Brazilians, and to rethink my comparatively prudish misgivings.

At the beach, I am irrevocably fixed on body image — perhaps this is why I have never found a day of sunbathing and sand castles nearly as relaxing as the airport adverts claim. The horror is evident upon setting foot on

The fixation on body weight is thought to be an outward expression of low selfesteem, stemming from a societal obsession with being paper-thin.

the sand: thongs, bronzed skin, and Speedos all give me a hyper-acute sense of selfconsciousness, and, if I am honest, inadequacy. Defeated, I am struck with a desire to immediately embark on a selfredeeming mission to punish my biceps and abs into some semblance of beach-worthiness.

Thankfully, this sentiment does not last longer than the time it takes for someone to suggest a game of Frisbee, or a quick dip in the water. Yet, for those with anorexia, who have the misfortune of having developed a stronger sense of inadequacy in their own body, these feelings do not go away. For some reason, the perception that their body is unattractive becomes so deep-rooted as to penetrate their reality.

In contrast with the other wellknown eating disorder, bulimia nervosa, most anorexics were never overweight. The fixation on body weight is thought to be an outward expression of low self-esteem, stemming from a societal obsession with being paperthin. As exhibited by the vast majority of women seen on popular magazines and fashion runways, this theory is supported by the observation that cultures in which chunky is beautiful, such as the natives of Hawaii, tend to have extremely low rates of anorexia nervosa. Some studies have shown qualities that overlap with another psychiatric disorder, obsessive-compulsive disorder. In particular, anorexics tend to have a well-developed sense of control over their environment, in this case their own body.

Current psychiatric opinion is that anorexia nervosa is essentially the manifestation of a defence mechanism for the emotional and physical stresses anorexics have not learned to deal with in a healthy or constructive manner; in lay terms, it is a cry for help. As a result, anorexics will deprive themselves of almost any nutrition, occasionally induce vomiting for what little they have eaten, exercise to point of exhaustion, and abuse laxatives — anything to help take off the calories. This leaves sufferers emaciated, lethargic, constipated, and with severely depressed immune systems. A fine layer of downy-soft hair, called lanugo, develops — an attempt to insulate the body in the absence of body fat. In the end, the body essentially devours itself to provide the energy to go on living.

A friend of mine, also in medical school, heard many of her patients describe their fixation on weight loss as a desire to “disappear.” It is this image, something we have all felt from time to time, that best describes and helps me understand the experience of having anorexia nervosa. Perhaps the next time I meet someone with the illness, I just might have something to offer beyond medical care.

Terry Wuerz is a fourth-year medical student at the University of Manitoba.