Frances F. Conte
Classic anorexia nervosa (self-starvers) occurs most frequently in adolescent girls between 10-15. Self-starving and episodes of bingeing is most frequent among girls ages 15-18, while binge/purgers make up an older group between 19-30.
What are the forces occurring during adolescence that propel a young girl into this love/hate relationship with food?
Girls are more apt to diet because of the cultural pressure that give the message: THIN IS BEAUTIFUL! At a time when a young girl’s body shape is changing and growing, particularly in the breasts, hips and thighs, a young girl’s perception of her body image becomes unstable or confused. For young girls with an early onset of anorexia nervosa it has been found that menstruation had been a traumatic experience for them, having been ill prepared for the changes they would experience. Fears and conflicts about sexuality and impending sexual confrontation are powerful triggers often resulting in extreme anxiety and social withdrawal. Decision making and accepting criticism, particularly from family members and peers are particularly distressful. Comments about being chubby, or plump can have dire consequences for the potential anorectics who already have a conceptualized distortion of their body, believing that they look much heavier than they actually are, or at best—are ordinary. This distortion in attitudes about oneself may contribute to the self-loathing and poor self esteem that weight gain in later years produces.
The cultural message to be thin is communicated to children from many sources—television, motion pictures, magazines, books, family, friends and teachers. This value of the perfect body then becomes introjected. However, the other message that children receive from the media and advertising is that food tastes great—any time, any place! Food is a part of family life, recreation, socializing, watching television, snacking alone, between meals, in the movies, in school. Desserts are tempting! Fast food chains are convenient! These mixed messages have an enormously conflicting effect on susceptible children. Juxtaposed to these advertisements exalting the joy of eating are those reinforcing the terror of being fat! Diet soft drinks, lite beers, appetite suppressants, exercise and fitness commercials are all cultural persuasions to achieve thinness. The message seems to say that being thin and extraordinary looking will solve all of life’s problems, bring success, transformation and an end to suffering. Unhappily, dieting and the pursuit of thinness will become the focus of the adolescent’s life, distracting her from pain, loneliness and insecurity and providing her with a sense of meaning and purpose.
In almost 50 percent of anorectics some traumatic event precipitated the onset of the disorder. Among those that have been reported to trigger anorexia in a predisposed adolescent are: death of a loved one, divorce, illness of a parent or family member, or romantic rejection which the adolescent believes was the result of being overweight.
It is difficult to account for the increase in eating disorders in Western societies, but some suggestions have been offered:
1. The greater availability of improved nutrition in the more affluent countries of the world, which makes food easily accessible and not something a family works for directly.
2. The incidence of early onset of menstruation in Western societies which abruptly terminates childhood and hastens the adolescent to premature adulthood.
3. The increase in parental demands for social and academic accomplishment in their children.
4. The limbo of adolescence which makes developmental issues of disengagement from parental control and individuation more difficult to negotiate.
5. Increased insecurity and lack of trust in social and cultural institutions such as schools and government.
6. Lack of intimacy and close interpersonal relationships which are often shallow and open to exploitation.
7. Love of self (narcissism) and preoccupation with instant gratification, and distrust of the future.
It might be useful to present a perspective on the emotional conflicts experienced by an individual who may become a disordered eating victim. Listed below are several underlying principles:
1. The (pre) anorectic is compliant, approval seeking and cooperative as a child. She may actually assume the role of assisting or supporting the family emotionally. She may become a high achiever, a pleaser of others, thus raising family morale. At the same time she may lack trust and self assurance.
2. She may seek an externally perfect image to cover up her inward feelings of insecurity, inadequacy and fear of rejection.
3. She may outwardly avoid and control sexual contact and enjoyment while inwardly fearing that others will discover her sexual fantasies.
4. She may have difficulty expressing anger and hold her feelings in. She may feel manipulated and exploited and retaliates by reclaiming her life through self starvation which is her way of gaining power over others.
5. While her behavior may appear supportive, her anger at being cast in the role of nurturer emerges as she gains power through rejection of food, thus becoming a challenge to her family, and/or punishing them.
6. She must work frantically to be perfect in everything she does. In fact, she becomes at once a demanding and rejecting parent to herself.
“These factors and others blur the boundaries of the self, make people feel vulnerable to passivity, loss of control and liable to intrusion, invasion, and control by vague, outside forces. Anorectics dread obliteration by the outside world—a fear represented by food.”
(From: John Sours,
Starving to Death in a Sea of Objects