The physical/psychological affects and consequences of an eating disorder are not well known, or rather, not considered as much as they should be in terms of affecting and impeding the affected person’s ability to process cognitively well enough for psychotherapy to be of any help.
The fact is, a person actively engaging in symptoms of anorexia or bulimia are in a state of starvation. Their body is starved, and just as important, their brain is starved. A person with bulimia may be at a near normal weight, but if the food they ingest isn’t being utilized by their body, it’s just the same as if they weren’t eating at all. If the amount of food ingested is being compensated for in any way, such as purging, exercising, or laxative abuse, the same result will occur. While a person is enveloped in the disease, it is not possible for them to grasp the reality of the harmful affects, short or long term, this can have on their bodies. This may be denial, lack of insight, or the absence of cognitive reasoning…an obvious effect of starvation.
I won't attempt to list or explain the effects that starvation itself can have on the body (please note the sidebar reference to Ancel Keys’ Starvation Study, and those results), or what, if any, are the differences in prognosis based on the length of time that a person has suffered from the disease. I do want to offer my interpretation of the emotional impact of certain physical effects of anorexia, and how they are also involved in the onset of the disease. It is common for a young girl, who is approaching puberty and pre-adolescence, to have fears about reaching womanhood, the obvious physical changes that occur in her body, and how that relates to her sexuality.
The attitude and expectations of society that are placed on a female can be confusing and can raise many questions and emotions that she may not be prepared to handle. If there are abuse issues, past or present, these can also increase those fears. The lack of knowledge, amount of parental involvement, and attitudes about gender roles all can have an affect on the way a young woman perceives her body. The consequences of anorexia; amenorrhea, lack of breast development, and an overall "little girl" or boyish appearance, can ‘protect’ her from the expectations of womanhood or adulthood in general. An anorexic, while trying to control her life and be seemingly independent, actually sets herself up for eventual loss of control and increasing dependence on others to "take care of" her. In some, this can lead to a learned helplessness, which involves manipulation of others around them.
There are many more possible physiological affects of long term starvation, some reversible and some not, that require both physical and psychological healing. As I recall my own experience, one of the most obvious things that I can see now, is how over the years, this disease slowly took it's toll on me. When my eating disorder began, my weight loss, and focusing my life on food and eating was an achievement. It energized me. I made it my life's purpose, and I was successful at it. I can't recall at what point, but in time, my attempt to run a household and raise my two adopted sons became exceedingly more difficult. I pushed myself to prove my strength and worth, both to myself and others, refusing to face reality, hoping I could change it. It took great effort to just get through the day. I could barely climb the stairs to my bedroom. We even at one point, discussed that it might become a necessity to put a chair lift on the stairs, or completely move to a one-story house. I became weaker and weaker, yet pushed myself harder all the time. I couldn't tell anyone how weak and sick I felt. I had been told many times that it was my own fault, and my choice, so I thought I deserved to feel that way.
After my first inpatient treatment in AZ, I did have more strength and hope, and that's when I made the decision to go to nursing school. I don't know how I made it through and graduated. I drove 3 hours a day to attend classes, I couldn't focus, and I was always exhausted. I felt that I had to prove myself, to myself and others. It was a miracle that I made it through school alive and earned my degree. I had five automobile accidents during that 2-year period. I fell asleep at the wheel three times, and just lost control the other times. I was never injured. The entire time I was in school my health continued to worsen. I lost weight slowly, but continuously, my anxiety was out of control, and I felt increasing pressure to set my goals higher for my nursing career. I could barely take a deep breath by that time. The pain was intense when I sat on any unpadded surface. I was bruised all the time from my bones protruding. It was excruciating to get into the bathtub. I pulled away from anyone's touch, for fear of pain, and their discovery of how bony I truly was. I was in misery, both physically and emotionally, but I was imprisoned by my disease. I had to push myself through each moment, always feeling like I would collapse at any time. I went to bed at night, wondering if I would wake up in the morning.
I don't know how I survived, except that my will to live somehow remained strong. It's painful for me to recall that time of my life, and all the experiences that I missed out on. I wish for others who are suffering, to see and believe the reality of where it can lead. I want them to experience the restoration of their bodies and what real strength feels like again. I will never forget, after being in true recovery for several months, how it felt to discover that I could actually run a few feet again! My legs were wobbly and still very weak. It was a very strange, but freeing feeling. At that point, I could finally envision myself being strong again. I found that I liked the feeling of strength as it began to return to my muscles. I finally felt hope that my life could actually change!!