This area is very hard to organize and express in writing. My personal awareness comes from experiencing it. Scientifically, I’m not educated on how the thinking part of the brain operates, or the specifics about what happens when that process is altered by starvation.
I can only share from my own experience, and attempt to describe the contrast between “then and now” of how my mind works, and how I can now carry my thoughts out to an end, instead of running away in the middle. I think in terms of there being three main phases in the process, simply, before, during and after.
BEFORE the disease itself unfolds, somewhat ‘normal’ personality traits may already be in place for the individual. There can be a predisposition for perfectionism, order, symmetry, and what may be considered as ‘safe’ routines. A person my base their worth (value) as a person, in their mind, on performance. All aspects of their life are considered either “good or bad”. The intense fear of loss of control in their life, along with possible criticism about their actions or capabilities can cause a desperate attempt for safety and security. Thoughts may come rapidly, with disorganization, which further distresses those who have a great need for simplicity and are accustomed to “black and white” thinking. The attempts to organize and file their thoughts into some sort of pattern can cause great anxiety and fear, because in a sense, that’s another area where they are losing control. Anxiety and obsessiveness are often at the root of this pattern of thinking, or perhaps the mindset itself leads to a generalized state of anxiety. These personality traits are common in those who develop eating disorders, particularly anorexia.
There are countless situations which can play a part in a person developing an eating disorder. By the time intensive treatment is necessary, the etiology is not as important as the process of behavioral change, discovering what factors may be maintaining their disorder and developing positive coping methods. Whatever the triggers are that bring the focus to weight, food, body shape and size, direct the thoughts even deeper into those personality traits which will better enable them to control their weight loss, to make their life more “perfect” (above reproach), and very likely gain attention. Attention from others very often may at first be positive, which may then become negative, as the drastic dangerous results of starvation become obvious.
DURING the anorexic disease process, and as it progresses through many different phases, the mindset discussed above strengthens, and the irrational thinking processes become more locked in. This is when the starvation affects begin to greatly impede the ability to think and process reality. There will present a decreased attention span, limited focus, and actual limits on accessing knowledge, which may continue to worsen as the brain itself becomes more starved. Reality itself becomes distorted, particularly in the aspects of weight, body shape and size, the meaning and purpose of food, and often joy and pleasure in life takes on a “bad” connotation. For me, suffering and punishment became a goal. I believed that pain indicated strength in my character, and what better pain but starvation? Obvious starvation impresses a higher self control, which in an anorexic’s mind, may indicate safety and security. Control becomes the supreme goal of every day, until that control reverses and turns on them, becoming a trap towards death. Paranoia grips and threatens their very existence. All thoughts are calculated and weighed. There is always an attempt for balance.
Throughout the disease process, as symptoms continue without interruption, the scope of thoughts narrows, becoming even more focused on food, and less on life itself. You may see behavior where the anorexic tempts and “tests” themself, as if there is a need to demonstrate control and denial, and strength, especially in others’ eyes. Being in the presence of food, cooking it, and seeing others eat, can actually stimulate smell and taste so that the anorexic thinks they can taste the food, their stomach may feel full, and there may even be a pretense of feeling more energy. Somehow, exposure to food strengthens the resolve to not eat it. It’s all part of the denial, and continued reinforcement of their belief that they can do without food, yet as the resistance grows stronger, the need for control increases. In an anorexic’s mind, others’ view and impression of them is of great importance. Questions, assumptions, and a sense of hope revolve around their presentation to others, and in many social situations.
Continuous daily rationalization is common; tomorrow they will change, tomorrow they will be able to eat, the limits they have set for themselves and adhered to, will not apply anymore; it will all be easier. These thoughts somehow allow an anorexic to get through each day, and to justify their current behavior. There is little or no insight to the consequences of their restricting, over-exercising, or other symptomatic behaviors, and one may not believe that these will have any long-lasting effects on their future. Thoughts often run in a circular pattern, reinforcing negative behaviors, which makes it very difficult to interrupt/break the cycle.
AFTER: which will be my own references to the process of recovery that I have personally experienced. I’m not sure if I should phrase this section as AFTER, because actually I consider myself still experiencing many changes that constitute the process of recovery. Considering this, I will attempt to describe the changes that have occurred in my thinking, and in my ability to understand it all. In the early stages of recovery, particularly while weight restoration was the focus, there were two competing forces in my mind. There was the one stream of thought that was completely obsessed with weight, body, shape, food, calories, activity (exercise), and comparisons. This was the dominant mindset, my brain was still very much in a starved state, and unable to break free of anorexic obsessions.
Yet for me, there was also a great desire for recovery, and freedom from it all, although I didn’t yet understand what that meant. In fact, this more passive mindset had survived all the years of my illness to that point, out of desperation and a deep desire and hope that someday I would know what it was like to be alive. I lived with my disease, always believing that there was an end somewhere. In the last days before I came to the facility where I truly found recovery, I felt a heavy hopelessness, and I doubted my strength to survive. But something else was there too, a strong desire to live. By that time, I believed that I was ready for someone else to control this, until I could do it myself.
Even at that, the fight within continued, and my resolve often waned in the presence of fear and the realization that recovery would involve much more than weight gain. Even with all the treatments that I had been through, I had never reached the point where I really understood that, or else refused to fully accept and believe it. As I began to approach my normal body weight, my thoughts began to clear, and I was able to focus on the changes that needed to occur in my life, and within myself, for me to continue through the recovery process. I wanted to change, as frightening as that was.
It has taken me a long time to understand and interrupt my black/white, all/nothing thinking, that had always prevented me from stepping outside myself, which allowed me to see within myself. That may sound odd, but that’s the way I see it. That type of thinking had always caused me great turmoil in decision making. I was constantly trying to determine between good and bad, right and wrong, with input coming from both my anorexic pattern of thinking, and the new understanding that I was developing, expanding my options, and opening up my life, so to speak. Somehow I have found the resolve and strength that I needed (with more than a little push and pull from outside forces), to keep pushing forward, challenging myself and my old patterns of thinking, and taking the necessary risks to grow and change.
The difference now is that I am excited about what recovery has given me and I believe that there are even better things ahead. As I stated, this is my own experience, while others may have different interpretations. While I know that many things have changed for me, I know I have more work ahead of me. It has taken me a long time to reach this point, and my journey has not been a smooth process. Someone very wise once told me that recovery is not linear. Time has made the difference, along with close connections to a network of support, and most important, maintaining symptom control. These are the only ways to keep my thoughts in check. I do still have anorexic thoughts pop into my mind from time to time, but the difference is that now I am able to recognize them, interrupt them, and move past them, without acting on them.