Eating Disorders: Anorexia Nervosa for Writers

I’m writing a short story at the moment for an anthology and my heroine has the early stages of an eating disorder. But as I explored her back story I had to spend a little time differentiating which eating disorder it was, which (funnily enough) triggered this blog post. Eating disorders, like many mental health diagnoses, have a significant amount of pop psychology and generalisations associated with them. This is fine for the layperson, but if you want to use these real-life challenges in your stories, then writers need to know of their nuances. Eating disorders, with Anorexia Nervosa and Bulimia Nervosa being the most common diagnoses, offer a diversity of effects on an individual and a complexity in understanding their differences and commonalities.  

For example, Although Josie (my character) is an adolescent female (yep, that’s a stereotype — although it’s most common in young females, like all eating disorders, anorexia can develop at any age or stage of life for both males and females), my guess is that most readers would be surprised to find that she’s not underweight. In fact, as we follow her for a day we see all the hallmarks of early Anorexia Nervosa, but Josie has curves. Oh, and she purges, but she doesn’t have Bulimia Nervosa.

Confused yet?

Well, if you are, then this two-part blog series is for you. If you have a character that shows signs of an eating disorder, or one that may pop up in future manuscripts, then keep reading.

There are three essential features of anorexia nervosa: persistent energy intake restriction; intense fear of gaining weight or of becoming fat; and a disturbance in self-perceived weight or shape. Your character would demonstrate the following:

Below Normal Body Weight

Images of emaciated, skeletal girls is usually what comes to mind when you say the words ‘Anorexia Nervosa’, so it’s not surprising that below normal body weight is the first criterion for diagnosis. Admittedly, ‘normal’ body weight is a little problematic considering the diversity of body shapes and types we see today, but clinicians generally use the Body Mass Index as their primary indicator. For children and adolescents, there may alternatively be failure to make expected weight gain or to maintain a normal developmental trajectory (i.e., while growing in height) instead of weight loss.

An Intense Fear of Gaining Weight

Individuals with this disorder typically display an intense fear of gaining weight or of becoming fat, which is not usually alleviated by weight loss. In fact, concern about weight gain may increase even as weight falls.

Individuals with anorexia will limit their calorie intake in one of two ways; restricting or binge-eating/purging. If they use restriction, your character will primarily accomplish weight loss through dieting, fasting and/or excessive exercise. If they’re more of a purger, they will experience recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). It’s the binge-eating/purging type of anorexia that is frequently confused with bulimia nervosa, but that’s next week’s blog.

Distorted Perception of their Body Image

Some individuals with anorexia feel overweight, despite the decreasing digits on the scales. Others realize that they are thin, but are still concerned that certain body parts, particularly the abdomen, buttocks, and thighs, are ‘too fat’. They can employ a variety of techniques to monitor their body size or weight, including frequent weighing, obsessive measuring of body parts, and persistent checking in a mirror. The self-esteem of your character will be highly dependent on their perceptions of body shape and weight. Weight loss is often viewed as an impressive achievement and a sign of extraordinary self-discipline, whereas weight gain is perceived as an unacceptable failure of self-control.

Denial

Some individuals with anorexia may not recognize or acknowledge their fear of weight gain, and most individuals do not recognise the serious medical implications of their malnourished state (which is a challenge for treatment). Often, it will be a family member that seeks medical attention after marked weight loss. In fact, individuals with anorexia nervosa frequently either lack insight into or deny the problem. If your main character has this disorder, then it’s probably useful to have secondary characters note some of the behaviours they observe.

Serious Health Complications

The semi-starvation state of anorexia nervosa can result in significant and potentially life-threatening medical conditions. All the risks and effects of malnourishment are a real risk. When seriously underweight, many individuals with anorexia nervosa have depressive signs and symptoms such as depressed mood, social withdrawal, irritability, insomnia, and diminished interest in sex.

They Obsess about Food

Most individuals with anorexia nervosa are preoccupied with thoughts of food (in part because they’re hungry, in part because they’re scared of it). Some collect recipes or hoard food. Other features sometimes associated with anorexia include concerns about eating in public, feelings of ineffectiveness, a strong desire to control one’s environment, inflexible thinking, limited social spontaneity, and overly restrained emotional expression.

Josie, my character, is modelled around a few girls I’ve seen over the years. These girls don’t meet the first criteria — below normal body weight — meaning she wouldn’t meet the threshold for diagnosis. I’ve worked with these girls. I went to a speaker who talked of these girls. At normal weight, maybe even over-weight, these girls are petrified of eating. Because we have a population whose average waistline is growing, and a never-ending supply of high calorie foods, they have a lot more weight to lose before adults become concerned. Of course, by then, the thought processes and behaviours have been going on for quite some time…

I include this so writers can be aware that any diagnosis can have shades of grey (more than fifty, in fact). Your character doesn’t have to look like a wraith to explore the impacts of mental health issues. Yes, anorexia can be life-threatening (in fact, it has the highest mortality rates of all psychological disorders), but it can also be far quieter and more insidious.

Next week I’ll discuss bulimia nervosa, the other common eating disorder. Until then, do you have a character that may meet any of these diagnostic criteria? Have you read a book with a character with an eating disorder? 

I love hearing from you, connecting with others is why I write. You can comment below, or connect with me on Facebook, Twitter or Instagram.

Have a wonderful week,

Tamar

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13 comments

  1. “Others realize that they are thin, but are still concerned that certain body parts, particularly the abdomen, buttocks, and thighs, are ‘too fat’.”
    Something probably not helped by ‘experts’ warning about abdominal fat even in people of normal BMI!

    “Most individuals with anorexia nervosa are preoccupied with thoughts of food (in part because they’re hungry, in part because they’re scared of it).”
    Again, not helped by ‘experts’ warning about almost every food there is, particularly if it’s tasty, convenient, and affordable!

    I may seem hard on ‘experts’, with or without inverted commas, but I find much of their advice contradictory and unhelpful, to the point that I’ve long been intrigued by the suggested diagnosis ‘Orthorexia Nervosa’, which is well worth googling, though it’s controversial and not (yet?) officially accepted.

    I don’t have an anorexic character, but I do have a character in one of my stories who is immensely fat, and also one of the villains. I’ve angsted about the character, but his bulk is a major outward sign and symbol of his excess and greed and writing him thinner just didn’t work for me. It’s basically an SF story, so think of the Baron Harkonnen from ‘DUNE’, or Jabba the Hutt, though my character is human, if inhumane, and therefore closer to the Baron.

    Thanks for this, Tamar!

    Liked by 1 person

  2. In my WIP, my character might appear to outsiders to be anorexia: she’s underweight, severely so, and has been from childhood because she a) doesn’t eat enough (restricts) and b) purges through vomiting. But I’d hesitate to diagnose her with an ED despite these things because she recognizes that there’s an issue, she’s not obsessed with food, and she’s not obsessed with her body image.

    Rather, she has difficulty eating because “it hurts” and vomiting is her way of purging herself of horrible memories regarding her mother and violence and her fear that her mother does not love her. She’s carrying a huge dark secret, too, and she’s literally sick because of the secrets and her desire to be free of it. It’s a psychological suspense novel revolving around a police shooting (the mom’s an undercover cop), so my character’s apparent ED doesn’t come into play much. But it’s still there.

    I had “anorexia” (with some purging) in college, and I never fit the “typical” profile of being obsessed with body image, etc. The ED served more as a symptom of my undiagnosed bipolar disorder. In that way, I’m not certain if I should ever have been diagnosed with anorexia! Still, my nutritionist was the most helpful professional I saw at the time: he taught me how to eat in a healthy manner and ways to cope in the most stressful food-situations that I encountered.

    Liked by 4 people

    1. How interesting! I do love how people refuse to fit into boxes, no matter how much psychology tries to make them 🙂 The Diagnostic Services Manual (DSM-V which psychological diagnoses are based on) also has some less common ED, so I wonder if your character may fit into one of those…then again, we don’t always need a label, huh?

      Liked by 3 people

  3. Interestingly, I was watching a television show last night that discussed the myths of anorexia – which pretty much backed up what you have written here.
    I’d not thought of it in terms of character and back story (probably because having a tween daughter, I was preoccupied with filing symptoms in my mind…).
    It was really interesting to read your post and consider the issue in terms of writing backstory and character development.

    Liked by 3 people

  4. I am in a relationship with someone with this disorder and trying to learn all I can without talking to her about it. I don’t want it to trigger her, nor do I want my naivety to cause an argument. Thanks for this post and I am following.

    Liked by 3 people

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