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.
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.
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?
Have a wonderful week,
PsychWriter made it again to the top 100 Websites for Writers! That’s the second year running!
Thank you to all who voted, your support means the world.
Check out all the fab websites HERE.