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Psychoanalyze Your Characters 5: Anorexia Nervosa

If you took a blog break during the holiday, here's my late December post about creating realistic characters who have survived trauma.

Today I'll focus on the most lethal eating disorder: Anorexia Nervosa. There's actually a link between one kind of trauma -- sexual abuse -- and eating disorders. One study found that 1 out of 4 women with Anorexia Nervosa has been sexually abused. The rates of sexual abuse were even higher for other eating disorders: 1 out of 3 women with Bulimia Nervosa, and 1 out of 2 women with Binge Eating Disorder. I'll cover Bulimia Nervosa in my next post.

"Anorexia" means a lack of a desire to eat, but it doesn't necessarily mean a lack of appetite. Individuals who develop this disorder at first have to stave off severe hunger to achieve weight loss. The diagnosis must also include "Nervosa", referring to psychotic thinking including intense fear of weight gain, distortion of body image, and obsessional preoccupation on food, weight, and shape.

There are four symptoms of Anorexia Nervosa:

1. Severe underweight (less than 85% of expected body weight or less than 17.5 Body Mass Index). For example, a 5'7" woman would meet criteria if she weighed less than 111 pounds (50.35 kg).

2. Intense fear of gaining weight. Many individuals fear that if they gain one pound, they'll suddenly gain one-hundred pounds. The eating disorder provides a false sense of control, and individuals fear losing that control.

3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body shape on self-evaluation, or denial of the seriousness of the current low body weight. Individuals determine their self-worth solely based on their weight/shape.

4 Amenorrhea in women (absence of at least three consecutive menstrual cycles). Individuals meet criteria if they only have menses when on the birth control pill.

When people joke they wish they could get Anorexia Nervosa, I fume inside. This disorder is a personal hell, locking individuals into an addiction that brings so much misery to them and their families. Their self-worth is so impaired they don't feel deserving of caring for themselves -- of living, really. It's selflessness gone awry.

Walter Kaye, M.D. is doing some fascinating research on the brains of individuals with AN, finding logic in the illogical refusal to eat when underweight. He's shown that individuals with AN have high levels of serotonin activity in their brains. Serotonin is a chemical messenger implicated in sleep and appetite, and the high levels of serotonin activity produce agitation for those with AN. When these individuals stop eating, the serotonin activity decreases, providing a sense of calm and happiness. However, eating a combination of carbohydrate and protein elevates serotonin levels, jacking up their anxiety and the "noise" in their brain. If eating made you feel this horrible, would you eat? Probably not.

Individuals with this disorder have difficulty making decisions, tend to be emotionally stoic (not only are they restricting their food intake but they're also restricting their emotions), perfectionistic (often achieving 4.0 GPA's), and highly anxious.

Men can and do suffer from Anorexia Nervosa though it's more common in women. I'm not familiar with fictional heroines suffering from this illness -- are you? A famous singer who died from AN is Karen Carpenter:
Her music is is beautiful, and it's a tragedy the world lost her smooth voice to this illness. In effect, Anorexia Nervosa steals a woman's voice.

Here are two of my favorite books about eating disorders:

There's a lot more I could say but I'll stop here. Please let me know any of your questions or comments.

Now onto the Meet an Author Monday Blog Hop, hosted by Lisa Sanchez.


Nicki Elson said…
It seems that people with AN struggle with it their whole lives, even after diagnosis and treatment. The serotonin research is fascinating - how wonderful would it be if that led to some new and long-lasting solutions!

Thanks again for the background on this disorder. Let's see, for fictional heroines - Kelly on the original Beverly Hills 90210. I think they covered just about every disorder and trauma imaginable on that show. Amazing how it could ALL happen to the same small group of people.
Anonymous said…
Wow! Those are some scary stats!
I'm back to working on my thesis, but school doesn't start until next week. I hope your first day back at work is an easy one. :)
J E Fritz said…
Fascinating and frightening. It's especially interesting that serotonin produces agitation in those with AN. I wonder if it's something genetic or if their mind learns to hate the things associated with eating? Or if, like many disorders seem to be, it's a combination of internal and external factors.

Thanks for another interesting psychoanalysis.
I always find your analyses fascinating. This is definitely a scary disease, and very misunderstood.
Jennifer Lane said…
Nicki, yes this seems to be a chronic illness. While most start exhibiting symptoms in adolescence, it isn't unusual for women in their 40's or 50's to still be struggling in some capacity. The serotonin research is leading to the use of some new medications for AN called "atypical antipsychotics" like Abilify, Geodon, and Zyprexa, which help individuals tolerate the agitation of refeeding better sometimes.

Kelsey, I've heard that about 1/4 of ALL women have experienced some sort of sexual abuse, which is very disheartening. Ah, the old thesis. I just had a cancellation to start my workday so that gives me some time to catch up on stuff! :)
Jennifer Lane said…
JE, is that a little bunny you're cradling in your photo? Cute! Yes, it appears to be an interaction between nature and nurture, though learning more about brain structures (the nature part) seems to take some of the shame away. It's also true that our environment and experiences can change brain structures--internal and external factors are so interwoven!

Sue, very true about the lack of understanding. Many people think AN is a "choice" made by skinny rich girls, which is so far from accurate!
Unknown said…
Wow, those statistics about sexual abuse are sad. It makes sense that sexual abuse would knock your self-worth and lead to all sorts of problems.

<< high levels of serotonin activity produce agitation for those with AN >>

I wonder how he came to this conclusion (assumption?) There seems to be a lot of factors that would cause agitation in a person with AN after eating.

<< When people joke they wish they could get Anorexia Nervosa, I fume inside. This disorder is a personal hell, locking individuals into an addiction that brings so much misery to them and their families. Their self-worth is so impaired they don't feel deserving of caring for themselves -- of living, really. It's selflessness gone awry. >>

Very interesting post, Jen. I like your passion. ;)
Jennifer Lane said…
Sexual abuse is about the most evil thing one person can do to another. :(

I'm trying to remember the exact study, but I think Kaye used functional MRI's to compare brain activity of those with AN to those without eating disorders, and found differing levels of serotonin receptor activity. Dopamine is also involved. The article was fairly convincing in proposing the link between serotonin and agitation.

Thanks Bookfun! Tell the others I said hello.
Unknown said…
Interesting LINK! (I almost missed it!) :P
And brilliant blog series!
Jennifer Lane said…
Thanks, Hannah! The underlying motivations of an eating disorder are very interesting.