Writing Anorexia Nervosa

A person with anorexia nervosa can see themselves as hideously fat even while dangerously underweight

Anorexia nervosa (usually just called anorexia) is an eating disorder characterised by an overpowering fear of being fat or of gaining weight. This fear is so all-consuming that it can lead to illness from self-starvation. This article looks at how to write engaging and believable characters with the condition.

The basis of the psychopathology of anorexia is believed to be valuing of thinness. People with anorexia feel that being thin is extremely important, to the extent of it being an obsession. For this reason, anorexia is much more common among women compared to men, and more common among women exposed to fashion media or who have an interest in sport and fitness compared to other women.

More specifically, thinness is considered important because it’s where a person’s sense of self-worth derives from. Thinness is seen as a virtue by anorexics, which is why the condition is so hard to understand for people who don’t have it.

Some might be surprised to hear that anorexia is one of the most deadly of all psychiatric conditions, up there with schizophrenia and major depressive disorder. An unusually low body weight is linked to a wide range of physical ailments, as many elementary bodily functions cannot operate past a certain level of starvation. Even without intending to, it’s common for anorexics to become sick and die as a consequence of lengthy periods of starvation.

If you are writing about a protagonist that suffers from anorexia, their internal dialogue might have a lot of anxiety based around a need to be in control of their body weight. Sometimes such a person will have a ruthless, almost sadistic approach towards their own body. This explains why there is a high degree of comorbidity with Obsessive-Compulsive Disorder. A person with anorexia often becomes extremely particular and fussy about their food and their calorie intake.

Then again, the approach might be more feminine. Instead of a desire to control, having a meal might conjure feelings of fear, almost panic. The sight or smell of food might trigger a reaction similar to that of a person with a phobia encountering their object of fear. It might be enough to also trigger powerful feelings of self-loathing.

Much like psychosis, anorexia tends to come and go in ’bouts’. An episode of anorexia is often triggered by a traumatic life event. It may be that sudden high levels of stress and anxiety result in a desire to compensate for a perceived loss of control.

Anorexia is not a psychotic disorder. A person with it will generally know that they have something amiss about them – but therein lies the difficulty. This reasonable part of the mind struggles incessantly against the part of the mind that commands that one must be thinner no matter what. It might be that the part of the mind that desires thinness above everything is somehow stronger, or more able to assert itself.

The effect that this might have on a protagonist of your story is therefore similar, in many ways, to that of one with depression. Constant feelings of having undermined oneself lead to guilt, personal recrimination, and a loss of confidence in one’s own intelligence, one’s competence or even one’s will to live. As is true of most of the conditions in this book, anorexics tend to have damaged self-esteem.

Like many of the other conditions in this book, it’s believed that anorexia nervosa frequently has an origin in childhood abuse. It might be that this is the reason for why it goes in bouts: dysregulated stress responsivity arising from the trauma leads to extremes of anxiety, and when one of those extremes is reached, a sudden desire for extreme control appears.

The experience of other characters who have a friend or family member suffering from anorexia is usually a difficult one. In many ways, watching someone waste away through anorexia is similar to watching them waste away through a heroin addiction.

This often brings with it a range of feelings that might profoundly affect that character, in particular frustration at not being able to get through to the anorexic about how dangerous their condition is, and guilt about not being able to “do more” for them. Although it’s true that it’s hard to reason with people who have mental illnesses – by definition – it’s still very common for friends and family of people with them to feel guilt about not being able to do more to get them to live a healthy, normal life.

A more distant character who encountered someone with anorexia might get the feeling that the anorexic is uptight and rigid. Anorexia is often associated with a sensitivity to insults and disrespect, as as perfectionism, and a character that demonstrated any of these traits could plausibly develop anorexia or have a past history of it.

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This article is an excerpt from Writing With The DSM (Writing With Psychology Book 5), edited by Vince McLeod and due for release by VJM Publishing in the summer of 2018/19.

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