Inside the mind of anorexia: shedding weight to the death

What to expect from someone who suffers from anorexia, a deadly obsession over weight control that may increase in Arab society as fashion and slenderness become more valued

Females have always been the victim of the gruelling judgment of the society that measures success by outer beauty, and with fashion dressing walking hangers as a benchmark for beauty, some girls fall gradually victim to anorexia nervosa, which always destroys their heath and frequently causes their death.
"We simply thought that the issue would be resolved by forcing her to eat more: Just how difficult can the concept of eating a bit more be?!" was the question in the minds of those surrounding Jane Carpenter, the singer of the famous Carpenters' clan who was the first celebrity to die in 1983 of anorexia. By the age of 32 she had literally starved herself to death, taking doses of laxatives to shed weight. She also tricked her family by secretly taking a drug that induces vomiting, whose deadly counter-effects includes a slow dissolving of heart muscle.
Jane at first simply felt she needed to lose a few pounds, but between suffering multiple misfortunes through her short life and not feeling loved enough by her family, the whole thing turned into a huge human tragedy that lead to her death. Anorexia nervosa existed before Jane Carpenter, but as a celebrity, her death brought worldwide and attention to how an obsession over weight control and exercise can spiral out of control.
Ahram Online asks an expert to shed more light on the psychological disorder that affects mostly females, is "surely on the rise" in Arab countries and kills 12 per cent of those who suffer from it.
"Anorexia nervosa is definitely one of the most challenging and complicated psychiatric diagnoses. Although in our Arab countries people don't report such cases, either out of ignorance or fear of stigma, the number of anorexic females is surely on the rise as more people endorse western attitudes and celebrity images," assures Rasha El-Kholi, assistant lecturer of Family Medicine, Cairo University.
Anorexia nervosa profile:
"The age group most likely to be affected lies between 15 and 19, with 25 per cent of the cases associated with obsessive compulsive disorder and the remaining 75 per cent with depression. Unfortunately many develop suicidal attitudes towards the end.
The patient (usually a girl) has a severely distorted body image, belongs to western-thinking, upper socio-economic level and a dysfunctional, over-controlling or abusive family. The problem is then initiated by the urge to lose weight.”
El Kholi then describes how a shift from wanting to lose weight turns into anorexia.
“[They] usually keeping a record of their calorie intake and confine it to 300 - 700 daily. Naturally their Body Mass Index spirals down. In 95 per cent of the female cases the menstrual period becomes disrupted. Then they stop eating and enter into a phase of denial, never acknowledging that their health is deteriorating," explains El-Kholi.
Is there a road out of this anorexia dilemma?
"Although anorexia nervosa is still regarded as one of the most challenging disorders and nobody fully understands the turning point that changes the course of neurotransmitters in the brain to cause such a stubborn state, many cases have been brought to safety.
The key is continuous surveillance by the family and the doctor, both during the treatment and after, as anorexics have been proven to do whatever it takes to trick others into thinking that they are gaining weight whether by lying, wearing baggy clothes or stuffing their pockets with sand to add extra grams on the scale.
The surveillance should continue after weight gain as relapses are very common.
Coordination is of utmost importance between a family doctor, dietician and a psychiatrist to interview the patient and counter their state of denial and furthermore acknowledge the health hazards before setting a plan to increase the calorie intake gradually till it reaches 1000, then 1600, then until 3500 daily. An inpatient should increase in weight by 0.5 to 1.5 kilograms weekly, while an outpatient increase in weight should range between 0.3 to 0.5 kilograms per week."