How Does Anorexia Occur?

Eating enough food to sustain and maintain proper nutrition is a strong biological drive. And although there are medical conditions that will interfere with eating (mostly physical damage or illness to the digestive system), this drive isn’t easy to overcome. Since, in anorexia nervosa, there is no underlying disease process which affects the ability to eat, our only recourse is to look for psychological reasons.

Commonalities in Anorexia

A good place to look for how anorexia nervosa occurs is to see what characteristics patients have in common. This isn’t the best way, as we can’t really determine causes from symptoms, but it does give a general picture of how it happens.

* Depression — usually stemming from a loss of control (ability to direct events) or unrealistic ideas about body image, weight, societal standards.
* Loneliness — a lack of meaningful, intimate relationships (not sexually, but emotionally intimate). A mistaken belief that someone doesn’t deserve such relationships.
* Insecurity and anxiety about the future. Unresolved worries, especially when they include thoughts about not being “good enough.”
* Perfection — unrealistic need to be perfect, either innate or because of undue pressure from others. This includes an inability to derive pleasure from any less than perfection and leads naturally to a distorted body image.

How anorexia meets these needs

If anorexia is a consequence of the feelings above, the next question is why not eating (or eating and then purging) is seen as helpful. The harmful side is obvious, so why does it occur at all? What to victims get out of it?

The first thing anorexics gain is control over part of their life. Choices about eating are real choices, something they can directly control. There is a real biological craving to eat involved, and overcoming this desire can be felt as doing something difficult, a success, or even fell heroic. And when checking the results, there’s a real and immediate target that reinforces the behavior – the number that shows up on a scale.

In the US, the ability to control (and lose weight) is seen as an honorable thing to some degree. It takes will power and is difficult for so many, that making the switch to being a “weight loss expert” can be seen as a kind of secret talent – it gives comfort.

Parallel with this need for an oasis of control, being thin also is felt as a way to gain approval from others and society at large. Particularly in women, being thin is worthy of envy – it’s a subject of conversation and losing weight is deemed a worthwhile goal.

We recognize these “benefits” as false and ultimately, any good someone gets out of obsessing about weight is more than offset by the harm, both physical and emotional that happens.