From fear of eating to appetite for life: food and eating in an anorectic mind

Abstract

The aim of this research is to describe ex-anorectic patients' relationship with food and eating. Why and how do young women develop a twisted idea of eating and food? How do they describe their relationship with food and eating? The causes of anorexia are collected from the narratives of 11 Finnish women who have survived their own anorexic trip as winners. Anorexia is a serious psychiatric condition that can lead to death at its worst. The causes of anorexia have not been clearly evidenced, which makes it difficult to draw a distinct insight into the problems of anorexia. In this article, the complex nature of eating disorders is discussed from the point of view of anorectics' relationship with food.

Keywords:

• eating disorder
• anorexia nervosa
• food
• eating

Introduction

Attitudes toward food have been a public topic for several decades. For example, at the beginning of the twentieth century the connection between nutrition and people's control over life had already been realised in household instructions in Finland. In the 1950s, citizens' eating habits were affected by nutrition education: the excessive use of sugar, fat, and white flour as well as counting vitamins and minerals in nutrition became issues of great interest. This trend has only strengthened nowadays. The thought that by controlling eating an individual also proves his or her control over other areas of life seems to lie behind this phenomenon (Mäkelä, 2000; Puuronen, 2004; see also Turner, 1984). Nutrition recommendations are only recommendations, but for those people who are inclined to anorexia these guidelines turn their life into a tangle of problems that revolve around eating, and often into a serious eating disorder (see Lucas, 2004).

An anorectic system of meanings originates in change. It is a sort of turn away from something reasonable for oneself, striving for ideal citizenship, or something bigger. Although modern women seem to be on a continuous diet, Claude-Pierre (2000) warns not to consider this as the immediate and only cause of anorexia. The excessive admiration of slimness is, according to Claude-Pierre, extremely dangerous, but anorexia is a much more complicated illness by its nature than just an individual's vanity concerning slimness. Indeed, becoming anorectic is not connected to any particular common reason, such as the ideal body figure presented in the media or traumatic experiences (for example, Abraham & Llewellyn-Jones, 2001; Freedman, 1986; McRobbie, 1997; Orbach, 1989; Simpson, 2002; Thompson & Heinberg, 1999), but the change can be situated in various areas of life and the changes often tend to cumulate (for example, Buckroyd, 1997; Charpentier, 1998; Engblom, 1998; Michel & Willard, 2003). One does not catch anorexia like flu but anorectic behaviour begins as a strive for and an obligation to do things right. When starting to pay attention to his or her weight, an individual learns two ways to control it: dieting and the methods that prevent the food from being absorbed (Abraham & Llewellyn-Jones, 2001). According to Ster (2006), many anorectics have had a strange relationship with eating throughout their lives, turning, at some point, into a serious illness. Food and body are especially women's grounds through which they express themselves, either their good or bad feelings.

According to another physiological explanation, refusing to eat causes an increase in the percentage of opioids in the brains of anorectics, lifting the mood and thus causing a sense of well-being and making an anorectic dependent on hunger little by little (Abraham & Llewellyn-Jones, 2001). In addition, nerve transmitters and stress hormones are assumed to have their part in the emergence of anorexia (Attia, Mayer, & Killory, 2001; Michel & Willard, 2003) while some studies have also discovered genetic causes of anorexia (see Bulik et al., 2006). In all, healing from anorexia is possible but it is also quite usual that it may recur (for example, Bulik et al., 2006; Fay & Price, 1994; Michel & Willard, 2003).

This study was focused on anorectics' relationship with food and eating. Interestingly, a direct translation of the word anorexia nervosa refers to loss of appetite when translated into the Finnish language. This translation is, however, misleading because rarely do anorectic patients have anything wrong in their appetite. If it was lost, would there be any reasonable explanation as to why the anorectics do not feel successful until they can resist their constant feeling of hunger (Michel & Willard, 2003)? The feeling of hunger can diminish with time but most probably their appetite is and will be huge. Food occupies their mind constantly, which actually proves the above-mentioned argument. The problem is, therefore, how the anorectics take their hunger. They know that they should eat but the fear that they would not be hungry at the time of next meal makes them control the food and the amounts they eat. When starving, the anorectics become obsessed and they can have the most peculiar food fetishes (Oldis, 1986).

The causes of anorexia have not been clearly evidenced, which makes it difficult to draw a distinct insight into the problems of anorexia. Furthermore, patients' views are often neglected when studying the phenomenon (Vanderlinden, Buis, Peters, & Probst, 2007). The present research gives an extraordinary and unique sight to the forms of eating disorders, anorexia and the enigma of illness. The purpose of this article is to reveal how anorectic patients feel about their relationship with food and eating. What makes young women abstain from eating and experience it as rewarding? In the article, ex-anorectic subjects describe their relationship with food and eating. This kind of perspective is important when trying to understand the illness and how the ones suffering from it perceive their behaviour. Through the survivors' stories, it is possible to learn more and figure out ways of helping other anorectic patients.

Method

The aim of this research is to understand the reality of anorectic life and related experiences through the individuals' perspective. Those who did get ill are the real experts in describing what makes a young person develop anorexia by abstaining from eating. The goal of narrative research is to give subjects the opportunity to make their voices heard because the information that is formed in this way is more polyphonic and varied. In this research, participants were Finnish ex-anorectic women (n = 11) aged between 23 and 45. They had developed anorexia between the ages of 10 and 18 years. The survival story told by each ex-anorectic is her own view of her suffering, disappointments, successes, and joys.

The research participants were selected in this research based on their own willingness to participate. The Finnish Anorexia Association (SYLI) helped to find the research participants: it informed people through its channels of the possibility to participate in this research. The interviews were designed to concentrate on the interviewees' narration. Indeed, the narratives in this research were built upon the starting question presented by the researcher, and the interviewees' were allowed to tell about their journey with anorexia freely. At the end of an interview, and even after an interview for some of the participants, the interviewees' were asked some specifying supplementary questions.

To guarantee sufficiency, the data collection was complemented with written survival narratives. Through the authors' personal contacts, 10 written narratives about anorexia were received. At this stage, the narratives started to seem repetitious. Therefore, of these 10 narratives, six narratives that somehow differed from each other were selected for this research. Finally, the eventual data consisted of five interviews and six written narratives.

The purpose of this study was to describe the causes of anorexia through the ex-anorectics' narratives about their personal experiences. Narrative is also reflected in the method of data analysis, which, in this study, was carried out by narrative analysis (see Lieblich, Tuval-Machiach, & Zilber, 1998; Polkinghorne, 1995).

The results are analysed by analysis of narratives that is based on Polkinghorne's (1995) classification on analyses (analysis of narratives and narrative analysis) because the data comprised stories and narratives: the prerequisites for the analysis of narratives. This analysis has an emphasis on the paradigmatic tradition of knowledge as a part of the analysis of narratives as well, because the data are categorised by its content. The narratives were analysed as whole and they were categorised. Categorical content analysis was used in order to gather up separate expressions that were categorised as factors that caused anorexia among the participants of this research.

Results

Permitted and forbidden eating

According to the anorectic patients' narratives, their eating routines were quite twisted and morbid. One participant could only drink water and eat a couple of apples a day, while another overly ate those foods that she had allowed herself to eat – but only within permissible limits. Anorectics are masterful in cheating themselves, which might be because of the inner survival instinct. They promise themselves the strangest dispensations concerning some foods although they include plenty of fat and calories.

For one of the participants, eating meant gobbling few overly-healthy foodstuffs and incomprehensible promises to eat nuts and seeds that contain plenty of fat. Another woman designed her diet on three products that she considered safe to eat – apples, yoghurt, and water:

My diet comprised a couple of apples, a couple of yoghurts, and plenty of water. Water filled my stomach nicely and I thought that it cleaned my body from all extra crap.

I ate crazy amounts of yoghurt and wholegrain products, and of course, cottage cheese. I don't really understand the ideology because I had promised myself that I'm allowed to eat nuts every day although they had lots of calories. It's funny because although otherwise I would eat super-healthy or not at all but I had never lack of nuts or sunflower seeds.

Another participant said that she never quit eating nor had she eaten just salad. When she did eat, she had only safe foods; in other words, foods that she considered healthy and permissible. Certainly, she could spend hours without eating anything during her long walks but ate afterwards only according to her own routines: ‘I have never lived so that I would have spent days without eating or that I would have lived months with having one banana a day’.

One of the ex-anorectics had realised that she did not want to eat when she was at the darkest phases of her life. As she started to feel hunger during her abstinence from eating, the greatest pleasure of life was to go for a run. However, she had allowed herself to have one foible: she could eat one piece of chocolate for every five kilometres she ran. She had calculated the calories carefully and concluded that she could eat that within reason:

I ran so much. I went for a morning run, about 10 kilometers every morning, and the same run in the evening, too. First, I allowed myself to eat one piece of chocolate for every five kilometers but as the illness developed, the limit became ten kilometers, I guess. That was the only sweet I could have. Otherwise, I would eat just cold foods because I thought that warm ones make me fatter. I did not eat bread or meat whatsoever. Indeed, I was a vegetarian for the whole anorectic time and a long time afterwards, too.

One of the participants had only breakfast and supper. Mostly she ate oatmeal that was cooked in water or flavoured with a drop of yoghurt. In addition, she could have coffee and tea and a rye bread with a turkey slice and cucumber:

The amount of food was so small and super healthy. I would always calculate that the food I ate would have the same amount of calories every day and that it would correspond or would preferably be slightly less the consumption. Of course, I would drink lots of water during the day because it kept the hunger away somehow when I was at work.

Within the net of anxiety

As a human being is starving, moods change dramatically. One easily develops an inner state of anxiety. The participants of this research talked about a bad feeling that resembled mental malaise similar to anxiety and depression. Quite often, anxiety starts from the feeling of shame toward one's body and from the fear of food (Michel & Willard, 2003). Over one-half of the participants in this research reported of some sort of depression-like state and malaise during their illness.

One of the ex-anorectics in this research started to punish herself when facing disappointments or failures. She knew one thing that she could do the best:

Partly the anorexia was like that; if I was unsuccessful or disappointed, I just thought that at least I can succeed in one thing. I found the feeling of satisfaction when I succeeded in losing weight. That worked every time, guaranteed. You know, I punished myself with it but simultaneously it comforted me: this is something I can do successfully.

Anxiety that follows anorexia makes the anorectic patient either starve even more or gain weight because of others' pressure. One of the participants had descended into serious overeating and rapid weight increase:

I didn't know at all that how much I weighed until I was being forced to weigh myself – that was really hard when I started to gain weight. I had a feeling that I can't handle it and the whole world was upside-down. – So then I became anguished because of the weigh increase and I started just to devour. – My own body felt so strange because I wasn't allowed to do all my own anorectic routines and because of the distress, I didn't have the energy to exercise.

This participant used her new way of dealing with distress quite efficiently; to the extent that she actually doubled her weight in a few months. She gained 50 kilos by eating chocolate, candies, and other goodies.

Another participant said that her life went to the point when each bite increased her malaise and finally she was more than underweight. Even regular weight controls did not ease her eating problems:

Well, I didn't regard those controls as a problem; actually, I was very proud of losing weight. – After the summer, my life went concretely so that I would just think all days long how I could skip eating as much as possible and how I could exercise enough. – I remember those situations when I was forced to eat a bun or a pastry at a coffee table and after which I was crying and exercising in the living room floor wishing that no one would come to see what I was doing there.

The reasons for developing anorexia can be the most manifold. One participant's anorectic journey started from distress after being cheated on by her boyfriend. The other's eating problems started from trouble and bullying at work. One of the participants was raped. She could not talk about the incident with anyone and she was totally isolated. Cooking for her parents was the best part of her day – however, she did not eat:

Somehow, it felt so natural to start removing the anxiety by losing weight. Abstaining from eating made me direct my thoughts from guilt around food and calorie calculations. Somehow I wanted to shrink the marks that guy had left inside me. But of course, they were far deeper.

Fear of gaining weight

One of the participants developed her fear of gaining weight little by little. She succeeded in losing a few kilos and exercised relatively often to keep in shape. Then she was going on a language course abroad with a friend. However, the participant's only memory of the trip was that she was afraid of gaining weight during the trip:

I did want to taste all those local delicacies and I could hold back eating the whole day to be able to buy some delicious cake from the shop. At that time, I could still eat those cakes. – At the age of 16, I went to Australia as an exchange student. Then, I decided that I won't eat anything sweet any longer and that I would exercise a certain amount a day; and those amounts were really huge. I would exercise about three hours a day just not to gain weight.

Fear of gaining weight filled turned into anorexia and the fear did not ease as the condition developed. This ex-anorectic woman spent her exchange-student year being afraid of gaining weight. That only made her compound efforts and she exercised all day long:

I would, for example, spend weekends so that I just walked. I walked very far and sat down to draw some scenery a while and then I walked back. It usually took the whole day and I didn't eat anything because I didn't have any packed lunch with me. I tried to control things like this; in a certain way, I tried to keep myself out of those situations where I might had to eat something that others ate – for example, something that someone else had prepared and I didn't know for sure what that was. So that would have been out of my control. I tried to minimize all that. Gaining weight would have been a breakdown.

Discussion

Anorexia can be considered a mental disorder and some other psychosocial stressful situations – such as a loved one's death or illnesses, parents' divorce, sexual abuse, moving away from home, break-up, graduating, low self-esteem, the excessive admiration of slimness, or bullying – can trigger off self-destructive thoughts and their implementation (Buckroyd, 1997; Charpentier, 1998). In this research, some anorectics seemed to have experiences of dramatic change or break-up in their early-life interactional relationships that clearly involve a threat of destroying the self or object experience. These kinds of break-up experiences make people vulnerable to changes and adversities and give birth to the experience of separateness that can, when reactivated, lead to self-destructive eating behaviour (Engblom, 1998). Studies show that the propensity for anxiety has its influence on developing anorexia. For example, Michel and Willard (2003) noted that even 90% of anorectics had suffered from some kind of anxiety before anorexia.

The fear of gaining weight can often be a sign of developing anorexia. It can become a reason to keep the whole life revolving around food. When everything else becomes more organised and controlled and one manages to lose some weight, anorexia probably has predominance over its victim (see, for example, Seller & Ravalia, 2003; Zandian, Ioakimidis, Bergh, & Södersten, 2007). Little by little, life turns into routine performing and all changes, such as trips and visits, make life uncertain. What if I have to eat something else other than what I have in my list of permissible and healthy foods?

The anorectics in this research believed that fibre-rich and low-fat food is healthy and does not increase weight. They could also place various food stuff separated on the plate in order to keep the food ‘clean’ enough. In practice, the food must be dry because it seems healthier. As the anorectics do not eat fat, they cannot taste all tastes. Apples, especially the green ones, are allowed because they can taste best the acidic and sweet taste combination in apples (Ster, 2006). Anorectics also mislead by having food on a smaller plate: their proportions then seem larger. According to the participants' stories, they were not interested in other's company while eating but come up with their own eating times when no one else was eating. Some anorectics enjoyed preparing food, but only for other people (Lucas, 2004).

Indeed, anorexia nervosa is mostly related to different obsessions, an infinite desire to lose weight, and a huge fear of weight gain. Anorectic life seems to just rotate around food and dieting. The secret goal is to destroy one's own appetite completely. Life is controlled and over-regulated; repeating the same routines day after day because of the fear of loss of control. The anorectics believe that the control shows discipline and self-mastery (Bordo, 1993; Mussell, Mitchell, & Binford, 2001). Furthermore, anorexia has clear connections to perfectionism as well. Halmi et al.'s (2000) study proved that levels of perfectionism were greater in each of the three anorexia nervosa subtypes than in the healthy comparison subjects. Moreover, increasing perfectionism was associated with lower body weight and greater prominence of eating preoccupations and rituals, as well as diminished motivation to change. Thus, greater severity of eating disorder symptoms was associated with greater perfectionism.

Conclusion

There are some limitations in the research that should be contemplated. The number of participants was relatively low and therefore the results are not generalisable as such. However, in qualitative research like this study, the purpose is not to produce generalisable information but to describe the participants' experiences and thoughts and to regard them as exemplars of the phenomenon studied. In this research, the participants exemplified a selected group of anorectics: women who were willing to tell their stories and who had all conquered anorexia. They were able to analyse and describe their relationship with eating and food openly.

The complexities related to anorexia arouse many difficult issues. On the other hand, one should eat healthy to avoid gaining on weight. One should exercise to maintain well-being and make the effort for success at school and in life overall. All these are important and good qualities and goals but the anorectics adhere to these features in a way that harm themselves and end up with excess. From an educator's point of view, the balance between encouraging young people to have a healthy lifestyle and not putting too much pressure on them seems extremely difficult . How does one notice when the line between a normal and a distorted attitude toward eating has been crossed, how does one prevent this from happening, or how does one help those who have already developed anorectic eating habits?

More research should be conducted from the point of view that gives space for the anorectics' voice: the modern busy way of living does not provide enough time and space for care and support, and listening to youngsters' worries. As the medical side of anorexia is relatively widely studied, now it is time to pay attention to the causes of anorexia and give voice to those who suffer or have suffered anorexia. More consideration and research should be aimed at survival stories as this certainly is a method something that can be adopted to not only help and treat anorectics but to prevent youngsters from developing the disease.

All in all, anorexia is certainly a complex phenomenon to be considered by parents and other educators. In many ways, food is the anorectic patient's voice: a way of expressing the malaise (May, 1990), and the rationales used by anorexic patients to explain non-eating are more varied than implied in current diagnostic guidelines (Lee, Lee, Ngai, Lee, & Wing, 2001). Therefore, it is important to enhance the understanding of anorectic patients' eating experiences with qualitative studies like the one reported in this article.

Parents' and educators' task is to support youngsters' awareness of their strengths, to show and guide them in what they are good at and to direct their interest in gaining positive experiences in these areas (for example, McRee & Halpern, 2010). Of course, it is impossible to totally prevent bad things from happening but what can be done by rearing and education is to provide children with the feelings of security and appreciation that also function as the foundation pillars of healthy and positive self-respect (for example, Sheridan & Burt, 2009) and which could help in the battle against eating disorders like anorexia.

This research showed that recovering from anorexia can be viewed as a development conversion during which persons with anorexia begin to observe the world around them in new ways, making anorexia gradually disappear. The process is slow because they will have to re-learn the so-called normal life (Savukoski, Uusiautti, & Määttä, 2012; see also Sim et al., 2010). Yet it is important to allow time for setbacks and an occasional return to anorectic life as the healing is not always, if ever, straightforward. Overcoming anorexia appears to be driven both by the spiritual survival of the process, the main objective of which is to reach and overcome the emotions caused by the anorectic experiences, and by learning to live with these feelings (Savukoski, Määttä, & Uusiautti, 2012). According to Zandian et al., ‘teaching patients how to eat is an essential intervention and once eating behavior is normal, the other symptoms, including the psychiatric symptoms, dissolve’ (2007, p. 289). Therefore, anorectics' feelings toward eating are worth studying and discussing. In addition, it shows that the healing involves a great deal of practical problem-solving. Learning concretely how to eat eventually helps one find ‘the appetite for life’ (Ryerson, 2005) and have the courage to try other things rather than strictly follow anorectic routines.

Additional information

Notes on contributors

Marika Savuskoski

Marika Savukoski, EdD, is a director of early education in the Municipality of Keuruu, Finland. Her personal research interests are in eating disorders, especially anorexia nervosa, and her research has been focused on positive behaviors, coping and survival from anorexia.

Satu Uusiautti

Satu Uusiautti is a postdoctoral researcher at the Faculty of Education, University of Lapland. Her personal research interests are in qualitative methods, positive psychology, and happiness, success, and well-being at work and in life overall.

Kaarina Määttä

Kaarina Määttä, PhD, is the professor of educational psychology at the Faculty of Education, University of Lapland, and deputy vice-chancellor at the University of Lapland. Her latest personal research interests have focused on love, attachment, and social relationships during human beings' life span; early education; guidance on and processes of doctoral theses; and on positive psychology and human strengths. Her latest book (published in English) deals with the pedagogy of supervising doctoral theses from various perspectives.