Almost Anorexic is a term coined by Dr. Jennifer J Thomas to define the gray area that exists within the continuum of anorexia between a person with no disordered eating patterns and one formally diagnosed with an eating disorder (ED). This gray area is one that lacks recognition, yet is profound with suffering. It is where disordered eating begins and the pathway to a full blown ED is paved. Becoming aware of almost anorexic behavior, perhaps even in your own habits, is important to prevent it from fully developing into an ED. It is incredibly difficult to break habits within an eating disorder because of chemical changes that ensue in the brain and body. Therefore, proper awareness and support from those close to someone suffering with an eating disorder is crucial to creating changes in their quality of life. One of the most prevalent eating disorders, especially amongst adolescent girls, is Anorexia Nervosa. The APA defines this disorder as involving the persistent refusal of food, excessive fear of weight gain, refusal to maintain minimally normal body weight, disturbed perception of body image, and amenorrhea (absence of at least three menstrual periods). As do other eating disorders, anorexia nervosa comes with its own particular set of misunderstandings and social stigmas that I would like to direct focus on. One of these misunderstandings is that having anorexia nervosa is something to be envious of. It is not uncommon for those with eating disorders, or without, to wish they had “just a little bit” of anorexia so they could reach their weight goals. Additionally, it is typical for those with almost anorexic tendencies or those with the disorder to receive compliments about their weight loss. This is especially true when the weight they reached is considered healthier than the one they held before, but what others do not know is that the manner or time frame of this weight loss was not healthy at all. Those suffering with EDs who hear these passing comments from unsuspecting and undereducated individuals may develop a sense of denial that they even have a problem, or feel that they should be grateful, or are special for having their ED. In an attempt to raise awareness of the gray area that is almost anorexia, I will share with you the story of my insufferable time there.
For a long time this was not an easy story to tell. In fact, even admitting I had an eating disorder at all has taken years of self-acceptance. Shame was the leading cause of my denial. How could I ever be, or admit to being, so shallow as to starve myself to seem skinny? This was a genuine fear of mine – how I would be perceived if people knew I had an ED. As if it were an intrinsic part of myself. One thing I have learned throughout the process of self-recovery is that the voice in my head who was the pilot of my persistent food-deterring and self-deprecating thoughts was unwanted and I had to learn to fight to suppress them. (Mine went unnamed since this is not a tactic I had learned until recently, but oftentimes survivors name their voices Ed or Ana). Another important thing I have come to learn is that so many students, even my own friends, beside me during my middle school days (the peak of my disordered eating) struggled with similar thoughts and habits but remained silent because of the same shame. I did not view any of these people as shallow or weak like I had viewed myself. What we had in common, however, were deteriorated self images due in part to the popularity of social media.
Social media played a substantial role in my own experience with almost anorexia. Besides instagram models and celebrities flooding my feed, there were also my own classmates who would post confidently in bikinis garnering hundreds of likes and, subsequently, pages run by grimy little boys would rate them as “hot” or “not”. The pressure was so high and my self-esteem apparently so low, that it got to me. When I posted photos of myself I’d refresh my page rapidly to see who liked it. I would stare at myself in group photos, highly scrutinizing my body. I began to equate my appearance with my worth and it manifested into an obsession with my weight.
My disordered eating started as an innocent attempt to eat healthier. In 7th grade, I declared my veganism to my family, which my brothers laughed at and retorted that I wouldn’t last a week. I found pride in my label. I could do good for the earth and my body. Alongside my new vegan diet, I downloaded a calorie tracking app (myfitnesspal). It is a food diary app with a limit on the amount of calories you could eat per day to reach your self-imposed weight loss goal. My initial thought of what is a healthy amount of weight I can lose? soon transformed into, what's the most amount of weight I can lose? And how quickly can I achieve it? So I chose the plan that would result in the most weight loss in the shortest period of time. I was never overweight to begin with and have been extremely active all my life. As soon as I could walk, I was playing a sport and if one was out of season, my parents put me in another. In elementary schoolI played in hockey, basketball, and baseball leagues all at once. Therefore, any extra numbers on the scale could be associated with the extra muscle mass I attained compared to the app’s default healthy weight range for typical 5’4 teenage girls. It can be associated with the simple fact that I was going through puberty and my body was changing. Nonetheless, in my head, I was fat and in no way ready for upcoming pool parties.
Cutting calories was a dangerous game that escalated quickly. At first, I would reach the app's recommended daily amount, but I realized by eating even less I would see results even quicker. And seeing those results felt so rewarding. At night I would ward off feelings of hunger and every morning I would lift up my shirt and stare at my stomach in the mirror. I recall running downstairs to my mom exclaiming “look how flat I am!” and her positive responses only reinforced my feelings of pride. My grandmother at this time complimented me for looking “more like my mother” as a reference to her petite figure that I just didn’t naturally possess. I do not blame the people in my life who were not fully aware of my disordered eating. If they had known, they most certainly would not have encouraged my new figure. This is why I stress that comments on others' weight should be withheld, even if you believe them to be positive, because you do not know what sort of fire you may be fueling in the other person's head. People with EDs or developing ones are incredibly skilled at hiding their behavior and you can never fully know who is going through what.
It felt good to be in control of my appearance, but I was otherwise miserable. I could not enjoy a meal without a secondary voice in my head telling me to spit it out. I associated each bite I took with a certain amount of calories, fats, and carbs. I had anxiety everyday at lunch when I had to figure out how I was going to transfer food from my mouth to my napkin without anyone noticing. I had anxiety when I couldn't perform at the same physical level I used to in my sports. In fact, I’d lost so much muscle I was in pain whenever I threw a ball because my joints were not supported enough for the stress I put them through. However, during my yearly check up with my pediatrician, nothing was mentioned of my weight dropping from the previous year's 140 lbs to nearly double digits (which I was upset about not reaching). A few weeks later however, my doctor called to inform me that my blood test results came in revealing that I had a high cholesterol. This was a turning point for me as I knew I had to make changes to my diet and, honestly, I was tired and becoming increasingly insecure of my frail figure and baggy softball pants.
Recovery has been a non-linear, multifaceted journey. The groundbreaking step for me was acceptance. Many with anorexia nervosa are in denial and hide their habits instead of seeking help. According to the Eating Disorders Coalition, only 1 in 10 people with eating disorders receive treatment. Meanwhile, a meta-analysis of longitudinal studies of patients with anorexia nervosa concluded that the disorder has a mortality rate of 5 deaths per 1000 people. With 1 in 5 of these deaths being due to suicide. (Mitchell, 2011). For these reasons, it is vital to treat the condition in its early stages, when a person is in that “almost” gray area. Therefore, everyone, especially parents, should be informed on what this gray area looks like. Waiting for someone to fit the DSM-5 credentials of a disorder before recognizing their illness is illogical and dangerous. People struggling with eating disorders deserve help before their condition worsens to the point where they're physically forced to create change. A lack of visibility does not not denote a lack of suffering.
“Apa Dictionary of Psychology.” American Psychological Association, American Psychological Association, https://dictionary.apa.org/anorexia-nervosa.
Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies. Arch Gen Psychiatry. 2011;68(7):724–731. doi:10.1001/archgenpsychiatry.2011.74
“Eating Disorders Coalition:” Eating Disorders Coalition: https://eatingdisorderscoalition.org/.
Thomas, Jennifer J., and Jenni Schaefer. “Introduction: A Touch of Anorexia.” Almost Anorexic: Is My (or My Loved One's) Relationship with Food a Problem?, Hazelden, Center City, MN, 2013.