Norma (not her real name) was 18 the first time she saw Dr. Jean Wilkins, a specialist in eating disorders at Montreal’s Sainte Justine Hospital. Another one of Dr. Wilkins’ patients brought young Norma to see him. She was in bad shape. She suffered from restrictive anorexia.
Dr. Wilkins quickly determined that Norma’s life was in danger. But she refused to be examined. The doctor gave Norma the option of returning several days later – with her mother. His bet paid off. Norma came back and agreed to an examination.
Louise Marchand Files Anorexia, Health, Mental Health
According to Dr. Wilkins, establishing a bond of respect and trust with an anorexic patient is the first step towards healing.
After a long course of therapy, Norma began to put on some weight. She studied nursing. For a time she worked as a nurse trainee at that very same Sainte Justine Hospital.
The causes of anorexia are complex. It isn’t caused solely by a person’s family situation, or by some weakness within the sufferer. It’s the result of a complex mix of biological, psychological and social factors.
Dr. Howard Steiger is head of the eating disorders program at Montreal’s Douglas Institute, a psychiatric facility. He specializes in adult eating disorders.
“There’s a large biological component to anorexia,” he says. “It’s hereditary. Eating disorders run in families: for example, you see it in identical twins. But a genetic predisposition isn’t enough. Environmental factors trigger genetics.” So someone can be prone to anorexia, but won’t necessarily suffer the disorder. Something in their lives (family, environment, school…) will provoke an eating problem.
That trigger element varies among individuals. An individual might begin to diet, and go too far. Anorexia can arise as early as the beginning of puberty. Dr. Wilkins says some young girls stop eating to block body changes (growth, menstruation…). “Anorexia lets them put things on hold if they feel they’re growing up too fast. But it’s a trap.”
Media images don’t help matters. But societal ideals of beauty and fitness can’t cause someone to become anorexic all on their own. “Everyone can be influenced by these images,” Dr. Wilkins says. “That can contribute to anorexia, but it’s never the main cause.”
Not all experts agree. Dr. Steiger thinks that cultural stereotypes play a major role: “There’s biology behind eating disorders, but there’s also psychology. If we can reduce cultural pressure on people to lose weight, it’ll reduce the incidence of eating disorders. It’s worth the effort to try.”
No matter what elements set off an eating disorder anorexia never happens if the patient doesn’t refrain from eating at some point, says Dr. Steiger. “We can’t act on biological factors. But if we can reduce social pressures related to weight, some people won’t start to diet, and won’t become anorexic.”
Dr. Steiger is co-chairperson of the working committee of the Charte québécoise pour une image saine et diversifiée, (The Quebec Charter for a Diversified, Healthy Self-Image). This charter’s aim is to combat society’s cult of thinness. He’d like the mass media to represent a broader range of physical types.
“It’s really important to talk to influential people in these industries, whether it’s in the fashion world or the media,” he says. “We have to recognize that they’re in a position to have a positive impact when it comes to getting people to appreciate varied body types. Diversity is very important.”
The causes of anorexia are complex, and so are the ways available to treat it. In terms of biology, the first tool at the therapist’s disposal is food. When a doctor first receives an anorexic patient, job one is to get the patient to eat. That way, the patient’s life will no longer be in danger.
Forcing an anorexic patient to eat isn’t a long-term solution. It must be accompanied by psychological therapy. The reasons why the patient has stopped eating must be understood, and dealt with.
Dr. Wilkins cites the case of a female patient placed on weight-gain medication. She was fine with that. As she gained weight she observed that she wasn’t really deciding on her own to eat more; she was being forced to eat. She admitted that as soon as she was discharged from hospital, she’d go back to depriving herself of food.
That’s why Dr. Wilkins never force-feeds his patients. He thinks working on the causes behind the disease is a far more effective approach.
Teens at Risk
Teenage anorexia isn’t often associated with other psychological problems. But in adulthood, patients
can suffer from a multitude of other disorders, including depression and anxiety. They can have difficulty dealing with stress. They can become obsessive-compulsive.
Dr. Wilkins says patients need to understand that anorexia can’t be beaten overnight. It takes about 4 years to cure anorexia. “With this disease, progress doesn’t happen in baby steps, but in micro baby steps,” he says. “You can’t rush a patient. You can’t force someone to stop being anorexic. A lot of diplomacy is needed. A bond of trust has to be built.”
The therapist must tread lightly. “If you’re dealing with a young anorexic and you tell her, ‘you look a lot healthier,’ even if your intentions are good, she can take that to mean, ‘you’ve put on weight,’ or, ‘you’re fat.’ When starting out with young patients, it’s next to impossible to not say the wrong thing at some point.”
Caution is crucial when treating anorexia. And it’s important to impress upon the patient’s entourage the need for support in the healing process. All lines of communication must remain open.
Two Types of Anorexia
The first type is termed mental, or restrictive anorexia, characterized by fasting (not eating). These patients suffer from a phobia of gaining weight. They eat very little, and do a great deal of physical exercise to eliminate the few calories they consume.
The second type resembles the first. It is called bulimia. These patients go through cycles of excessive eating, then of purging (vomiting, laxatives, etc.). Malnutrition is the result. Women stop menstruating. Heart problems arise. The patient becomes obsessive about controlling their weight and diet.
- About 3% of girls aged 15-25 suffer from anorexia. In Quebec, that means 100,000 girls and women suffer from this disorder.
- 90% of all restrictive anorexics are female; 70%-80% of all bulimics are female.
- Between 5% and 20% of all restrictive anorexics die of the disorder.
- But there is hope: between 50% and 60% of all anorexics are eventually cured.
– From: ANEB (Anorexie et boulimie Québec) and The Academy of Eating Disorders