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Illustration by Mary Berger

November 11, 2021

Perseverance Against Deterioration

Opinion: Speaking the unspoken: My experience with anorexia nervosa and its effect on adolescents under stress

By Hannah Burkhart | For The Post

Content Warning: This story discusses disordered eating and body dysmorphia.

The discussion of anorexia, and any type of disordered eating, can make people who have been personally affected by it extremely uncomfortable and trigger them. I am one of those people.

The term “trigger” in disordered eating refers to words, actions or any type of interaction that reminds someone with the disorder of their experience, and in many cases, leads them to fall back into old habits.

Anorexia nervosa is an eating disorder in which one obsesses over their weight and what they eat to the point of starving themselves and overexercising. It includes an intense fear of gaining weight, according to the Mayo Clinic, as well as a distorted body image.

The stigma of not talking about eating disorders, especially anorexia, is still in full flame, because many people who have anorexia are in denial, and people who have struggled with it in the past may be triggered by the term itself. I have been in both of those positions, but I want to try to create change in the discussion of anorexia, and I have decided to tell my story.

Louise Cruz, nutrition education coordinator at WellWorks, said disordered eating should be properly discussed because it is an illness, just as any other illness is, and when it comes to an illness, the first step to recovery is talking about difficult experiences.

“Depression, and all kinds of mental illness now, is coming to the forefront,” Cruz said. “This is something we deal with. It's normal, and same thing with eating disorders. It's a thing. People are easily triggered toward them even more so now, so people do need to talk about them so they know that they're not alone, and that there's hope, and that it's necessary to get treatment.”

“Depression, and all kinds of mental illness now, is coming to the forefront,” Cruz said. “This is something we deal with. It's normal, and same thing with eating disorders. It's a thing. People are easily triggered toward them even more so now, so people do need to talk about them so they know that they're not alone, and that there's hope, and that it's necessary to get treatment.” —Louise Cruz, nutrition education coordinator at WellWorks

Angela Bohyer, a professor of applied health sciences and wellness at Ohio University, said people with anorexia in particular risk their health by not eating enough, which is defined by nutritionists and dieticians as inadequate nutritional intake. People with anorexia oftentimes have an inadequate intake of many vital nutrients.

“Typically, people that have eating disorders, and this is specifically those with anorexia nervosa, people have inadequate intakes,” Bohyer said. “That means an inadequate intake of carbohydrates, protein and fat. Then also, when people start eliminating foods and they start eliminating calories, they sadly then don't get enough of the micronutrients, which are vitamins and minerals.”

Bohyer said there are multiple possible long-lasting effects to the body from anorexia, with one being the kidneys shutting down. Not ingesting enough carbohydrates over a long period of time has a serious effect on vital organs.

According to Gaudiani Clinic, acute kidney injury, in relation to eating disorders, is caused by dehydration and volume depletion, a contraction of the kidneys, as a result of the body’s sodium loss. Chronic kidney disease can also develop from eating disorders if they have gone untreated over a longer period, like months or years. Eating disorders that include the act of purging food from one’s stomach, such as bulimia, lead to the biggest risks of kidney damage.

Cruz said one of the scariest effects of not getting enough nutrition is cardiac problems. She said people with anorexia can start experiencing heart palpitations early on in the disorder, and that it can lead to heart attacks or complete heart failure. She added that another long-lasting effect of malnutrition is developing a brittle skeletal system from the deprivation of calcium and vitamin D.

The summer after my freshman year of high school, I was overexposed to photoshopped images on social media of models and Instagram influencers. I spent most of my time scrolling through different pro-anorexia, or pro-ana, hashtags on Tumblr for “thinspiration” to become the thinnest I possibly could.

I have always been a petite girl, but when I saw images of girls with thigh gaps, tiny waists, defined ribs, collarbones and exposed hip bones, I started to see myself differently in the mirror. As a cheerleader, I had very muscular legs, but I started to see that muscle as fat when I looked at myself. I started to view the vital organs in my lower stomach as a fat pouch.

I became addicted to watching myself fade away.

Throughout middle and high school, I did not have very many friends. I was shy because every time I tried to speak up, people looked at me and continued to talk among each other. Since I did not have many friends, summers were quite boring for me. Social media was my getaway from the reality that was my lonely life. I had several internet friends who seemed to relate to me when it came to my mental health and body image issues.

Although I was not popular in school, I had a few close friends who would have done anything to be there for me, but when they mentioned anything about my weight or avoidance of food, I was in complete denial.

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Mary Berger

The addiction started with me simply cutting out all fast food, but then I started cutting out all greasy foods, then any drinks with “empty calories” and then I cut out all meat except for chicken. My family noticed that I stopped joining them at the table for dinner. They would try to encourage me to eat the food my mom prepared, but with my calorie counting, I was fearful of practically all foods other than apples, oatmeal, salad, boiled eggs and toast. I over-exercised to the point of exhaustion.

Bohyer said some people with anorexia focus on just a few foods for their diet. She said this could be because they find comfort in those foods, or they read on the internet that a certain food is super healthy and decide to only eat that food for a long period of time.

“Typically, people will only do this maybe for a few days,” Bohyer said. “But with somebody who has an eating disorder, it becomes more chronic, so it becomes weeks and weeks, and weeks can turn into months. If you only eat kale and oatmeal for months and months and months, you start to systematically eliminate vitamins and minerals from your diet.”

If you only eat kale and oatmeal for months and months and months, you start to systematically eliminate vitamins and minerals from your diet.”—Angela Bohyer, a professor of applied health sciences and wellness at Ohio University

If family or friends tried to give me food, I would cry in fear. I had this idea in my head that just by smelling or touching food I would gain weight. I started avoiding going places with friends when I knew food would be involved. I stopped going out to eat with my family for special milestones because I preferred eating oatmeal, a piece of toast and an apple for dinner everyday. I slept in until noon during the summer so I would be able to skip breakfast.

I was literally deteriorating. Friends stopped inviting me to places because they knew I would say no if food was involved, so my social life completely disappeared.

Bohyer said another reason people with anorexia may not want to go out in public is because of the idea of their body being perceived by other people. She said oftentimes, people with eating disorders hide their body with baggy clothes because they do not want other people to know what they really look like, or they believe they are not as thin as they want to be.

The warning signs my family and friends saw in me that I did not see at the time, aside from extreme thinness, included my unhealthily pale, nearly purple skin; my menstrual cycle abruptly stopping; my hair falling out; a constant state of anger and sadness and much more. Since then, I have deciphered that my sour mood was most likely due to lack of vitamin C and vital carbohydrates.

Bohyer said my distinctly pale skin also could have been due to anemia, which would have been caused by the fact that I was not getting enough iron intake. She also said my hemoglobin, a protein responsible for transporting oxygen in the blood, and hematocrit, the volume percentage of red blood cells in blood, could have been low.

My struggle was not unwatched. People wanted to help me. My parents tried to have conversations with me and explain to me that what I was doing was not healthy. I remember my mother crying as she tried to get through my head that others did not see me the way I saw myself. My best friends sat me down and told me they noticed me dodging events that included food and tried to help me open my eyes. Classmates from school messaged me on Instagram asking if I was okay when they saw my beach photos over the summer.

After noticing my family’s concerns at Thanksgiving my sophomore year of high school, something started to click. I became embarrassed and ashamed of myself. I proved to my parents that I was serious about recovering by eating a bowl of Cheerios and a bite-size piece of Hershey’s chocolate before bed one night. My dad helped me get into lifting weights and bought me chocolate Ensure Plus. My obsession switched from losing weight to seeing my muscle gains.

I started going to the gym everyday to lift from that point on. As a reward for the start of my recovery, my parents paid for a membership for the nicest gym in my local area. I went from 94 lbs to 125 lbs.

I recovered forever, or so I thought.

During my senior year of high school, I started cutting out foods again because I was looking at myself in the mirror too often and became self-conscious about my stomach. I had full-blown body dysmorphia. I remained below 110 lbs until midway through my freshman year of college. I had more friends in college who related to my experiences and knew what to do to help me.

Today, I am 135 lbs, and I’m the healthiest I have ever been, but something that people must know about eating disorders is that for some people, the triggers never truly go away once diagnosed, even after recovery.

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Mary Berger

Since my experience with anorexia, multiple social media platforms have attempted to curate pro-ana posts through the use of content management strategies, including deleting posts violating guidelines. According to The Atlantic, Tumblr officially announced on February 23, 2012 it would moderate blogs that "glorify or promote anorexia, bulimia, and other eating disorders; self-mutilation; or suicide.” Although this is true, I was still finding pro-ana posts on Tumblr from 2014 to 2015.

At a few points throughout my eating disorder journey, I downloaded various calorie-counting applications, and I truly believe these apps can take eating disorders to an entirely different level. According to Duke Health Center for Eating Disorders, “26.1% of participants in one study described that fitness/exercise/weight loss applications further perpetuated their disordered eating behaviors and attitudes.”

Although I was young when anorexia first affected my life, people of all different demographics experience eating disorders for a multitude of reasons beyond the pressures of society’s beauty standards. COVID-19 has also driven an increase in eating disorders for some.

“It doesn't always have to start in the teens,” Cruz said. “It can start in the twenties, it can start in the thirties. It can start any time, and right now, with COVID, I see more eating disorders now than I did before, and it's not always just anorexia. There's this other big piece of binge eating now, in which people binge and restrict, reward and punish, and it's just as much an eating disorder as anorexia is.”

OU’s Counseling and Psychological Services provides support for students suffering from disordered eating. Cruz said she is a resource available for students to meet with through the university after a CPS release and referral for counseling and further help.

AUTHOR: Hannah Burkhart
EDITOR: Taylor Burnette
COPY EDITOR: Anna Garnai