7 Things No One Tells You About Anorexia

It’s not romantic, it’s not sexy, it’s just grotesque.

Detail from Danse Macabre in St. Nicholas’ Church, Tallinn, Estonia by Bernt Notke (1435–1509), Wikipedia

I’ve written about my experiences with my eating disorder before. One doesn’t really choose to have anorexia or bulimia or to overeat so it is important that if you’re going through it right now you know that this isn’t your fault. It can happen to anyone, male, female, rich, poor, gay, straight, and the triggers for it can be depression, anxiety, autism, economic stress, and on and on and on. The purpose of this list is to just be painfully honest about what you’re in for.

1. You’ll be lethargic, but unable to sleep.

This was one of the first things that happened to me. I’d go to bed at about 11 pm and wake up at 4 am. At first I thought this was great because normally I need eight hours of sleep and here I was doing “just fine,” on six. But the problem was I couldn’t, sleep more than six hours in a go, but I also was extremely tired throughout the day.

If you think about it, it does make perfect sense. When you stop eating or aren’t getting a reasonable amount of especially but not exclusively protein your body doesn’t need that much time asleep to do that metabolic voodoo that it do, but it also doesn’t have the resources to fuel your mind. Which brings me to number 2.

2. You won’t be able to concentrate and you may experience memory loss.

This is one of the more annoying symptoms that accompanies an eating disorder because you will fall into this cognitive fog slowly enough that you don’t notice and when you lose memories, they’re gone meaning your social interactions are going to get really weird. I had about two very serious bouts of anorexia and unfortunately one was during my MSc coursework. I actually did fine, but I probably could have done much better if I was eating. (Also, just … don’t have an eating disorder while you’re studying human remains because it gets really disturbing really fast.)

You might wonder what’s going on here and … okay so here’s a neuron:

You can sort of think about a neuron like an electrical wire, and while that’s very simplistic and I’m not getting into immune and endocrine stuff here (which are also heavily impacted by an eating disorder), this will do for what I’m trying to explain. That “myelin sheath,” bit is made of glial cells and basically acts like the wrapping of an electrical cord. It dampens electrical conductivity in that area so that there is only connectivity at the dendrite and the axon. Again, I’m simplifying here but the myelin sheath is basically fat.

Your stressed body will naturally protect your brain, but there’s a limit to what it can do. When you start to get sick your brain will globally atrophy and … well … don’t be chowing down on fat, but your neurons need a bit to survive so just keep that in mind. Literally.

3. You will become socially isolated.

Because my eating disorder flair up coincided with my MSc and moving countries I had a better time of this than most people. I was sort of forced to socialize and others were forced to at least talk to me. That said, I know for a fact a lot of them really didn’t like me. In some cases it was down to jealousy. Which is absurd. But the sad fact of the matter is there is a lot of pressure on young people to be thin and so some people are going to look at you an not see your illness and the struggle you’re going through and only see that you’re skinny.

But more relevantly to basically most reasonable human relationships your cognitive and psychological issues during an eating disorder flare up are going to make you a TERRIBLE friend. You’re not going to be able to eat with other people — obviously — and they will feel weird eating around you. But more than that you’ll forget things they’ve said to you and you’re not going to be able to be there for them when inevitably they have issues.

This is not to say you’ll lose your friends. You won’t. Some people are always going to be stand up, but there will be quite a few people who just don’t have the patience for you. It’s not right and those people suck, but it’s going to hurt you regardless of how in the wrong they are.

4. It’s REALLY cold.

I don’t mind cold weather at all. In fact, I rather like it. I love snow and I love winter sports. If I had to choose being too hot or too cold in general I would choose cold. But there’s cold and there’s the sort of permeating, unrelenting cold you get when you are too thin. It’s a bit difficult to explain because it’s just so intense that unless you’ve been through it you can’t truly understand it, but I’ll try.

Imagine how on a winter’s night you maybe have a nice warm bath, get all dry and wrapped up in warm pyjamas and then curl up in a big soft cushy bed with lots of pillows and blankets. It’s nice right?

Now imagine doing all that but still being cold. Imagine heaping all the blankets you have on your bed and still feeling cold. Imagine putting on your warmest pyjamas, realizing they’re not warm enough and then adding thermal underwear socks and a sweatshirt but still being freezing cold. Imagine building a fire or turning on your heater and wishing you could just burn your skin on it just for that fleeting feeling of warmth.

This one I’m not quite so sure of the biological causes but I imagine it’s once again your body’s stress response. Your body is trying to protect your vital organs like your brain and your heart and it’s doing that by cannibalising your muscle and bone and redirecting most of your blood-flow not to your limbs but to your core so that even when it’s warm out your body is still acting like you’re hypothermic.

So basically, you’re starving yourself so you can look good in a swimsuit but you won’t have any muscle tone and you’ll be so cold that wearing a swimsuit even in the hottest summer is painfully cold.

5. Your bones will hurt.

This is what I usually cite as my wake-up call. I was walking back from lab one afternoon because I had some writing to do that I was hoping to work on in my dorm room. I normally returned late in the evening. It wasn’t a super cold day, in fact it was spring. I was carrying my backback with a computer and books and who knows what all else. Anyway, there was a slight breeze and I genuinely thought my sternum was going to break.

If you’ve ever broken a bone you know how bone pain feels. It’s not awful really, but it is constant and because it’s your skeleton you don’t really think about it until it happens. So to give you an idea of how this feels, if you’ve ever had a fracture it’s that, but all over. And it happens relatively fast. Medically speaking when this happened to me I was not underweight. I was stable. But I was underweight for me so my body was trying to adjust.

So, for adults and to a degree for adolescents as you start to starve your body will try to get the necessary nutrients from body fat, then muscle and then bone. When it gets to the bone it will eat the trabecular and cortical bone and will — as a result of that wreak havoc on the axial skeleton.

Quick anatomy and biochem reminder. Your axial skeleton consists of your skull, backbone (vertebral column), ribs, breastbone (sternum and manubrium), and pelvis. These bones have a great deal of trabecular bone which is sort of a latticework that makes up the structure of particularly vertebrae but also the inside of the ends (epiphyses) of your long bones. Cortical bone is found in the inner part of the shafts (diaphyses) of your long bones. Additionally, bone is made up of lots of important nutrients including calcium and phosphate. These are somewhat difficult to find in a normal diet and are quite difficult to properly metabolise even if you are eating properly and so if you starve yourself even though the bone is the last thing the body will go for it comes up pretty fast just due to the necessity of those nutrients and the difficulty of supplying them.

Basically, I’m talking about ostepenia or bone loss. This puts you at increased risk for fracture and if you’re female particularly if you have had or want to have kids later this will increase the likelihood of you developing osteoporosis in later life. And it hurts. It’s just a constant feeling of fragility.

6. Your skin, nails, and hair will degrade

I kind of knew to expect this because it’s one of the earliest signs of nutritional deficiency, but I noticed about a month in that my hair was getting brittle and dull. I won’t say it fell out in clumps but I was losing a lot of hair. It broke pretty easily. What did surprise me a bit was that my nails also got quite brittle and broke frequently and my skin became thin. I’ve always bruised pretty easily, but when I was quite sick if I bumped into something or if someone gently touched me I’d bruise and sometimes even bleed.

The upside of this is you’re unlikely to have acne, but I don’t know that nearly dying is really an appropriate response to even the worst acne or skin condition.

Once you start recovering your skin will bounce back pretty quickly but the hair, particularly if you wear yours long will take some time to recover. It is literally not pretty.

7. Recovery is going to be mentally as difficult as the disease itself.

The way I got out is I had these two guy friends who told me they wanted to work on their flexibility and asked me to join them at the gym. The deal was I’d go with them to the gym work out with them, help them stretch and then maybe we’d go get food together or maybe just hang out. One of them absolutely knew what I was going through, but I’m not sure if they both did. But they didn’t make me eat, they just got me exercising and commented how food helps them build muscle and feel good. To be just totally honest, I’m not even sure if they were doing it on purpose or if this was just their normal routine and they genuinely wanted someone who knew how to stretch and had a good understanding of human anatomy.

But I do remember every single time I was in that gym I was having a crisis that the muscle I was gaining would cause me to gain weight. Intellectually I knew this was good for my health and my gym buddies successfully got me hungry enough that I did start eating again, but I had increasing anxiety throughout my recovery.

I really recommend if you’re ready to try to get better getting a regular exercise routine because it absolutely does help and gives you a sense of accomplishment and ownership of your body and health. But I also recommend that you try to get a counsellor or get into a support group. This was not available to me due to my location, responsibilities, and financial situation, but I could have benefited from it.

As you recover you will experience relapses whether they be you actually purging or skipping meals again, deriding yourself for gaining weight, or just thinking about engaging in destructive habits. This is not really something you can control which is why its important that you have a good support structure. I had to rely on my friends, and as such feel indebted to them even though I know I was also there for them. But one that’s a lot of pressure to put on your social group even if they don’t mind and two there are professionals who are trained to help you out here. If you’re in a position to take advantage of their services then do so.

If you’re struggling with an eating disorder you have my utmost sympathy. I’m going to list some resources for US and UK hotlines and organisations where you can get support. I haven’t checked these out and cannot vouch for them, and some of these are specialised to the particular disorder and not all of the numbers are free or 24 hours, so do visit the sites and try to find the best fit for you. If you are family or friend of someone with an eating disorder there are some resources here for you as well. I wish you luck in your journey.

USA:

National Eating Disorders (NEDA):

https://www.nationaleatingdisorders.org/help-support/contact-helpline

Online chat available at site.

Phone: (800)931–2237

Text: (800)931-2237

ANAD:

https://anad.org/our-services/eating-disorders-helpline/

Phone (630)577–1330

Eating Disorder Hope:

https://www.eatingdisorderhope.com/treatment-for-eating-disorders/get-help

Phone: (800)931–2237

UK:

Anorexia and Bulimia Care (ABC):

https://www.anorexiabulimiacare.org.uk/

Phone: 03000 11 12 13

Beat Eating Disorders:

https://www.beateatingdisorders.org.uk/support-services/helplines

Online chat available at site.

Helpline: 0808 801 0677 or help@beateatingdisorders.org.uk
Student line: 0808 801 0811 or studentline@beateatingdisorders.org.uk
Youth line: 0808 801 0711 or fyp@beateatingdisorders.org.uk

Life Works:

(lists numerous helplines and charities that can help)

https://www.lifeworkscommunity.com/eating-disorders-treatment/guide-to-uk-free-eating-disorders-helplines

Doctor of Palaeopathology, rage-prone optimist, stealth berserker, opera enthusiast, and insatiable consumer of academic journals.

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