Reflection - Anonymous

Lifting the Weight off My Shoulders: My Struggle with Anorexia Nervosa

Anonymous UC Davis Student

Many of my friends and peers who discuss having children ask me how many I would potentially want to have in the future. When this topic is presented to me, it feels as though someone has jabbed a knife into my lower abdomen. e phantom menstrual cramps that occur even without a proper functioning uterus are not the only source of the stomach pain though. If asked about hypothetical o spring, I usually respond with a lie about how I haven’t thought about it or how it will depend on the other genetic contributor of the child. e truth is that I have thought about this topic, probably too much. I will not be able to have children because of my past struggles with an eating disorder, speci cally anorexia nervosa. Anorexia nervosa is a psychiatric disorder that is de ned primarily by limited food intake and body mass indices below normal.5 is is something that I have had to come to terms with in the recovery process of my eating disorder and has had physical, emotional, and psychological consequences on my life.

The prevalence of eating disorders among high school and college athletes, although speci c values vary, is approximately 20-24% compared to the national average of approximately 1-3%.6 Knowing this, it is not shocking that my eating disorder developed when I was playing four high school sports: tennis, soccer, swimming, and diving. I was fteen years old. I should have been experiencing the hormonal and bodily changes of puberty. Most eating disorders occur in adolescent and young adult females from fourteen to twenty years of age.5 All of the sports I played had di erent coaches with di erent expectations for how their players should diet and work out. I sought to please all of my coaches by adhering to their strict requirements for dieting and exercising. I desired perfection of their standards. Perfectionism is a prevalent antecedent to eating disorders because of a strict adherence to rules that individuals follow.6 No one ever questioned me when I started to lose weight. ey just assumed that I was thin because of the various sports I was involved in, though my weight was 20% below the ideal weight for a ve foot six female.11

My parents were always concerned with me eating enough, but they did not question me when I told them that I had eaten earlier or had gone to dinner with friends. What they, and others, didn’t know was that I was so concerned with becoming fat that I would do extra workouts after my three- hour practices and limit my food intake to approximately 500 calories per day. Covertly, I ran in the morning before my parents woke up, or late at night after they had gone to bed so that nothing was suspected. Like many others with eating disorders who feel a sense of control with eating, refusing to eat and exercising excessively gave me control as well.11 My psychologist suspects that I knew that what I was doing to my body was unhealthy, but I was not willing to change because my disorder had such a hold on me. is concealment of disordered eating is another reason that many cases of anorexia nervosa and bulimia nervosa, a form of eating disorder that involves binging and purging, go unreported.3 Both excessive exercise and limitations of food intake are primary symptoms of typical anorexia nervosa3, but I didn’t tell anyone about my obsession with having a perfect body for the sports that I played.

As a sixteen year old, I did not consider the complications that could result from forcing my body to look “perfect.” I was only concerned with the voice in my head that told me that I didn’t deserve food when I missed a shot in soccer; I couldn’t turn it o . ough I was one of the thinnest athletes on my teams, my mind thought di erently. ere was always something to change, something to obsess over, something to consume my mind and how I viewed myself. Individuals with an eating disorder commonly have other comorbid psychiatric disorders, including a number of anxiety and mood disorders5 Unlike nearly 50% of individuals with anorexia nervosa who also su er from depression and suicidal thoughts, I was never depressed or had thoughts of suicide, though my obsessions prove that I struggled with an anxiety disorder.5

Extreme dieting and exercising contribute to what is known as the Female Athlete Triad, a combination of amenorrhea, osteopenia, and disordered eating.7 Amorrhea, the absence of a regular menstrual cycle, is also common in athletes without eating disorders and can be caused by excessive exercise.7 e delayed onset of puberty is also the cause osteopenia, or a lack of normal bone mineral density.7 For me, the e ects of this could be noticed by the large amount of stress fractures that resulted while playing sports and the extensive amount of time that I had to sit out for injuries. No one suspected that I would punish myself when I got these injuries by refusing to eat. is reinforced the third part of the triad, disordered eating. I knew that I had an obsession, but I was unwilling to change.

I thought things would be different in college. I turned down sports scholarships from various colleges, eliminating the reason to perfect my physique for my sport. I was moving away from the coaches, sports, and expectations that followed. When people asked me what I was most anxious about in college, I usually said that I was afraid of gaining the Freshman Fifteen, the common weight gain that many college students experience, showing that my disorder still had an intense hold on me. Little did I know that college students are particularly susceptible to eating disorders because of the stresses associated with the adjustment to college life.10

Like many other freshmen, I found that college is much harder than high school academically. Even when I studied long hours for a test, I would not get the grade I wanted. I could not always control my grades, but I still had control of my diet and exercise routine. Disordered eating is often preceded by feelings of lack of control and a strong desire to maintain control.8 Skipping meals at the dining commons and avoiding social endeavors so that I could workout became part of my routine. e obsession that I had with food and exercise was overwhelming; the voices in my head telling me that I wasn’t good enough only grew louder. Critical inner voices occur in approximately 65% of individuals with eating disorders, often leading to negative self-talk and depression.10 I was barely able to stand up for three hours in chemistry lab, though I was able to explain most of my fatigue and fainting by telling others that I had been up late studying and hadn’t slept much. No one was able to help me because no one knew there was an issue.

Though I avoided most doctors, as do many others with eating disorders, I was required to get medical clearance in order to study abroad.10 During the introductory questionnaire session, the attending physician asked me the date of my most recent period. I couldn’t remember; it had been so long. Approximately half of patients with an eating disorder experience reproductive system complications and a delayed onset of puberty.11 I explained that I had rst gotten my period when I was sixteen and had it for a few months since, but hadn’t had it in a long time. With a panicked glance rst at me and then at my chart, the doctor excused herself for a moment and returned with three other doctors: a gynecologist, a psychologist, and a nutritionist. ey had collaborated and expressed concern for my overall health, each asking questions speci c to their specialty. It wasn’t until then that I realized the full extent of what I had done to my body. I had an eating disorder.

I broke down in the arms of four strangers who were more concerned for my health than anyone else had been in the past four years. ough many health professionals fail to recognize and treat eating disorders in their patients1, my doctors recognized a problem and were committed to treating me as soon as possible. ey ran a number of blood tests that checked for hormone and vitamin imbalances. I also completed psychological tests and surveys, which are typical for psychiatric treatment of eating disorders. Tests for GnRH levels, hormones associated with reproduction, and vitamin levels for malnutrition are common in the diagnosis and treatment process of eating disorders.1 Each doctor explained my current condition di erently, using the tests to reinforce their diagnosis. ey educated me on the damage I had done to my body. I decided I wanted out. I wanted the voices in my head gone.

I began a very detailed and extensive recovery process including psychiatric, nutritional, and hormonal measurements. e same day that I was diagnosed with anorexia nervosa, I was given a strict protocol, including eating and exercising logs, mood calendars, and a double round of hormone treatments. Cognitive therapy is the most common treatment for eating disorders because of the primarily psychiatric component of the disorder, but physical measures may also be taken for treatment.4 I was on the long road to recovery. Looking back, I asked my doctors why they took time to help me when they could have as easily just let me go on my way. ey concurred that because it’s so di cult to recognize an eating disorder, they had recognized mine and wanted to be certain that they treated me while they had the chance to. Estimates show that nearly 45% of eating disorders are undiagnosed by doctors, but are later realized due to the bodily e ects presented.11 Many doctors, including my own, are currently using my case as an example to help fund better educational opportunities about eating disorders to medical students.

Though the malnutrition I experienced was correctable, other body systems were more permanently a ected. e current recovery rate for patients with eating disorders is approximately 78% with su cient treatment and proper therapy, showing a positive outlook for these disorders.11 My nutritionist helped me view food in a positive way again; food was no longer the enemy. My psychologist helped me realize my perfectionist and obsessive tendencies, working to remediate both and nd a healthy way to think about my body. I started doing yoga, a common anxiety disorder treatment3, to alleviate my anxiety and reach new personal goals with new poses. I began hormone treatments to raise my baseline levels of reproductive hormones and correct the years of damage that I had caused. I was able to get back on track in school and I started enjoying my classes again.

Things were looking up. A few months into the recovery process, I saw my gynecologist to discuss my hormone treatment results. She walked into the room with the results, shaking her head. e reproductive hormones GnRH, TSH, and LH, essential for proper reproductive function, were still below normal levels.11 We were at the end of the second round of treatment and nothing had changed; there were no other treatment options. My eating disorder had caused severe damage to my endocrine system and su cient hormone levels could no longer be produced for ovulation. In order to maintain essential body functions such as heartbeat and brain function, my reproductive system was compromised.11 With the failure of hormone treatment and other medications, I lost the hope of ever having children. My gynecologist began a discussion on other options for parenting, but I wasn’t interested in listening. All four of my doctors contacted me frequently during the week to be sure that I didn’t relapse or slip into old habits after hearing the hard news. When I was diagnosed with anorexia a few months prior, I knew that there was a chance that I would lose reproductive capabilities, as about half of women with eating disorders do.5 I thought that I would prevail; I didn’t want to be included in another eating disorder statistic.

Being told at age nineteen that I was sterile didn’t hit me right away, but rather it has hit me slowly over time. It hits me on the days when I see pregnant women walking through the farmer’s market, looking happy and carefree. It hits me when I hear others tell me that I have my dad’s nose or my mom’s hair, knowing that I can’t pass on these genes to my own child. It hits me when friends tell me about the experience of pregnancy, knowing that I will never experience it.

I am forever indebted to my four doctors who used their instincts and medical knowledge to diagnose me and see me through the recovery process to today. ese doctors’ attention to detail was crucial in a situation where many cases go unreported. Many doctors are calling for better education about eating disorders in medical schools.11 When I am asked how I will avoid relapse in the future, I usually emphasize that I know too much about anatomy and physiology now. e biopsychosocial impacts of anorexia nervosa prevented me from having a normal adolescence and will prevent me from experiencing pregnancy in the future. ough I cannot change what happened in my past, I look towards the future with a new hope for life; I am free from the weight of my

disorder.

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