Anxiety, desire for control can be at root of anorexia
Anorexia is more than a diet gone too far. It is about much more than food, as it very frequently goes hand in hand with substance abuse or psychosocial disorders, such as depression or anxiety.
Special to The Seattle Times
Anorexia warning signs
Anorexia nervosa is characterized by an obsessive fear of gaining weight and a refusal to maintain a healthy body weight. Warning signs may include:
• Extreme weight loss
• Calorie restriction
• Obsession with food, eating, calories and weight control
• Denial of hunger or weight loss
• Excessive or compulsive exercising
• Strange eating habits or food rituals
• Refusal to eat certain foods or entire food groups
• Avoidance of social functions, family and friends
• Intolerance to cold, especially in the extremities
• Hair thinning or loss
Local Treatment Resources
The Moore Center
The Emily Program
Opal: Food+Body Wisdom
Academy for Eating Disorders
National Eating Disorder Association
Eating Disorder Hope
Kim Cantley’s first childhood memory is of having a panic attack in the shower.
When she was 7, she began to feel like she needed to change her body. At age 12, she decided that she could prevent her panic attacks by not eating.
Initially, her plan appeared to work — the sense of control she gained by restricting her food did lower her anxiety. It also kicked off her 12-year struggle with anorexia.
Lisa Geraud, senior clinical director at The Moore Center in Bellevue, said anorexia is not always about wanting to be extremely thin — sometimes it’s about wanting to feel in control.
Strictly regulating food and body weight offers a small sphere of control for people who otherwise feel out of control. When this is the case, unintentional weight gain may lead to thoughts of “I’m losing control” instead of “I’m fat.”
For years, Cantley, 26, of Kennewick, hoped in vain that her panic attacks would “just go away.” She sought treatment for her panic disorder when she started college, finally receiving an official diagnosis.
“That made it worse, because then I really knew there was something wrong with me,” she said.
Medications failed to prevent her attacks, and restricting her food no longer gave her the feeling of control she craved. When she was 21, she turned to alcohol to try to numb her anxiety.
Geraud said it’s common for eating disorders, substance abuse and mood disorders such as depression or anxiety to coexist.
“There are often pre-existing anxiety disorders in people who develop eating disorders, especially as children” she said.
Children tend to think in very concrete terms, she said, and when they have anxiety or other uncomfortable emotions and feel the accompanying physical sensations in their body, they may think that if they can change or control their body, they can prevent those emotions and feelings. Alcohol or drugs might be used for the same purpose.
“You think you are gaining control, but you’re not,” Cantley said.
With her panic attacks becoming more and more frequent, she left college to work as a barista. At just over 5-foot-7, her weight dropped to less than 100 pounds.
“I looked terrible,” she said. “My customers kept asking me if I was OK. I would tell them, ‘I don’t know what you mean. I’m fine.’ ”
When she was 24, two things happened: Her control over her panic disorder — and her life — hit rock bottom, and she became an aunt.
“I made a promise when my nephew was born that I would start living a healthy life.”
She didn’t know how to tell her parents that she needed treatment for her anorexia, so she sent them an email.
“They were completely supportive. Everyone was supportive. I had more support than I thought I would, but I don’t know why I thought I wouldn’t.”
Cantley’s parents had suspected something was wrong but didn’t know what to do. She said it had been relatively easy to hide her eating disorder from them while growing up. She had never had a big appetite and her weight, while unhealthily low, remained within a socially acceptable — even desirable — range through high school.
“It was in college that it got bad,” she said. “I dropped down into kids’ sizes.”
She spent three months in the five-day-a-week partial hospitalization program (PHP) at The Moore Center before deciding that she needed help 24-7.
“On the weekends, I would just exercise and drink coffee.”
She relocated to Florida to spend a few months in residential treatment at the Renfrew Center. (The Moore Center’s PHP program is now seven days a week, and they will be offering residential care on the Overlake Hospital Medical Center campus later this spring).
Cantley, now a flight attendant, hasn’t had a full-blown panic attack since completing treatment. She needs only a fraction of the medication she once took and makes a point of eating regularly and normally. When she skips a meal because her schedule makes it inconvenient to eat, she notices an increase in her general anxiety level.
“I still have alcohol once in a while,” she said, “but I don’t need to anymore.”
Carrie Dennett is a registered dietitian nutritionist with a Master of Public Health degree in nutritional sciences from UW. Her blog is nutritionbycarrie.com and her website is carriedennett.com. She can be reached at firstname.lastname@example.org.