Who is at risk for developing anorexia nervosa? People who become anorexic often were good children — eager to please, conscientious, hard working, and good students. Typically they are people pleasers who seek approval and avoid conflict. They may take care of other people and strive for perfection, but underneath they feel defective and inadequate. They want to be special, to stand out from the mediocre masses. They try to achieve that goal by losing weight and being thin. Some clinicians believe that the symptoms of anorexia are a kind of symbolic language used by people who don’t know how to, or are afraid to, express powerful emotions directly, with words. For example, making one’s body tiny and thin may substitute for, “I’m not ready to grow up yet,” or “I’m starving for attention.” Refusing to eat may translate to “I won’t let you control me!” People who develop anorexia often feel stressed and anxious when faced with new situations. Many are perfectionists who have low tolerance for change (including the normal physical changes their bodies experience at puberty), feeling that it represents chaos and loss of control. Some set rigid, unrealistic standards for themselves and feel they have failed totally when they cannot achieve and maintain the degree of excellence they demand of themselves. Although people with eating disorders don’t want to admit it, many fear growing up, taking on adult responsibilities, and meeting the demands of independence. Many are overly engaged with parents to the exclusion of peer relationships. They use dieting and weight preoccupations to avoid, or ineffectively cope with, the demands of a new life stage such as adolescence, living away from home, or adult sexuality. Who is at risk for developing bulimia? People who become bulimic often have problems with anxiety, depression, and impulse control; for example, shoplifting, casual sexual activity, binge shopping, alcohol and drug abuse, and cutting and other self-harm behaviors. They do not handle stress gracefully. They may be dependent on their families even though they fiercely profess independence. Many have problems trusting other people. They have few or no truly satisfying friendships or romantic relationships. They may diet, thinking to improve their lives and feel better about themselves. The deprivation leads to hunger, which leads to powerful cravings, which lead to binge eating. Feeling guilty, and afraid of weight gain, they try to remove calories from their bodies by vomiting, laxative abuse, fasting, or other methods of purging. Are some people at special risk? Because of intense demands for thinness, some people are at high risk for eating disorders — wrestlers, jockeys, cheerleaders, sorority members, socialites, dancers, gymnasts, runners, models, actresses, entertainers, and male homosexuals. Eating disorders and physical or sexual abuse Some clinicians find that a high percentage of their clients with eating disorders also have histories of physical or sexual abuse. Research, however, suggests that people who have been abused have about the same incidence of eating disorders as those who have not been mistreated. Nevertheless, the subject arises often enough to warrant discussion here. People who have survived abuse often do not know what to do with the painful feelings and overwhelming memories that remain, sometimes even many years later. Some try to escape those feelings and memories by numbing themselves with binge food or through starvation. Some try to symbolically cleanse themselves by vomiting or abusing laxatives. Some starve themselves because they believe they are “bad” and do not deserve the comfort of food and the nurture it represents. As with all eating disorders, the starving and stuffing that follow abuse are coping behaviors. The key to recovery is finding out what the person is trying to achieve, or avoid, with the behaviors. S/he then needs to find, and use, healthier and more effective behaviors to feel better and make life happier. Almost always professional counseling is necessary to complete the process. Western culture — an incubator for eating disorders People with eating disorders seek external solutions for internal problems. They feel empty, depressed, anxious, fearful, sorrowful, guilty, frustrated, insecure and depressed. They want to feel better, which is good, but they choose woefully ineffective ways of doing that. In fact, starving and stuffing have the opposite effect: they cause MORE emotional pain and distress. Nonetheless, manipulating food and body weight is encouraged by Western culture, which exhorts all of us, and especially women, to improve ourselves by “fixing” the external package, the body. Make-over reality shows on TV are a prime example. The message is, “Change your hair color and style, buy new clothes, paint your face, shove your feet into shoes that hurt and make walking difficult, tone your muscles AND LOSE WEIGHT and you will be happy, admired, and loved — an instant new identity, a new you. The problem is, of course, that sprucing up the outside (or starving it to death) does not fix what’s wrong on the inside. True happiness and deep contentment are achieved through psychological and spiritual growth and ultimate realization of one’s worth and place in the world, not by abusing the body. It takes a lot of wisdom and maturity to realize and accept this hard truth, and the young people most vulnerable to eating disorders are those who most lack those characteristics.