"Your daughter has anorexia nervosa."
My daughter Elena was seventeen years old when her psychiatrist told me this. At the time, I thought I understood her diagnosis. The articles I'd read linked anorexia nervosa to our society's glorification of the slender figure, so I thought my daughter was trying to diet - trying to get that "supermodel" look.
I was wrong. I had no idea what my daughter was going through. It's very hard for a mentally healthy person to understand the anorexic mindset. Here are some of the things I wish I'd known then about my daughter's disorder.
Elena's anorexia nervosa was triggered by a traumatic event. There is a strong link between trauma and anorexia nervosa. One study reported that 50% of the anorexic and bulimic patients studied had experienced sexual abuse. (http://www.ncbi.nlm.nih.gov/pubmed/2913600) And so had my daughter.
When Elena was thirteen years old, a stranger raped her at a party. Elena was a proud girl. She wanted people to see her as a winner, not a victim, so she hid the rape and didn't tell anyone. But her entire personality changed: she went from bubbly and happy to grim and bitter. When we pressed her, she insisted nothing was wrong.
My daughter's eating disorder was all about control. Shocked and humiliated by the rape, Elena felt herself torn apart by powerful negative emotions. Like many rape victims, Elena didn't want to accept the idea that this was a random event and out of her control. Random events can reoccur at any time - a horrifying thought to a rape victim. So Elena's subconscious mind concluded that the rape was her fault: she had been stupid and careless. But this conclusion turned those powerful negative emotions against her.
Tormented by shame, fury, and self-hatred, Elena began to restrict her intake as a way to discipline and punish herself. Rationing out food to herself and withstanding hunger pangs made her feel emotionally stable again. The starvation acted like a sedative on her overwrought nerves, fuzzing out the world and calming her anger and anxiety.
Elena's anorexia nervosa wasn't about looking like a model. Soon after the rape, when Elena first started restricting, she was afraid people would notice how distraught and ill she was. Instead, classmates began to compliment her and begged her to help them diet. This was a pleasant side effect but not a goal. Elena saw her own appearance as a kind of disguise she put on to fool the world. In fact, when she was at her worst, she wouldn't even look in a mirror. Her self-hatred and body dysmorphia became so severe that her reflection looked like a frightening stranger to her.
Over time, Elena developed a kind of phobia about eating. When I saw my daughter losing weight, I tried to tempt her into eating by cooking her favourite foods. It didn't work. Elena's compulsions had become so strong that the thought of eating terrified her. Since she was using the restricting to control away thoughts about the rape, eating began to seem like a re-experiencing of the rape. Like many anorexics, Elena has gone into full-blown panic attacks at the thought of being forced to eat.
Elena couldn't explain what she was doing. When typical people go on a diet, we usually have clear goals: a smaller size and hopefully a healthier body. But Elena was starving herself for reasons she couldn't understand. She had convinced herself that the rape didn't even matter to her, that it had been nothing but a minor inconvenience. She had no idea it was continuing to affect her life. Consequently, Elena had no real idea why she was restricting. Her eating disorder had become a series of powerful compulsions too strong for her to manage on her own. Since she couldn't explain this to herself, how could she explain it to anyone else?
One doctor visit wasn't enough. The first psychiatrist who saw Elena pronounced her completely normal. In my heart, I knew that he was wrong. I could tell that my daughter was far from well. But I let myself be reassured by his white coat and credentials.
Elena's daily life took tremendous courage. Life with anorexia nervosa is not just a diet gone wrong. Anorexia becomes a prison built up out of self-hatred and shame. Elena's disorder isolated her from friends and family, controlled her actions, and severely damaged her health. Anorexia is very hard to survive. Its complications shorten the lives of 20% of its victims. (http://www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics/) A significant number of these deaths are suicides.
I didn't realize how little I understood about my daughter's terrible illness until Elena and I began working together on her memoir, Elena Vanishing. Only then did I finally learn these things I wish I had known all along.
Hope and Other Luxuries, A Mother's Life with a Daughter's Anorexia, Clare B. Dunkle
Published by Chronicle Books
19 May 2015
£15.99