The physiology of starvation
The physiology of starvation must not be underestimated. Starvation is addictive and it takes hold extremely quickly. It causes changes to both the body’s and the brain’s physiology. Whilst initially someone on a restrictive diet or with reduced food intake due to an illness may not be showing anorectic thoughts initially, they will creep in after a week or two of restriction.
After only a day or two of restriction people experience starvation highs which are similar to the endorphin hit after exercise. Next, the starvation cognitions develop, mood deteriorates, depression, social withdrawal and anxiety all set in. Body dysmorphia, negative and obsessive thoughts about shape and weight, fear of certain foods and around eating develops and social situations become difficult. Personalities change as once gregarious, fun loving people become anxious, quiet and withdrawn. All of these symptoms care a consequence of food restriction (as well as in some, a cause) and this is how it is possible to ‘slip’ into anorexia in the absence of an obvious psychological trigger.
Boys and men often develop it after a stomach bug or other illness which has caused a limited food intake. This is what the Minnesota Starvation Study (Ancel Keys, 1945) so clearly illustrates. When the depression and emotions that people with anorexia suffer are the result of starvation we can’t treat those without re-feeding because they won’t lift until a young person is at 85% weight for height and this is why step one of treatment is always re-feeding and weight gain.
In many ways starvation is like any other addiction: drugs, alcohol, nicotine etc. The significant difference, however, is that addictive substance (food or the lack thereof) can’t be removed as it can in every other addiction, and it is this that makes eating disorders and particularly anorexia, so incredibly tricky. The analogy with alcohol - that an alcoholic in recovery can’t even have one small drink as it can trigger a relapse - so an anorexic in recovery can’t skip a meal or a snack as the pull back to restriction can just be too great.
What often makes food restriction so appealing is that it gives people a sense that they can control a tangible area of their life, when much or all of the rest of it feels out of control. Of course, that sense of control is deceptive as the illness takes control so fast, both physiologically and psychologically, and one is actually out of control leaving the illness in control.
Starvation numbs the real emotions and cognitions and replaces them with starvation thoughts and feelings and so people do feel less bad when the trigger was emotional. It’s also why it often happens during periods of stress and exams, when however hard one works, the outcome is uncertain. I never talk about cure, only about recovery because as in other addictions food restriction often becomes the ‘achilles heel’, and the go to strategy in times of stress.
