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Weight loss: many faces of eating disorders. hannah’s case WEIGHT LOSS: MANY FACES OF EATING DISORDERS. HANNAH’S CASE
In struggling to identify precisely the different subtypes of patients with eating disorders, writers have spilled a great deal of ink in the pages of medical books and journals. I'm about to spill a little more, but it's worth it, because identifying these illnesses and their effects on patients points the way to appropriate treatment.
Hannah reported that one day she was suddenly overwhelmed by the idea that she was fat. At the time she weighed no pounds-by no means an abnormal weight for a girl of thirteen who stood five foot two. Nonetheless, the notion that she was overweight consumed her. She had always been active, but she stepped up her daily exercise to over an hour a day.
When her weight failed to fall fast enough, she began decreasing her food intake. At first she did feel hungry, but she just "trained herself to ignore the feeling. She denied ever inducing vomiting or using laxatives or diuretics.
Strangely, Hannah told me that she believed she "did not deserve food," and that she wasn't "good enough" to be allowed to eat. She saw her excessive exercise as a way to "earn" what little food she did consume.
Despite her refusal of food, she began taking over the job of making meals for her entire family. She grew irritable, experienced suicidal feelings, and had trouble sleeping. She never menstruated.
After a couple of months, Hannah said, she was no longer hungry. She managed to get by on as little as one candy bar a day. Although she lost nearly forty pounds over the course of a year- 36 percent of her body weight-she felt as though her weight had never changed.
Hannah's case is a classic example of restricting anorexia- weight loss through self-starvation exclusively, without bingeing and purging. Restricting anorexics are perhaps the most easily recognized and well-defined of all patients with eating disorders.
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WEIGHT LOSS
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