In order for a patient to be diagnosed with anorexia they have to meet certain requirements according to the (American Psychiatric Association [APA], 2013), there must be a reduction of energy consumption in relation to the requirements of a relatively low body weight in the context of age, gender, developmental path, and overall physical health status. A relatively low weight can be defined as a weight that is less than what is considered normal or, for children and adolescents, less than that minimally assumed (APA, 2013). There is a severe fear of gaining weight or becoming fat, or unrelenting behaviour that stop the patient from gaining weight, even though they are already at a dangerously low weight (APA, 2013). There is a disruption in the way in which one’s body weight or shape is confronted, there is a direct influence of body weight or shape on one’s self-evaluation, or an ongoing lack of recognition of the gravity of the current low body weight (APA, 2013).
A day in the life of Samantha, who has been diagnosed with anorexia nervosa.
I am awakened by the sound of my phone’s alarm clock. It is 7:00am. I lean over and hit the snooze function. I am so tired, even after getting a full night’s rest. My bedroom feels so cold, and I just want to stay in my bed under the warm duvet.
However, I must go to my compulsory tutorials and lectures in order to meet the DP requirements for my course, so I force myself out of bed to take a shower and get dressed. As soon as I get up, I step onto the scale. I do my morning workout which consists of 100 crunches and then go to the bathroom and weigh myself again to see if this has had an impact on the number. The result gives me an indication of whether or not I can eat breakfast.
The number on the scale is not low enough, I will be skipping breakfast today, and substituting it with a cup of coffee. Zero calories. Glancing in the mirror, I see my naked body. I pinch at my sides, all I can feel is the fat. I try to connect my fingers around my upper arm, something I have been trying to achieve for months on end. I hate what I see, and the voice in my head is louder than ever before, I try and shut it out, but it is just too much to bear.
In the shower, I notice that my hair is falling out and clogging the drain. My skin is noticeably dry and is flaking off. After my shower, I dress myself as fast as possible in order to retain the heat that has built up in the shower. I feel cold already and I don’t want to see my body anymore. I put on my hoodie and sweatpants. These items keep me warm, and they have a way of keeping the comments people make and the glares I get from many of the girls on campus to a minimum. Also, when my clothes are too tight, I feel fat. I pace around the apartment to burn a few extra calories before I fill up my coffee cup, which will be today’s breakfast, I turn off the light and leave my room.
During my classes, I find it difficult to concentrate on the content my professors are teaching us. I keep worrying about lunch period, and whether or not my friends will want me to link up with them. How will I avoid eating again? Many of my close friends have started commenting about how much weight I have and how little I eat. At the beginning of my weight loss journey, it made me feel good to hear their comments, it felt as though all my hard work was paying off. I feel guilty for sitting so long in class, each class lasts forty-five minutes. I think about how many crunches I could be doing while listening to the professor.
I keep on thinking about excuses that I can give to my friends, in order to avoid lunch altogether. The thought of going to the cafeteria and being surrounded by people devouring their hamburgers and other calorie loaded meals gives me anxiety. I think about whether I can actually spend that time walking, or dash to the gym for an hour. Eating lunch is out of the question. My parents, who stay half an hour away from me, have invited me for supper tonight to “”catch up. I know they only invited me because they are worried about me and want to make sure that I eat, there is no escaping this one. I spend the meridian exercising, the voice in my head tries to convince me to skip my last class and carry on working out. But I am scared to fall behind the rest of my peers and I have to go to class. I’m starting to fall behind in my school work, and skipping class will only make things worse.
I manage to go for a run before driving over to my parents’ house. My mom gives me a hug me when I walk through the door, sending an intense feeling of anxiety through my body. She says, “”Sammy, I’m worried about you. You’re looking so skinny and there is no colour in your face. Are you eating enough? I tell her that everything is fine. “”I have just been under a lot of pressure at university. She tells me she will book me an appointment with the doctor, but I assure her that there is no need for that. The voice in my head is rejoicing.
I summon the courage to ask the question I’ve been thinking about all day, “”What is for dinner? I don’t even want to know the answer. I start tapping my foot and I wonder how my parents don’t notice that I am on the verge of having a panic attack. The voice in my head urges me to fake illness, to leave without eating one single bite. But I fight the temptation. I have already lost most of my friends and I don’t want to run the risk of growing apart from my family.
When we sit down to have dinner, I add up the calories of all of the food set out on the table in my head. I think about how I am going to avoid eating more than 150 calories. I end up with miniscule portions of everything except the garlic bread, and when I start eating I cut everything up into very small pieces. I try to eat as slowly as I can and chew my food at least 15-20 times before swallowing so that by the time everyone else is finished, I’m only halfway through my meal and I can say that I’m not hungry anymore. This doesn’t qualify as a lie since I’m not ever really hungry anymore, and seeing or smelling food makes me feel ill. I’m not sure when I stopped being hungry, but it has made losing weight a lot easier.
When I get home, I try to do my homework but end up climbing into my bed. The voice in my head keeps telling me that the food I ate for dinner is going to turn into fat if I do not work it off before I go to sleep. I won’t be able to eat at all tomorrow and I’ll need to exercise a lot this weekend. I’ll have to find an excuse to get out of the party my friend has invited me to on Saturday night I guess that will be okay though since I haven’t really spent that much time with them in the last while anyway. The more I hang out with my friends, the more I have to make an effort to make it seem as if everything is alright.