The last few years have been a little hell for the family of Luis and Susana (fictitious names). In 2020, shortly after confinement, his eldest daughter, Lea, was diagnosed with anorexia, at the age of 20. Since then, the family has lived under the physical and emotional instability that this eating disorder generates.
Lea has been admitted to two day centers twice, has visited psychologists and psychiatrists and has continued to study the career in fits and starts. When it seems that her weight is picking up and she tries to lead a normal life, her weight decreases again. Lea’s body goes up and down, and her family goes to and fro with an illness that is characterized by an abnormally low weight, the intense fear of increasing it, and the distorted perception of the person who suffers from it. A condition that can lead to serious complications and involves a long, laborious and often very expensive treatment.
Anorexia nervosa is a fairly well-known disease. Detecting it should be easy (“low weight and that’s it”) but, as Lea’s mother points out, it is not always so. In fact, as far as her daughter is concerned, Susana is still unable to explain “how all this started” and she doesn’t understand why they took so long to act. “Although I can tell you that the one who realized it was me. I began to notice that Lea didn’t want to eat breakfast, that she was obsessed with playing sports and that she, who always helped make dinner, stopped doing it… Already in 2019, when she did the selectivity, I had the feeling that she didn’t eat well, but I thought it was the pressure of the moment.”
However, one day, Susana clicked. With something as simple as a salad: “She would prepare it without a drop of oil,” she recalls. “It was when I saw clearly that this was not normal… Now we realize that she had habits that were not healthy for a long time. For this reason, what I would like is for parents to detect it soon, because the later anorexia is detected, the worse ”, she sums up.
When these lines are being written, Lea is still “justita”, although she is already out of the day hospital. In these years with anorexia, she has learned that it is a disease suffered more by women (nine out of ten cases), that the treatment is long and implies not only eating again, but also understanding where the need to lose weight at all costs arises. . She is clear that her anorexia was not caused by the pandemic: “She had nothing to do with confinement. The problem was that I didn’t feel good in my skin, ”she explains, before breaking down in tears. In fact, neither Lea nor she realized that her weight was getting less and less: “I didn’t see it until my mother weighed me… At that time she didn’t weigh me, she only looked at me in the mirror.”
And since what he saw did not make him “feel good”, he practiced sports to the point of exhaustion and, especially, “restricted food”. The verb “restrict” abounds in the dynamics of anorexia. During the interview, Lea, although she is sparing with words, uses it on several occasions.
When, in June 2020, Lea admitted to her mother that “she could be doing things to lose weight,” everything accelerated. A visit to the GP opened everyone’s eyes. Diagnosis: anorexia. “We were very scared, of course, because they also tell you that you cannot climb stairs or make any effort, and that if you faint you should call the emergency room…”, recalls the mother, while Lea points out that: “More than scaring me, I did not understand nothing; I wasn’t aware of the severity.” Luis, the father, still doesn’t quite understand why he realized so late: “I’m very athletic, like Lea, and I didn’t see it that much. There comes a time when you don’t know if the sport is to feel good or if it’s too much”.
The family doctor confirmed that it was, without a doubt, too much. And he referred them to a unit specializing in anorexia. The psychiatrist Omar Díez Pazo and the general health psychologist, Laura Invernón, specialists in eating disorders and adolescents at the Eira Salut Mental center, work in this discipline. In centers of this type, a therapy is started that, they explain, is long (the average is two years) but, they say, it works: “Anorexia is cured, without a doubt,” they say in unison.
Often, patients are forced by their parents. A court order may even be required to begin treatment. “Normally it is not necessary to go that far, the parents’ own authority is usually enough, but if it is necessary to go to court, it can be done, and also in adults,” explains Laura Invernón. Another way to get to therapy is to divert the focus: “Tell them: ‘You don’t want to treat the problems with food but you do with something else, so let’s focus it there.’ We are going to see a psychologist to talk about anxiety or depression”, illustrates Omar Díez. The starting point for many of these patients is dealing with denial of the disorder. “It’s not that we start from zero, we start from minus five,” summarizes Laura Invernón.
If anorexia is a disease whose main sign is a strong weight loss… Why is it so difficult to detect? “It’s difficult, because those who suffer from it take care, very well, to hide it,” the psychologist replies. Omar Díez insists on not blaming the parents: “There is a lot of skill in hiding a disorder like this on the part of the patients.” Another thing that happens at the beginning of anorexia, she adds, is that in a culture like ours, which exalts thinness: “The girl has received a lot of reinforcements. Everyone congratulates her because she is losing weight. And that’s where the disease can explode.”
Also, these specialists explain, there are factors that influence anorexia. Like social networks, where there are many ways to maintain and hide the disorder among these patients: “They share tricks, they reinforce each other. Undoubtedly, the internet and social networks are an aggravating factor”.
But anorexia isn’t just about food: it’s an extremely unhealthy way of trying to cope with emotional problems. “When you have anorexia, what you often do is equate thinness with self-esteem,” they detail from the Mayo Clinic website. “Yes, without a doubt, anorexia is an expression of discomfort that goes far beyond the body and food,” confirms Laura Invernón. “Controlling or changing the body is an attempt to manage discomfort. That is why you have to ask yourself what has happened to this person to get to be like this ”. Understanding where this self-destructive craving for weight stems from is the key to the cure.
The most common reasons for suffering from a disorder of this type are usually linked to a traumatic event. “Ill-treatment, sexual abuse in childhood or adolescence, aggression of all kinds…”, these specialists recount. “There is also a correlation with bullying.” In Lea’s case, her parents are convinced that two factors played a role: in high school she experienced an episode of bullying and, after finishing school, she went to live alone in Barcelona to study. “When I was looking for the origin of the disease, I think that in the case of my daughter there is something that lies with her going to a residence, away from the family,” says her father. Lea confirms that the experience was horrible: “I couldn’t integrate and, furthermore, I spoke Spanish and it was the time when there were all the demonstrations and people were a bit: ‘What are you doing here, foreigner?’… Integration was very difficult”.
When Lea entered the day center for the first time, the priority was to feed her, to gain weight: “Physical health is a priority, because we are in a very poor physical state and obviously we restore that,” says Omar Díez Pazo. Thus, first the eating behavior is thoroughly worked on. In large part, because if there isn’t a well-nourished brain, you can’t start doing anything. “But when the physical part is better, it is important to work on that background of discomfort; you have to make a sensitive approach to trauma and understand the reasons for the disease”.
It is a long process in which Lea and her family are still immersed. “For her sisters it is also difficult; there are fights”, says the father. Given this situation, the experts ask that the other children not be neglected and that things be explained to them very well, so that they empathize: “If instead of mental health the girl had a physical problem, cancer, for example, the whole extra attention would not seem so bad. Mental health has a stigma that makes it less tolerated ”, observes Laura Invernón.
The cure takes time, but it arrives, they insist. But how? “When in the end what you treat is less profound, less pathological, and you see that they can be managed. When they tell you, ‘I’ve had this stressor but I’ve dealt with it. That is to say: their body image and their eating behavior continue well, despite having had stressful factors”, explains Omar Díez. In short, when excessive importance is no longer given to the body and food and the patient has developed other tools to manage discomfort.
That is where Lea wants to go: “I see it as difficult, but I have no other, because I am tired of living with this. I want to play sports and eat what I want. I want to be cheerful. That’s feeling good.”