The Psychology of Self-Starvation

According to Dr. Walter Kaye, professor of psychiatry at the University of Pittsburgh, anorexics use starvation as a mode of self-medication. How? Starvation prevents tryptophane, an essential amino acid that produces serotonin, from getting into the brain. By eating less, anorexics reduce the serotonin activity in their brains, says Kaye, ‘creating a sense of calm,’ even as they are dying of malnutrition.

This is a fascinating finding. But it doesn’t prove that anorexia is caused by genetic factors. All it suggests is that once a person goes down the road of self-starvation, physiological factors can create an unwarranted sense of calm and serenity in what is actually a dangerous, life-threatening situation.

Historically, in the field of psychology, anorexia was thought to be the product of having an achievement-oriented, ‘type A’ personality, especially once a person (usually a young woman) reached adolescence. Expecting too much of herself and feeling put upon by the demands and expectations of others, the young person seeks to gain a sense of pseudo-control by starving herself. However, in recent years, anorexia has been showing up in younger children around nine or ten years old, while also crossing the racial, socioeconomic spectrum.

So much for cultural or environmental explanations. Up to now, the treatment of anorexia has focused on a combination of the medical model and neoFreudian methods. The medical model consists of having the patient stay in the hospital and be force-fed. This is, of course, all well and good, except that the patient must eventually go home. At this point, the neoFreudian therapy took over. In essence, such therapy encouraged the anorexic to look at how the parents might have created this mess. It didn’t work too well, because blaming, even when it’s deserved, is not the primary route to self-esteem and mental health.

Some fascinating developments are now taking place in the treatment of anorexia. Parents of anorexics have traditionally been told to stay on the sidelines, letting the hospitals, doctors and Freudian therapists do all the work. Interestingly, the trends are shifting towards family-centered approaches, essentially coaching parents to be strong with their kids. Consider this excerpt from a recent Newsweek article:

‘I told my daughter, ‘You’re going to hate this’,’ says Mitzi Miles, whose daughter Kaleigh began struggling with anorexia at 10. ‘She said, ‘I could never hate you, Mom.’ And I said, ‘We’ll see’.’ The first dinner at the Miles home outside Harrisburg, Pa., was a battle—but Mitzi, convinced by Kaleigh’s doctor she was doing the right thing, didn’t back down. After 45 minutes of yelling and crying, Kaleigh began to eat. Over the next 20 weeks, Kaleigh attended weekly therapy sessions, and Mitzi got support from the medical team, which instructed her to allow Kaleigh to make more food choices on her own. Eleven months later, Kaleigh was able to maintain a normal weight. Mitzi no longer measured out food portions or keeps a written log of her daily food intake.

Notice how the root premise of this therapy is not only that the parents must be involved, but also that objective reality overrides everything. Reality trumps 45 minutes of yelling and crying on the part of the child who wants to starve herself. In other words: ‘If you don’t eat, you’re going to die. Therapy flows from this basic premise that reality trumps emotions. Parents are supported and coached to be firm and unwavering. The child, if motivated and old enough to benefit, obtains her own therapy too. Mitzi Miles, a mother who, clearly, has earned the title, is operating on this premise of objective reality when she stays the course with her daughter, and yes, quite literally, forces her to eat. It’s not about control or authority; it’s about respecting objective reality. Respect for objective reality is the core of mental health, and the exact opposite of mental illness.

From a parenting point of view, it’s about helping your child come to terms with this one, simple fact: When one’s desires and whims contradict reality—especially in a life-or-death situation—one must go with reality.

Of course, objections are already being made to this approach of treating anorexics.

What if the parents are abusive? Then the child shouldn’t be with them, or, if the abuse is verbal rather than physical (and, therefore, not illegal), therapy should consist, in part, of holding the parents accountable for becoming more reasonable in their communication.

What if the child is engaged in a power struggle with the parents in the first place, and forcing the anorexic to eat only makes things worse? It’s doubtful that there are many things worse than starvation. If a parent cannot effectively get anywhere with the child, even with therapy and coaching, the only alternative (unless the anorexia suddenly goes away) is to place the child back in the hospital. Skilled therapists can also help families come up with other solutions. For example, asking a relative who is more trusted by the child to get involved, to act as a psychological buffer, and to help break the deadlock between parent and child.

If you think about it, this approach to dealing with anorexia in young people is consistent with other forms of dealing with childhood problems. If a child develops a drug habit, a rational and responsible parent will do everything in his or her power to keep the child away from drugs, and to force abstinence. Doesn’t the same apply when a child develops a starvation habit? Logic dictates yes, but for years, up until this recent breakthrough in the treatment of anorexia, parents—and reality—were shunted off to the side, so the medical doctors and the Freudian-based, excuse-making, parent bashing therapists could have total control. Now that’s all starting to change, and it’s good news, not only for anorexics, but also for psychotherapy in general.

Source: ‘Fighting Anorexia: No One to Blame,’ Newsweek 11/28/05.