Almost Anorexic: Is My (or My Loved One's) Relationship with Food a Problem? (The Almost Effect) - Softcover

Jennifer J. Thomas, PhD., is an Assistant Professor of Psychology, Department of Psychiatry, Harvard Medical School, and Co-Director, Eating Disorders Clinical and Research Program, Massachusetts General Hospital. Her groundbreaking scientific research, which focuses on the development of an eating disorder typology that better reflects clinical reality, has been funded by the National Institute of Mental Health, the Klarman Family Foundation, and the Hilda and Preston Davis Foundation. She has published forty scientific articles and chapters, serves on the editorial boards of International Journal of Eating Disorders and Journal of Abnormal Psychology, and is a member of the Academy for Eating Disorders and Eating Disorders Research Society. She lives in downtown Boston, where she also maintains a private psychotherapy practice, helping people with almost anorexia and other officially recognized eating disorders.

Jenni Schaefer’s breakthrough bestseller, Life Without Ed: How One Woman Declared Independence from Her Eating Disorder and How You Can Too, established her as one of the leading lights in the recovery movement. With her second book, Goodbye Ed, Hello Me: Recover from Your Eating Disorder and Fall in Love with Life, she earned her place as one of the country’s foremost motivational writers and speakers. Jenni's straightforward, realistic style has made her a role model, source of inspiration, and confidant to people worldwide looking to overcome adversity and live more fully. She speaks at conferences, at major universities, and in corporate settings; has appeared on many syndicated TV and radio shows; and has been quoted in publications including The New York Times. She is also chair of the Ambassadors Council of the National Eating Disorders Association. An accomplished singer/songwriter, she lives in Austin, Texas.

Not everyone has a problem with food. And not all attempts to eat healthfully are bad. But crossing the fine line from normal eating to almost anorexia—even just a little—can be a big problem. When food and weight begin to consume your life, joy is often what gets cut out to make room for all of that obsessing. This was true for a young woman we’ll call Emma.

Emma

Upon graduating from a prestigious Chicago arts college, 22-year-old Emma couldn’t wait to move to California with her boyfriend, Sean, who had just been accepted to law school. A shy and bookish Midwestern native, Emma saw her relocation as the perfect opportunity to reinvent herself. She approached the Los Angeles lifestyle with zeal—adding blonde highlights to her chestnut brown hair, ordering vegan wraps at hipster cafes, and interviewing for countless jobs in her chosen field of journalism. But within a few weeks, she found herself second-guessing the move. Despite her impeccable resume, the recession meant fewer employment opportunities. Although she had a close-knit group of girlfriends back home, she found it difficult to meet new people without the predictable structure of school. Trying to hide her disappointment from Sean, Emma took a part-time retail job at a Santa Monica boutique and re-focused her energies on setting up their new apartment.

Still on a student budget, she snapped up free but mismatched dinnerware online, and started eating from the only matching cup and bowl set. She didn’t realize how important this ritual had become until one morning she bubbled up with irritation to see her cup, coffee-stained from Sean’s all-nighter, lying dirty in the sink. Exasperated, she skipped breakfast. With Sean spending more and more evenings at the law library, their romantic evenings cooking over a bottle of wine dissipated into Emma microwaving steamed vegetables to eat alone in front of the TV.

Though Emma considered herself lucky to be employed, she knew she didn’t fit in with the other salesgirls at the boutique. The more she told them about her dream of writing, the more they questioned her commitment to sales. The only thing they complimented was her dietary restraint, calling her “tiny Emma” and marveling at her “super-healthy” lunches of carrot straws and hummus. Never having considered herself particularly thin, Emma stepped on the scale at home one night, surprised to see that she had lost 5 pounds from her 5’5” frame since leaving Chicago. Though the weight loss hadn’t been intentional, gaining recognition for something—anything—after weeks of unsuccessful job searching, felt absolutely intoxicating. Determined to be worthy of her newfound “health nut” moniker, Emma added new rules to her daily regime. She began eliminating snacks, measuring portions, and pushing mealtimes later in the day. When Sean took Emma out for Thai food to celebrate acing his first midterm, Emma vetoed the first restaurant in disgust because it didn’t serve brown rice. Impressed with her self-control, Sean happily identified a more health-conscious restaurant where Emma could avoid white carbs.

A welcome side effect of Emma’s food restriction was the emotional numbness it provided. Although she had previously characterized herself as pensive and empathic—“crying at the drop of a hat,” her mom used to say—she felt increasingly anesthetized to her failed job search and growing emotional distance from Sean. The constant lump in her throat and knot in her stomach were replaced with a new sense of safety and calm.

Her preoccupation with food, on the other hand, was maddening. Her valiant mental efforts did nothing to push away negative thoughts about the minutiae of her diet that bombarded her every moment. Did I serve myself too many almonds at breakfast? I know I counted them twice… Can I wait until 3:00pm to eat lunch? If I eat too early, what will I do if I get hungry again and it’s not time for dinner? …Should I have just one square of chocolate with dinner tonight? If I have one, will I be able to stop? On some level, she worried that a number of her food rules were irrational—like eating even numbers of foods (e.g. 8 raisins rather than 7) and eating clockwise around her plate. But Emma felt compelled to follow them.

By the end of the fall, she had lost 17 pounds and her period was intermittent. She couldn’t remember the last time she had kissed Sean. Truth be told, she didn’t feel very interested in much of anything. Except maybe food. When Sean broke up with her after finals, she had the surreal sensation that she was watching a scene from a movie. She knew that she should feel sad, but she felt nothing. As he admitted guiltily that he had met another woman—someone more “fun”—she wondered absentmindedly whether she had put too much olive oil in their stir-fry earlier that evening.

When Emma arrived at the O’Hare airport baggage claim, her father gasped at her gaunt appearance. “Wow, Emma, you look…” her father trailed off. Emma’s face burned. “I know.” Insisting that Emma see her primary care doctor for a check-up, her father accompanied her to an appointment the next day.

Emma hopped off the scale and looked at the doctor expectantly as he made a quick note. “FEDNEC—weight not significantly low,” she discreetly read. While she wasn’t aware that FEDNEC stood for Feeding and Eating Disorders Not Elsewhere Classified, Emma did know one thing for sure. I guess I’m not anorexic after all. She was surprised at her disappointment.

Symptoms of Almost Anorexia

Frequent Weight Changes: Does your weight shift due to intentional attempts to drop pounds?

The hallmark feature of anorexia nervosa is being extremely underweight. Of course, not all individuals who are underweight have anorexia, but anorexia cannot be diagnosed without a significantly low weight. Emma lost 17 pounds in just a few months, but her weight at the doctor’s office was not low enough for her to be considered severely underweight. This is because the anorexia diagnosis depends on an individual’s final weight rather than his or her degree of weight loss. Someone could lose 10, 20, or even 100 pounds using unhealthy behaviors, but would only be diagnosed with anorexia if his or her final weight fell in the underweight range. As a matter of fact, recent drastic weight loss or frequent weight changes are a red flag for almost anorexia, since people without eating disorders usually maintain a relatively stable weight or slowly gain weight as they get older. Frequent weight changes often go hand in hand with other symptoms in the grey zone between normal eating behaviors and full-blown anorexia nervosa.
Frequent Restriction: Do you regularly restrict food by amount or variety?

People with anorexia nervosa severely limit the number of calories they eat. On the flip side, those without eating disorders typically eat when they are hungry, stop when they are full, and allow themselves to enjoy occasional treats. Normal eating like this means that you don’t have to eat all of the treats at once—you can choose to leave some for later. In this way, mild restriction would be considered a part of normal eating. Examples of food restriction that might be considered almost anorexic include attempts to follow rigid dietary rules like only eating at specific times (e.g., no eating after 7:00 pm), only eating a limited number of “safe” foods (e.g., no white sugar or flour), and only eating a pre-set small number of calories (e.g., less than 1,000) per day. Remember that Emma was able to eat dinner with her boyfriend but refused to do so at a restaurant that did not serve brown rice; food restriction can manifests as limiting variety. In our society, there seems to be an ever-expanding list of ways to restrict food. (Isn’t that ironic?)

Infrequent Compensatory Behaviors: Do you ever try to “make up for” calories consumed?

Frequent or severe compensatory behavior is a defining feature of anorexia nervosa binge/purge type and bulimia nervosa. Compensatory behaviors include purging (self-induced vomiting; inappropriate use of laxatives, enemas, or diuretics) and non-purging forms (fasting, or excessive exercise). What all of these behaviors have in common is that they are intended to compensate for, or “get rid of,” food that has already been eaten. Most attempts to compensate are just that. They are purely attempts and not truly effective for long-term weight loss. Individuals with almost anorexia may engage in these behaviors infrequently (a bulimia diagnosis requires weekly purging) or use milder forms of compensatory behaviors such as juice fasts, colonics, or cleanses. They also might exercise in a moderate but obligatory—“I have to no matter what”—kind of way. Even though Emma does not purge, her restricting and weight loss still place her in the grey almost anorexic zone between normal eating and a diagnosis of anorexia nervosa.

Infrequent Binge Eating: Do you ever eat large amounts while feeling out of control?

You may be surprised to learn that eating too much can be a symptom of anorexia, a disorder that most people associated with eating too little. However, a diagnosis of anorexia nervosa binge/purge type, bulimia nervosa, or binge eating disorder requires frequent binge eating. Binge eating involves consuming a large amount of food (e.g., two boxes of cereal with milk; a whole large pizza; or all of this plus more) in a short period of time (e.g., less than two hours). Because we all overeat once in a while, a true binge also requires a sense of loss of control. Describing bingeing to her therapist, Jenni used to say, “I feel like my body is literally being taken over by somet...