This mental illness with a very high mortality rate is quietly finding Chinese women

Right-angled shoulders, ant waist, the belly button can be touched with the back hand; swan neck, bamboo legs, and a vest line above the waist.

Nowadays, under the hype of popular culture, "thinness is justice" has become an unshakable aesthetic belief. "Control your mouth and move your legs" is no longer just a stopgap measure for losing weight, but is regarded as a life philosophy of pursuing a healthy body, resisting the signs of aging, and enhancing personal charm.

With the promotion of popular culture and the deepening of scientific research, the concept of "diet" has been given multiple meanings. It is not only an effective tool for managing weight and shaping body, but also the key to promoting health and rejuvenation.

But many people overlook one point: there is only one letter difference between "dieting" and "anorexia", but there is a 6-fold mortality rate gap between the two, as well as the risk of trapping people in long-term and difficult-to-escape psychological and physiological difficulties.

Mortality rate among women with anorexia

Six times more than women of the same age

Dieting is generally seen as a controllable and common way of managing food for health or weight loss, while anorexia is a serious psychological and behavioral disorder that is the core feature of anorexia nervosa.

According to a comprehensive analysis of 36 studies, young women with anorexia face a mortality risk that is six times higher than that of women of the same age, and the longer the course of the disease, the higher the risk. This shocking fact reveals the lethality of anorexia nervosa, which is like an invisible blade, silently hanging over the patient's life.

Sadly, despite the alarmingly high mortality and destructiveness of anorexia nervosa, it still has not received enough attention and widespread concern. One of the most important reasons is that "dieting" as a fashionable lifestyle is very confusing, causing many people to fall into it without knowing it. They may insist on the so-called "dieting" every day, but they are completely unaware that the shadow of "anorexia" has quietly enveloped them.

Although "dieting" is not the cause of "anorexia", many people who adopt "dieting" as a way of eating will not necessarily be entangled with "anorexia". However, "dieting" is the best disguise and cover for "anorexia". It exists in a seemingly reasonable and healthy way, making the "anorexia" behavior hidden and difficult to detect, confusing others and trapping oneself.

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When we give up high-calorie hamburgers and fried chicken, refuse high-sugar cola and milk tea, reduce high-carb rice and noodles, and choose vegetables, fruits, high-quality protein, and whole-grain staple foods, we are indeed taking an important step towards a healthier and more balanced diet.

When we consciously reduce the amount of food we eat each time, control the number of times we eat each day, or even try to adopt a light fasting method such as not eating after noon or regularly fasting, we are undoubtedly following the dietary principles in scientific research, aiming to optimize the body's metabolic function and further improve health levels;

When we begin to accurately calculate dietary calories, carefully check the nutritional composition tables of all foods, and strictly control the types and sources of food, this series of behaviors does not deviate from the scope of healthy eating. Instead, it reflects a higher pursuit of dietary quality and a responsible attitude towards our own health.

But it is precisely because these seemingly normal and reasonable behaviors of "clean eating" or "healthy eating" may sometimes mask the specific symptoms exhibited by patients with anorexia nervosa, such as significant weight loss, extreme self-starvation, excessive concern about body shape, and lack of flexibility, rigidity, and extreme eating patterns.

Therefore, from the perspective of eating methods and eating styles, those involved do not realize that "this may be a problem", and bystanders do not realize whether "something is wrong", making it difficult to identify signs of "anorexia".

More importantly, judging whether a person is anorexic by being "skinny" is the biggest misunderstanding and prejudice against anorexia nervosa. Although the diagnostic criteria for anorexia nervosa always include significantly low weight, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) further clarified this diagnostic criterion, emphasizing that there is no specific weight limit for anorexia nervosa. In other words, we cannot deny the possibility of "anorexia" just because a person is "not thin." In fact, people who are slightly fat or large may also suffer from atypical anorexia nervosa.

From "dieting" to "anorexia", from "healthy eating" to "eating disorders" and then to "eating disorders", it is a gradual evolutionary process. The frequency and degree of unhealthy behaviors gradually increase until they reach the clinical "significant" diagnosis level, and people are often already deeply trapped in it.

Most of the time, it is difficult to define the first symptoms, and the mentality of "not realizing it is a problem" often allows "anorexia" to exist openly, and even develop to the point where it is difficult to control. Therefore, whether a person has established an unhealthy relationship with food is the key to identifying the risk of "anorexia" in advance.

When food no longer brings satisfaction

It might mean losing control.

The meaning of food to us has far exceeded the simple level of "filling the stomach" and "survival".

When we are depressed, food can provide instant comfort; when we are happy, food can bring double happiness. It has become a medium for emotional communication. When we enjoy food, we are also expressing love, absorbing happiness, relieving stress, and establishing connections.

People's eating behaviors and attitudes toward appearance form a broad spectrum, with "normal eating" at one end and "eating disorders" at the other.

"Normal eating" is regular, balanced, and flexible. It will not lead to the extremes of "either not eating a single bite, or eating a lot"; nor will you fall into guilt and self-blame because of "eating one more bite" or "gaining one more pound"; and when eating, you will not see cold numbers or calories instead of the food itself.

"Eating disorders" are the exact opposite. They are stereotyped, rigid, and extreme. Patients often have distorted perceptions of food and weight and show excessive desire for control, which causes eating behaviors to deviate seriously from normal.

In this spectrum, there is a gray area of ​​"eating disorders", which is full of disorder, chaos and ambiguity, and "dieting", "anorexia" and "bulimia" are just in it. Here, eating one less bite may be seen as a manifestation of healthy self-discipline, but it may also be a harbinger of anorexia; eating one more bite may be just a temporary indulgence, but it may also become a trigger for binge eating. We are wandering in this gray area, not sure whether our behavior has crossed the normal boundary, nor whether we are stepping into the abyss of eating disorders.

It is difficult to draw a clear line between "dieting" and "anorexia". If the difference is measured by whether one "feels like vomiting after eating", "unable to control vomiting and diarrhea", or "being skinny", then the person is often deeply trapped in the predicament of anorexia nervosa, suffering from great physical torture and unspeakable emotional pain.

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However, we can set a more graspable warning signal for ourselves: when we find that food no longer brings satisfaction and pleasure, but anxiety, guilt, self-blame, or even an uncontrollable painful feeling, this is a reminder that we may have stepped into the gray area of ​​eating disorders and are at risk of sliding onto the brink of "anorexia."

Behind the uncontrolled eating habits

It’s out of control emotion regulation

Although "intense fear of gaining weight and becoming fat" is an important basis for diagnosing anorexia, simplifying everything as "because of fat" or "fear of being fat" will lead us into the toxic logic that "anorexia" is "self-inflicted, blind weight loss, lack of self-confidence, and being too vain."

Unreasonable "weight loss" and "dieting", or even "anorexia" and "bulimia", are actually just symptoms, just like coughing and fever after a virus infection. They are signals of physical or psychological problems. In fact, behind the uncontrolled eating habits lies uncontrolled emotional regulation.

In this prevailing culture where "being fat is a sin, being fat means being sick, being fat means being lazy, and being fat means being undisciplined", the idea that "everything will be better if you lose weight" has become the simplest and most direct attribution.

"Becoming thin" is seen as a specific and actionable goal, as if achieving it can solve all problems related to "fatness" and all difficulties in life. However, what really causes pain is not "obesity", but the strange eyes of others, the collective rejection of society, the sarcasm of relatives and friends, and the incompatibility of the group; what is really hated and rejected is not "food", but the sense of powerlessness, the loss of emotional control, and the despair of life.

Cognitive neuroscience research shows that when people feel socially rejected or excluded, the brain areas associated with physical pain will also be "lit up", producing a feeling of "injury". Here, hunger becomes the strongest weapon to defeat emptiness and loneliness, and it is a desperate attempt by people to eliminate pain. From another perspective, people are using the method of "pain to stop pain", using "hunger" to cover up the depression, anxiety, emptiness, loneliness and helplessness hidden deep in their hearts.

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Recent studies have found that ghrelin, which regulates appetite, may regulate pain perception by affecting neuronal activity and the release of neurotransmitters in the pain conduction pathway. For example, one study found that after painful stimulation, rats in the ghrelin-treated group showed a lower pain response threshold, suggesting that ghrelin may have analgesic effects.

Therefore, sometimes problematic behaviors in the eyes of others are actually a form of "self-help." Focusing on "dieting" can make people forget the real problem, and feeling "hunger" can make people ignore emotional torture, making everything seem not so bad, except "gaining weight."

Dealing with anorexia

It's not just a simple "eat well"

When people experience unbearable inner pain, they will resort to hunger at all costs as the quickest and most convenient way to relieve pain. At that moment, it becomes the only "antidote" in their hands, and they gradually become deeply trapped in it because of repeating the same pain relief method. In front of hunger as the "only straw", "eating well" seems so pale and powerless.

When facing the "anorexia" who "would rather die than surrender", don't ask "why don't you eat", but "why are you suffering". For those in charge, "not blaming yourself" is the first and most important step to overcome "anorexia"; for bystanders, be less critical, be more understanding, be more companion and caring, they have tried very hard and have been trying, don't say "eat well", but "I am always here".

I just hope that one day, you and I who suffer from anorexia can return to the essence of eating and feel every flavor of life.

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References

[1] Timothy Walsh, Evelyn Atiyah, Deborah R. Glashofer. Eating disorders. Wuhan: Huazhong University of Science and Technology Press. 2023.

[2] Hilde Bruch. The Golden Cage: The Psychological Causes and Treatment of Anorexia. Beijing: China Renmin University Press. 2023.

[3] Gabor Mattei. Empty Heart: The Truth and Healing of Addiction. Beijing: China Machine Press. 2023.

[4]Ackerley,R.,Wasling,HB,Liljencrantz,J.,Olausson,H.,Johnson,RD,&Wessberg,J.(2014).HumanC-tactileafferentsaretunedtothetemperatureofaskin-strokingcaress.JournalofNeuroscience,34(8),2879-2883.

[5]NinaBeckmannetal.Howtheunconsciousmindcontrolsbodymovements:Bodyschemadistortioninanorexianervosa,InternationalJournalofEatingDisorders(2020).DOI:10.1002/eat.23451

[6]WalterH.Kayeetal.NeuralInsensitivitytotheEffectsofHungerinWomenRemittedFromAnorexiaNervosa.AmericanJournalofPsychiatry(2020).DOI: 10.1176/appi.ajp.2019.19030261

[7]SandraG.Boodman(2007).EatingDisorders:NotJustforWomen,WashingtonPost

Planning and production

Author: Su Jing, National Level 2 Psychological Counselor

Reviewer: Fan Chunlei, Associate Researcher, Institute of Psychology, Chinese Academy of Sciences