During the past week, I had two separate conversations about mental health with fellow high school students. Although each interaction went differently, I ultimately walked away with the same understanding: many people within my community do not know half as much as they should about mental illness.
I realize that sounds like a condescending generalization, however; I do not mean to entirely exclude myself from it. Until around a year ago, I was as unaware and uneducated as both of the people I talked to last week, and I’m sure I would’ve said things very similar to what they did. In fact, I’m sure I still do. I know many of you reading this probably do know about mental health! And being uneducated but willing to learn isn’t really the pressing problem. But after having conversations with both people my age as well as adults, I realize that when ignorance becomes hurtful and demeaning, and when people are opposed to learning new information about uncomfortable issues, something’s got to change.
Because of this, I’ve decided to write a little bit about the neurological aspects of anorexia nervosa. I am fully aware that there is a plethora of mental illnesses/disorders that I won’t be able to speak to here, probably because I also don’t know half as much as I should about them. That being said, I think the first way to dismantle the stigma surrounding mental health is to educate ourselves, and learning a little bit more in any way we can is the first step towards doing this.
The first overlooked concept that needs to be addressed is the difference between disordered eating and eating disorders. Over 90% of teenage girls experience disordered eating, while only less than 1% fall into eating disorders. They line between these two things is very blurred, however I’ll do my best to distinguish them: let’s say you went on a diet, and you wanted to lose 5 pounds. Someone with disordered eating would lose 5 pounds, be satisfied, and stop their diet. Someone with an eating disorder may lose 5 pounds, and be unable to stop. Those who have eating disorders are very goal-centered and determined, and would struggle to stop dieting or gain any weight back that they had lost. Although disordered eating is very challenging, and something that plagues people of all ages, it is not a neurological illness.
Anorexia nervosa, which does constitute as a mental illness, as stated in a paper by Walter H. Kaye, is “characterized by restricted eating and relentless pursuit of thinness.” I am sure most of you know that. What you might not know is that those who suffer from anorexia experience widespread, acute changes of brain function. The characteristics that contribute to and are developed during anorexia can be categorized under two names: state and trait.
An example of a trait-related alteration, to put things simply, would be the ability to put off immediate rewards for the promise of something greater. Although this trait can be incredibly beneficial to an individual (possibly better their work ethic, increase determination) it can also be detrimental in regards to having an eating disorder. Before my diagnosis, I was able to put of eating entire meals for the promise of having one cookie at the end of the day. Trait-related alterations play a huge role in determining who is prone to eating disorders; studies show genetic, heritable traits account for 50-80% of the risk of their development.
State-related alterations include neurological effects of anorexia, such as reduced brain volume and altered metabolism. People with anorexia have demonstrated an increased amount of certain neurological systems, including ones that impact impulse control, and executive functioning—essentially, your brain can override your desire to eat. After going to my first doctors appointment, I was informed that my mental illness was preventing the myelin in my brain from forming adequately (due to the striking lack of fats I was consuming).
Having anorexia prevented me from enjoying food or other activities I used to love. Not only can this illness reduce your bone density, impact your heart rate, your brain development, and even your fertility, but from a social aspect, it is incredibly isolating. 1/3 of people diagnosed with anorexia never recover, and even for those who do, certain harmful traits persist well into their recovery. Eating disorders have been linked with other mental illnesses, including severe depression and anxiety.
I hope, in some way, that this was able to emphasize the legitimacy of eating disorders. This is NOT something that people make up, and most definitely NOT something that is even remotely in their control. There are biological and neurological aspects to this illness, just like there are to any other. It is also important to note that eating disorders impact both men and women, and we should not limit our view of eating disorders to the very stereotypical, female image that may appear in our minds. No one can be “too heavy” to have an eating disorder, and no one can be “too light” either. The stigma surrounding eating disorders is perpetuated every day by those who refuse to learn and talk about them. Being a high school student, I’ve learned that going to school with an eating disorder can be very tiring and hard to navigate.
Some might be thinking, “How can my high school be inaccessible to someone with a mental illness? They can walk around campus…They can do their homework?” Here is my response:
Last year, I spent nights unable to do my work because I was either too focused on the cookie I wanted to eat, or too distraught over the extra helping I took at dinner. I spent many lunches alone, afraid I would be judged for choosing to eat nothing. A mental illness is as debilitating as any other disability, sometimes more so because no one can truly visualize how much you are suffering.
We all have the power to dismantle the stigma surrounding mental health. I hope this helped, to people who wanted to learn, and people who needed to be reminded that what they are going through is real and hard, and that they are strong. I know it is easy to forget that sometimes.
My Fast 