She was exposed by toxic substances when she was a baby. She was mature for her young age. She was smarter than her school. She was not intelligent enough to attend her school. Her school was too rigid. Her school had too much flexibility. She studied ballet as a kid. She suffered from hormonal imbalance. She was simply unbalanced. She was painfully inmature. She wanted attention. She wanted to be forgotten. She was obsessed by sex. She hated sex. She wanted to look like a boy. She wanted Kate Moss. She was a part of the current zeitgeist.
Here are 75 reasons given by doctors, therapists, and others for Hadley Freeman’s severe anorexia.
Freeman, the author of a riveting new memoir, “Good Girls: A Study and Story of Anorexia,” became sick during the 1990s, but over the past few years, the incidence of anorexia, which predominantly affects preteen and teenage girls, seems to have gone up. “During COVID, a lot of published data showed increases in eating disorders both inpatient and some outpatient as well,” said Joanna Steinglass, the director of research at the Eating Disorders Research Clinic at Columbia University and the New York State Psychiatric Institute. The increase in eating disorders was not just in the United States where Freeman is from, but in other countries as well, including Britain where Freeman received her diagnosis and was treated.
We’ve known about Anorexia For a very long time. It’s a mystery why things seem to be getting worse.
Has the pandemic caused an increase? Could it be linked to social networking? Is there a link between the rise in anxiety and depression among girls?
When I was a teenager, the “dying to be thin” narrative predominated in the shadow of Karen Carpenter, the singer who died in 1983 of complications from the illness. A combination of maternal (mostly) mistakes and a society that favored a model-thin body were blamed for the disorder at the time. Ballet and gymnastics were looked at as risky endeavors; “perfectionist” tendencies were also a potential red flag.
The truth is, we still don’t know exactly what causes anorexia. In recent decades, we’ve learned a lot more. Anorexia used to be viewed as a result of cultural and individual influences and behaviors. But we now know that it has a neurological component.
“Over the last 20 years, we have an increased understanding of the neurobiological basis of anorexia,” Steinglass said. “Not that there isn’t a person there and behaviors — but there are brain mechanisms to all this.” Recent research shows, for example, that when anorexics decide what to eat, different parts of the brain are activated than in those of people without Disordered Eating. Other research has shown that metabolic features are involved.
Evidence also suggests a genetic component, but the extent to how genes and the environment might combine to cause the disorder is unknown. As one doctor at the Eating Disorders Research Unit at King’s College London tells Freeman in her book, “You need genetic soil and environmental triggers.”
Freeman has written several books recently that address their experiences with anorexia. In her best-selling memoir, “I’m Glad My Mom Died,” Jennette McCurdy writes about having anorexia followed by a severe case of bulimia. In “Strangers to Ourselves: Unsettled Minds and the Stories That Make Us,” journalist Rachel Aviv recounts her own hospitalization for anorexia at age 6.
For those predisposed to anorexia, a common element seems to be a “precipitant” or “trigger” incident. Aviv’s trigger was Yom Kippur when she realized that she could refuse food. “The decision retained the religious energy from the holiday and carried an aura of martyrdom,” she writes. For McCurdy, it was her quietly anorexic mother instructing her in “caloric restriction” when she was an 11-year-old child actress desperate to forestall puberty and look younger and thinner to get roles. For Freeman, it was in gym class, seated next to a classmate with remarkably bony legs, who, looking at Freeman’s thighs said, “I wish I was normal like you.” That did it. As Freeman writes, “A black tunnel yawned open inside me and I tumbled down it.” Normal, she writes, was boring: “Normal was nothing.”
And so anorexia became Freeman’s identity. “In the ’90s when I was a teenager, there were other options: goth, skater, punk,” Freeman told me. “But I chose this.” Her descent into illness was swift and profound, requiring multiple hospitalizations.
In group settings such as in hospital wards, it is possible to inadvertently encourage anorexia. Aviv and Freeman observed that while the goal of this study was to teach girls new behaviors, they were actually learning them from each other. This reinforced and intensified their disordered eating. One 2016 study found that girls with highly educated parents and more girls in their school are more likely than boys to develop anorexia.
This evidence of social influence is what leads some to blame social media for either being a cause of the disease or contributing to its exacerbation. In January of this year, a mother from Hastings-on-Hudson in New York filed a suit against Meta, TikTok and its parent company ByteDance. The Rivertowns Enterprise reported that the apps started showing her daughter’s posts about eating disorders when she started following accounts relating to diets and exercise. Some eating disorder clinics discourage their patients from becoming friends on social media. They say that while mutual support may be beneficial, the potential for competition and relapse into old behaviors outweighs this benefit.
Not surprisingly, habits — how they form and how they can be broken — are one focus of current anorexia research. The act of not eating can become a trap and a ritual. As Aviv notes in her book, “Eventually, an impulsive decision gathers momentum, becoming increasingly hard to reverse.” Freeman’s anorexia was abetted by her obsessive-compulsive disorder. “Anorexia is super OCD heavy, obsessively counting calories,” Freeman said. “For me, the routine felt very reassuring, very soothing.” Starving yourself, she says, can become a way of self-soothing.
Freeman mentions in her book how some doctors think that anorexia is similar to autism spectrum disorders, and both share a rigidity of thought. It is possible that there is a genetic link. One 2022 Swedish study found that the children of mothers with eating disorders are “significantly associated with Attention deficit hyperactivity disorder and autism spectrum disorder,” even after controlling for family histories of these conditions.
All three books highlight a feeling of powerlessness, and the desire to control the situation as the central feature of the disorder. These feelings of powerlessness are often centered around the discomfort associated with puberty and sexuality, as well as adulthood. (“I still wear board shorts to hide my ass, which is curvy and womanly and disgusts me for being those things,” McCurdy writes of her earlier mindset. “I wish there was nothing sexual or suggestive about my body.”)
Freeman, however, is keen to dispel the notion that anorexia simply involves the desire to look thin. She says that the goal instead is to appear ill and like a skeleton. It’s about courting death. Among psychiatric illnesses, anorexia is among the deadliest; both Freeman’s and Aviv’s books describe revisiting the cases of wardmates after their deaths.
“Anorexia is a way of telling people you’re unhappy without saying it because saying it looks entitled,” Freeman said. “It’s a highly visible outward expression of saying something is very wrong here.”
You can also find out more about it by clicking here. You can learn more about it here. This is a very bad thing. In a 2022 British study, 15,000 students were found to be twice as likely to have mental health issues as boys. In a 2019 Lancet Psychiatry report, self-harm by teenage girls and women tripled from 2000 to 2014. The proportion of American girls who’ve had a major depressive episode in the last year increased 145% between 2010 and 2020. Nearly three in five teenage girls reported feeling “persistent sadness” in 2021, according to the Centers for Disease Control and Prevention, the highest ratio in a decade. Whichever susceptibilities they are born into and whatever pain they’re feeling in the world, girls clearly seem to be taking it out on themselves. We should ask why.
