Teenagers struggle to escape anorexia’s grasp

By Lilly Blomquist

Female students experience the mental, physical and emotional effects of an eating disorder that consumes their daily lives.

Every day, she went through the motions: three hours of track practice, three hours of gymnastics practice, one hour of cardio before bed and a total of 800 calories consumed.

But, she was not fully living.

Elon University senior Hannah Durbin spent years in fear, isolation and rigidity while she battled anorexia nervosa. When Durbin entered cardiac arrest her freshman year of college, she realized the eating disorder had spiraled out of control and that her life was at stake.

It all started in a quest to find happiness, but anorexia was the root of all of her unhappiness. She wanted to gain control of her life, but anorexia was controlling her. She was a slave to the disorder that dictated and consumed her every thought and move.

She could not break free.

“I tried to escape for years, but I couldn’t,” Durbin said. “There was this fear that I would have to live this way for the rest of my life and that recovery was not possible.”

Anorexia is an eating disorder that is characterized by an abnormally low body weight, restriction of food intake and a fear of gaining weight. About 1 percent of female adolescents have anorexia, according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD). Anorexia has the highest mortality rate of any mental illness since one-fifth of those with anorexia die from a result of health complications or suicide.

Confined to anorexia  

Durbin’s pattern of restrictive eating and overtraining began her junior year of high school after her grandmother died, her boyfriend broke up with her, her grades began to plummet and her friendships started to dwindle.

Durbin felt sad and overwhelmed. She thought she had lost control of her life, so she resorted to controlling her food intake as a way to alleviate these negative emotions and find happiness.

“There’s an intense and never-ending feeling of guilt and anxiety and fear around food because you feel like the only thing you can control is what you put in your body,” Durbin said.

Dr. Jeannie Sykes, a clinical nutritionist and registered dietitian who specializes in eating disorders at Cone Health Family Medicine Center in Greensboro, said some people who develop anorexia experience emotional dysregulation, the inability to regulate their emotions. She said these people use food restriction as a coping mechanism to eliminate unwanted feelings.

“They are very, very uncomfortable with certain emotions and have difficulty recognizing these emotions and what they can do with these feelings,” Sykes said.

Senior Hannah Durbin explains anorexia led to never-ending sadness. Photo courtesy of Hannah Durbin.

Durbin said restriction temporarily distracted her from the negative emotions and provided a fleeting sense of relief and comfort. Since she wanted to escape from her pain, Durbin continued engaging in disordered eating behaviors, which soon escalated into a cycle of under-eating that she could not escape.

“I started to become addicted to that feeling of restriction, and it temporarily took away my feelings of sadness,” Durbin said. “Every day when I woke up, I wanted that sadness to go away, so I would restrict and overexercise.”

Although Durbin thought restriction would lead to happiness, she discovered the opposite. She said malnourishment took a toll on her mental health, leading to depression, anxiety and irritability.

“It’s just years and years of darkness and not understanding what life looks like and feels like,” Durbin said. “Walking around and seeing people be happy and smile was something I could never understand.”

According to ANAD, as many as 50 percent of those with anorexia have another mood or anxiety disorder. Even for those who had depression and anxiety before developing anorexia, the eating disorder worsens the symptoms.

Dr. Stephanie Zerwas, the clinical director of the University of North Carolina Center of Excellence for Eating Disorders, said malnourishment leads to depression and anxiety because of a change in dopamine, a neurotransmitter that controls the brain’s reward and pleasure centers. Nutrients from food increase mood and dopamine levels. Since those with anorexia lack proper nutrition, they experience elevated anxiety and the ability to forgo pleasurable activities, like eating.

Durbin said she not only felt an intense sadness she could not escape, but she also experienced a preoccupation with food that permeated her thoughts. She said anxieties about food consumed every second of every day, preventing her from living a normal life.

To alleviate some of this fear around food, Durbin ate the same meals every day, which included low-calorie and nutrient-dense foods without any fats or added condiments. Durbin ate plain egg whites for breakfast, a handful of fresh fruit for a snack, a low-calorie tortilla wrap with spinach and two slices of turkey for lunch and then a small portion of dinner that her mother made for her.

Durbin wrote down her meals in a food journal and planned them days in advance. She downloaded multiple tracking apps on her phone to record every calorie she consumed, careful not to exceed the number of calories burned during exercise.

“I was so consumed by the thoughts going on in my head,” Durbin said. “It’s not lighthearted thoughts. It’s calculations of what did I eat 10 minutes ago, what can I eat later today and how many steps did I take. It’s constant numbers running through your head.”

Malnourished individuals have persistent thoughts about food because the brain sends signals that they need to eat more to maintain survival.

“If you’re malnourished, you are going to be preoccupied with food,” Sykes said. “That’s one of the ironies about anorexia nervosa.”

Anorexia leads to a physiological change in the body and brain that causes a self-sustaining cycle, according to The Atlantic. Those with the eating disorder cannot prevent these thoughts because their thinking becomes habitual.

In addition to the mental effects of the disorder, Durbin said she also suffered physically from stomach pains, fatigue, thinning hair, easily bruised skin, loss of her period for five years and feeling perpetually cold.

Although her emaciated figure and physical signs indicated something was wrong on the surface, Durbin said her emotional pain and sadness were far worse.

“It’s hard to believe when you look like you’re dying, but it feels even worse in your head,” Durbin said.

Developing the disorder

A combination of interrelated biological, environmental, social and cultural factors contribute to the development of anorexia, according to the National Eating Disorders Collaboration.

Individuals’ genetic makeup determines the personality traits that make people more susceptible to having anorexia. According to ANAD, as much as 80 percent of the risk is genetic.

Julie Dillon, a nutrition therapist and certified eating disorder specialist-registered dietitian for BirdHouse Nutrition Therapy in Greensboro, said perfectionism is a personality trait that fuels anorexia. These people are achievement-oriented and disciplined. They believe they are never skinny enough.

For those who are genetically predisposed to having anorexia, certain events, such as dieting, experiencing a traumatic experience or increasing exercise, can result in developing anorexia.

“Genetics load the gun, and the environment pulls the trigger,” Dillon said.

Durbin explained she has always been a perfectionist, so when she experienced a chaotic period in her life, developing the disorder was inevitable.

Senior Lauren Miskovsky said she also has a perfectionist and ambitious personality. Her senior year of high school, she became passionate about health and fitness, but when she was exposed to a college environment that valued physical appearance, she took her interest to the extreme.

Senior Lauren Miskovsky says she felt compelled to exercise three to four hours every day while she had anorexia. Photo courtesy of Lauren Miskovsky.

Miskovsky said living alongside similar peers caused her to compare herself to others and to become dissatisfied with her body. Miskovsky’s eating disorder escalated her sophomore year of college when she would eat 1,000 calories a day with no sugar and minimal carbohydrates and would exercise for three to four hours at a time. Her weight dropped to 110 pounds, which is far below her post-recovery weight of 150 pounds. She was diagnosed with anorexia spring of her junior year in college.

“In my eyes, I thought being skinny would make me happy,” Miskovsky said. “I would just do anything that would make me skinnier.”

In addition to nature and nurture, Zerwas said the societal belief that thinness is associated with attractiveness also perpetuates anorexia. She said some people internalize this belief more than others and feel pressure to conform to this standard of beauty.

Despite the genetic predisposition and environmental component of anorexia, Dillon said everyone is at risk for developing the eating disorder because of society’s thin ideal.

“We live in a world that has its own eating disorder,” Dillon said. “Our culture is very fat phobic and part of the experience of anorexia is a fear of weight gain. I’m afraid there’s going to be more people affected by it because of our culture.”

Freshman Maria Rossi said she was always a little heavier as a child, so conversations with doctors and her parents revolved around weight loss and dieting. She quickly associated thin bodies as better than heavier bodies, and she became self-conscious about her appearance.

Rossi said having a negative body image made starting high school a socially challenging experience.

With a combination of her perfectionist personality and the belief that being skinny would make her more likable, she started running two hours every day and limited her daily food intake to an apple and a bowl of cereal. In the first few months of school, Rossi lost 45 pounds and hit her lowest weight of 93 pounds. She was diagnosed with anorexia her sophomore year of high school.

“Going to high school is already a really rough transition, and being a little bit on the heavier side is ever harder,” she said. “I did get made fun of a little, and I really took that to heart.”

Starting the process of recovery

In the spring semester of Durbin’s freshman year of college, she started to experience a throbbing pain in her chest. She went to the doctor and discovered that she was having heart palpitations and that her resting heart rate was 35 beats per minute, far below the normal heart rate of 60 to 100 beats per minute for adults.

A lack of essential vitamins and minerals causes the heart’s walls to thin and weaken and decreases the pumping function of the heart, according to Everyday Health. As a result, the liver and kidneys begin to fail, and blood pressure drops.

When Durbin’s heart functioning became worse, she was rushed to the emergency room. That was the moment Durbin realized she was incapable of battling anorexia on her own.

“It took me awhile to get myself on board because I was so in denial that I had one,” Durbin said. “I was really hesitant because I thought I could manage it on my own.”

From there, she began the process of recovery at an overnight hospitalization program.

Hannah Durbin shares the mental turmoil she experienced before being admitted to an inpatient hospitalization program to treat anorexia. Photo courtesy of Hannah Durbin.

When people with anorexia seek help for their condition, they often attend treatment programs that have a comprehensive approach to restoring their health.

Treatment centers usually have a nutritionist who meets with patients to create a meal plan, supervise their food choices and educate them on normal eating habits. Doctors often address the physical health issues by checking the patients’ weight and vital signs. For the psychological component of anorexia, patients attend therapy sessions to learn more effective ways to express their emotions rather than restricting.

In order for those with anorexia to eradicate their irrational fear of food and have a normal relationship with it, these individuals start the recovery process by confronting their biggest fear: gaining weight and eating an excess in calories.

Focusing on nutrition first does more than just restore patients’ physical health. Eating more addresses the underlying issues that are not manifested on the surface, which Durbin said is something people tend to overlook about the recovery process.

“It’s obviously not an illness you develop for aesthetic reasons, so when people say that recovery is easy and you just have to gain weight, it’s really frustrating,” Durbin said.

Durbin said facing her fear of food and having to change her familiar lifestyle and restrictive food rules was a scary process.

“A lot of it was getting over the fear of change and the fear of transformation because my disorder was my security blanket,” Durbin said.

Durbin also compulsively exercised during her experience with anorexia, so she said eating more and gaining weight made her want to burn off the calories. During her treatment program, she was not allowed to exercise, so she had to abandon that familiar habit and passion of hers.

Rossi said she channeled her driven nature into recovering at an outpatient treatment center her sophomore year of high school, but departing from her comfortable habits made her feel as if her life was out of control.

“On one end, I wanted to recover so badly, but on the other, gaining weight was so terrifying to me,” Rossi said. “I was really split in the middle for so long about what I wanted to do. Some days, I felt like I didn’t have an eating disorder at all, but other days, I would just hit a wall.”

Although beginning the recovery process with an increase in calories can be jarring for those with anorexia, the experience is rewarding.

Dillon said malnutrition decreases the function in the brain to feel motivated, but she said proper nutrition restores motivation, helping patients become more committed to recovering.

Durbin said while she was in the hospital, she became motivated to live a normal life again, so she created a list of goals, like running a marathon, becoming a personal trainer and living on her own, to maintain her commitment to recovery.

Sykes said eating more also helps those recovering from anorexia think more rationally and clearly. She said anorexia causes a decrease in gray and white matter in the brain, which compromises cognition and impairs judgment. She said this mental clarity helps people understand the severity of their condition for the first time.

White matter is also responsible for regulating emotions, so normal eating decreases symptoms of depression and anxiety that appeared from anorexia.

Lauren Miskovsky finds inner peace while continuing her recovery journey in Australia, where she studied abroad her first semester of junior year. Photo courtesy of Lauren Miskovsky.

Miskovsky experienced depression and anxiety for the first time after developing anorexia, but she said seeking treatment the summer before her junior year of college increased her mood.

“I noticed a difference in myself and the things I was able to do, and I got excited about things other than exercise,” Miskovsky said. “That was really uplifting.”

After those with anorexia gain back the needed weight and finish at the treatment centers, the process of recovery has only begun. Healing someone physically is only part of the solution.

“People don’t understand that this is a long, long, long recovery for most people with eating disorders, so when they come back looking and acting normal again, people in their immediate circles and families think they’ve gotten that handled,” Sykes said. “It’s just not that simplistic.”

Durbin came back to school her sophomore year of college. She said she looked healthy on the exterior, but no one understood the pain she felt on the inside.

Without the supervision and guidance of experts, Durbin had to use all of the techniques she learned during treatment on her own. She said recovery was a long process of progress and setbacks.

Hannah Durbin says recovery takes conscious effort to deny the occasional disordered eating thoughts and behaviors. Photo courtesy of Hannah Durbin.

“Recovery is not linear,” Durbin said. “It’s always up and down. It’s a roller coaster.”

Durbin reverted back to her old restrictive habits several times during college due to stress, change in location, peer comparisons or conversations about dieting and exercise.

“When I felt overwhelmed, the first thing I thought to do was skip a meal,” Durbin said. “That meal turns into one, which turns into two, and before you know it, you’re fully back in.”

Rossi said she also experienced periods of relapse in college.

“Basically, you have to start from square one, and do it all over again, which is so incredibly hard mentally and physically,” Rossi said.

Durbin said she is now aware whenever she starts falling into a pattern of restricting. She said surrounding herself with supportive people has helped her gain the confidence to share her struggles and ask for help when she needs it.

Is full recovery possible?

On average, those with anorexia take seven years to fully recover. Zerwas said the longer people wait to seek help, the more challenging overcoming anorexia becomes.

But, recovery is an individual process that looks different for each person.

After spending years bound to a rigid way of living, Durbin said she has finally escaped from this limiting way of life. She now considers herself to be fully recovered both mentally and physically, which she said she never thought would be possible in the depths of her disorder.

Although Durbin said her mental transformation was the most notable part of recovery, she was also able to restore her weight. At her lowest, Durbin was 98 pounds and a size double zero. Now, she is 147 pounds and a size 6.

Despite the pain and challenges she faced during anorexia, Durbin said experiencing and recovering from an eating disorder has given her the strength and confidence to accomplish anything.

“I’ve gained so much resilience, and I’m wholeheartedly so proud of myself for that,” Durbin said. “I’m a go-getter, and I know that I’m capable of a lot now because of what I went through.”

For Durbin, full recovery means living a balanced lifestyle and listening to her body.

She now views exercise as a chance to empower her body and gain strength rather than an obligation or a way to burn calories. She honors her cravings and treats herself when she wants instead of counting calories and following strict food rules.

Durbin has also learned to let go of perfectionism in regards to her appearance but also her academic, social and professional life. She said she finds satisfaction in trying her best, regardless of whether that leads to success or failure.

Freshman Maria Rossi shares her recovery progress on Instagram during National Eating Disorders Awareness Week. Photo courtesy of Maria Rossi.

Dillon defined full recovery as a mentality individuals gain when they feel confident in their own skin and no longer have an urge to manipulate their weight or eating habits.

Rossi said she has developed a newfound appreciation for her body after recovering from anorexia, so she also considers herself to be fully recovered.

“Now, I do have a positive body image,” Rossi said. “I do love myself and my body, and I want people to feel the same way because it’s such a freeing feeling.”

To help other people feel confident in their bodies, Durbin said she shares her insights on social media. She said she dedicates her account to the positive mentality she has gained but is also honest with her followers when she struggles.

“It’s focusing on an all-encompassing lifestyle and showing the ups and downs and being vulnerable about that,” Durbin said.

Hannah Durbin reveals the positive mental transformation she has experienced after recovery. Photo courtesy of Hannah Durbin.

Durbin said having the opportunity to share her story and help others recover is a rewarding experience because she never believed she could recover herself.

“I get messages from people every day spilling their hearts out to me, and I love being the person who gets to help them because I know exactly what they are feeling,” Durbin said.

Miskovsky said recovering from anorexia has likewise redefined her passion for helping others and nutrition. She said the recovery process has taught her the importance of proper fueling and eating a balanced diet, so she wants to work as a dietitian to share that knowledge with others.

For the future of Elon, Durbin hopes to change the conversation around eating disorders as the president of Project Heal Elon, a club that raises awareness about eating disorders and donates money to eating disorder treatment funds.

Durbin started the club at Elon this year to provide support for students struggling with eating disorders and to inspire others with her own story of recovery.

“A lot of people don’t understand the concept of true recovery and truly believe that they’re just going to have to live this way for the rest of their lives, but you don’t have to,” Durbin said. “I’m a living role model for that one.”