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right-angled shoulders, ant waist, backhand to touch the navel; swan neck, bamboo pole legs, waistline above the waist.

nowadays, under the exaggeration of popular culture, "thinness is justice" has become an aesthetic belief that is difficult to shake."shut up and move your legs" is no longer just a quick fix to lose weight, but is regarded as a life philosophy that pursues a healthy body, resists the signs of aging, and enhances 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 weight management and body shaping, but also the key to promoting good health and rejuvenating youthful vitality.

but many people overlook one point:there is only one word difference between "diet" and "anorexia", but there is a 6-fold mortality gap between the two, and the risk of putting people into long and difficult psychological and physical difficulties.

mortality rate among women with anorexia

6 times that of women of the same age

dieting is generally viewed as a controlled and pervasive way of managing food aimed at health or weight loss, whereas anorexia is a severe psychological and behavioral disorder that is a core feature of anorexia nervosa.

according to a comprehensive analysis of 36 studies,young women suffering from anorexia face a risk of death that is as high as 6 times that of women of the same age, and the longer the disease course, the higher the risk.this shocking fact reveals the fatality of anorexia nervosa, which is like an invisible sharp blade that hangs silently over the patient's life.

it is sad that despite the frighteningly high mortality and destructiveness of anorexia nervosa, it still does not receive enough attention and widespread attention. one of the most important reasons is that "diet" as a fashionable lifestyle is very confusing, causing many people to fall into it without knowing it.they may insist on the so-called "diet" every day, but they have no idea that the shadow of "anorexia" has quietly loomed over them.

although "dieting" is not the cause of "anorexia", many people who adopt "diet" as a dietary method may not necessarily be troubled by "anorexia". but "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 burgers and fried chicken, refuse high-sugar cola and milk tea, and reduce high-carbohydrate rice and noodles, and instead choose vegetables, fruits, high-quality protein, and whole grain staple foods, we are indeed moving towards a healthier and more balanced diet. an important step has been taken in dietary life;

when we consciously reduce the portions we eat each time, control the number of times we eat each day, or even try to adopt light fasting methods such as skipping meals after lunch or regular fasting, we are undoubtedly following the dietary principles in scientific research and aiming to optimize the body's metabolic function. and further improve health;

when we begin to accurately calculate dietary calories and calories, carefully check the nutritional labeling of all foods, and strictly control food types and sources, this series of behaviors does not deviate from the scope of healthy eating, but reflects a higher quality of diet. pursue and take a responsible attitude towards your own health.

but precisely becausethese seemingly normal and legitimate behaviors of “clean eating” or “healthy eating” may sometimes mask specific symptoms exhibited by people with anorexia nervosa., such as significant weight loss, extreme self-starvation, excessive body care, lack of flexibility, rigidity, and extreme eating patterns.

therefore, from the perspective of eating methods and eating styles, the authorities are not aware that "this may be a problem", and bystanders are not aware of "whether there is something wrong", making it difficult to identify traces of "anorexia".

what's more,judging whether a person is "anorexic" by being "thin and skinny" is the biggest misunderstanding and prejudice against anorexia nervosa.although the diagnostic criteria for anorexia nervosa have always included significant low body weight, the diagnostic and statistical manual of mental disorders (dsm-5) further clarifies the diagnostic criteria, emphasizing that there is no specific weight for anorexia nervosa. limit. in other words, we cannot deny the possibility of "anorexia" just because a person is "not thin." in fact, people who are slightly obese or have a large build may also suffer from atypical anorexia nervosa.

from "dieting" to "anorexia", from "healthy eating" to "eating disorder" and then to "eating disorder", it is a gradual evolution process. unhealthy behaviors gradually increase in frequency and intensity until they reach clinically "significant" diagnostic levels, and people are often deeply involved in them.

"the first symptoms" are difficult to define most of the time, 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 deal with. therefore,whether a person has developed an unhealthy relationship with food is key to identifying the risk of anorexia in advance.

when food no longer brings satisfaction

maybe it means out of control

the meaning of food to us has gone far beyond the simple levels of "satisfaction" and "survival".

when you are feeling down, food can give you immediate comfort; when you are feeling happy, food can bring you double the happiness. it has become a medium for emotional communication. in the process of enjoying food, we are also expressing love, absorbing happiness, relieving stress and building connections.

people's eating behaviors and attitudes toward appearance form a broad spectrum.on one end is "normal eating" and on the other end is "eating disorder"。

"normal eating" is regular, balanced, and flexible. there will be no extremes of "either not eating a bite or eating a lot"; nor will it be just because of "eating one more bite" or "gaining an extra pound". falling into the emotion of guilt and self-blame; not to mention that when eating, what you see in your eyes is not the food itself, but cold numbers or calories.

"eating disorders" are exactly the opposite. they are stereotyped, rigid, and extreme. patients often have distorted perceptions of food and weight, and show excessive desire for control, leading to serious deviations in eating behavior.

and in this pedigree,there is also a gray area of ​​"eating disorders", which is full of disorder, chaos and ambiguity, and "diet", "anorexia" and "bulimia" just wander within it.. here, eating one less bite may be seen as a manifestation of healthy self-discipline, but it may also be a sign of anorexia; eating one more bite may be just a temporary indulgence, but it may also become a trigger point for overeating behavior. we wander in this gray area, unsure whether our behavior has crossed the line of normality or whether we are heading toward the abyss of an eating disorder.

it is difficult to draw a clear line between dieting and anorexia. if measured by whether they “want to vomit after eating”, “have difficulty controlling vomiting and purge”, or “thin to the point of skin and bones”, then the person concerned is often already deeply trapped in the predicament of anorexia nervosa, enduring tremendous physical torture and suffering. with unspeakable emotional pain.

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however, we can set ourselves a warning signal that is easier to grasp:this is a reminder when we find that food no longer brings satisfaction and pleasure, but anxiety, guilt, self-blame, or even an uncontrollable painful feeling., indicating that we may have entered the gray area of ​​eating disorders and are at risk of slipping to the edge of "anorexia".

behind the uncontrollable eating patterns

it’s out-of-control emotional 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 fat" will lead us to mistakenly believe that "anorexia" is "self-inflicted and blind." the toxic logic of “losing weight, not being confident, being too vain”.

unreasonable "weight loss" and "diet", and even "anorexia" and "overeating" are actually just symptoms, just like coughing and fever after viral infection. they are signals of physical or psychological problems. actually,hidden behind uncontrolled eating patterns is uncontrolled emotional regulation.。

in this popular culture where "being fat is the original sin, being fat is disease, being fat is laziness, and being fat is lack of self-discipline", the concept that "everything will get better if you lose weight" has become the simplest and most direct attribution.

“getting thinner” is seen as a specific and actionable goal, as if achieving it will solve all the problems related to “fatness” and all the problems in life. however, what really causes pain is not "fatness", but the strange eyes of others, the collective rejection of society, the cynicism of relatives and friends, and the incompatibility of the group; what really causes pain is not "food", but the sense of self-powerlessness and emotional loss. , the despair of life.

cognitive neuroscience research shows thatwhen people feel socially rejected or ostracized, areas of the brain associated with physical pain also light up, creating a feeling of "hurt."here, hunger becomes the strongest weapon to defeat emptiness and loneliness, and it is a desperate attempt by people to relieve pain. from another perspective, people are using "pain to stop pain" and using "hunger" to cover up their inner depression, anxiety, emptiness, loneliness and helplessness.

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research in recent years has found that ghrelin, which regulates appetite, may regulate pain perception by affecting neuronal activity and the release of neurotransmitters in the pain transmission pathway. for example, one study found that rats treated with ghrelin showed a lower pain response threshold after being given a painful stimulus, suggesting that ghrelin may have analgesic effects.

therefore,sometimes problematic behaviors in the eyes of others are not a form of "self-help". focusing on "diet" can make people forget the real problem and feel "hunger", which can make people ignore emotional torture and make everything seem not so bad, except "gaining weight".

coping with "anorexia"

it’s not just a simple “eat well”

"hunger" is the fastest and most convenient way for people to relieve pain at any cost when they experience unbearable inner pain. at that moment, it became the only "antidote" in my hand, and by repeating the same pain relief method, i gradually became stuck in it and found it difficult to extricate myself.in the face of "hunger" as the "only straw", "eating well" seems so pale.

when faced with "anorexia" that "would rather die than surrender", instead of asking "why you don't eat", you should ask "why you are suffering". for the authorities, "not blaming yourself harshly" is the first and most important step to overcome "anorexia"; for bystanders, blame less, understand more, add some companionship, and show care. they have already worked hard. , and i have been working hard. don't say "eat well", but "i am always here".

i only look forward to the day when you and i, who are "anorexia", can return to the essence of eating and feel every taste of life.

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references

[1] b. timothy walsh; evelyn attia; deborah r. grassover. 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: renmin university of china press. 2023.

[3] gabor mattei. empty heart: the truth and healing of addiction. beijing: machinery industry press. 2023.

[4]Ackerley, R., Wasling, H. B., Liljencrantz, J., Olausson, H., Johnson, R. D., & Wessberg, J. (2014). Human C-tactile afferents are tuned to the temperature of a skin-stroking caress. Journal of Neuroscience, 34(8), 2879-2883.

[5]Nina Beckmann et al. How the unconscious mind controls body movements: Body schema distortion in anorexia nervosa, International Journal of Eating Disorders (2020). DOI: 10.1002/eat.23451

[6]Walter H. Kaye et al. Neural Insensitivity to the Effects of Hunger in Women Remitted From Anorexia Nervosa. American Journal of Psychiatry (2020). DOI：10.1176/appi.ajp.2019.19030261

[7]Sandra G. Boodman(2007). Eating Disorders: Not Just for Women, Washington Post