Commentary on Carrie's story

This short story on a girl's descent into anorexia is a very small fraction of what living with an eating disorder is like.

What could possibly lead a seemingly happy, well-adjusted, talented girl into a deadly disease? That's what I start to explore in this story.

There is no one CAUSE of eating disorders. They are not caused by a bad family situation or teasing or whatever. Maybe these things all contribute to the onset of an eating disorder, but it is impossible to pinpoint such an illness to one particular factor.

It takes the right concoction of factors to initiate an eating disorder. Certain things make it more/ less likely for someone to get an eating disorder.

Anorexia has the strongest correlation to temperament of ANY psychological illness. Common characteristics of anorexia: perfectionistic, cautious, highly regimented, discipline, perceived feelings of inadequacy.

People who have depression, OCD, or other anxiety disorders are more likely to have an ED.

Those whose family members have suffered from EDs are more likely to get one themselves. In fact, one eating disorder in your family is likely to hike up your probability of suffering from one.

Moms who are obsessed with dieting/ appearance are more likely to have a child with an ED.

People who are in competitive, individual sports, like dance or gymnastics are more likely to have an ED.


Although eating disorders are diagnosed by the DSM IV TR as REAL PSYCHOLOGICAL ILLNESSES, some people still think of them as a willpower thing. "Just eat, and you'll be fine." Like an anorexic can will herself to eat. Like a binger can will herself to stop bingeing. It's not going to happen, if it's a full-blown clinical case of the disorder.

To demonstrate how an eating disorder is NOT a choice, let me explain "concordance rates." Psychologists study identical twins because they have the same genes, and whatever difference between them can be described as environmental.

Do you think of schizophrenia as a choice? Of course not! Most people see schizophrenia as a biological disorder. Twin studies of schizophrenia have shown that if an identical twin has schizophrenia, there is a 50% chance the other twin will have it as well. In other words, the concordance rate is 50%. That describes that for schizophrenia, there is a LOT of biology involved! Yet, there are environmental factors that influence schizophrenia onset as well (although these are unknown).

Well, guess what? The concordance rate for anorexia is 50% as well. That means that someone who has anorexia is as able to choose her disorder as a schizophrenic is able to choose becoming schizophrenic!

Many people have eating quirks, or have gone through periods of starving/ bingeing, but that doesn't necessarily mean that's an actual eating disorder. Sub-clinical disordered eating is pervasive in our country.

To be actually diagnosed with anorexia nervosa, for example, you must meet the following criteria:

1. The refusal to maintain body weight at or above a minimally normal weight for age and height. Maintaining a body weight less than 85% of the expected weight.

2. An intense fear of gaining weight or becoming fat, even though the person is underweight

3. Self-perception that is grossly distorted, excessive emphasis on body weight in self-assessment, and weight loss that is either minimized or not acknowledged completely.

4. In women who have already begun their menstrual cycle, at least three consecutive periods are missed (amenorrhea), or menstrual periods occur only after a hormone is administered

85% is pretty significant... If say, an 120 pound person lost that much weight, they would be down to 102 before even meeting the diagnostic criteria for anorexia!


Eating disorder prevention is way easier than treatment because once an ED has been launched full-blown, it is hard to go back. Average treatment time can last 5-10 years for clinical cases. Usually this involves relapse of some kind.

Anorexia has the highest death rate of any other psychological illness, including depression or alcoholism. All eating disorders, especially anorexia and bulimia, result in tons of health problems.

Recovery takes so long that I wish I could write another story titled, "Carrie still has an eating disorder after 10 years, and she doesn't know what the heck is going on!"

The onset of an eating disorder is only the beginning, and unfortunately, it doesn't get easier throughout the treatment process.

This story is merely something to open your eyes. Enjoy