440 CHAPTER 10
may not be as obvious to others include irritability, fatigue, and headaches (Mehler,
2003; Pomeroy, 2004). People, particularly females, with anorexia may also appear
hyperactive or restless, which is probably a by-product of starvation, given that
such behavior also occurs in starved animals (Klein & Walsh, 2005).
People with anorexia who purge may believe that they are getting rid of all the
calories they’ve eaten, but they’re wrong. In a starved state, the body so desperately
needs calories that once food is in the mouth, the digestive process begins more rap-
idly than normal and calories may begin to be absorbed before the food reaches the
stomach; even if vomiting occurs, some calories are still absorbed, although water
the body needs is lost. Diuretics only decrease water in the body, not body fat or
muscle, and laxatives and enemas simply get rid of water and the body’s waste be-
fore it would otherwise be eliminated.
All four methods of purging—vomiting, diuretics, laxatives, and enemas—can
result in dehydration, because they all deprive the body of needed fl uids. And de-
hydration can create an imbalance in the body’s electrolytes—salts that are critical
for neural transmission and muscle contractions, including that of the heart muscle.
When dehydration remains untreated, it can lead to death.Psychological and Social Effects of Starvation
Researchers in the 1940s documented a number of unexpected psychological and
social effects of extreme caloric restriction in what is sometimes called the star-
vation study (Keys et al., 1950). When healthy young men were given half their
usual caloric intake for 6 months, they lost 25% of their original weight and suf-
fered other changes: They became more sensitive to the sensations of light, cold,
and noise; they slept less; they lost their sex drive; and their mood worsened. The
men lost their sense of humor, argued with one another, and showed symptoms
of depression and anxiety. They also became obsessed with food—talking and
dreaming about food, collecting and sharing recipes. They began to hoard food
and random items such as old books and knick-knacks. These striking effects per-
sisted for months after the men returned to their normal diets. Such fi ndings have
since been substantiated by other researchers (Crisp et al., 1980). It is sobering
that, even on this diet, the participants in the starvation study still ate more each
day than do many people with anorexia.
The participants in the starvation study were psychologically healthy adult men,
and they developed the noticeable symptoms after less than 6 months of caloric in-
take that would now be considered a relatively strict diet. Most people (females)
with anorexia develop the disorder when they are younger than were the men in
the study—and the consequences of restricting eating at a young age may be more
severe than those noted in the starvation study. In fact, recent studies of the long-
term consequences of starvation during puberty indicate an increased risk of heart
disease (Sparén et al., 2004). Moreover, patients with anorexia generally maintain
unhealthy eating patterns for much longer than the 6-month study period. The
long-term effects of starvation can also lead people with anorexia to forget what it
was like to live without the medical and psychological effects of the disorder. Marya
Hornbacher described this kind of mental state:
I was beginning to harbor [the] delusion... that I was superhuman. When you coast
without eating for a signifi cant amount of time, and you are still alive, you begin to
scoff at those fools who believe they must eat to live. It seems blatantly obvious to you
that this is not true. You get up in the morning, you do your work, you run, you do not
eat, you live.
You begin to forget what it means to live. You forget things. You forget that you
used to feel all right. You forget what it means to feel all right because you feel like shit
all of the time, and you can’t remember what it was like before. People take the feeling
offull for granted. They take for granted the feeling of steadiness, of hands that do not
shake, heads that do not ache, throats not raw with bile and small rips from fi ngernails
forced in haste to the gag spot.
(1998, pp. 110–111)U. of MN School of Public Health CVD History Archive
In the starvation study Keys et al., (1950), men ate
half their usual daily calories for 6 months. In this
short amount of time, participants became
preoccupied with food, as frequently occurs
among people with anorexia. They also developed
symptoms of depression and anxiety, which are
often comorbid with anorexia. This photo shows
a researcher obtaining information about a
participant’s physiology before the participant
begins to restrict his caloric intake.