What should I eat during anorexia?

Hunger art and anorexia


Red letters on a gray board: You shall not eat without feeling guilty. The next picture, green letters on a white board: Losing weight is good. Gaining weight is bad. Red on white: You can never be too thin. In addition, seven other panels with similar sentences.

The series of images The Thin Commandments by Johannes Wohnseifer is so reduced and at the same time so cold and naked in an elegant way that the viewer can interpret a lot into it - so many people will probably cling to the explanatory text. Others will admire The Thin Commandments for purely aesthetic reasons. This work of art fascinates me above all because I recognize myself in it.

More precisely, I recognize a world in which I found myself as an anorexic teenager for a year. The Thin Commandments document the guidelines of a parallel universe that is all about not eating, losing weight and getting thinner and thinner. The abstract pictures show a sick but attractively simplified world. A world that more and more people are falling into and that doctors, therapists, parents or friends are often confused about. But why is that so? Why do young, apparently healthy people stop eating? And why is it difficult to get her to start again?


Actually, it's not about food at all! Inaccurate but still ... I will try to explain this dilemma, which is ultimately based on a struggle for identity - at least from my experience. It came suddenly, at 16 or 17 maybe. It stayed a year, disappeared very slowly and I was ashamed for a long time for this embarrassing slip on my résumé. Only today do I no longer see the anorexia phase as a disease but as a necessary process. But more on that later.

Why exactly did I stop eating? I couldn't say that for a long time. Everything was fine at home. The family worked. My sister and I were baking and cooking professionals when we were twelve, we pored over recipe books like other girls' magazines. We celebrated our meals, held coffee parties with cakes and cocoa and celebrated our dinners like holy masses.

Sometimes we thought we were too fat. Then we tried diets or exercise programs, but immediately failed. My anorexia popped like a bomb in this ideal world. Out of the blue, I began to skip hot lunches. I lost weight and it felt great. I thought: "Great, in the future I will be attractive and self-confident about the world ..."

In the weeks that followed, I continued to reduce my meals; it was a gradual process. I stopped eating fatty foods and didn't eat sweets. I drank gallons of water, moved a lot and stood on the scales several times a day. Soon I was only concerned with one thing: not eating. From morning to night I thought about how to handle the next meal. I pulled back and ran around all day watching my body get thinner.

At first I felt extremely good. Today I know that this is nature's trick: in order to keep functioning, the body's own emergency power generator starts up during the first weeks of hunger, and the brain produces a good mood in the form of serotonin and other happiness hormones. At the same time, the body knows it needs to save energy because not enough is getting in, so blood pressure and hormone production are reduced. The blood circulation slows down, the body temperature drops ... Due to the slowed metabolism, the supposed lucky charms stay in the blood for a particularly long time, so that you feel strong and energetic for weeks, even though you are not consuming enough energy.

At some point it was over with the luck, it went downhill. I just felt tired and driven by my own eating rules. But I couldn't go back. If I had started normal to eat, that would have destroyed the purpose of my life that I just created, which consisted solely of losing weight. So I continued to enjoy every gram that disappeared. Every bone that stuck out, every pair of pants that slackened gave me confidence.

And yet I was dissatisfied: Even when I weighed 44 kilos at 1.68 meters, I found my reflection still too fat.

My parents, siblings and friends saw it more objectively. My mother asked me if I liked the way I looked. And if I wouldn't worry about my health. After all, persistent underweight would result in massive physical damage. She wanted to know why I couldn't eat something real again, for example a lunch she had lovingly prepared. She was worried, overwhelmed and hurt at the same time. I shrugged and thought: “What do you all want? I can do what I want. Besides, I look normal. "

3. DIAGNOSIS anorexia

The distorted perception of one's own body is the psychological core of anorexia, says Dr. med. Ernst Pfeiffer, who explained the phenomenon of anorexia from a scientific point of view on a cold Sunday in February. The 61-year-old is a senior physician at the Clinic for Psychiatry, Psychosomatics and Psychotherapy for Children and Adolescents at the Virchow Clinic of the Charité in Berlin.

Pfeiffer has been dealing with the different types of eating disorders for more than 20 years Anorexia nervosa (Anorexia), bulimia (Eating-vomiting addiction), the so-called Binge eating syndrome (Binge eating) and their subgroups. Pfeiffer helped to develop this treatment focus at the Charité.

We are sitting in his tidy office on the 4th floor, the emergency cell phone in view. You have to go back a long way, says Pfeiffer right from the start. Anorexia nervosa cannot be explained purely psychologically. Twenty years ago it was thought that she was a juvenile weirdo that could be counteracted with a little psychotherapy and a few family meetings. Pfeiffer waves it away. “Today we know: just talking does not help. On the contrary, those who rely solely on psychotherapy are acting irresponsibly. Anorexia is a serious psychosomatic disorder. We are confronted with a complex bundle of causes and interactions between body and psyche. "

Anorexia is a relatively new phenomenon. In 1845 the psychiatrist Heinrich Hoffmann wrote the story of the soup fool, a creepy warning for the children of the bourgeoisie - it is supposedly based on an episode from Hoffmann's everyday working life in Institute for the insane and the epileptic in Frankfurt.

In the 1870s, doctors from France, England, and the United States published the first scientific papers on a disease called Anorexia hysterica, hysterical loss of appetite that they had observed mostly in women. In 1868, William Gull, suspected more than a hundred years later, recommended the treatment Jack the Ripperhaving been to have the patients fed by a strong-willed person.

Eating disorders have been a growing problem since the 1980s. According to a recent study by the Robert Koch Institute on the health of children and adolescents in Germany, 21.9 percent of the eleven to seventeen year old adolescents show signs of an eating disorder.

Eating disorders are the third most common mental disorder among young girls, anorexia affects every hundredth woman between twelve and 20. And five percent of all anorexia patients die. Which makes anorexia nervosa the mental illness with the highest mortality rate.

But why is it so difficult to treat anorexia syndrome when you know all of these things? And why is the chance of a cure so bad? Only a third of the patients become one hundred percent healthy! Pfeiffer nods: “Unfortunately, that is correct. Eating disorders are difficult to pin down because they affect the body and mind. In addition, they cannot be viewed as isolated diseases. On the contrary, in many patients different types of eating disorders merge. In addition, there are usually other psychological problems; many anorexic people suffer from depression, for example. In addition, many patients come to us at an advanced stage, which also makes healing difficult. You are very far removed from healthy eating habits and a realistic body image. "

Outside the fog is clearing. Patients stroll up and down the Kastanienallee of the Virchow-Klinikum as they did a hundred years ago. The root cause research is far from over, says Pfeiffer "We assume that a complex set of causes, combined with a relatively high genetic readiness, causes anorexia."

Basically, anorexics can be divided into two groups: The active type is more extroverted and aggressive, he tends to be destructive
Behavior. People with the restrictive type of the disease also have certain personality traits: poor interpersonal skills, over-conforming behavior, docility, ambition, and great ambition. You are shy, over-sensitive, hyperactive and prone to a pessimistic worldview.

"So that someone with these characteristics really gets sick"says Pfeiffer, »But he must also have a genetic readiness for a mental illness in general and anorexia in particular. There are no definitive findings, but today we assume multigenetic inheritance. "


If you believe the expert, a bundle of causes and genetic readiness also ensured that a diet tick turned into a psychosomatic syndrome for me. I know the characteristics that Pfeiffer describes: Before the illness, I was insecure, over-sensitive and dissatisfied. I felt too fat, ugly, and didn't know how to express myself. I felt misunderstood.

I found the world confusing, frightening and cruel, I found myself powerless. The fact that I dyed my hair blue in the tenth grade and from then on scurried around with bowed my head, baggy clothes and a disgusted look was probably my first attempt to compensate for this powerlessness.

The eating disorder was my second. But why eat? Couldn't you just stop combing your hair or tying your shoes? No, because nobody cares about any of this, at most it makes the others laugh. Quitting eating, on the other hand, is radically destructive. If you refuse to eat, you say goodbye to many things that unite people: you part from eating as a social, heartfelt, pleasurable and satisfying event. One turns away from family life, from friends and from all joie de vivre. You withdraw into an unreal parallel universe. Everyone else, one thinks, lives in a strangely voracious, emotionally cold and completely decadent world with which one does not want to have anything to do with.

It is a feeling like Franz Kafka in history The hunger artist describes: There is a man sitting voluntarily in a cage, whose art is starving, not taking part in the world of others. His substitute food is paradoxically the attention of the audience - the starvation artist dies when his performance goes out of style and nobody wants to see him anymore. In his last words he confesses that he did not starve voluntarily, but only because he did not discover any food that he liked - one could say that he never found his place in the world.

This is how it is with anorexia: one withdraws from everything, but at the same time vies for attention. One draws attention to oneself compulsively, but at the same time shows constantly how despicable the others are. You get entangled in a helpless self-staging and thus ensure that other people perceive you as sick. At the same time, deep down, you want nothing more than to belong. The only fatal thing is that the wish cannot be fulfilled because one does not allow closeness and no help.

As I said: I only enjoyed this state at the beginning of the illness. After the initial exhilaration had passed, I felt like the hunger artist in the cage. I was crouched in a prison that I had put myself to and that I couldn't escape. The people around me were always depressed and stressed. I wish I was back to my condition before the illness. On the other hand, I refused to accept help. I was silent in counseling centers and at the psychiatrist's. Maybe I was afraid that if I stopped starving my life would lose its meaning.

In any case, I was sure that nobody could help me: Why should strangers know something about me that I don't even know myself? How should other people solve problems for which I am solely responsible?


"Partially motivated" is what Ernst Pfeiffer calls it, without changing a face."Difficult!" Most patients have to be convinced that they urgently need help. That is a challenge, because the worse the physical condition, the less realistic the picture of one's own body and the greater the motivation to continue starving. This vicious circle needs to be broken.

That is why the Virchow-Klinikum is about nutritional management at the start of therapy, i.e. about increasing weight and normalizing eating behavior. In a therapy contract, a target weight is set that the patient must achieve in the course of treatment. "Patients have to relearn how to eat"says Pfeiffer. “Most of them no longer feel what their body actually needs. That's why we create nutrition plans for them and show them photos showing normal servings.«

The better someone adheres to the weight agreement, the more freedom and rewards they will get. Only when the patient is physically stable is it necessary to work through the psychosocial conflicts that could be the basis of the illness and to deal with the body image. Psychotherapy is also used in Berlin, but behavior and body therapy see greater opportunities: movement and dance should help patients to better assess and accept their appearance. A self-developed therapy concept called Dialectical Behavioral Therapy (DBT) should show them that everything has a positive side (dialectical) and that compulsive behavior can be replaced by so-called skills (behavioral).

But how do you get those with disordered eating to take the big step: to eat? I would have freaked out myself if I had been forced to eat during the peak of my anorexia. I would have sat there with a petrified expression, maybe forced a bite or two into it, chewed as slowly as possible and hoped that the terrible moment would pass quickly. Then I would have made up for my guilty conscience as soon as possible with a lot of sport.

"It can have a motivating effect to confront the patient with their examination results."says Pfeiffer. Often physical traces of the disease were already evident: the estrogen level is too low, the heartbeat is slowed down or disturbed, perhaps organs or parts of the brain have even been damaged. Then the senior doctor looks at the clock and gets up. “I'm sorry, but I've got some work to do. But please write that we are always grateful for donations. Goodbye."


Eating as a therapy for eating disorders sounds like a real challenge. How does that look in practice? How do you bring the positive side of calories into the minds of patients? How do you take the fear of fat and sugar from those with eating disorders? How do you make them the lusty eaters they were before the eating disorder?

Vera Baumer has to ask herself these questions every day: As a dietitian, she has been treating people with eating disorders for 18 years. She has also been working as a specialist in nutritional therapy for ten years ANAD e. V., a Munich association that offers therapeutic residential groups and a comprehensive therapy concept for those with eating disorders. “When I decided to work in 1993,” the 38-year-old recalls, “hardly anyone was interested in this disease. But I was fascinated by the topic. And after completing my training, I was actually lucky enough to be able to help set up one of the first programs for people with eating disorders at the Max Planck Institute in Munich. "

It's fun to listen to Ms. Baumer, our short phone call turns into an hour and a half. She has an optimistic and loving way of talking about her work. The nutrition therapist makes it clear to her patients from the outset that she is not asking anything of them personally. She tries to offer orientation without putting the patient under pressure.Baumer and her colleagues spend the whole day in residential groups. They prepare breakfast, cook and eat with the patients. First of all, it is important that the patients eat independently at all. And there is no one-size-fits-all approach to achieving this goal.

In one-on-one discussions, the nutrition therapist tries to get to know the patients and find out which methods could help them. Some find it a relief to stick to a meal plan. The plan can temporarily relieve the patient of the responsibility to eat normally or properly. This makes it easier for many people at first, because then they no longer have to worry about the tiresome topic. "I always compare it with a city map or a hiking guide that you follow until you find the way on your own."says Baumer. But it usually takes a long time before the joy of eating returns.

In a therapy limited in time, this can often only be partially conveyed, sometimes not at all. Setbacks are also part of the daily work of the Munich resident. Every meal is a new challenge for the patient. It is not uncommon for someone to poke around listlessly and thus drag the whole dinner party down. Consistency is required. "It is a good practice to exclude someone who does not eat from the meal.", explains Vera Baumer. You have to show the eating patient that it is not possible to refuse a therapy offer. Vera Baumer does not want her approach to be seen as harshness - she regards clear rules when eating as a guide for those affected. “To help patients, you have to give them clarity. It doesn't help anyone discussing at the table. " It is better to talk about motivations and problems in the following one-on-one interview.

"Every now and then you think: Now just eat, it can't be that difficult."the expert admits. "But of course that is nonsense, because that is exactly the greatest challenge for the patients." On the other hand, everyone concerned is responsible for the course of their therapy themselves. Baumer has therefore got into the habit of conveying to her patients that they can make new choices with each meal. “These young people do not have an incurable disease, they can choose for themselves at each meal whether they want to get well. This is a huge opportunity. "


Vera Baumer's constructive view of eating disorders is both admirably optimistic and reassuringly pragmatic. Your tactics seem harsh to me at first, but if I'm honest, I overcame the disease in a similar way. It was only when I realized that if I continued to block any help that no one would care about me anymore did I want to go back to normal. I was scared of being alone soon. At the same time I realized that I was the only one responsible for my fate - and that life is too beautiful to be thrown away voluntarily.

This insight was the beginning of the end of the disease. It took a few years to go back to looking normal, and the fear of getting fat is still on my mind.

My work as a cook was helpful, almost therapeutic. Instead of worrying about myself and the world all the time, my goal was to become a good cook. The cooking was great. I got to know many other chefs who invested all their energy and passion in their profession - together we managed a workload every day that was actually impossible. I was proud to be part of this hard-working and a little crazy guild. The kitchen gave me new self-confidence. The job also gave me freedom. I could do what I wanted, go where I wanted to. And I didn't have time to think about what had happened.

Today I find the phase of my eating disorder's life to be an interesting, formative process. It led to a personality change - one of the more blatant kind. Without this crisis I would certainly have become someone different. It was an experience that made it clear to me how extremely satisfying, earthy, pleasurable, luxurious, but also essential good food and drink are.

The only thing puzzling to me today is why not many more people think as positively as Vera Baumer. Most of the people I encountered during my eating disorder froze in worry. Some were embarrassed and grimaced in pity, as if a ghost stood before them. I'm definitely not a fan of merciless optimism, but I still wonder if eating disorders would be easier to treat if they were less negative and fearful.


On the other hand, of course, it doesn't help to completely ignore the dark side of eating disorders. They are especially creepy because they are vehemently and seemingly inexplicable against the beauty of life. They show the dark side of our colorfully racing society and reveal the downside of a life of prosperity, in which body cult, egocentrism and limitless enjoyment are regarded as values.

Never before has it been so difficult and so necessary to stage and position yourself as an individual. Never before has your own self resulted so consistently from the right way of life. And never before has the beauty of the human body been so strongly linked to promises of salvation as it is today. Beauty promises health, joy, satisfaction, wealth, happiness, good sex, cold beer, a long life and much more. Sure, social factors don't trigger anorexia - but they work as amplifiers.

Anyone who deliberately becomes lighter and lighter adapts their body to an environment and a time in which everything is becoming ever more fleeting and faster. At least that is how the artist Johannes Wohnseifer, who created the picture series, sees it The Thin Commandments created. The phenomenon of the dematerialization of bodies brought him to his room installation in 2003 Into the light inspired, in the context of which the work was shown for the first time. In pictures, sculptures, videos and lettering, Wohnseifer presented what happens to bodies that are exposed to fast speeds, or how building materials and construction methods change with increasingly powerful machines and vehicles.

And of course it was also about what happens to the human body: How do we change in times of restlessness, fast food and slim fast? On the phone, Wohnseifer, born in 1967, is a calm, likeable contemporary. He remembers how, when researching the exhibition, he first looked at eating disorders and then on the internet for the so-called Pro-Ana- Pages was hit: forums in which people with disordered eating can exchange information about their illness and encourage each other to continue starving.

There he found the Thin Commandments, a small part of the Pro Ana Manifesto, which includes other similar rules of conduct. "For me the fascinating material was that it went perfectly with the concept."he explains. »The Thin Commandments document the radical thinking of eaters. They show how self-perception and the view of the environment become distorted under the influence of the disease. And they demonstrate how the human body becomes an efficiency machine, how it is consistently made lighter until it collapses. "

The story of how the Thin Commandments came about is particularly exciting or perhaps tragic. The ten commandments are not an invention of the pro-ana scene: They originally come from an American psychologist who wrote down the thoughts of her patients in order to show them their distorted worldview.

But what else can you do? Doctors and therapists are sure that one must recognize eating disorders early on in order to be able to treat them successfully. They rely on advice centers and health education work in schools. In addition, it is repeatedly demanded that one should avoid models in magazines or show normal people more often in advertising.

Johannes Wohnseifer doubts such ideas. With models, appearance and ideal measurements are part of the job, he says, everyone knows that and everyone can abstract that. If from now on great normal people were depicted everywhere, the pressure would only increase to look good - then a mother of five children also has to be cover-compatible.


Maybe it is so. Or maybe not. After all, the images of supposed beauty influence our demands on reality and probably also on ourselves - especially because beautiful is almost always equated with happy. In the end, we ourselves believe that only those who are slim and beautiful can also be happy.

I can no longer say whether I used to believe in ideals of beauty or whether such a belief contributed to my illness. If so, it was at least not done consciously. Today, in any case, people who I think are beautiful almost never correspond to any ideal dimensions. This is probably also due to the fact that, for me, real beauty no longer has anything to do with external appearance.

I find inner peace, contentment, honesty and authenticity to be beautiful - a radiance that some people carry within themselves. It is the inner beauty that surrounds someone. It's quiet and sustainable - and it's more than just a promise of happiness.

Text: Manuela Rüther
Illustration: Tilo Göbel

From Effilee # 16, May / June 2011

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