What is our body telling us when we have an eating disorder?

Let's say you cannot speak. You don't dare ask for help, but you can't resolve your problems alone. What do you do?

One strategy might be to act out your distress. You might go hungry, shaping your figure like an empty spoon, as hollow and lifeless as you feel. You might secretly stuff your body with food the way you've stuffed down fear and shame, and then violently purge, as if to get rid of those unspeakable emotions. Or you might just keep on eating more and more until the outside world seems to shrink by comparison, each new binge mimicking the onslaught of feelings too huge to contain within the mold of acceptable expectations.

When viewed as wordless cries for relief, the psychological pantomimes of anorexia, bulimia and binge eating make perfect sense. The mystery is why the afflicted so often misread the messages their ailments embody - as do the people around them. Eating disorders are often unrecognized or belittled by parents, teachers and doctors, misunderstood as choices made by girls and women obsessed with their weight. But they are mental illnesses, and they can be as lethal as guns - shaped by genes, loaded by culture and triggered by emotional pain and existential dread. Recovery must be measured not only in pounds, but also, crucially, in the discovery of a sense of self.

Between the ages of 14 and 21, I spent countless hours cross-examining the emaciated reflection in my mirror. "What's wrong with you?" I'd demand. "Who are you, anyway? And why don't you know who you are?" Yet instead of recognizing my obsession with weight loss as a sign of an identity crisis, I told myself my problems would be solved if I just lost a few more pounds.

Like most girls with eating disorders in the '60s and early '70s, I never received treatment. Then, at 22, I fell in love. My lover knew how to see and hear and touch me. He fed me pasta, wine and laughter, and, in so doing, taught me how to nourish myself. Suddenly, starving my body made no sense.

But shadows of self-doubt remained and, within them, the half-life of my eating disorder. I no longer deprived myself of calories, but for decades, I "could not" eat meat. Evenings and weekends, I "had to" work, while everyone else had fun. And although I thought I was content with my husband, the slightest marital disagreement would render me mute. Instead of confronting our problems, I would run away, literally, often running through injuries for hours. By the age of 36, this relentless physical punishment had permanently crippled my right ankle.

Then, my marriage of 20 years fissured and, at age 46, I once again became a stranger to myself. The woman who lived in my skin would stand blinking blindly in front of the bathroom mirror. She would burst into tears in the drugstore. More familiarly, she went days without eating. Hopping on and off the scale, she'd mutter, "At least you're losing weight."

Fortunately, separation was accompanied by long-overdue therapy. I saw that the threat of divorce had hurled me into another paroxysm of uncertainty. The plea behind my attempt to make less of my body should have been obvious to anyone, including myself, but it took a skilled psychologist to help me interpret my own signals. I emerged from this crisis with a more powerful voice in my marriage and a new respect for the eloquent conditions we call eating disorders.

Over the years I'd noticed that virtually all the women I knew with histories of anorexia, bulimia or binge eating were intensely self-critical. When I mentioned my observation to eating-disorder researchers, they went me one further: The risk for eating disorders, they explained, is largely genetic. And while no one has fully solved the puzzle, science has shown that the contributing genes often express themselves through a signal personality trait: perfectionism.

Bingo. I'd known the curse of perfectionism since childhood. I knew there must be a right and a wrong way to do everything. Nothing created more anxiety than the feeling I was wrong, and it didn't take much to set it off. I believed in the imperative of perfection as my culture defined it; the less perfect my life felt, the harder I worked to perfect my body.

Perfect girls, as I imagined them, didn't talk about fear or shame. To admit any vulnerability or ask for help would be wrong. So my beleaguered subconscious found a way to turn perfectionistic stubbornness into a nonverbal alarm. And what could be more primal than to articulate distress through extreme eating behavior?

I think of all the women who've told me they wish they could be "just a little" anorexic. My reply that that's like wishing they could be just a little bit dead is usually met with uncomfortable laughter and an abrupt change of subject. It's as if the connection between mind and flesh were a fact these women would prefer to forget. Our culture has been trained by the media and the fashion and beauty industries to view the female form as a perfectable and depersonalized commodity, but our bodies beg to differ.

Imperfection and blemishes are part of the human condition. We may not look exactly as we would wish, but our bodies contain us. They carry us and work for us and give us pleasure. They speak for us when we dare not admit the truth. We owe it to ourselves to remember how to listen.

About the author

Aimee LIiu is the author of three novels and two memoirs, most recently Gaining: The Truth About Life After Eating Disorders (Wellness Central, 2008).