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	HOW OLD WOULD YOU SAY THIS WOMAN IS? 45? 50? MAYBE 60? TRY AGAIN. SHE IS TWENTY-TWO. This young woman is severely anorexic. She does not quite encapsulate the supposed beauty of the thin does she? .....Yet this is the ghostly reflection so many of us seem to wish to see when we look in the mirror.....

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Sometimes we get asked what it is we want out of all this. Well here we go. Here's a summary....

...HERE'S WHAT WE WANT:

We want our bones to show. We want our stomachs to growl. We want our hair to fall out. We want our kidneys to fail. We want our muscles to waste. We want our teeth to rot. We want to be infertile. We want our skin to chafe and bruise. We want our livers to fail. We want soft down to sprout all over our faces, our backs, our stomachs, our arms, our legs. We want to turn yellow. Then blue. We want our joints to creak. To ache. We want our feet to swell. We want arrhythmia. We want atrophy. We want anemia. We want arthritis. We want osteoporosis. We want memory loss. We want nausea. We want reduced lung capicity. We want to wheeze. Cough. Choke. We want a cathartic colon. We want edema. We want a torn esophagus. We want brittle nails. We want dizziness. We want parotid gland enlargement. We want thyroid abnormalities. We want impulse control disorder. We want to stumble, to fall, to black out. We want heart palpitations. We want respiratory failure. We want paralysis. We want brain damage. We want hypoglycemia. We want hypothermia. We want hypometabolisms. We want osteomalacia. We want our blood pressure to drop. Oh and diarrhea, we want that too....
...We want...
...But oh no, you get us wrong. We don't want to die!! Heaven forbid, we don't want that. Don't you understand? We do this to show how in control we are. How enviable. And we are..... aren't we girls?

Some of the ways in which eating disorders can present themselves (by Dr Paul Robinson) System Symptom/condition Mechanism Psychiatric Depression Low weight Bulimia Co-existing depressive illness   Obsessive-compulsive disorder Deliberate self harm Psychosis Low weight, obsessional traits Depression, personality disorder Refeeding, stimulant abuse, Co-existing psychotic illness Alimentary Dental erosion Parotid enlargement Haematemesis Gastric acid, carbonated drinks, bingeing on sweet foods Vomiting, bingeing, chewing and spitting food Pharyngeal damage, oesophagitis Mallory Weiss   Prolonged gastric fullness Delayed gastric emptying Distorted interoception   Abdominal pain Diarrhoea/constipation Prolapse Gastric dilatation/perforation Laxative abuse Laxative, enema abuse Paediatric Endocrine Failure to grow in weight, height or both Amenorrhoea Infertility Anorexia nervosa in child OR in mother Hypothalamic hypogonadism Hypothalamic hypogonadism Polycystic ovaries in bulimia nervosa   Problems with pregnancy, low birth weight Malnutrition Rheumatology Osteoporosis Low oestrogen, malnutrition, ?high cortisol Cardiology Low blood pressure Arrhythmias Cardiac wasting, dehydration Hypokalaemia, low phosphate in refeeding Haematology Pancytopaenia, purpura Low weight, bone marrow depression A & E Overdose, deliberate self harm Collapse Depression, personality disorder Cachexia, GI bleed, acute abdomen Infectious diseases TB Depressed immunity Neurology Delirium Myopathy Neuropathy Pressure palsy (eg ulnar, peroneal) Refeeding, Wernicke's encephalopathy Nutritional myopathy (type 2 fibre degeneration) Unknown Wasting, pressure on vulnerable nerves

JOB DESCRIPTION OF AN ANORECTIC

Position: Anorectic
Hours: Long shifts leading to all night-shifts. Expect to work at all times of day or night, depending on need.
Vacations: None, without a very good reason. Sick leave requires extra effort when returning to work.
Requires: Young, intelligent, attractive or talented, men considered but mainly a position for women. Often single, position has been known to cause relationship difficulties and separations. Ideal candidate would be prepared to sacrifice all for the sake of work.
Bonuses: Long hospital stays possible. May save money on food but lose it on drugs if you aren't careful. No rewards for extra effort in the long term although short term positive(?) benefit may be felt emotionally.
Career possibilities: Few, although some people have been known to last a long time in this position, it will hopefully have only a limited staying power.
Training and education: Can get in-house training in dinner-queue mental arithmetic, a wide knowledge of calorie counts, fat grams etc will be acquired.
Overall duties: Liaise exclusively with ED, daily meetings at the mirror, on the scales etc. Working mainly in the company gym and canteen, meals of tomato ketchup or mustard with carrot sticks recommended.
Pension, insurance: Expect heavy bills, few pension rights.
Prospects: The most committed workers will go straight to the bottom.