Sunday, February 04, 2007

Ranking eating disorders

Last week a study published in the journal Biological Psychiatry (love the name! um, what other kind of psychiatry is there?) made the headlines by proclaiming that the most prevalent eating disorder in the U.S. is binge eating disorder. It said that 3.5% of women have episodes of "uncontrollable eating" at least twice a week for at least three months at a time. In classic sensationalist style, BED is now bring described as the "biggest" eating disorder in the U.S.

I had binge eating disorder for much of my teens, 20s, and 30s. It didn't have a name then, or at least I was unaware of it. It didn't seem unusual to me; other women in my familiy clearly had it too. It wasn't a good thing, and I wanted to change my eating patterns. I saw various therapists and finally landed with a good one in my late 30s. I signed up for 10 weeks of eating sessions and wound up with 8 years of intensive, fantastic therapy. Somewhere along the way I stopped eating compulsively, and while I still overeat on occasion, I have a healthier relationship with food now.

I hardly noticed when I "recovered" from compulsive eating. My weight dropped a whopping pounds. That's about it.

Why am I telling you all this? Because I'm worried that the hoo-ha over binge eating disorder will add fat (excuse the pun) to the anti-obesity fire. And that's bad news for all of us, whether we're fat, "normal," or suffer from anorexia or bulimia.

I don't want to play the "which is worse?" game. But as someone with personal experience of both B.E.D. and anorexia, I have to say there's no comparison. B.E.D. isn't a good thing, but it doesn't disrupt your life. Anorexia, the most deadly psychiatric disorder, kills. And while some people maintain a facsimile of ordinary life while they're anorexic, most do not.

I'm not saying it's OK to have an eating disorder. But I worry when I see all e.d.s lumped into the same category and discussed in the same terms. It simply isn't true. Anorexia is a life-and-death diagnosis. B.E.D. is not.

More anti-obesity rhetoric won't cause the prevalence of anorexia to rise, but it might trigger more people who are susceptible into active restricting and anorexia. And it certainly contributes to the culture of thinness that reflects our overall disordered relationship with food and eating.

It can and does affect treatment protocols, too. In my experiences (and the experiences of many families I've talked to), I've seen how the culture and bias toward thinness extends into the medical profession--sometimes quite deeply. One of the dirty little secrets well known among families with anorexic children is that doctors consistently set target weights that are far too low for true recovery. Not surprising, when you consider that a third of all eating disorders specialists have suffered (or still suffer) from an eating disorder themselves.

So my fear is that all this uproar over B.E.D., and how it's the "biggest" e.d., will cause more grief for families who are struggling with the ravages of anorexia.


Anonymous said...


I am not sure whether or not I agree with you here. Yes, anorexia is very disruptive and dangerous to oneself as a whole. Totally am not disputing you there at all-I know what it's like firsthand. But when 600,000 people die every year as a result of some sort of cardiovascular difficulty related to overeating-BED may be, in its sub-clinical form, a life and death dilemna.

I don't think the point of this research was to downplay the effects of AN. I think it was to point out that the pathology these sufferers-of someone whom overeats and keeps it down, someone whom overeats and throws it up, and someone who really doesn't eat very much at all and may or may not purge-is intwined. Even though what is seen may be different, the emotions are equally hellish.

And about how BED is the "biggest"; it's not, but, yeah-it is indeed the most prevalent. As far as medical respect goes, I can't tell you how much more anorexia receives. As an anorexic, you WILL get more insurance coverage and sympathy from a professional than any bulimic ever will. If you have to take an MLOA *medical leave of absence* from school as one suffering from AN, your school will give you more slack than one suffering from bulimia will get. And it's not fair. For me, I was far more emotionally unstable when I was unable to control my eating after a few years of AN than I was in my little AN cocoon.

Bottom line here is they all suck. They simply just suck and I hate them all. They are horrible and ravaging; anyone who tries to put one against the other in a manner which invalidates another person's suffering should be sorry.

Harriet said...

Hi Anonymous,

We can agree on that--that all e.d.s suck! I'm with you all the way there.

I know the point of the BED research isn't to downplay anorexia . . . but I also know the way our black/white media and mentality tends to work. I've seen this in action in my kids' schools, for instance. I think we're in the midst of a way overblown anti-obesity hysteria that suggests all the wrong solutions to the wrong problem. I've blogged about that earlier so I won't repeat myself here. But it does seem like there's room for only one e.d. du jour in our tiny collective psyche.

I don't know what state you live in, but here in Wisconsin, eating disorders are considered "behavioral health issues" (i.e. mental health) and are covered only a tiny bit by insurance anyway. Alas.

So . . . let's agree to keep talking and communicating about how godawful eating disorders on all parts of the continuum are, and to keep educating ourselves and others about the realities of them.

I am wishing you and all of us a healthy year and relationship with food.

Anonymous said...

Cheers to you as well, Harriet! Your passion for educating many on the true nature of e.d's-through this blog, your article in NYTimes Magazine-is evident, and I admire it to the fullest extent.

PS: It seems as if e.d's are universally "behavioral" problems, down in FL it's no different. And I also believe that the obesity "epidemic" is overexposed. Rather than forcing kids to watch SuperSize Me and jot down their diets for a grade, we should just let them have their cake and eat it too.

Unknown said...

What the media attention to this issue misses - and you've both nailed - is that very little of the attention to these EDs is based in fact.

It is aesthetic prejudice masked as health concern.

Fiona Marcella said...

"Biological Psychiatry" hmmmm - it seems that there's a lot of other types of psychiatry out there, although I agree with you, biology surely should play a huge role in any of them.

As for BED, having lost a dear work colleage to the illness, I beg to differ as to the seriousness with which it should be taken. ALL eating disorders suck, and all of them can kill too. (Incidentally his ED was quite obviously biologically based and sadly EDs including AN ran in his family).

Anonymous said...

I agree with you, Harriet. I also think that a problem with connnecting binge eating and obesity is that of cause and effect. It seems to me that the increasing focus on obesity may cause binge eating, not the other way around (as with bans on alcohol and binge drinking).

Harriet said...

I think psychiatry gets into trouble when practitioners "forget" that the brain is actually an organ of the body and in the body. I've seen too much of that kind of psychiatry, thanks very much.

I don't mean to diminish the very real tragedy of your colleague.That's truly the first time I've heard of someone dying from B.E.D. I'm sorry for you and obviously for him.

Anonymous, you hit the nail on the head for sure! Probably the biggest reason why Americans are fatter today than we were 20 years ago is the proliferation of low-fat and nonfat foods, which of course came about because of our national horror of fat and its evils. Turns out that eating some fat in your diet is a heck of a lot better for you than eating a whole lot of carbs and fake stuff. Big surprise. Fat triggers the satiety hormones in the brain, whereas a big box of fat-free doughnuts just makes you want . . . more doughnuts.

Which is why I take every opportunity to challenge the thin-is-always-good, fat-is-always-bad mentality that seems to pass for wisdom these days.

Fiona Marcella said...

I agree totally with anonymous that the dieting culture will lead to many more eating disorders of all types - and genetically vulnerable people will suffer and die as a result.

Anonymous said...

First off I really want to say how much I value your blog in general. I am convinced that if more families were as educated, aware, and proactive as you are the recovery rate for ED's in general would skyrocket.

That being said, I do feel a need to comment on the issue of BED/COE being acknowledged by psychiatry and the media. First off, as others have mentioned, you absolutely can die from BED - gastric ruptures from extreme binges are not uncommon and are fatal. And of course, there are the long term implications, as with any ED.

Secondly, I am puzzled by this attitude that one ED is more severe than the other. All ED's are related and very few people who have an ED have only one throughout their lives. Left untreated or inappropriately treated ED's mutate, like a virus, making them harder and harder to squash. Yes, the medical implications of one ED may be more severe than others, but medical implications are not the ED itself. Eating disorders, whether they come in the form of restricting, bingeing, purging, over-exercising, etc, are not about those things at all really. They are about something much deeper, and though the physical manifestation may be completely different, oftentimes polar opposites, the origin is often very much the same.

Why distinguish between disorders as though there is a sort of competition for "worst disorder" when we really should be looking at them as a whole, in many regards? Is it really the physical manifestation that we want people to focus on?? If so, how is that not feeding into the disorder itself? Why not look at ED's from the perspective of etiology? If we did that, wouldn't we all be more ED-aware than if we spend time picking apart disorders from the outside in?

Harriet said...

Thanks for the smart and thoughtful comment, anonymous. You're right, basically. I am just so dang tired of all the focus on "obesity" (which most of the time is, as Laura points out, a matter of aesthetics and not a health emergency--characters on Sex and the City talking about 10 pounds as if it represented a huge health threat, etc. As someone who has carried a few extra pounds (and sometimes more than that) I've shriveled under the looks and criticism from others around weight. And I have noted with deep sadness all the compliments my daughter received when she was severely anorexic. The day she was diagnosed, the EKG tech complimented her on being "nice and slim"--this was at 4'11" and 70 pounds. I wanted to kill that woman. Tha's the attitude I'm going up against. But you are right to point that all EDs are dangerous and awful, and that ED itself is something of a hydra that can take many forms, all of them devastating. So thank you for pointing that out.

Anonymous said...

I've suffered from anorexia, bulimia and BED (for over 20 years) and they've all disrupted my life. The disease that came closest to killing me was bulimia (due to excessive abuse of laxatives), however, my BED has caused me intense pyschological distress and made me suicidal at times. I think ALL eds cause terrible suffering.

Em (body&soul)... my site is password protected but if you are interested in reading my story you can email me at threexthree at gmail dot com and I will give you access.