Writers note / Content warning: As you are aware, I usually try to keep this blog fairly light and easy. But just today I’d like to share a piece that is close to my heart, and there kind of isn’t any way to sugar coat it. (Pun not intended.)
There seems to be a resurgence of interest in the local media concerning eating disorders apparent in our society. Eating disorders are no new phenomenon, however there are some well established (and often inaccurate) cues that go off in our brains when we hear those words.
Anorexia. Bulimia. Thin girls. Thin WHITE girls. ADOLESCENT thin WHITE girls..
Those are certainly accurate to a degree, but how about this:
Overeating, Fear, Control, Any sex, Any race, Any age, Any financial demography.
There are so many variants on the spectrum, that the peeps that put together the latest version of the DSM V (the psychiatric bible of diagnostic medicine) have now changed the ‘label’ to OSFED – Other Specified Feeding and Eating Disorders. Try saying that fast.
OSFED encompasses the MANY eating and feeding disorders that affect the population. Included are Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Pica, Avoidant/Restrictive Food Intake Disorder, Rumination Disorder (etc, etc, etc)
Our understanding of people that suffer from eating disorders is often brightly coloured by what we read and see in the media; Rich girls at private schools who are perpetually terrified of French Fries. The reason this image is so much more represented is often because it is those girls that are able to afford to seek help, and have their treatment officially documented.
So what about the rest?
There is mindblowing information coming at us that suggests that in fact eating disorders do not discriminate. Boys, men, older women, older men – all just as at risk for developing a diagnosis of OSFED. Additionally the historic reasons for why some people are more vulnerable to developing these disorders is also taking a cricket bat to the head.
It appears that a mixture of vulnerable genetics, gut bacteria and the right (or wrong) environment are all playing a part, far more critically than the previous idea that thin-girl objective and social ideals were solely to blame.
And eating disorders aren’t always apparent in the form of a critically low BMI.
Extreme over eating, or Binge Eating Disorder (now classified as a disorder of its own in the DSM V) is a chronic disease hidden away in a more socially acceptable package. We are used to hearing that the national rates for diabetes type II are rising. We are used to seeing pictures of over weight Americans with their heads obscured from the screen, walking around the street holding takeaways. We order in super size too.
We drink litres of soft drink, we buy family packs of processed food. We indulge in rich meals and use one form of dissonance or another to tell ourselves that it is okay, because tomorrow we shall eat only apples.
So we can hide the fact that in private we fight a desperation for more. There is a bastard living in our head saying ‘just one more piece, you just need to feel happy, it will help’.
(or realistically “fuck it, you’ve ruined your diet today anyway.”)
When out with others, it looks normal to have the extra cake or cookie. I’m not even saying that we shouldn’t indulge. But for people that suffer with binge eating disorder, this socially acceptable indulgence can become a feeding frenzy that causes guilt, physical pain, and an ongoing battle with self worth.
Here’s what the DSM V considers ‘binge eating disorder’
So that’s the clinical diagnosis. There are many reading this who can say that they have done this from time to time. Hell, we all know what a ‘veg out’ night looks like (and it usually does not involve vegetables), but to people really suffering from this disorder, they are trapped in a kind of hell that seems to swallow them up as fast as they are swallowing down their own misery.
Binge eating disordered patients have spoken to me about the cravings, the absolute drive to get high caloric foods into their mouths as fast as they can. That each bite and swallow numbs the internal pain that they are suffering. That for the 15mins that it takes them to consume what a non-disordered person would eat in a day, they feel satisfied.
But that 15 mins or so then turns to excruciating pain in their gastric systems, they have extreme guilt, they berate themselves for having no will power, they feel helpless and haunted.
They may try to get rid of it by attempting to purge, or even hurting themselves physically as punishment for failure. But more often than not they are just left to sit, cry and vow to do better tomorrow.
And this absolutely guts me.
Being in the vocation that I am in (Nutritional Therapist) I have talked to people on both ends of the OSFED spectrum. Anorexia Nervosa has the highest mortality rate of ANY psychological disorder. Recovery rates are poor. Sometimes (or dare I say often) people who have clinically ‘recovered’ from anorexia go on to develop binge eating disorder or become clinically overweight. The deep seated problems often remain, and they merely slide up the spectrum scale.
When these patients have been through the required therapy and put back on the ‘correct’ amount of weight to be cleared for discharge, they are left to go at it alone.
They are told things like “just have one chocolate bar a day – you should be able to do that” or when they return to their therapists, having put on a large amount of weight, seeking help for what feels like the exact same issues they had when they were diagnosed with anorexia (guilt, loss of control, obsession with food and weight) they may be told to find a yoga studio or gym, or learn to meditate. The therapy just seems to disappear.
(I am only speaking from experience I have had with clients who have been grossly let down by the system, please understand that).
I am not saying that these things will not work, in fact I frequently advocate them, however with the psychopathology of something as serious as OSFED, you can’t expect a patient to smile and say “oh lovely! I’ll just swan off to a meditation retreat and come back right as rain and cook you all some quinoa and free range lentils” It ain’t gunna happen.
There is deep seated anxiety to get through. There are embedded patterns of behaviour ranging from habitual restriction to extreme comfort eating (or concurrent episodes of both).
I’m sure the therapists are just doing what they have been told to do, and sticking to whatever curriculum there is for treating eating disorders. But even the best researchers are now admitting it isn’t working. (angi.nz/about)
In my (extremely humble) opinion, I believe anorexia nervosa and binge eating disorder are almost EXACTLY the same. They just manifest in the opposite way.
Let me qualify: Anorexia says ” I am grossly unhappy and distressed with my body. I feel out of control when it comes to food and weight. I want to aim for a life of perfection and control in all things. I will restrict my food intake because it is the one thing in my life that I can have absolute control over, and it takes away my anxiety”
Binge eating disorder says “I am grossly unhappy and distressed with my body. I feel out of control when it comes to food and weight. I want to aim for a life of perfection and control in all things. I will eat food to make myself feel better, because it takes away my anxiety.”
Except it doesn’t. It reinforces it.
And these people become overwhelming depressed and isolated.
So why have I written this?
If I am so opinionated about eating disorders, why don’t I magically come up with the answers?
Because I have been affected by the reflection in the mirror for years. I won’t always admit it, but the voices are strong on days where I am not.
And also because at the moment, the great minds who have spent the last 10 or 20 years clinging to their PhD’s also don’t know.(But they are getting closer, and this is great).
These stories don’t make good media. We want to see or read about thin people who triumph over their disorders and end up looking akin to a fitness model or GAP advert. We don’t want to hear that the recovery of someone with a gravely low BMI can then go on to be categorised as over weight.
It doesn’t sit well with us.
Instead, we indulge in articles boasting about the radical weight loss and success of someone or other and sit, desperate for an answer to our own problem.
We want the answer to be simple, neat and tidy.
But for many, it is not.
Eating disorders (whether clinical or borderline) are so much more common than we think.
Diagnostically, you may not fit the criteria but you know there have been times where the world fades away to a blur in the midst of repulsion at the man or woman staring at you from the bathroom mirror. You may stand on the scales each morning only to feel attacked by the number blazing back at you.
You may feel you are helpless to change, or hopeless with willpower.
You are not alone.
We need to talk about this. In the open, in all its scarred, brutal and seemingly catastrophic agony. We need to help each other, and offer nonjudgmental support.
We need to stop saying naive things like “why can’t you just have one Tim Tam?!”
Or “but you look so good?! You aren’t fat at all, it’s all in your head!”
Trust me. We have heard it all.
I want to find a way to help. To restore health, vitality and LIFE back to those who have become consumed with weight, control and unobtainable perfection.
I want to help myself. So let’s open the dialogue.
Edanz Helpline Free Phone 0800 2 EDANZ