- Intense fear of gaining weight or becoming fat, even though underweight, or persistent behavior to avoid weight gain, even though underweight.
- Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
With these criteria, the implication is that "the patients' behaviors are focused on getting/remaining thin. Yet some (many?) people with anorexia restrict food (and perhaps also purge and over-exercise) to regulate mood and to control anxiety. Sometimes being thin is simply the end result of behaviors which the patient has become dependent upon to control mood."
Yes, commenter I don't know (but would like to). Exactly.
For me, anorexia wasn't really about poor body image or a fear of getting fat. I was always too skinny growing up. I was called "Toothpick" routinely. I think this was my nickname on my softball team. Even after I went through puberty, I was still gangly. It's my mom's genes. If anorexia is about being thin, then I would have had no reason to develop it. I was already thin by most people's standards. And if anorexia was about vanity, I would have gained 40 pounds in 2001 instead of going into treatment looking like hell. But it's not that simple. And that's why I get irritated when I see pictures of thin celebrities on magazine covers with headlines like "Diet gone wrong?" and subheads like, "Friends fear anorexia."
Anorexia is not a diet gone wrong. It's a mental illness. Why is there so much confusion over this issue?
For a long time now, I've felt annoyed when I see articles blasting Ralph Lauren for his thin models (or terrible photoshopping) in the same breath as discussing the seriousness of anorexia. Isn't talking about anorexia in relation to Ralph Lauren ads already compromising its seriousness? Maybe I'm alone on this one because I see plenty of people who police media for body image issues while commenting on eating disorders and recovery. I just think they're entirely different issues.
In my case, I was not affected by too-thin models until I developed anorexia. Then, I just looked to them to rationalize my behavior and appearance, i.e. "See, it's totally normal that I look like a skeleton. Look at Calista Flockhart!" (Note: I developed anorexia way back in 1998, so Ally McBeal is what I remember. This does not give you permission to remind me how old I am). Or, I would make Calista (unbeknowst to her...I think) participate with me in some starvation competition, created entirely by me, in my ill mind. It's like I was on a quest to just need less and less. I didn't want to look like Calista; I wanted to need less than her. I thought this made me somehow purposeful, superior.
I agree that suggesting that all women should be stick thin is bad, but this is a totally separate issue in my mind. I could just as soon say, "Anorexia sucks and too-thin models set a bad standard" as "Anorexia sucks and lilies are pretty." They're just not related, even if you say them in same sentence. Also, go ahead and gasp at this, but while we're discussing body image, I'll just say that I don't think putting "large" women in ads means society is better off. I think society would be better off if size was irrelevant completely. How about just healthy women? There are healthy women with a range of BMIs. Personally, it affects my psyche and self-esteem more to see women in perfect make-up with super-smooth, shaved legs than it does to see women who are thin. That's my insecurity, because I hate make-up and I'm very lazy about shaving. Setting a standard of beauty always has dangers, no matter what the standard is. When I was a beanpole in junior high, I was aware that the standard of beauty was developing boobs. I was flat as a board. I developed very, very late, so I always felt scrawny. We had Ensure at home so my sister and I could put on weight (which I thought would go to my chest, almost magically). I got reacquainted with Ensure in the worst days of recovery. Oh, the irony.
In my opinion, the DSM doesn't really do service to the underlying drivers of anorexia. I think most self-destructive behaviors are a way to self-medicate, and I'm very aware that my anxiety went way, way down when I was heavily involved with my eating disorder. Everything seemed very peaceful and quiet when my mind was just tallying calories. For me, recovery is about learning to manage anxiety in a healthy way. It has very little to do with appreciating the Dove beauty campaign. Yes, there are days when I "feel fat," but this mostly translates to "I feel stressed." Somehow, they got linked in my mind (stress-->fat-->eat less-->less stress), but that doesn't mean the driver is for me to be thin; the driver is for me to be calm, and thinness was the result.
The DSM sort of supports the idea of Ralph Lauren ads and anorexia being paired. I just don't see this. This direct linkage seems to fuel the fire that eating disorders are adolescent obsessions with looking good. That fuels another fire -- that treatment is simple: Just eat, write body affirmations, paint your nails, you'll be fine. This starts a whole other inferno of self-hate and shame for the sufferer who feels like, "Why can't I just get better then? Am I just a vain, stubborn idiot?" The only thing that has extinguished all this has been to realize (with the help of Carrie's blog) that this is an illness.
In short, I'd guess I'd say that I think the DSM definition of anorexia needs to be fleshed out a bit. Har har har. I crack myself up.
What do you think the link is between images of thin women in media and eating disorders?
***
Today's gratitude:
1. Sweet potato chips from Trader Joe's. New discovery. Very good.
2. I feel great today. The first night I took Lexapro, I slept 5 minutes and I felt very loopy and sick to my stomach yesterday. Today, that's all gone. I'm sure it's too early for the medication to have any real influence, but I feel great. If it's placebo effect, I'll take it.
3. Got my health insurance and 401(k) set up at work. I feel very accomplished today.
4. I'm still reading "Hawaii" and I think I've gotten through the most boring part (about the lava and the canoe voyage...yawn). I hate not finishing books. I'm determined.
5. Larry says he's quitting the Diet Coke. He read an article about how it increases risk of kidney cancer and says he wants to switch to iced tea. I'm impressed.
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17 comments:
I totally remember admiring Ally McBeal's body but oddly I never thought she was too thin. (I am dating myself as well I guess). For some reason I am more disturbed by the gorgeous people that live in LA than by the skinny movie stars and models in the media. It is their job to stay thin and look good, whereas random people on the street just look like that naturally (I assume)?
Anyway, I don't have an eating disorder but I do have an intense fear of gaining weight or becoming fat so according to this definition I do in fact have a disorder.
I confused myself with this comment...I don't expect you to understand it. :)
That's funny about the Diet coke. Funny because i just had one. I guess it won't be so funny if i get kidney failure! I hope you can check out my blog. I'm completly new at this and some feedback would be greatly appreciated. I feel like your blog is different from others I read. Your posts are alway insightfull.
I definitely agree that society needs to stop looking at anorexia as a 'diet gone wrong,' for me anorexia developed as a way to numb and distract myself from life/feelings/all that tough stuff- and from there it morphed into an obsession with staying thin and controlling/regulating everything related to my intake/weight.
While I definitely don't approve of the media using images of very underweight/unhealthy looking women- I don't think it should be correlated with anorexia but more perhaps with poor body image which might contribute to the triggering of eating disorders in those PREDISPOSED to having them or already having them. While I was sick and even sometimes during recovery I compared myself A LOT to celebrities/models- but it really was just adding fuel to the fire of my illness. I feel that when the media/groups try and connect anorexia to these images, it's degrading since they are not the cause of anorexia since it is after all...A MENTAL ILLNESS.
Such a complicated topic.
I totally agree that skinny models/pursuit of thinness/diets gone wrong should not be conflated with eating disorders.
On the other hand, I think the media should be blamed for creating an atmosphere in which eating disordered behaviours are accepted, encouraged and even admired. Body image was part of my ED, but I know it is not as important as for others, nonetheless no matter what the aetiology is, I think the media emphasis on thinness and dieting creates a climate in which eating disordered behaviours are less likely to be noticed as this.
Brilliant post, this one really made me thing ;)
Sarah x
oops sorry *think!
The commenter is Cathy, she emails me sometimes because we are both from the UK, both fall into the non fat-phobic category of anorexia and both attempted recovery as outpatients. She's lovely, if you asked her for her email I'm sure she'd say hi :) she does YouTube videos too, under the name of misstiggykins.
Anyway, you probably already know my thoughts on this subject, because I go on about them a lot! Personally the media had nothing to do with my eating disorder. It made recovery a bit harder, but I had zero interest in fashion or celebrities before, during and after I was ill. The way I see it, certain people are genetically predisposed to developing eating disorders. When that predisposition is triggered, they will assign meaning to their behaviours. In my case, I realised that not eating numbed my anxiety and depression, so I started to correlate being a healthy weight with having out of control mood swings. I wasn't trying to make myself look like a celebrity (if anything I knew that I was becoming LESS attractive and that made me feel safe), I was just convinced that I would go crazy and kill myself if I wasn't restricting and underweight.
I get irritated with the fact that the media almost come across as wanting to blame themselves for eating disorders, because they don't cause them. They might be part of the trigger for some people, but for others they are a non-issue. Eating disorders are mental illness, like you and everyone else said. Proper nutrition, weight restoration, therapy and time cure them. Even in countries where there is no western influence, the rate of anorexia in the population is exactly the same as over here, they just attribute their behaviours to different causes. It's the same illness, and I would probably have developed it whereever I lived.
Ok, first, I must admire your "fleshed out" comment. I am a pun lover so this totally made my morning.
Second, I totally agree that the media does not cause eating disorders. I think personal (i.e. personality traits and ways of being in the world,) biological, and environmental factors are all responsible.
That being said, I think people focus on the media for a variety of reasons.
a) they're undeducated or not up to date with current research
b) it can make anorexia seem more "controllable" if you say, "this visible thing in front of me that I DO understand causes this thing in front of me that makes no sense whatsoever"
c) the media can contribute to unhealthy body image, which makes one more susceptible to acting out dieting/restricting behaviors, which in turn can trigger anorexic behaviors in people who have the genetic predisposition and personality traits for full blown anorexia
d) according to my research for one of my public health practice classes, there is a paucity of research demonstrating eating disorder prevention curriculums that lower eating disorders in any significant way, and those that have shown mild statistical significance haven't been tested in all age groups or among all races and ethnicities. I think it's easy to just look at something that we all have in common (the media images) and say that changing it could help, since we don't know what else will. It's an error in reasoning, but like I said in a, most people don't realize it.
Also, e) the fashion industry and media loves to talk about itself. Any attention > us ignoring them and focusing on actual education.
Okay, so my novel is complete. By the way Kim, I always read your blog, think about it for up to two days, and come back to comment because you really make me think! This one I just fired off though because I love talking about this topic :)
This is one of those posts where I wish I had some great comment to leave, but honestly, Katie pretty much covered it (including the fact that I want Cathy to be my friend, as her comments are always brilliant and relatable).
I plan on keeping this with me: "Yet some (many?) people with anorexia restrict food (and perhaps also purge and over-exercise) to regulate mood and to control anxiety. Sometimes being thin is simply the end result of behaviors which the patient has become dependent upon to control mood."
But this is also the kind of post that frustrates me, as just because I understand and totally GET that, it doesn't make anything easier--explaining to people, stopping my behaviors, etc.--so I just wonder, now what? Yes, I do that and think I look thin and sick, but still...?
Sorry. Mini-rant, but another great post. It does help to know I'm not alone, even if I sound like I'm bitching ;)
P.S. Loved Ally McBeal, but admired Portia de Rossi much more than Calista.
I am going to have to read this again when I have time to read all the comments, but this is VERY interesting.
I have always not agreed that I'm/was anorexic (I was not ever diagnosed because I refused to see a doctor, but I more than met the weight definition)... because I did do it to be thin, not as a way to control my anxiety (I did develop an anxiety disorder after I was very underweight - go figure). I mean, I was thin to begin with, but then I gained weight at college and wanted to lose it. And then I just lost too much because I was terrified that it would come back instantly once I started eating a lot again.
I think that true anorexia IS what you're saying - and that this intense fear of gaining weight and wanting to be thin thing is something else. I don't know if making a distinction would help with treatment decisions though. Seems like both kinds don't have that great a recovery rate.
Kim
Its scary how a lot of our thoughts are alike. Your blog and words are unlike the others I visit....I can only relate to a certain degree to the others because they are so ED, food, fear - focused.
For me, its deeper, its depression. Its not about the stupid food and its NEVER ever been about vanity or looks....not even a little....never ever.
Its a sadness..the cause the effect ???
so confused and frustrated with it beyond any rationality. What u wrote is true with regards to only looking to the thin girls to "rationalize" it. I would see Nicole Richie, just bare bones only, and think ...right? and i am the one being stereotyped and told to be put away in some hospital ? and she walks around and runs on the beach?
it infuriates me...i could go on and on.
Vanity wasn't even an issue for me. I was more concerned with the way I felt, of achieving mastery over myself and the world around me (note: not the people around me - I was far too detached for that.)
as someone in the entertainment industry, seeing how mostly emaciated women succeeded showed me a clear signal: to work, you must be this small. as more women of different sizes come onto the scene, it becomes inspiring to people like myself, who are struggling, to just accept that weight really doesn't have much to do with it at all.
Hehe I just emailed Cathy the link to this. I hope she enjoys reading other people's thoughts on her general wonderfulness :P
I have thought a lot about this issue because I initially believed that my eating disorder WAS a diet gone wrong...until I looked into the years before the disorder. I realized that I was displaying warning signs for years. I just had no idea. My parents once confronted me about a potential ed, and I thought they were absolutely nuts. That was before the word 'diet' every crossed my mind. Because my sister and mom have also struggled with disordered eating, I'm on the side of science...there is clearly some biological connection.
I was always too thin growing up, too. In fact, one of the reasons why my parents NEVER suspected I had ED until I was hospitalized and basically told them I had one, was because they never imagined I would think I'm "fat". I didn't. I just got sucked into the thrill of an obsessive behavior.
It wasn't all about mood control for me, though. It was more about the relish...of accomplishment? Of having a definite purpose in life that I can actually attain? Something like that....
But, I disagree, I think we should condemn the practice of too-skinny models. Despite the fact that some of our anorexia is not purely from a desire for thinness, it is most certainly true that unnaturally skinny models trigger girls and females. The media definitely plays a HUGE role in the increasing amount of eating disorders...it becomes a source of unhealthy inspiration, and it only fuels the pre-existing tendency for anorexia inside of a person.
My experience was similar to yours (as usual). I was always thin, and even my lifetime high weight was hovering just below "healthy" BMI range (age 13). No one ever called me fat. No one in my family dieted. I didn't look at models and wish I was as thin as them. I started just trying to "eat healthy", to not gain weight as opposed to losing it, and it just snowballed from there. When I was sick, I didn't really think I was fat. I just didn't realize how sickly thin I was. I think that EDs are way more complex than even the new DSM appears to give them credit for; there need to be less definite "symptoms" and more common themes of experience and feelings outlined.
I'm late to the party, but I just clicked over from Carrie Arnold's blog and I am so thrilled to see this that I had to comment.
I don't even think it makes sense to treat an eating disorder as a discrete illness, at least in my case. For me, my eating disorder was a coping skill to deal with my anxiety and depression. I was so miserable and I was starting to hallucinate, that I decided that I needed something to control my thoughts. Anorexia fit the bill quite well because it allowed me to focus on something external, on linear goals with linear thoughts, I could obsess over calories instead of obsessively thinking about how miserable I was. I kind of knew body image problems would come with the eating disorder, they were a part of the linear obsessive thoughts I needed to crowd out the misery, but it was never a problem before the eating disorder, though it continues to be a problem for me. Anorexia was a really good coping skill, and I haven't found a healthy one that is nearly as effective.
In treatment we are so often told that eating disorders are not about food, but then everything we do revolves around food and body image. Sure, those things definitely need to be addressed, but they are not the entirety of the problem. And for someone like me who says, "well, yeah, I have those problems, but they aren't really THE problem, and solving them won't make me much less miserable, and might make me more miserable because I won't have anything to crowd out the misery anymore," all the focus on food and body image can feel very alienating. I used to think that if even the eating disorder specialists couldn't understand me, were so far from understanding me, then I must be really bad off. How will I ever get better if the very people meant to help me can't even understand me? Hearing other people saying similar things to what I've been saying all along is incredibly validating, which is so needed when treatment is so invalidating. Thank you so much for that.
I wrote on my own blog about my decision to become anorexic, which was a slightly controversial post, if you are interested: http://madewithawesome.blogspot.com/2009/08/i-chose-anorexia.html
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