It amazes me that, though historical records of eating disorders date back centuries, just how very little these disorders are understood, even today.
Take, for instance, a “conversation” I engaged in this week – and I use the term conversation lightly, because it was really more of a haranguing, self-absorbed monologue on the other’s behalf. The blogger, who coincidentally happens to describe themself as a fat acceptance activist, dismisses scores of women with eating disorders as simple cases of thin-envy.
Apparently, the notion of “acceptance” isn’t all-inclusive for some.
As a practicing Buddhist, I believe that the way to attract positive vibrations and experiences to oneself is to surround oneself with people who are themselves filled with positive energy. There’s a saying in the bible I like: “He that hangs with fools shall be destroyed. He that hangs with wise men shall be made wise.” I will use gender-neutral pronouns henceforth, because while I have no particular wish to either draw negative attention to this blogger or engage said blogger in additional debate, I do want to address the fallacy of the blogger’s claim.
The blogger denies the very real experiences of many women with eating disorders, with the claim that many of these women are simply “clinging” to an eating disorder in hopes that “recovery” will make them magically thin.
For one who makes it a point of their activist platform that fatness is not a character flaw, it seems hypocritical to then accuse women with binging disorders of using their disorder disingenuously to conceal their so-called true weight-loss intentions.
I view it much in the same vein as accusing someone, who insists they eat a balanced diet, of secretly overeating and/or eating “bad” foods simply because they are overweight.
Because the very DSM-IV criteria for anorexia is a “refusal” (or inability, as I prefer) to maintain at a minimum body weight, it must follow that the disorders women allegedly beguile themselves with include bulimia and binge eating or collectively, binging disorders. (Note: all of these disorders can exist independently of obesity).
All of the leading professional organizations devoted to the study and treatment of eating disorders – ANRED, NEDA, ANAD, and the AED to name a few – acknowledge the often extreme shame and guilt characterizing these disorders. It’s been well documented that many patients with these disorders report that they will often binge in private, away from prying eyes, due to the extreme shame they feel over their uncontrollable urges.
In fact, the DSM-IV diagnosis for binge eating, which has received wide empirical support as a distinct eating disorders category, requires a marked distress about the binge eating.
Ellen Shuman is the director of A Weigh Out Life Coaching programs and the Acoria Eating Disorder Treatment, and also co-chairs the International Academy for Eating Disorders special interest group on “Health at Every Size (HAES).”
Shuman’s facility adopts the HAES approach in dealing with patients with binging disorders, NOT a continued cycle of dieting and starving as assumed by the blogger referenced above. As a former patient of the Acoria Center, I can attest this to be true.
As a recovering binge eater herself, Shuman is well aware of the shame associated with the disorder. She writes:
We feel out of control with food. We try to keep what we’re doing a secret. (Not easy as my weight soared to 289 pounds.) We eat in bathrooms and we thank God for the relative anonymity of drive-throughs. We know all the most isolated parking spots in the tri-state. That’s where we do much of our eating because we wouldn’t dare do it where anyone might spot us. We hold our breath and pray for the strength to pass a UDF without going inside. When we’re not feeling numb from the effects of our latest binge, we feel shame.
You can read Shuman’s experiences with binge eating disorder and the resultant shame and guilt it instills in an article previously featured in Cincinnati Magazine.
Simply said, an eating disorder isn’t something one admits to readily or easily, with the hopes of a magical get-thin-quick cure. In fact, making the decision to get help is often the most difficult and arduous point in the entire recovery process.
Shuman admitted of her own decision to confess all about her disorder, “I know it takes soul searching and guts to go public with a problem that held so much shame in years past.”
As a recovering anorectic and bulimic myself, admitting that I had an eating disorder which had become uncontrollable was probably the most difficult point of my entire recovery process. Admitting you need help is never easy, but confessing to shameful behaviors and practices like binging makes seeking recovery even more difficult. From speaking with countless other women who have or have had eating disorders, I have found this to be a common thread amongst the disordered.
The blogger’s overarching blanket statement is therefore not only erroneous, it’s highly offensive to the legions of women who experience very real, psychological-based eating disorders.
Zie also erroneously assumes that treatment for binging disorders involves a confessional of the sufferer, that they “did this to themselves,” which they then use to justify a continued cycle of dieting. This could not be further from what actually occurs behind closed counseling doors.
Sufferers aren’t led to believe their actions to be consciously self-inflicted, but are often given information on new research which increasingly shows binging disorders to be the cause of biochemical differences. Patients are made to understand that their disorder is a psychologically-based one, and not something one can “choose” to have. And because most with binging disorders have already engaged in cycles of dieting, it would be unethical for a therapist to then prescribe further intentional weight-loss as means to recovery.
Let me reinforce this very important point: You can not choose to have an eating disorder.
Another important point: The acknowledgment and treatment of eating disorders is not a threat to the fat acceptance movement.
Eating disorders are psychological disorders which, to be diagnosed, must meet a host of diagnostic criteria. Obesity has more complex origins, both cultural and organic, with recent studies showing genetics to be more influential in one’s weight than simply a lack of willpower.
I can see where some may fear that acknowledging these disorders may lead others to the belief that all obese people must naturally have an eating disorder. But obesity and binging disorders can exist independently of one another, and they can also be interrelated. This is not to say that such disorders necessarily cause obesity, but studies have shown that those who are predisposed to obesity have a greater risk factor for developing binge eating disorder (C.G. Fairbum et all. Arch. Gen. Psychiatry. 55, 425 1998 and also Yanovski, Susan Z. Int. Journal of ED. 34, S117 2003.)
Considering the prevailing pressure to diet and the known psychological and physiological effects dieting can bring, the correlation that a naturally overweight person might develop disordered eating is a logical one. Instead of altogether denying that a relationship may exist – and again, this is not the case for all people – we need to encourage more awareness and education on both eating disorders and obesity.
As a historian, I must often traverse two worlds when writing of the past. There is the past as narrative, a recounting of the events which actually happened. And then there is the experiential past, the past according to those who lived through the events and have formed their own truths. Both are two halves, necessary in reconstructing the past as a whole.
One does not need academic journals or “scientific studies” to validate the experiences and truths people have. If a person feels they have an eating disorder, and a medical professional agrees that they do, let’s not discount their treatment and recovery with false assumptions, asinine statements and manipulation of data to meet our own preconceived and politically motivated agendas.
Instead, let’s offer sufferers our support, our empathy and our compassion. Anything else would fall outside the realm of true “acceptance.”
For more information on shame and guilt associated with binging disorders, or on eating disorders in general, read on…
Bakalar, Nicholas. “Survey Puts New Focus on Binge Eating as Diagnosis.” The New York Times. 13, Feb. 2007.
Burney, J, Irwin, HJ. “Shame and guilt in women with eating-disorder symptomology” J Clin Psychol 56, (2006), pp. 51-61.
EDNOS: Eating Disorders Not Otherwise Specified. Eds. Claes Norring and Bob Palmer. Routledge, 2005.
Fairburn, Christopher G. and G. Terence Wilson. Binge Eating: Nature, Assessment & Treatment. Guilford Press, 1993.
Fairburn, CG, Cooper, Z. The eating disorder examination Fairburn, CG Wilson, GT eds. Binge Eating: Nature, Assessment, and Treatment , (1993). 317-360 Guilford Press New York.
Fairburn, CG et all. “Risk Factors for Binge Eating Disorder.” Arch. Gen Psychiatry. 55 (1998) pp. 425 – 432.
Potts, Nickilee. “The Secret Pattern of Binge/Purge.” The American Journal of Nursing. Vol. 84, No. 1. (Jan. 1984), pp. 32-35.
Roth, Geneen. Breaking Free From Emotional Eating. Plume. May, 2003. (or any of Roth’s other publications).
Sacker, Ira M. and Marc A. Zimmer. Dying to be Thin. Warner Books, 1987.
Saftner, JL, Crowther, JH. “Variability in self-esteem, moods, shame, and guilt in women who binge.” Int J Eat Disord 23, (1988), pp. 391-397
Thompson, Becky. “A Way Outa No Way”: Eating Problems among African-American, Latina, and White Women.” Gender and Society, Vol. 6, No. 4 (Dec., 1992), pp. 546-561.
Thompson, Becky. A Hunger So Wide and Deep: American Women Speak Out on Eating Problems. University of Minnesota Press, 1996.
Wilfley, Denise E. et all. “The clinical significance of binge eating disorder.” International Journal of Eating Disorders. Vol. 34, Iss. S1 (2003), pp. S96 – S106.
Other related publications found at Gurze.
National Eating Disorders Association
Anorexia Nervosa and Related Eating Disorders
Multi-service Eating Disorders Association
Academy for Eating Disorders
Eating Disorders Coalition
International Association of Eating Disorders Professionals
National Eating Disorders Information Centre