The-F-Word.org

A contact passed on this opportunity for journalists who write on eating disorders and health professionals who interact with them.  This would be a great opportunity for health professionals to harness the power of the media, while also educating them on how to report on eating disorders responsibly.

• SAMHSA ADS Center Training Teleconference: The Power of the Media and Its Impact on Mental Health Recovery: How can the mental health community work with the media to positively and more accurately portray individuals with mental health problems? To help consumers, the general public, and the media explore this question, SAMHSA ADS Center invites you to a free training teleconference entitled “The Power of the Media and Its Impact on Mental Health Recovery.” The call will be held Friday, March 26, 2010, 3:00 p.m.–4:30 p.m., (ET). To learn more and to register, visit the following page: http://promoteacceptance.samhsa.gov/teleconferences/default.aspx. We encourage you to share this invitation with interested friends and colleagues. Please note: Registration will close at 5:00 p.m., ET, on Friday, March 19, 2010. Explore the SAMHSA ADS Center Website for more information at http://www.promoteacceptance.samhsa.gov

I’d heard of Angie Jackson, the Florida mother who’s been making the news rounds since she live-tweeted her abortion last month, but it wasn’t until I saw this Slate story on Jackson’s bizarre, evangelical fundamentalist upbringing that I took the time to read further into it all.  Religious cults?  End-of-days extremists? Demonic energy purging and faith-healing?   Even the National Enquirer couldn’t make up stuff this juicy.

Aside from the obvious connection between abortion and this blog’s focus on feminism, it seems that Jackson also has some experiences with the other two F-words discussed here.  First some background:   Jackson was raised  in a conservative, evangelical household that would make Rick Warren look like a lefty liberal by comparison.  Her grandmother, a fringe Christian leader and author of Christian apocalyptic thrillers, acted as a “spiritual midwife” in “Zion home births” conducted without medicine or medical intervention (which she considered to be “pagan religion”).  In her mid-20s, Jackson googled her grandmother’s name and discovered a trail of deaths and tragedies that occurred as result of her grandmother’s extremist teachings and shortly after began an antithetical blog, Angie the Antitheist, where she writes frequently about atheism and the abuses of faith healing.  It was on her blog that Jackson, the mother of a four-year-old special-needs son, announced her decision to terminate her second pregnancy after her birth control (she was on three different forms) failed.  Read more of Jackson’s background in her own words here.

In an interview with The Frisky, Jackson said that she initially thought that people might be more accepting of her decision to have a non-surgical abortion in her first trimester because of the serious health risks a full-term pregnancy would hold for her (it still didn’t stop the death threats lobbed at her and her family by good “Christian” folk).  She suffered from such severe sexual abuse as a child that she was told beginning at the age of 8 that she would never be able to have children, but got pregnant at 22 and went on to deliver her son after a grueling 98-hour delivery.  Yes, you read that right — a 98-hour delivery.  Yikes!  On her blog, Jackson details some of the serious health problems she suffered from at the time of her first pregnancy, including anorexia, bulimia, body dysmorphia and self-harm (cutting) — all of which she says is closely linked to her cult upbringing.  She writes:

I was told, over and over and over, in the repetative indoctrination style of a cult, that I was a burden, that I had too many needs, and that I was no good. I tried to cut away my flesh (my “Adam nature” or sinfulness) with a razor blade. I tried to make my physical body as small as possible, thinking maybe then I wouldn’t take up too much space or be so in the way. I starved and I ran. When my hip went out, I couldn’t run anymore so I went back to throwing up. I once carved the word “FAT” into my left thigh, and the scars are still there.

And from an excerpt in her forthcoming book (trigger warning for glamorizations of eating disorders):

My grandmother taught that there were worlds or realms – the spirit realm and the flesh realm. Flesh was always bad. I can’t help feeling like that has to mean something in the origin of my eating disorder. Starving was a way of making myself less about my body – that evil, human, sinful natured, Adam and Eve descended, recently molested and victimized body – and more about my thoughts, and the voices in my head. After all, that’s what I was taught to do.

So, given her history, Jackson just assumed her missed periods to be amenorrhea caused by a “particularly bad bout of anorexia.”  In fact, she only found out that she was pregnant because her weight loss had plateaued and she had trouble reaching her goal of getting below 100 pounds.  Anorexia wasn’t Jackson’s only problem; she was in an abusive relationship, had struggled to get off drugs and was struggling financially.  She describes that first visit with her doctor and her consequent efforts to get healthy:

“You need to gain weight,” he told me, looking at my 5′3″ 104 lbs frame. “You need to gain 50 pounds, and you need to do it yesterday.” That was my battle for the next four months, trying to put on and keep on enough weight to make sure the fetus’ brain developed properly.

I quit smoking pot, and mostly quit smoking cigarettes. (Yeah, I snuck a few here and there, most memorably on my wedding day, early in my third trimester.) I laid off the diet sodas, energy drinks, and diet pills I’d relied on to get me through school, and dropped out of college. I changed everything about my body, from what I put into my body, to how long I kept it there (no bulimia for me, as the electrolyte imbalance that would cause could be extremely damaging to the fetus), to what size I tried to be. I dropped bad habits, bad friends, but regretfully, picked up again the bad relationship I had with my ex-boyfriend…

I struggled to stay healthy, while planning a wedding (on an extremely lean budget), fighting with my fiancee, fighting with my mother, and moving three times. I didn’t always win that fight, and I spent days and days in the maternity wardmergency room, on IV drips and supplements. My iron levels were low, but the prenatal vitamins with iron in them made me throw up. I was living off pizza, ice cream, and Subway sandwiches, but I couldn’t keep weight on to save my life (or my fetus’). A week after my honeymoon, I went into the ER with a fever and a stomach flu, and over the course of that week I lost 10 pounds through vomit and diarrhea. I wondered if either one of us would make it out alive.

Miraculously, Jackson and her son did make it out alive, but with her doctor’s warnings that a second pregnancy could be seriously risky for her health.  And from some of her recent blog posts, it appears as if Jackson is still struggling with body image and disordered behaviors, thus complicating her preexisting health risks all that much more.Jackson’s case is a biographer’s dream not only for her bizarro religious upbringing and decision to live-Tweet her abortion., but what I find most interesting is how the issue of personhood (generally defined as personal integrity and autonomy) plays out here in relation to abortion and eating disorders.  Indeed, it’s an issue that lies at the very heart of the heated abortion debates.  Anti-choice zealots argue that personhood begins at conception, with some going so far as to claim that even sperm or ovum possess all the rights of personhood, while pro-choice activists maintain that to affirm the personhood of the fetus is to, in effect, deny personhood to the woman bearing it — and by proxy, to all women.

I’m sure you can guess which side of the abortion fence I straddle. As a Buddhist, I would have a difficult time reconciling a decision to have an abortion for myself, but as a feminist, I absolutely believe in a woman’s right to make medical decisions for her own body. Abortion is about so much more than women’s reproductive rights; a woman’s right to decide on abortion when her health and life are at stake is synonymous with her very right to be.  Uh huh, I see you nodding, but how exactly does the issue of eating disorders come into play?

It may be a leap here on my end, but I see the denial of bodily integrity to women when it comes to their reproductive choices as representative of a much larger and historical devaluation of the bodies of women in general. And I’m not alone. In the anthology Unbearable Weight, Susan Bordo includes an essay titled “Are Mothers Persons?” in which she examines women and reproductive rights that, at first blush, appears incongruous in a book about women, body image and eating disorders. Bordo’s motives become increasingly clearer, however, as she examines court cases and legal decisions in which pregnant women have been systematically denied agency over their own bodies and in making medical decisions for themselves and their unborn babies. The American legal tradition has traditionally upheld cases involving bodily integrity or “the right to one’s own person” — that is, in cases brought before the court by male plaintiffs. Cases involving pregnant women and mothers, however, evoke a legal double standard.

Social control of women is predicated on bodily control of women — throughout the centuries, women’s bodies have been subject to assault, rape and other forms of violence, their movements restricted both literally and figuratively, their sexual expression and self-determinations denied, their bodies sexualized and commodified, their health issues dismissed and undertreated, access to food restricted and regulated, ad nauseum.  Is it any wonder then that 90 percent of eating disorder cases are seen in girls and women? Women seek to control their bodies precisely because they continue to lack control over their bodies.

And that’s what I find most interesting about the case of Angie Jackson, a woman with a history of abuse, both externally and self-inflicted. Sure, Jackson has serious medical problems that could complicate a full-term pregnancy, but as she very plainly stated on her blog, she also just didn’t want to be pregnant. For Jackson, terminating her pregnancy represented the best possible choice she could make for her physical and emotional health, and by live-Tweeting it, she declared her rejection of some of the same fetters that helped make her a victim of sexual abuse and eating disorders.  If that’s not good enough of a reason to trust women, what is?

It’s Friday, the sky is blue, the sun is shining and I’m much too buoyant to dwell on frustrating and depressing news, so instead I’ll share some fuck-yeah! good news from the north. Canada’s National Eating Disorder Information Centre has teamed up with Toronto-based advertising agency Zulu Alpha Kilo to creatively combat unhealthy body images promoted by the fashion industry.  The small-budget guerrilla-style advertising campaign involved sending fashion editors and brand marketing directors across the country a Hallmark-style greeting card which reads, “Thanks for helping to make me such a successful anorexic.” They also sent out T-shirts with an absurdly small waist featuring the message, “Please try this on to experience how your ads make us feel.” And an interactive transit shelter with a poster reading “Shed your weight problem here” currently functions as a garbage bin for fashion magazines, complete with a slot at the front which allows consumers to add their glossies to a growing stack of Glamour, Vogue, and Fashion magazines.  The campaign’s broader goal asks marketers and fashion leaders to “cast responsibly and retouch minimally.”

More than half of all Canadian women diet, according to NEDIC, and one in four teenage girls engage in eating disordered behavior (in the U.S., it’s estimated that three out of four women have disordered eating and as many as 10 percent may have a full-blown eating disorder).  The fashion industry often bears the brunt for instilling unhealthy body images in girls and women and while NEDIC director Merryl Bear acknowledges that “a range of factors” are at play when it comes to eating disorders, the organization’s goal, she said, was to “focus on different audiences at different times to look at a broad range of some of the influences on body image and disordered eating.  We wanted to show that both the public and some fashion thinkers are ready for change. It may look provocative and edgy, but it is a very substantive campaign.”

NEDIC is collecting digital signatures for its petition, which asks fashion leaders and marketers to “broaden their definition of beauty and inspire us with looks that are beautiful and attainable.”  Watch highlights from the campaign below (beware: the video contains potentially triggering images of emaciated models).

Looks like the powers-that-be at the University of Southern California are seriously out of the loop on what NEDAW is and who sponsors it (hint: it isn’t The-F-Word).  I found this email from them in my overflowing inbox:

Hi Rachel,

We found chalking regarding the NEDAW posted illegally on the USC campus. Because this was the only email that we could find on your website, we are emailing you this warning. We have kiosks and bulletin boards around campus where you can legally advertise. Otherwise, please refrain from chalking anywhere on campus.

Attached you will find a picture of the violation we are referencing.

Seeing as you have no illegal advertising violations in the past, we are only issuing a warning.

Let us know if you have any other questions or concerns.

Thanks,

Jacob Yum
–
SCheduling Office
3551 Trousdale Parkway
ADM 299
Los Angeles, CA 90089-4014
Tel: 213-740-6728
Fax: 213-740-8157
Email: SCevents@usc.edu

My reply:

Sorry, I don’t run, sponsor or coordinate NEDAW, which is a NATIONAL movement sponsored by the National Eating Disorders Association.  I’m pretty sure they’re not behind your illegal chalking violation, either. Chances are it was a few students who acted on their own in order to promote healthy self-images on your campus.  The nerve!

-Rachel

Stay strong, fellow USC’ers.

I cannot go through this again
I cannot go through this again
I cannot go through this again
I cannot go through this again…

The words fade and give way to a synthetic drizzle of the melody, piano following along in the background. Together, they create the calm static of a dreamlike state, where all is zen. You’re floating oh-so-comfortably…

…and then, without warning, the rest of the band hits the ground running with its assault of drums, guitars and more synth. You are suddenly shattered back to chaotic reality.

“A-with a-teeth-a,” Trent Reznor sings with a venegance only he fully understands. I picture him literally biting the object of his passion and ripping it to shreds with the intensity of emotion matched in his voice.

She will not let you go
Keeps on and on
She will not let you go
Keeps on and on
This time, I’m not coming back
(she will not let you go)
-Nine Inch Nails, With Teeth

If I ever needed a song that described my emotions during the first year of my recovery, it was this one. Put simply, I was a mess. My state of mind changed rapidly from “I’ll never purge/starve/put my body through this shit again” to chaos and self-destruction. I never knew what would flip my emotions upside-down, for better or worse; sometimes it depended on the hour, the minute, the anything.

Everything felt like punishment. If I ate, I felt disgusted with any feelings of satiety I might have given myself. If I didn’t eat, I knew I wasn’t doing what I was “supposed” to be doing as a part of recovery, and therefore I felt like crap about that as well. If I had it both ways and ate/purged, the emotions doubled in their intensity each way. No matter what I did, I couldn’t win. At least with the eating disorder, I knew what I could expect. In this mess called recovery, I still felt like a prisoner to my eating disorder, only now I was attempting escape, getting caught, and paying what seemed like even more brutal consequences than what I was dealing with before.

I hated everything. I hated myself for getting into this mess in the first place, for my lack of understanding the world – and myself – without an eating disorder. I hated gritting my teeth and moving forward with recovery, because dammit, it was hard, and I felt absolutely clueless about whether I was really getting better or if I was completely fooling myself (and everyone else). What if everything I knew was a complete farce? I felt alien in a world where everything should have felt familiar, but the rules had changed, and I no longer knew the rules. Once I thought I had them re-learned, there was always that one little exception where, of course, I screwed everything up. Or so it felt.

As much of an emotional roller-coaster 2005 was for me, I had two inspirations that guided me. The most important was my husband, Patrick, who I met in October 2005. He didn’t miraculously save me from my woes, as he can attest, but he helped me help myself by making me feel worthy of being saved. Even when in doubt, that kept me going in the years that have followed.

The other inspiration was With Teeth, the Nine Inch Nails album released in May that year. The timing and theme of this album couldn’t have come at any better time for me. After a four-year absence from releasing new music and touring, Reznor finally revealed his biggest project ever: putting himself back together.

A  near-fatal heroin overdose woke Reznor up; he realized he would lose himself to drug and alcohol addiction if he didn’t stop. He checked himself into rehab and endured a detox that “makes him shudder to this day.” He’s been sober since June 11, 2001.

Reznor warmed slowly to writing new music. He wasn’t sure if he had anything to say now that he was sober and questioned his future in the music industry altogether. However, a renewed clarity surfaced once the process began. Eventually the words came together and Reznor recorded With Teeth, the soundtrack to his journey of re-defining himself.

Learning that Trent Reznor, a musician whose music I had adored since the age of 13, had undergone his own process of recovery, sparked inspiration in me. It not only gave me a new appreciation for his music, but I also developed a deep sense of respect for him as a person – not just for surviving, but for speaking openly about his addictions and the journey back. It was exactly what I needed. He returned from his own private hell stronger than ever…and so could I.

I listened to With Teeth for about a year straight with little interruption from other music on my playlist. Every song resonates with some stage of recovery, from the confrontational “Don’t you fucking know what you are!” in the song You Know What You Are? to “What if everything around you isn’t quite as it seems?” in the ending track, Right Where It Belongs. In the same way that I identify with certain songs because I listened to them repeatedly when I was active in my eating disorder, this album became my recovery anthem. The title track, With Teeth, represents the turning point for when healthier days started outnumbering the disordered days. The album as a whole is not only Trent’s story of moving forward, but it became embedded into the soundtrack of my own story as I took a leap of faith and kept going myself.

How has music played a role in the course of your disorder and recovery?

In the spirit of NEDAW, Rachel thought it would be helpful if  our posts focused on supporting recovery goals–I completely agree.  When thinking about my personal recovery goals, one phrase keeps resonating… be gentle with yourself, this is a process. Being gentle with myself… for nearly my entire life, even in recovery, I have done quite the opposite.  Growing up as a dancer, it was ingrained early on to be extra critical of myself, as well as compare my strengths and (most importantly) my deficits to my classmates.  With regards to the eating disorder, anyone who has ED knows that it’s all about beating one’s self up and being unforgiving of anything less than perfection.

Being gentle with myself and realizing that this recovery bit is a process–just as getting into the ED was a process–made me think of the transtheoretical model of change.  As a social work grad student, I am fortunate to get to attend seminars, and for the last five weeks, I’ve been in a Motivational Interviewing seminar.  Motivational Interviewing is an evidence-based, client-centered therapeutic intervention for all types of psychopathology (especially addictions), that aims to help clients argue for their own change.  MI is based on the transtheoretical model of change, which include six stages: precontemplation, contemplation, preparation, action, maintenance, and relapse.

This model of change is so helpful for me as a recovering person, because it recognizes that if you were to draw a line of what the process of recovery looks like on a piece of paper, it isn’t one straight line of successes.  Rather, it’s more like a zigzag, where somedays you may be ready to take action, and other days your back at precontemplation, unable to see that there is actually a problem with certain behaviors or ways of thinking.  I came from what is now considered to be a clinically “old school” treatment center, in that recovery is based solely on abstinence–either you are in recovery or you aren’t, depending on how well you behave within their prescribed definition of recovery.

Today, I still don’t do things perfectly in recovery, but that doesn’t mean I’m not in recovery.  It means that it is a process and that I need to be gentle with myself.  I was engulfed by ED for nearly 17 years, and it just doesn’t disappear overnight.

The message for myself, and to you, is to recognize the growth you’re making in your recovery and don’t be so hard on yourself.  It is a process.

This month is Black History Month and this week is National Eating Disorders Awareness Week, and Stephanie Armstrong addresses both in an interview on “Saturday Mornings with Joy Keys,” an interactive, live Internet talk-radio show that focuses on “providing people with tools to enrich and advance their lives mentally, physically, monetarily and emotionally.”  Stephanie  is the author of the new memoir Not All Black Girls Know How to Eat: A Story of Bulimia, in which the now 40-something, recovered, married mother of one daughter and two stepdaughters documents her descent into bulimia in her early 20s and describes her struggles as a black woman with a disorder consistently portrayed as a white woman’s disease.  The Brooklyn native also examines the “bootylicous” black woman stereotype and why the black community’s “code of silence” often leaves black women with eating disorders suffering in silence.  The work is being hailed as the first book by and among black women about eating disorders.  You may remember that Stephanie also answered the-F-word’s questions a few months ago.

Guests included Stephanie and Laurie Vanderboom, program director for the National Eating Disorders Association, which sponsors and coordinates National Eating Disorders Awareness Week.  A few interview highlights

Joy: What do you (NEDA) see when you have these programs?  Do you see a lot of African American women coming to the programs?

Laurie: We’re just beginning to and we’re just beginning to reach out.  There’s so much shame involved in an eating disorder that people hesitate to step up.  Stephanie, wouldn’t you agree that no matter what your racial make-up…

Stephanie: Absolutely, but especially coming from a culture that doesn’t support therapy, that doesn’t support getting outside help, and risking falling outside of the strong black woman archetype that we’re raised believing and have to become.  It’s hard to disassociate yourself with that image to get the help you need.

———————————-

Stephanie: One of the things I always talk about, especially in the black community, is that we don’t have an awareness of what exactly bulimia is.  It’s like you go to someone’s house and they’re drinking that dieter’s tea.  That’s bulimia.  Laxative abuse is bulimia.  Diuretic abuse is bulimia.  Compulsive exercising is bulimia.  It’s like we think it’s just throwing up, but it’s not just throwing up.

———————————-

Joy: I was talking with a professor of mine and he mentioned that psychologists don’t diagnose African American women properly with eating disorders, because they’re not used to seeing a African American woman coming to their office with this issue. Stephanie, do you feel that that’s the case?

Stephanie: Absolutely. Absolutely. I am constantly talking to women — some who are therapists, some who are young — who are constantly misdiagnosed. I’ve had doctors say, ‘Oh, you don’t have an eating disorder. African Americans don’t have eating disorders.’ I had a young woman call me yesterday – she goes to Clark Atlanta College and she’s at the American University in DC working on an exchange and she’s doing a paper in journalism and decided to do a paper on blacks and eating disorders because her aunt was bulimic and died from it. She calls me up and she said her teacher said, ‘Well, the problem is that there aren’t really that many black women with eating disorders, so that’s going to be a hard paper to do.’ It’s that overall belief that we don’t exist. (she briefly cites a rundown of research showing the prevalence of eating disorders among black women and girls, including this study) …the research is seeping in, but it’s still not getting the attention.

And it’s not just black women with eating disorders who are thought to be virtually non-existent.  Running Tiptoe recently posted a review of a recent “Intervention” episode featuring an Hispanic woman with an exercise addiction and a history of bulimia.  In her review, she offered this link to this 2006 study of “eating disturbances among Hispanic and native American youth,” in which it was found a much more significant pattern of disordered eating behaviors than previously thought.  There are more stats and studies on Hispanic women and eating disorders listed in this 2003 news report.*

Despite all the evidence to the contrary, eating disorders continue to persist in public opinion as a disease young, white girls from middle-class and wealthy backgrounds develop.  But eating disorders are the great equalizers: food is one of the few legal “drugs” out there; everyone needs it to survive;  and in industrialized nations, at least, is widely available and relatively cheap.  That, combined with the constant affirmations of weight loss as morally good and idolization of thinness saturating virtually every facet of our lives, and it’s no wonder that  those with emotional issues and unfulfilled needs might turn to food and the body to express a pain they cannot put into words.

Black girls and women with eating disorders.  Hispanic girls and women with eating disorders.  Adult women with eating disorders.  Boys and men with eating disorders.  Orthodox Jewish girls and women with eating disorders.  Poor girls and women with eating disorders.  We. All. Exist.

* For more information on eating disorders amongst non-white populations, see here.

This week marks National Eating Disorders Awareness Week (NEDAW), and so we will be posting tools/resources/tips/personal stories and more this week in support of eating disorder recovery.  To kick the week off, how about checking out and joining these supportive Facebook groups (because isn’t everyone and your grandma on Facebook?).

• Letters to My Body: Fostering body kindness and promoting stronger self-esteem; One letter at a time (check out the project’s website to read letters from others).

• 5 Resolutions to Transform the Fashion and Beauty Industries: Founded by model Magali Amadei and writer Claire Mysko, 5 Resolutions (http://5resolutions.blogspot.com) is a network for anyone who believes in promoting healthy beauty and fashion.

• Eating Disorders Coalition for Research, Policy & Action: The Eating Disorders Coalition for Research, Policy & Action promotes the recognition of eating disorders as a policy concern. This Facebook group was created so that people will know that there is hope. It is for everyone who is alarmed by the prominence and danger of eating disorders, but is unaware of what can be done to change it. We can ask our government to help create actual policies that will translate into advancing the goal of eating disorder prevention and recovery…

• Blogging for [ED] Awareness & Recovery: A group of bloggers that write specifically about eating disorders, whether a loved one has been diagnosed or you have been yourself.  This group is *NOT* for pro-ed blogs! These are strictly recovery and awareness-minded bloggers!

• I’m making fat socially acceptable and I’m not sorry:  This is a fat acceptance group. This group is for people who one day stumbled upon the truth that fat is not as bad as it is made out to be. In fact, most of the time fat isn’t bad at all – and even in the cases where it is (where is causes mobility or other issues) it isn’t being treated properly, and fat hatred is only hurting the issue…

• Dear Eating Disorder,: This is a group for those of us who suffer from an eating disorder can come and write a letter to let ED know exactly what we think of it. Whether you are recovering or recovered. Whether you are struggeling or in a good place. Whether the Eating Disorder is runining your life or the life of a friends or family members its time it should know. Tell your Eating Disorder your thoughts and feelings about it. Breakup with the Eating Disorder if you want!!!

• Start a Revolution.  Stop hating your body.: is an attempt to raise awareness about the vast array of problems that stem from body consciousness and lack of esteem including, but not limited to: anorexia nervosa, bulimia nervosa, body dysmorphic disorder, binge eating disorder, depression, and general dissatisfaction. Furthermore we acknowledge that society today has constructed a multi-billion dollar industry designed to perpetuate the desire for unattainable beauty while capitalizing on products for self-improvement. Our mission is to end corporate dominance over body esteem.

• Men Get Eating Disorders, Too: is a web and publicity campaign that aims to raise awareness of male eating disorders to enable men to get support. The site provides essential information and advice, links to support and a message board.

• Academy for Eating Disorders: The AED is a leading global professional association committed to promoting innovative eating disorders research,education, treatment and prevention.

• Eating Disorders Anonymous: For those with eating disorders looking for support OR someone with a loved one suffering and needing advice as to what to do OR supporting friends with eating disorders OR wanting to know more about eating disorders and their danger [this group’s content is public, so be forewarned that it’s not exactly “anonymous,” per se).

And, of course, be sure to join The-F-Word’s Facebook page, as well as friends of the blog: Big Fat Deal and Feed Me!. Know of any other great Facebook or MySpace groups? Give them a shout out in the comments below!

Journalist Kate Baily wonders why more women don’t come out and tell their fat friends that they look like Shamu and need to speed dial Jenny Craig.  In an article in The Daily Express, she cites a recent study of 3,000 women in which one in five revealed she secretly thinks her best friend is fat but would never dare say so.  Baily writes:

So it seems we can’t even rely on our best friends to tell us when it’s time to quit the cupcakes.

Am I the only one who thinks that’s a crying shame? Whenever I watch TV diet programmes I am amazed that nobody has actually sat down with morbidly obese Jenny and had a word with her.

In that same un-cited study, Baily notes that one in four women “plucked up the courage” to tell a friend she should lose some of her fat ass — thus demonstrating nothing more than 25 percent of women are friends with a jerk — and of the friends in question, 12 percent “went mental” and one in five ended the relationship.  Baily wonders:

Isn’t that just a little, well, neurotic for grown-up women with jobs and families?  Shouldn’t we just be able to come right out and say, ‘You look like a badly trussed chicken in those jeans – go on a diet immediately’?

Right.  I’m willing to bet that Kate Baily doesn’t have all that many friends.

So, why don’t more women point out their gal pals’ flab? Uh, duh.  It’s because A: friends don’t police their friends’ weight or food choices and make them feel bad about themselves; B: your friend is a big girl (no pun intended) and can make her own decisions about what’s best for her and her health; and C: most fat people already know they’re fat, and therefore don’t need nor necessarily want their “friends” to hammer that point home or to offer up unsolicited weight-loss advice.  And should your fat friend ever want that advice, it’s not as if women’s magazines, television commercials, news outlets and even the White House aren’t already mass-churning out weight-loss tips and diet plans complete with fatalist warnings on how you and your fat ass are at risk for any number of so-called obesity-related diseases and are Public Enemy No. 1 to both the environment and national security.

And if it’s a case of emotional/compulsive overeating, binge eating or other eating disordered behaviors, focusing on a friend’s weight isn’t all that constructive or healthy.  Anyone who’s struggled with an eating disorder will tell you that it’s not about the weight — it’s about emotional issues, psychological and/or physical trauma, a need for power or control, etc… — and that weight is but a symptom of much larger issues at-hand.  Telling a friend with disordered eating issues that they “need to go on a diet immediately” is not only counterproductive in that it puts the focus on the symptom and not the cause, it’s also downright rude, callous and virtually irrelevant.  It’s a little like telling your unemployed friend who’s on public assistance that their clothes are shabby and unfashionable and that they need to go on a Saks shopping spree immediately.   As well, Kate Baily suffers from the culturally-driven delusion that not only is fat always unattractive, but that it’s always unhealthy — not to mention, that it’s always malleable.  When I was actively eating disordered, I received copious compliments about my weight loss that only spurred a disorder that damn near killed me.  Now that I’ve regained some of the weight I’ve lost, I’m much healthier and happier for it — something a true friend would already know.

A few of my more health-conscious friends and I discuss healthy foods and recipes and fitness and so forth, but weight rarely factors into these conversations because not only is it not all that high on our priority list, it’s also vapid and boring.  As part of my own commitment to recovery, which includes taking the pledge to end fat talk,  I actively seek to surround myself with people who respect me enough to not  infantilize me by asking if I really need that second helping and who have far more interesting things to talk about than their daily carb intake.  You?

Given the blog’s focus, it’s not often that I have good news to report, so I tend to get a little giddy when the cosmos align in our collective favor. I blogged back in December, 2008 about proposed changes under consideration by the American Psychiatric Association to the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM).  Considered the psychiatric bible of the field, the DSM is used by doctors to make a diagnosis and provides insurance companies with diagnostic codes without which the insurers will not reimburse patients’ claims for treatment. Among the conditions up for debate included making binge eating disorder (BED) an independent diagnosis (BED is currently lumped into the vague catch-all category of ED-NOS, which encompasses those who don’t meet one or more of the criteria for anorexia or bulimia).

You’d think that a condition estimated to eclipse both anorexia and bulimia combined would be a no-brainer for inclusion, right?  You’d think wrong.  Some mental health professionals actually protested classifying BED as a disorder, suggesting it to be a “normal behavior.”  Luckily for those who suffer from decidedly abnormal binge eating behaviors, the duh truck must have finally arrived at the APA, because when they released a draft of its recommendations today, it included recognizing BED as an official independent diagnosis — read the recommended criteria for diagnosis here.  This is awesome news, for in addition to psychotherapy, there are medications that have been shown to help people with binge eating disorder (Topamax and Wellbutrin, for example). If binge eating disorder were included in the manual as a legitimate eating disorder, those people who struggle with it might have an easier time getting insurers to cover the treatment and medication they so desperately need.

The recommendation of BED as an independent diagnosis is certainly the biggest change for eating disorders in the DSM, but there are other proposals under consideration that I think are pretty fabulous, too.

Purging Disorder

The work group is considering whether it may be useful and appropriate to describe other eating problems (such as purging disorder–recurrent purging in the absence of binge eating, and night eating syndrome) as conditions that may be the focus of clinical attention. Measures of severity would be required, and these conditions might be listed in an Appendix of DSM-5. If these recommendations are accepted, the examples in Eating Disorder Not Otherwise Specified will be changed accordingly.

As someone who suffered from what would be considered purging disorder with anorexic tendencies and was misdiagnosed with bulimia, I’m excited to see this relatively newly-popularized condition being entertained by the panel.  Pamela Keel, an associate professor of psychology in the UI College of Liberal Arts and Sciences, has made great inroads in research indicating purging disorder to be a significant problem in women that is distinct from bulimia.

Anorexia

Many eating disorder activists are critical of the phrasing in the criteria for anorexia of a “refusal to maintain body weight at or above a minimally normal weight for age and height.”  Refusal here, being the key word as myself and others argue that it’s not so much a refusal as it is an inability.  For more on this, read Harriet Brown’s critique of the semantics.  In its draft, the APA recommended clarifying the criterion to focus instead on behaviors, acknowledging that the word “refusal” implies intention and is “possibly pejorative and difficult to assess.”  The panel also recommended deleting the criterion of amenorrhea, thus opening up the diagnosis to a broader range of sufferers, including a growing number of men reporting anorexic behaviors.

In DSM-IV, amenorrhea is required. However, individuals have been clearly described who exhibit all other symptoms and signs of Anorexia Nervosa but who report at least some menstrual activity. In addition, this criterion cannot be applied to pre-menarchal females, to females taking oral contraceptives, to post-menopausal females, or to males. However, there are some data that women who endorse amenorrhea have poorer bone health than do women who fail to meet this criterion.  Deletion of this criterion is recommended.

Bulimia

The current DSM-IV requires episodes of binge eating and inappropriate compensatory behaviors both occur on average twice a week for three months.  The panel cited a literature review that found that the clinical characteristics of individuals reporting a lower frequency of once/week were similar to those meeting the current criterion, so they recommended that the required minimum frequency be reduced to once/week over the last three months.  The bulimia diagnosis also currently includes two subtypes: purging and non-purging.  People with non-purging bulimia often try to purge calories via exercise or fasting, but do not use enemas, self-induced vomiting, laxatives, etc..  The panel found that non-purgers more  closely resembled people with BED, and so they recommended deleting this subtype altogether.

Obesity

Despite reports from the Boston Globe that the APA was considering classifying obesity a mental illness, I see nothing in the draft indicating that it would be included.  The sheer ridiculousness of such a proposal simply blows my mind and at first I thought the Globe perhaps erroneously conflated obesity with binge eating disorder, since those with BED tend to be overwhelmingly overweight or obese, but it appears as if the idea was at least introduced.  A study released last summer examined the evidence for making obesity a mental disorder and found it significantly lacking, acknowledging only “evidence that obesity is related to mental disorder and many of the medications used to treat psychiatric illness.”  Considering that the latter evidence has been around since the 1990s, the study basically only confirmed the obvious.

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Before we pop the cork on the champagne, keep in mind that this is only a draft, and is subject to change and that’s where you come in.  In a new twist for the APA, the organization has posted the draft online and is seeking feedback via the Internet from both psychiatrists and the general public about whether the changes will be helpful before finalizing them.  The draft manual, posted at www.DSM5.org, is up for public debate through April.  The final version is expected to be released in 2013.