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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?

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.

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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.

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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!

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.

I received an enthusiastic response to my call for eating disorder recovery stories.  These will all eventually be archived and made available once I complete the site redesign, but for now I’d like to spotlight them as part of a special series this week I’m calling “An Examined Life” (the title is inspired by the well known Socrates quote, “The unexamined life is not worth living,” which was first introduced to me by a wonderful friend influential in my own eating disorder recovery).  While many people resolve to transform their bodies each new year, I want to instead to focus on our minds and self-image.  Not only do I hope to show recovery is entirely within grasp for most people with an eating disorder (or disordered eating, poor body image, etc..), but also the different ways in which people from all shades of the disordered spectrum have gone about achieving it.   Our first story comes from an anonymous reader, who blogs at Spits at Mirrors, and struggled with bulimia.

Anonymous writes:

When I was a kid, Mary Lou Retton won a buncha gold medals in the 1984 Olympics and all my girlfriends and I becaume obsessed with gymnastics. When I was 7, my friend Katie and I took gymnastics together after schools. (This was by no means serious training, it was just once a week after school, the way other girls take ballet lessons when they are young.) I also read every book and magazine I could get my hands on about gymnastics, and saw the Nadia Commenici biopic when it came out.  This interest in gymnastics was when I first became consious of my weight, because the bios I read about the teenage girl Olympic gymnasts all mentioned their weights. These 14 year olds weighed the same amount that I did at age 7. I was not overweight, just your average-weight well-nourished American child. But I remember feeling bad about how much I weighed, because teenagers weighed as much as I did.

At one point Katie and I were playing on my swingset in the backyard, and we started talking about weight. Katie was shorter and had a smaller frame, so she weighed less than me by about 10 pounds, and I was very jealous. I think our fight turned ugly. Eventually my interest in gymnastics faded and was replaced by other things, like Sweet Valley High books (“Jessica and Elizabeth, the perfect size 6!”), music (I loved Madonna and Cyndi Lauper), and drawing comics. The next instance of weight awareness/self-hatred came when I was ten years old. I happened to be sitting in the living room with my family, and they were watching some PBS program about modern dance. I remember noticing how lithe the dancers were, and looking down at my own body and just seeing fat fat fat. That summer I went to camp, and while sitting down waiting my turn to play dodgeball, I looked at my thighs in shorts and thought to myself that they were spread out like slabs of fat on the chair.

Ever since then, I was convinced I was overweight and the conviction that I needed to “reduce” was with me.   Read the rest of this entry »

The Center for Eating Disorders at Sheppard Pratt is inviting Maryland’s middle, high school and college students to participate in the 4th annual “Love Your Tree” poster campaign, which aims to promote a healthy body image. In response to the statement, “Like a tree, my body is…” students are invited to create posters that challenge narrow beauty ideals, and embrace body diversity and acceptance. Posters will be accepted until December 18, 2009 and one will be selected to be part of an exhibit during National Eating Disorder Awareness Week in February 2010. Please download the Call for Posters for additional details. All entries must be submitted along with a completed Registration Form prior to the December 18th, 2009 deadline. Poster entries must be no smaller than 9″ X 12″ and no larger than 18″ X 24″. Only two-dimensional media will be accepted.

For more information, contact Kate Clemmer at (410) 427-3886 or kclemmer@sheppardpratt.org.

So, I had just dozed off again yesterday morning when my cat, who usually sleeps next to me each morning, tried to jump up on the bed.  Sweet, right?  Not so much… I was hugging the side of the bed and she nailed me instead above my eye.  Three inner stitches, five outer ones and a tetanus shot later, I’m sporting the Frankenstein look this week.  There were seven people ahead of me in line at the Urgent Care office, so I had lots of time to peruse through their fine selection of health magazines and found these snippets to share.

Can I get an amen?: Abby Sher, who used to perform with the comedy troupe The Second City, takes a comedic look at her struggles with obsessive-compulsive disorder and anorexia in her new memoir, Amen, Amen, Amen.

Hello, body; goodbye, loathing: Body image expert Sarah Maria is the author of the new book, Love Your Body, Love Your Life.   The self-help guide gives readers five steps to help end negative body image obsession and start living a confident and empowered life.  Bonus: Check out an interview with Maria at the blog Weightless.

Goodbye workout ruts!: Score fresh fitness DVDs for free when you trade in old ones at SwapADVD.com.

Down dog with eating disorders: A pilot study, recently published in the Journal of Adolescent Health,  found that yoga was effective in treating adolescents with anorexia, bulimia, and ED-NOS

Why you can’t eat just one: A group of neuroscientists have discovered a reason for why we (or rats, at least) can’t seem to get enough candy or junk food: we’re addicted.  Their study found that pleasure centers in the brains of rats on high-fat and calorie diets became less responsive as the bingeing wore on, making the rats consume more and more food.

Sink your teeth into this: Market research firm Mintel predicts the top five dining trends for 2010 will include healthier dishes, seasonal ingredients, lesser-known ethnic cuisines and a back-to-basics approach to old-fashioned foods such as burgers.

Thanksgiving is perhaps the holiday that inspires the most amount of anxiety and fear in the hearts of those (Americans) with eating disorders, especially those of us with bingeing disorders like bulimia or BED who know we can eat the feast twice over and then some.  We’ve discussed tips and advice for the holidays here before, but I got a note from Denver-based Eating Recovery Center this week with even more coping skills for sufferers and caregivers that I thought helpful to share.

The Eating Recovery Center offers these five recommendations to help individuals in recovery confidently manage holiday festivities:

• Shift the focus from food and counting calories to celebrating and spending time with loved ones.

• Stay away from any kind of good food/bad food talk.

• Surround yourself with people who have healthy relationships with their bodies, food and weight. When attending gatherings, bring a trusted family member or friend along with you if you can.

• Keep lines of communication open and involve your family and friends in your challenges, victories and goals.

• Before attending a holiday gathering, consider calling the host to ask what foods will be served. Bring along “safe food” if necessary.

During the holiday season, support from family and friends can significantly impact an individual’s ability to effectively handle these stressful situations. For those supporting someone with an eating disorder through the holidays, the Eating Recovery Center offers these suggestions:

• Ask your family member or friend what you can do to best support them.

• Ease into the holiday season by focusing on activities that don’t involve food, such as putting up decorations or sending cards.

• Stress levels can escalate during a holiday gathering. Offering a loved one the chance to “escape” for a few moments can help keep emotions in check.

• Be conscious of the snacks and treats displayed during holiday times. Reducing the availability of snacks can help your family member or friend maintain their regular eating schedule.

• Have patience and express your continued support.

Feel free to share your own experiences and suggestions in the comments below.

UPDATE: Be sure to also check out today’s New York Times Well column on food, family and tension at Thanksgiving.  The column addresses the ways in which family members can impose their own disordered eating onto others.

Matthew Tiemeyer, the about.com Guide to eating disorders, poses an interesting question about the definition of binge eating disorder and how it’s diagnosed.  He writes:

Here’s something I hadn’t thought about before. The definition of binge-eating disorder (BED) says that binges involve eating more food than most people would expect you to eat in a relatively short time. So what if all of the people in your world don’t find your eating out of the ordinary?

Another way of asking this question: Could the definition of BED be culturally-dependent? A blurb about a recent study suggests that black women meet BED criteria less often than white women. One of the project’s researchers says, “These (black) women could be binge eating, but they may have less anxiety and distress surrounding their eating habits, so they don’t recognize it as an issue.”

So I have to ask: If there’s no distress, is it really binge eating? Is it really an issue?

It’s irksome to find that the primary concern listed in the aforelinked blurb isn’t for the mental health or emotional wellbeing of women who may have binge eating disorder, but rather for the fact that OMG! they’re getting fatter! As for Tiemeyer’s question… what are your thoughts?

Thank you all so much for the outpouring of support in the death of my cat. What felt like an unbearable weight of sadness is now beginning to lift and I’m able to remember Grayson and his many quirks without constantly devolving into a blubbering mess of tears and tissues. I’ve experienced the death of pets before but never have I felt such raw and profound grief as when Grayson died. His entire life was bookended with struggles – I fought my mother for weeks just to get him and then I spent nearly $6,000 in a two month fight against nature to try and save him. And he, in turn, saved me. There was a time in my life when my furbabies were the only reason I slogged through each grindingly difficult day. I knew that no one could ever love my cats and care for them as much as I did and I cared too much about them to give into the pain.  Even in death, Grayson saved me from the agonizing decision to have him put to sleep.  He died on his own just seconds after I arrived.

Buddhist tradition teaches that no matter how strenuous our efforts or how desperately we hold on to anything, it is already in the process of leaving us, and that only by accepting this impermanence and letting go can we ever hope to achieve harmony and balance. It’s easier said than done, even for this committed Buddhist. The night that Grayson died, our veterinarian Paul allowed Brandon and I to stay with him for two and a half hours past closing as I struggled with the decision I knew I needed to make. Through my tears I remarked to him that I would have been much more able to accept the situation had Grayson been 18 and at the end of a long end of a long and happy life and not just a young eight years old. Paul then told us about his two golden retrievers, the same dogs I have fallen in love with during my frequent visits to the office these past two month. Both have lymphoma, he said, and weren’t expected to live till 11. He kept begging the universe to just let them get to 11, but when they got there, he started wishing for them to make it until 12. “You always want more time,” he said. “It’s never enough.” And it never is.

When our vet called at 1 a.m. that night and said that the decision needed to be made now, Brandon asked if I wanted him to come with me and I said no. Brandon was very fond of Grayson, but Grayson was my cat both before we met and after, and I wanted to be alone with him and my sorrow. Afterwards, as I sat numb in my car pondering whether I should go home or just keep driving wherever the roads would take me to, the thought came to mind to stop eating again. It’s been such a long time since I’ve had that compulsion to flagellate myself through starvation but it didn’t feel foreign… it seemed completely natural, comforting even. I had taken Wednesday off work and so had a lot of time to be alone with myself and my thoughts and for one of the few times in my adult life with ADD, my monkey mind was mercifully still. Perhaps it’s a sign of recovery that I realized the exact etymology of that cunningly seductive voice urging me back to that disordered heaven of hell. As Marya Hornbacher so beautifully details it:

Bulimia is linked, in my life, to periods of intense passion, passion of all kinds, but most specifically emotional passion. Bulimia acknowledges the body explicitly, violently. It attacks the body, but it does not deny. It is an act of disgust and of need. This disgust and this need are about both the body and the emotions. The bulimic finds herself in excess, too emotional, too passionate. This sense of excess is pinned to the body. The body bears the blame but is not the primary problem. There is a sense of hopelessness in the bulimic, a well-fuck-it-all-then, I might as well binge. This is a dangerous statement, but the bulimic impulse is more realistic than the anorexic because, for all its horrible nihilism, it understands that the body is inescapable.

The anoretic operates under the astounding illusion that she can escape the flesh, and, by association, the realm of emotions.

Genetics may have dealt me the eating disorder gun, but it was an inability to confront and manage what was at the time extremely difficult and trying family issues that pulled the trigger on my disorder. I could not express the loneliness or desperation I felt and so in flesh, I described a pain I could not communicate in words. Armed with this heard-earned self-awareness, the desire to starve myself came as little surprise in the wake of the profound grief I felt at the passing of my beloved kitty. I wanted to not feel the aching sorrow of his absence, I wanted to be free of the pressing anvil on my heart and soul as the realization that I will never again stroke his soft ears or set my ear against the rumbling purr of his belly set in, I longed for the reassurance that each day wouldn’t be a sad continuation of the next. Anorexia may have transformed me into a soulless cold caricature of a human, but it made walking through the valley of the shadow that much easier.

I’ve heard it said that we should give thanks for the grief we feel for it is a measure of how much we loved and were loved in return. I could deny my hunger, my body and my pain, but to do so felt as if I would be denying the memory of my cat and all that he had given me in the too brief eight years I was blessed with him. Instead, I chose not only to feel the pain and sorrow, but to wallow in it and savor it as a way of painfully, but properly repaying the gift of unconditional love.

Instead of restraining my emotions, I gave of them.  I made a concerted effort not to isolate myself and to feed my body and soul nourishing food. I donated all of Grayson’s medication and pricey prescription food to an animal shelter I used to volunteer at and spent an afternoon with the 75 cats there in wait of their own homes.  I took time to play with my remaining cats and to appreciate them and how very happy they make me.  I prepared a small gift box of treats from one of Cincinnati’s most decadently delicious bakeries to give to the vet who lent his expertise at no charge to our vet on Grayson’s puzzling and extremely rare medical condition. Over the weekend, I compiled a large box filled with goodies — cookies and fudge from my favorite indie coffee house, coffee cake and muffins from the same decadent bakery, homemade chocolate-covered pretzels– to give to the staff at the animal hospital who took such good care of my baby. I found the perfect fair trade, hand-carved stone sleeping cat paperweight to give to Paul, our vet, as a token of my extreme gratitude for treating and loving my cat as his own. And this weekend, we will be meeting a new cat, a three-year-old Himalayan who’s been so horribly treated in his short life that he’s afraid of people – to see if we would be a good fit to give him a forever home.

Despite his penchant for relentlessly chasing our little gray cat Bella, I’m certain Grayson had positive karma and if the Buddhist concept of life is at all definitive, I have no doubt there may come a day when he will be scratching my ears and not vice versa.

Thanks again, everyone.