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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.

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.

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.

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.

Posting will probably be lighter than usual in the next few weeks.  I’ve taken on some freelance web design jobs again in an attempt to help pay down our $5,700 vet bill from Grayson’s surgeries.  I also ended up deciding to foster Nigel, the chocolate point Himalayan who’s been traumatized by demon children and will need lots of love and attention in order to recover.  You can’t see his beautiful blue eyes in this pic, but you can see how absolutely gorgeous he is.

To top it off, both Brandon and I seem to be coming down with something.  He insists that his sore throat and stuffiness are just allergies, but I rarely suffer from them and I have the same congestion.  So, consider this an open post to discuss anything on your mind or offer links to related news or sites.  Here’s a few headlines to check out.

• PsychCentral has introduced the new blog Weightless authored by new blogger Margarita Tartakovsky.  According to Tartakovsky, “Weightless is about well-being, not weight; about fostering body image, regardless of your size. It’s about exposing women’s magazines, other mediums and so-called experts, when they’re touting unhealthy tips and promoting restrictive standards.  The goal of Weightless is to help women develop a better body image and work toward accepting themselves as they are, while being healthy and happy (fad diets and skinny-mini standards prohibited!); and to become sharp consumers, who can pick apart a commercial or magazine article and know which advice is helpful or harmful.”

• Lynn Harris at Salon.com examines purging disorder, a “new” disorder discussed in an article in this month’s Archives of General Psychiatry.

• Courtney Martin, author of Perfect Girls, Starving Daughters, is one of 10 finalists for the Washington Post’s “America’s Next Great Pundit” contest.  Check out Courtney’s column here.  The contest ends today at 3 p.m., so hurry up and vote!

Here’s five new-to-us blogs we love.  If you aren’t reading them already, go have a look.

• Operation Beautiful:   Operation Beautiful is simple: all you need is a pen and a piece of paper…  So says site editor Caitlin, who’s on a mission to leave positive, body-affirming notes in public spaces and invites you to do the same.

• The Manfattan Project: “A collection of photographs of stylish everyday people in New York City. These people are beautiful, they are well-dressed, they are confident. They are also, without apologies or contradictions, FAT.”

• Men Get Eating Disorders Too: Okay, so it’s technically not a blog, but the site does feature personal stories and inspirational articles all penned by men with eating disorders in an effort to dismantle the gender stereotype keeping so many men from seeking help for their disorders.

• More of Me To Love: The site’s mission is to “promote and spread the healthiness and happiness that you deserve through our welcoming community, certified experts and empowering programs. But More of Me to Love is more than the sum of its parts: it’s a lifestyle of living better and loving yourself.”

• The Plus Runner:  Blogger Sallie has completed 12 half-marathons and another dozen triathlons and she’s done it all in sizes ranging from 16 to 22.  Her goal is to “encourage more future runners, walkers, hikers, to hit the road, and redefine your life as an active person.”

Know of any other awesome blogs or websites?  Post ‘em in the comment below.

Google the phrase “Dying to be thin” and you’ll find some 61,000 results of books, documentaries, blogs, discussions, campaigns and even a Congressional report all bearing the mind-numbingly banal platitude.  Now there’s another title to add to the list.  Investigative journalist Suzanne Marcus-Fletcher, host of the Blog Talk Radio show the Body Politic, has compiled the new series for iTunes that addresses a variety of issues related to eating disorders.

Marcus-Fletcher’s Dying to Be Thin series taps Dr. Patricia Pitts, founder and CEO of The Bella Vita eating disorder treatment centers, and discusses such topics as “How do you know if you or a loved one has an eating disorder? “Misconceptions about eating disorders,” “The rapid rise of Manorexia among male teens and men.” The Body Politic also aired an episode live yesterday that addressed “”How dieting contributes to eating disorders.”  The series can be heard or downloaded from www.blogtalkradio/thebodypolitic, at www.suzannemarcusfletcher.com, and on iTunes podcasts at BTR: The Body Politic.  For examples of some of the stories you will hear on the programs, check out this press release.

I’m currently at a local coffee house sans headphones, so I haven’t had a chance to listen to the series yet myself.  If you check it out, let us know what you think of it.

The incomparable Diablo Cody is on the cover of the Aug./Sept. copy of Bust magazine.  The Candy Girl author and Juno screenwriter dished on her new horror film, Jennifer’s Body (named after a Hole song) and why the world needs to see more size-10 women naked.  Here’s a few highlights from Jill Soloway’s interview with Cody:

On Jennifer’s Body [For a brief synopsis of the film, read here]:

…I decided instead to write a genre movie that reminded me of The Lost Boys and all the kind of movies that I used to watch when I was growing up, in the ’80s.  And that’s what this movie is.  What really appealed to me was the idea of working with a female director [Karyn Kusama].  I’m sure somebody will prove me wrong, but I had never heard of a woman director and a woman screenwriter creating a mainstream horror film.

…It’s really about girl-on-girl crime.  It’s Mean Girls taken to an extreme.  When the alpha girl becomes cannibal-like, nitpicking is no longer enough.  Now she has to literally consume flesh…  She eats men.

…The movie also references eating disorders.  Jennifer’s eating habits revolve around a binge-purge cycle.  She actually throws up before she eats.  She’s possessed.  She vomits disgusting black bile on her victims before she eats them.  But in one of my favorite scenes, she’s binge-eating out of her refrigerator.  I thought to myself, “Man if we aren’t getting that across…”  I was happy about that.

On feminism, nudity and self-image:

I’m a 31-year-old feminist in Ugg boots and a T-shirt, so it’s funny to me when anyone accuses me of trying to be sexy or cute.  I couldn’t do that if I fucking tried.  I’m full-on rocking this post-feminist-academic-stripper attitude because I’m trying to confront, not titillate.

…I have no shame about nudity and I feel like nudity is confrontational in a way.  Maybe the world needs to see a size-10 woman naked.  Maybe they need to see my cellulite.  I kind of feel that I would love to put that out there.  Any time I do a red carpet, I feel vaguely confrontational.  I feel like, “All right, now somebody’s going to come onto the carpet who doesn’t have a stylist, who did her own hair and makeup, who’s wearing a $25 dress from H&M.  I have cellulite.  I have big hips and big thighs.  And you have to look at me.”  I feel like people have to pay attention to someone who would typically be invisible.

I came across this definition of “normal” eating at The Joy Project and thought I’d pass along.  How much of this do you follow?  What’s normal eating like for you?

Normal eating is being able to eat when you are hungry and continue eating until you are satisfied. It is being able to choose food you like and eat it and truly get enough of it- not just stop eating because you think you should. Normal eating is being able to use some moderate constraint in your food selection to get the right food, but NOT being so restrictive that you miss out on pleasurable foods. Normal eating is giving yourself permission to eat sometimes because you are happy, sad, or bored, or just because it feels good. Normal eating is three meals a day, most of the time, but it can also be choosing to munch along. It is leaving some cookies on the plate because you know you can have some again tomorrow, or it is eating more now because they taste so wonderful when they are fresh. Normal eating is overeating at time: feeling stuffed and uncomfortable. It is also undereating at time and wishing you had more. Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life.

In short, normal eating is flexible. It varies in response to your emotions, your schedule, your hunger, and your proximity to food.*

The site also gives a hunger satiety scale for anyone with disordered relationships to food to fill out to help them reconnect with bodily cues on hunger and satiety — download it here (PDF) — and explains what a well-rounded meal is and why it’s so important especially for people recovering from food-related addictions.  IN all, The Joy Project sounds like an awesome organization.  Here’s what they’re about:

The Joy Project is a non-profit, grassroots organization based on the philosophy of using real-world, workable solutions to end the epidemic of eating disorders. We work towards reducing the rate and severity of eating disorders by supporting and conducting research, education, and support programs.

…The goal of The Joy Project is to fill in the gaps caused by inadequate access to eating disorder treatment, and create a dialogue between researchers, treatment professionals, and those affected by eating disorders, in order to foster a better understanding of how to help people not only recover, but remain recovered. The Joy Project empowers eating disordered individuals by allowing them to use their own experience to advocate for themselves and others, and to create a community of support and hope among those who share the illness.

The organization offers support groups in the Minneapolis area and is nationally championing for change in ED diagnostic criteria, specifically to eliminate weight requirements for anorexia.  I am a big supporter of this initiative, as one of the reasons I was diagnosed with ED-NOS and not anorexia is because I didn’t meet the stringent weight requirement.  The fact that I lost much more weight in a shorter amount of time and was at a much higher starting point than most girls and women diagnosed with anorexia proved irrelevant in a diagnosis.  This is crucial only in that an anorexia diagnosis commands more respect and action from health insurance companies than a diagnosis of bulimia or ED-NOS, even if the latter disorders pose just as grave and deadly a risk.  Read more about the organization’s current goals and initiatives here.

The website also gives sample meal plans for people learning how to eat healthily and normally again and offers “INspirational” images of women of all body shapes who have achieved notable success.  Tips for avoiding relapse are also given, along with anti-binge strategies. In recovery?  Make a list of recovery projects and goals to help you through it or read tips on how to help loved ones struggling with an eating disorder.  Seriously, I just can’t gush enough about The Joy Project.  Go check it out.

* Taken from “Secrets of Feeding a Healthy Family” 1999, Kelcy Press