What Anorexia is "About"

With National Eating Disorders Awareness Week in full swing, there have been a heap of stories on eating disorders. Some of them good, some of them not, and some of them downright depressing.

"Once an anorexic, always an anorexic"? Well if that doesn't leave you jumping for joy...

I mean, I would be very very stupid to forget that I had an eating disorder. When I was first diagnosed (before it turned into the 8 year drama that it has), my mom would say that she hoped I could "put this all behind me" one day. Forget about it. Move on. Except to forget that my brain chemistry changes when I don't eat properly would set me up for a relapse.

Working through lunch isn't good for anyone; for me, it's playing with fire. And I will get burned.

But that doesn't mean I'm going to be anorexic forever. It doesn't mean that I have to obsess about food and weight and exercise every day. It just means I have to be mindful.

The other pet peeve of mine in stories on eating disorders is that they aren't about food; they're about control.

Ah, yes. Control. That beautiful, wonderful word we all have come to know and love. Many people with eating disorders are control freaks. It tends to go along with perfectionism. But that doesn't mean that eating disorders are about control.

Yet eating disorders are about food when you're malnourished or engaging in ED behaviors. The "why" isn't so important when your brain isn't functioning properly.

Even then, I wonder: why food? Why weight? Could that be part of the cultural context for eating disorders? The fear of fatness? Everything is low-fat this, "will help you achieve a healthy body weight" that. How could you escape without some sort of food-related neurosis?

On the other hand, most people don't develop eating disorders. So there's a brain thing going on in there, too.

How I see the control thing is this: you're trying to control your fears, your anxieties, your phobias. That's the "control" part. Most people with eating disorders do NOT see themselves in control of their food. They feel tremendously out of control- which leads to increased restricting, purging, exercise, bingeing- as a way to regain control. Only this doesn't work, and lather, rinse, repeat.

I see many parallels between anorexia and OCD* because OCD involves a tremendous need to control certain fears. With OCD, it's with neutralizing rituals. Have a bad thought? Pray for forgiveness. Leave the stove on? Check the knobs. With anorexia, there are similar kind of neutralizing rituals. Eat too much? Go for a run. Do a bazillion situps. Throw up. Eat less tomorrow.

I don't know that they are the same disease- and because they can exist independently, I would say they're not. But I think they are similar neurochemically, and there is certainly huge overlap in populations of sufferers.

OCD is an illness. Anorexia is an illness. Bulimia is an illness. EDNOS is an illness.

*and if you do a PubMed search of "anorexia nervosa and OCD" you will see that I'm not the only one who thinks so.

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Niika said...

Most people may not develop EDs, but there is a significant percentage of the population with disordered eating behaviors (dieting, counting calories, counting carbs and fat, overexercising, what have you) who don't develop full-blown EDs. So I think the cultural aspect is a lot stronger than we often give it credit for. On the other hand, people who do develop clinically diagnosable EDs have something more going on than just being influenced by culture, for sure. It's the difference between the "normal" dieter (though I'd debate even that) and someone whose life is being seriously disrupted or consumed by the abnormal eating behaviors.

Niika said...

Oh, and I should probably mention the significant number of "normal" people who have disordered eating behaviors on the opposite side of the spectrum (overeating, occasional binging, what have you).

Harriet said...

Great post, Carrie. I think I saw the same google news item as you about eating disorders and control. The misconceptions that rae out there just burn my boat.

carrie said...


I think there is a very strong cultural component to eating disorders. That many of the people I talk to have some form of disordered eating is testament to that. But I think there is a difference between the occasional dieter and someone who has an eating disorder, and that's the ability to stop. People with EDs can't choose to stop. It's not that easy.

But dieting is like a "gateway drug" for eating disorders. Most EDs start with a diet.


Well don't let them burn your boat if you're still in it! :)

Anonymous said...

EDs are still considered a "woman's problem" by most of our culture, so the poo-poo-ing and the condescending tone are almost required. :P


carrie said...


I don't think the "women's problem" view helps, yet things like breast cancer aren't really poo-pooed. Part of it is, I think, that breast cancer is accepted as a disease, while eating disorders are thought of as just a bunch of vain women obsessed with their looks.

Laura Collins said...

I think part of the reason find the cultural explanation appealing is that biological and genetic sound deterministic and hopeless.

People feel as if we can change society but we can't change biology. (I disagree, though. I think we're more likely to have success treating the biology than we have of truly changing society!)

carrie said...


I never quite thought about it like that. I always thought one of the major appeals of a societal viewpoint is that it's much more easily understood than genetics and biology. We know what a model is. We know what obesity is (well, kind of). But serotonin? Leptin? Not so easy to either explain or understand.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote


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