Drawing the line

This is a question that has always made me wonder: when is it an eating disorder? And when is it an extreme diet? Or a lot of comfort eating?

Is it the person's ability to stop? An article from Australia details the unhealthy lengths women go to in order to lose weight. Diet pills, fasting, vomiting: unhealthy, no doubt. But what makes something an eating disorder? Self-induced vomiting for weight loss seems to be a clear-cut thing. Yet if it's only once--what about then?

A famous Italian chef admits to binge eating disorder. He is quoted in the article as follows:

"I binge-eat like I used to binge drink," Zilli told The Daily Telegraph. "When I'm not in a good place, when I'm a bit stressed and depressed, I eat chocolate and desserts. Everything sweet. We are weird us chefs. That sends me to the unhappy place where the alcohol took me."

But how often does he do this? Is it the equivalent of a post-breakup sob fest on the couch with a few pints of Ben and Jerry's? Or is it something more regular? And how much of a problem, really, is emotional eating?

Do we say it's when the person realizes there's a problem? Because there's such a thing as both denial (when you know you're sick but don't want to admit it) and anosgosnia, which means you literally do not know that you are sick.

Do we say when there are physical complications? Or is that too late? Too broad? Not definitive enough?

I do understand that eating issues can exist on a continuum, but where do we reach the point between "not the greatest habits" and "Houston, we have a problem"?

Can we draw the line? Should we? And if so, where?

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6 comments:

Rachel said...

I dislike the fact that weight is used as a basis in the diagnosis of anorexia, especially when a diagnosis of anorexia usually spurs insurance companies to action when a diagnosis of ED-NOS does not. Most diagnoses of anorexia note amongst its symptoms a loss of 15 percent of body weight, but require a weight of less than 85 percent of what is considered normal for that person’s age and height for an official diagnosis to be made. In my case, I met every qualification for anorexia except the weight requirement, but only because I had a much higher starting point than most (300 pounds). Even though I lost more than 60 percent of my body weight in just a year, I still did not reach the low body weight required for a diagnosis. Had doctors considered the fact that my rapid weight loss resulted in about 10 - 15 pounds of loose skin and excluded that from my weight, I would have qualified for an AN diagnosis, or at least teetered on the borderline weight requirement.

(Also, in my case, I encountered a variety of doctors who reinforced my weight loss as good and healthy, despite the clearly disordered and dangerous forces driving the weight loss. I should note that I was very healthy even at 300 pounds and it wasn't until I developed an eating disorder did any health problems arise. But I believe my morbid obesity also contributed to doctors' inability to accurately diagnose my eating disorder, in addition to the body weight diagnosis requirement.)

I don't think there are any easy answers to your question, but I'm of the opinion that we should broaden the current definitions of what constitutes eating disordered behaviors, not restrict them. When I first sought out help for my eating disorder, the fact that I could have one never occurred to me - I thought I was too fat. I have to wonder how many other people never imagine their behavior could be an eating disorder because they're also too fat, or they don't purge enough, or they haven't lost XX amount of weight, or they binge but not thousands upon calories upon one sitting. (On this last point, it must be noted that what constitutes a binge should not be measured by the caloric content of the foods binged upon, but rather the feelings surrounding the binge).

For me, I know my behavior became problematic not when I first stuck my head in the toilet, but when I was physically and mentally unable to pull it back out. It's ironic how eating disorders are touted as being all about "control," because at their heart, they represent a loss of control. Like any addiction, I think it's the inability to stop the behaviors that most defines when disordered eating becomes an eating disorder.

fighting_forever said...

I made a similar post in my blog a while back. I think the problem is that eating disorders are divided into neat little categories, while in real life they come in a huge range.

People start off dieting in a bad way and end up with an eating disorder but there's no point you can say, "That's when they stopped being a dieter and became disordered."

The weight thing bugs me like crazy. I think Rachel brings up an excellent point in that it doesn't consider the weight people started at. How much weight you lose in a period of time should give a much clearer view of how disordered someone is. It also annoys me because if you drink a load of water, your weight goes up. If you're on the boarderline, you could be anorexic or not depending on how much you've had to drink that day, which has no relevence to whether or not someone is ill.

Laura Collins said...

I draw the line at mental symptoms. Some people play around with dieting, have a binge, even purge - but don't have cognitions that are disordered - just incorrect and dangerous.

If you are in a cycle of self-perpetuating thoughts that drive the behavior, that is an eating disorder to me. Your weight is a result of behaviors.

I see EDs as mental problems that drive behaviors that damage the body and create MORE ED thoughts.

Laura Collins said...

Oh, and I think Rachel and FF are on the money!

Sarah said...

These are such important questions. I wish I knew the answers. I know, for me, that I rarely consume the amount of food that I used to binge with any more. And one of the hallmarks of binge eating disorder is eating more food in a short time than the average person would consider normal. BUT now I consider overeating, or unplanned eating, a "binge." For me the feelings around the eating, and the recriminations, are so similar. I don't know. I think these little boxes we get put into -- or don't get put into -- do more harm than good.

Hope you're well, babe.

xoxo

stoicsobriety said...

I would think that the mental condition of one's mind at the time of eating(or not!) dictates whether it is called an ED or not.

you could restrict at times or you could b/p other times, but it may not actually mean that you're eating disordered. a big part of it is the mindset that you have. for me, it's the fear of what others think of me that drives me hard, that really leaves me quite desperate with panic attacks and the like. this, in turn, brings about thoughts of self-loathing. it might happen the other way round--either way it's one's mental faculty that drives the disordered eating. i think that's when it becomes a disorder.

i dont know how i might explain it, but i think all the other comments have got it spot on as well.

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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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