I really like your take on this as so many people really don't get the differences and of course, still not even understand that eating disorders are a mental illness.

Great post!

Mine didn't begin with a diet or anything to that notion. I was just unhappy. I think I got a high from only drinking coffee and eating one meal a day. It just spiraled after that. After that, I think restricting became a great means of controlling my sadness.

What do you think the percentage of eating disorders begin with dieting?

I am so, so with you. I really wish people would stop conceptualizing EDs as haywire vanity projects. Extreme vanity in itself is a stigma, but to have people believe your vanity is so extreme that you're literally killing yourself over it? How deflating. I definitely think some of the stigma of EDs would lift (which would probably make seeking treatment easier) if we thought about them differently.

This always bugs me -- this comparison of diets and anorexia. Like you said, diets = choice; anorexia = brain disease. They have similar surface features, but they are nothing alike at their cores. My eating disorder didn't even start with an innocent attempt to lose a little weight. I didn't even need to lose weight. I just felt a high from starving and it went from there. Very different from a "diet."

Alexandra,

I use the word "diet" to mean many things, which was a bad choice of semantics on my part. A "diet" can mean a deliberate attempt to lose weight, but it can also be an attempt to eat healthier or to exercise more. I have one friend who developed ED after she had to have some dental work done and just stopped eating properly. And like you related, my last relapse was linked less to a desire to lose weight and more to this oppressive depression and my losing my appetite and stopping caring about eating.

Accurately, I should say that 'malnutrition precedes almost all eating disorders,' rather than "dieting," since the picture is way more complicated than that. I am guessing your story isn't as unusual as I might have made it out to be, and I apologize.

Oh no, no. I didn't mean to imply that. I apologize. I definitely don't find my situation unusual. From the few people I have met in "real life" [although I consider all you women-and men!-part of real life as well, just people I have yet to meet] most of us began our disordered eating for one reason or another that had nothing to do with dieting. [Rape, sexual abuse, depression, etc]

It is such a complex issue, and I feel the source for every individual is so different [and yet, so similar to some degree].

I am very thankful for your blog, I follow you on twitter, and I find all these postings very interesting.

I wish some day to live a life in which I am happy with myself...just for being me...until then, I look to you other women [and men] as inspiration, and companions. Together, we will overcome :)

Thank's for your blog. I heard a talk show host today going off on the top doctor. She's too fat! She's obese! Sorry for the trigger words but I just got so mad! He didn't care at all about what she was saying or her credentials just her weight. And then broke into a 5 minute sales pitch for a "quick" way to lose weight. One of the few times I called a talk show, I couldn't put together a coherent response. I did ask him why it was he needed to attack her personal physical looks. He hung up on me. I'm going to go some of the sessions on media awareness at the NEDA confrence, maybe I can pick up some thing.

My ED morphed to a more of an anerxic kind after a dr. suppervised diet. I needed it for health concernes and they tried to get me to see a T, but I was not ready. It was just when they tried to get me to eat solid food again that I realized I had a real problem. Now I'm working on that.

Keep putting this kind of thing out there please. It does help.

Great post!

I spend a lot of time educating client's family members about the difference between a "Diet/choice" v. "ED/not a choice".

A lot of confusion out there because sometimes it does start as a diet or lifestyle choice, but then it spirals out of control.

The thing I always get confused about is this. . .

It seems to be possible for someone to actually take a diet too far -- to a point to meet AN criteria and then self-correct or recover with very little help. Is this anorexia and how do we differentiate anorexia from extreme dieting?

Also, I have a coworker who has extremely disordered eating.She works out every day, portion sizes her food, complains about her weight, doesn't eat bread. However, she is a healthy body weight and does seem to eat to meet her nutritional needs.

I have been thinking about this and it's interesting to consider if that is just disordered eating or ED-NOS. Where do we make the distinction? If healthy eating exists on a spectrum, at what point does dieting become eating disordered?

A:)

Alexandra,

I think most EDs have more to do with a fear of food than food itself. And the final precipitating factor is usually a period where someone doesn't eat adequately for whatever reason. When my ED started, I just wanted to work out to relieve stress, and then things compounded. Not eating made me feel better, and the weight loss was a little self esteem boost. The exact reason why someone stops eating properly is relevent to the person in knowing what their triggers are (stress ≠ my friend), but I'm not sure how clinically significant this is to the overall picture of EDs on a population level.

A,

You raise some very good questions, and I found a research article that I'm going to blog on later today where I will take a stab at some of them (though I don't have all the answers!).

A-- I think your comment really captured a lot of what came to mind for me when I first read this post. I know that Carrie's point was that EDs are not choices made out of vanity but diseases over which the sufferer has no control. However, and maybe this is just my own over-sensitivity, there was something about this post that really bothered me. I feel so often there is this dichotomy drawn by individuals with eating disorders between those people who have "real" eating disorders and those who are just choosing to diet and I do not think this is such a black and white line. I am concerned that by drawing these kind of lines we will end up denigrating and excluding people who may have eating disorders or need help but who look like they are "merely" dieting. Which I think is actually the point of Carrie's post. I just think we need to be careful about where and how we draw our lines. I think this gets especially tricky because I know that at many points in my eating disorder I was sure that I was absolutely in control and that I could start eating against whenever I wanted to, and I think it is often hard for people with eating disorders to recognize at times that what they are doing is beyond their control especially in the early stages of the disorder.

But I also really understand the need to make it clear that eating disorders are not about vanity nor are they choices--I don't know how many times I've been told that I just needed to get my priorities straight and stop worrying so much about how much I weighed. There is so much misunderstanding about eating disorders in the media and in society and so I think it is critical to make clear that eating disorders are diseases not lifestyle choices. I just want us to be careful about drawing lines and marginalizing people.

How are you supposed to know if you are a dieter or a person with an eating disorder? Does it have to do with how hard it is for you to stop? How long it takes for you to stop? And how are other people from the outside supposed to know?

And why does this distinction matter so much? Extreme dieting and eating disorders both get in the way of life.... Is the label that important?

Kay - last comment - seriously...

But if diets are choices and eating disorders are not, then I hope I am just on some diet because I want a choice! If I have no choice in this then I'm really scared.... I'd like to think I have the potential to regain some control (right now I'm in a bad place with my eating - sorry...)

Like Alexandra and Kim, my anorexia didn't start with a diet - I had never weighed myself or thought I was fat, I was suffering from depression and discovered that not eating made me numb. In fact, most of the people I've known with eating disorders tell similar stories, I don't know an awful lot of people who started out by dieting. I get the point, but saying 'virtually all eating disorders begin with a diet' (and citing a government webpage? That's not really evidence) kind of invalidates the thousands of us who didn't fall into anorexia that way. I like your blog and I agree that anorexia is a brain disorder triggered by malnutrition, but everyone with an eating disorder is different, it's not quite this black and white. It's easier, maybe, to say that the illness is completely out of our control, because that way we are absolved from all responsibility, but I don't believe that's very helpful for recovery - or necessarily true all of the time. Sorry if I'm just misunderstanding your opinions though, it's easy to do on the internet.

"I have a coworker who has extremely disordered eating.She works out every day, portion sizes her food, complains about her weight, doesn't eat bread. However, she is a healthy body weight and does seem to eat to meet her nutritional needs."

This has been me at various times during my recovery from bulimia. Not underweight, not purging, diet is basically okay, and if I binge, it's in secret. I've told very few of my co-workers over the years about being in recovery from an ED because by the time I entered the workforce, it had been over 5 years since I had stopped purging.

actually, i know that pretty much all the literature and research says that ed's usually start as diets, but in my case (and i know everyone's case is different so not trying to universalize mine) it actually started because i came back from doing solidarity work in mexico and had absolutely zero money having lived the life of a full time activist and only taking paid jobs when needed. as such, i whittled down my grocery list to less than ten dollars a week, became super obsessive about how little food i could get by on, which then triggered a severe and unfinished relapse into anorexia.
just an fyi that eating disorders don't have to start with a desire to lose weight.
which i guess in a way contributes to why you (and lots of us) get so frustrated that eating disorders are described as almost indistinguishable from diets?

so i feel like an asshole. i commented after i read the article, but hadn't yet read the comments. read them all just now and realized that i came off in wierd way that wasn't intentional at all. so i'm really sorry for the super irritating comment!

Steelworker,

No worries- there are a lot of comments!

I guess the best way to phrase it is "most EDs begin with an energy imbalance." In AN, that energy imbalance leads to some sort of positive reinforcement, whether internal, external, or both. In BN, the energy imbalance leads to (or worsens), the binge eating and purging, which is addicting and provides positive reinforcement.

thanks for understanding, carrie :)