Researchers have long known that brain diseases like mood disorders and anxiety run in families. In recent years, scientists have identified some of the specific gene variants that increase risk for these illnesses. All of this genetic research can almost make biology seem like destiny.

In fact, when I describe the biological and genetic basis for eating disorders, many people commonly say that it's depressing. That if an ED is biological, you can't get better (once an anorexic, always an anorexic). That any offspring will be doomed to repeat my eating disorder. Yet there is no 'anorexia gene,' no 'bulimia gene.' An eating disorder has been, and will always be, a complex interaction between nature and nurture, genes and environment, chemistry and culture.

Although it's a tad more complicated than this, genes essentially make proteins. Some proteins are so evolutionarily ancient and so important to your body that all humans will have identical copies of these proteins--one from their mother and one from their father. Some proteins have evolved more recently, or have greater flexibility in shape and form and function (the sequence of DNA ultimately determines the shape of a protein; the shape of a protein determines what job it does and how well it does that job). These particular proteins can tolerate small mutations, tiny changes to its shape, and so not all humans will carry the same copy. Several different versions of the gene, known as a polymorphism, exist among humans.

These polymorphisms aren't an on/off switch, an indication that you have the disease or you don't. Rather, they indicate that you are more likely to have an eating disorder, depression, anxiety, schizophrenia. This likelihood is also influenced by your life experiences (and the other way around), which can both increase or decrease your risk of becoming ill.

Researchers have found that genetics isn't destiny for those with anxiety disorders. In a study titled "What is an “Adverse” Environment? Interactions of Rearing Experiences and MAOA Genotype in Rhesus Monkeys" that will appear in the May 1st issue of Biological Psychiatry, researchers found that a rich social environment could protect monkeys from the negative effects of a gene polymorphism linked to anxiety. A press release summarized the research as follows:

There are some circumstances in a child's development – such as abusive parenting – that everyone would agree constitutes "adversity." This study suggests, however, that other, more subtle features of the broader social environment influence development, and that genes that affect our behavioral responses are sensitive to these influences. So even though an infant may be reared with its nurturing mother, the relative absence of other social partners, for both the mother and the infant, can result in the infant developing an anxious style of responding to challenges, particularly if it possesses a "risky" genotype.

Of particular significance, said senior author John Capitanio, Ph.D., is "that animals that were raised in rich, complex settings with mothers, other kin, and peers, were completely protected from the potentially deleterious effects of having the 'risky' form of the MAOA gene."

This isn't to say that genes aren't important--because they most certainly are. But we're just touching the tip of the iceberg with our understanding of how our genes interact with our environment. Any biological children that I have will be at a higher risk of developing an eating disorder. That's just reality. But I can make sure that they understand the dangers and futility of dieting, that they understand the true meaning of healthy eating and the range of shapes and sizes that human bodies come in. I can also step in at the first sign of trouble and make sure that he or she begins eating properly and maintaining an appropriate weight. I don't know for sure that this will protect them, but it can't hurt to try.

I've been adjusting to life outside The Boot. Though I still wear the silly thing on my commute to work, I have transitioned to matching footwear the rest of the time.

On Friday afternoon, I put a real shoe on my foot for the first time in a month. It felt freaky. Wrong. Abnormal. As if there shouldn't be something enclosing my foot like that. I kept it on for about an hour, and then took it off. Saturday, it was the same feeling. I actually went out in my nice new Nikes, a quick trip to the library and the grocery store, but I couldn't stop thinking about how odd my foot felt.

Sunday was better- my foot felt almost back to normal, and by Monday, it was just as if I had been wearing shoes all along.

All I could think was: if only I could get used to my healthy body this quickly! Of course, I was ill for about seven years by the time I truly returned to a normal weight, which is quite a bit longer than a month. But still, the feelings are the same. My body feels wrong, abnormal, itchy-in-a-metaphorical-way. It feels, well, huge. I still want to take my extra weight off, remove that freaky feeling.

I try to remind myself that this is like my foot, that I have to keep the damn shoe on and just slowly get used to it. Many times, I despair that this will ever happen, that I might just need to learn to tolerate and accept this feeling (as Tina eloquently captured here) and get the hell on with my life.

Today, the UK eating disorder charity BEAT updated their Twitter feed with an announcement about those women who had run the London Marathon to raise money for BEAT. A quick visit to the BEAT homepage shows that they are asking people to run in other races to help raise money for the organization.

Which is all well and good, but it strikes me as a little counterproductive for an eating disorder organization. It's one thing for a person to independently decide to run a marathon as a fund-raiser for an ED charity. I'd want them to be sure about their motives if they had an ED history, but, well, okay. However, I have a little bit more of an issue with BEAT actually asking people to run in marathons or other long distances when these activities are so frequently abused in people with eating disorders.

It almost strikes me as having an AA event with an open bar or a tanning salon hosting a fundraiser for melanoma research.

I blogged about a women several months ago who said she was recovered from AN but now runs "super-marathons" and was attempting to run the length of Scotland and England also as a fund-raiser for BEAT, and I raised some of these concerns there.

I have no doubt that BEAT's efforts are well-intentioned and the money is greatly needed, especially in the crappy economy. BEAT is a fantastic organization that does so much for so many people with such limited resources. I have no doubt that most of the people who participate will have the best of intentions. I don't expect anything to be "risk-free," but it seems awfully dangerous. There has to be a better way, one that would more likely promote health in the clientele BEAT serves.

I mean, isn't that the point?

I have always been struck by similarities between the autism and eating disorder communities. Both conditions are rather misunderstood, and research into causes and cures is in its infancy at best. Both communities are home to parent-activists advocating for better research and care, for insurance coverage and a chance for their children to lead healthy, fulfilling lives. Causes into both disorders are filled with controversy, although scientists are getting closer to understanding the neurochemistry unique to each disorder.

But an interesting theory has been floating around, led largely by the efforts of Janet Treasure in the UK, that suggests some intriguing similarities between autism and anorexia. An article in New Scientist titled "Anorexia linked to 'autistic' thinking*," looks at the striking similarities in cognition patterns between people with autism and those with anorexia.

Now, evidence suggests that people with anorexia have cognitive traits associated with ASD [autism spectrum disorders]. "Eating disorders and autism spectrum disorders are obviously not the same thing, but they do have some things in common," says Janet Treasure of the Institute of Psychiatry in London. Treasure had already discovered that anorexia was associated with extreme attention to detail and a rigid, inflexible style of thinking - traits also associated with ASD...

...Simon Baron-Cohen of the Autism Research Centre in Cambridge, UK, is also measuring whether adolescents with anorexia score higher on autistic traits than healthy people, as he suspects that some of them may actually have undiagnosed Asperger's syndrome. "We have always known that Asperger's syndrome was diagnosed more often in males," he says. "The new question is whether it takes a different form in females, and can account for at least a subgroup of those who are diagnosed with anorexia."

If it does, this could have important implications for the way that anorexia is treated. "As well as treating the 'eating disorder' the clinician and the patient might [also] focus on social skills," says Baron-Cohen, although he adds that weight gain would remain a key target.

No one, of course, is suggesting that everyone who has anorexia is autistic--far from it. But there are other similarities between ASD and anorexia. A recent study found that adolescent males with Asperger's Syndrome had abnormal levels of cortisol [the paper's abstract is here]. The authors of the study "believe these findings may help to explain why individuals with this condition have difficulties with minor changes to their routine or changes in their environment." Similarly, people with AN have similar abnormalities in cortisol and these some cognitive traits.

Males outnumber females in ASD, while the reverse is true for anorexia. Perhaps, assert Treasure et al., some females with AN have simply not been diagnosed with ASD because they are female.

Studies of women with AN showed that they have higher levels of autistic traits than healthy controls. Autistic-type thinking (which is usually roughly defined as poorer social skills, attention to detail, and resistance to change) is also associated with poorer outcomes in anorexia. A different study found a subgroup of AN patients that showed persistent stereotypical "autistic" thinking, a decade after diagnosis:

Ten years after AN onset, the former AN cases showed no major neuropsychological deficits. A subgroup with autistic features had test profiles similar to those observed in autism spectrum disorders. The AN group as a whole showed poor results on the object assembly subtest indicating weak central coherence with a tendency to focus on details at the expense of configural information. This cognitive style may account for their obsession with details, with implications for psychoeducational approaches in treatment programmes/interventions.

In my opinion, both autism and anorexia are caused by subtle differences in neurochemistry from a variety of systems. In anorexia alone, changes have been found in serotonin, dopamine/endorphins, leptin, ghrelin, cortisol, and neuropeptide Y, to name a few. Exactly which systems are altered, and by how much, probably explains to some degree why some people become addicted to exercise and others don't; why some begin bingeing and purging and others don't. Perhaps there is some overlap in this altered neurochemistry that could explain the overlap between the two sets of symptoms. No one has any answers for sure--the evidence is still out. But it's an interesting theory that deserves some attention.

*Picture could be triggering. I'm always baffled at some of these magazines' choices of images.

Most people with eating disorders know a lot about calories--at least how to count them. But I found an article in the Journal of Nutrition called "A History of the Calorie in Nutrition" that was fantastically interesting.

The calorie, as it were, was defined as a unit of heat "sometime between 1787 and 1824." The first definition (in French) appeared in 1845 as "la quantité de chaleur nécessaire pour élever 1 gramme d'eau de 1 degré, et que l'on appelle unité de chaleur ou calorie." Translated roughly: a calories is the amount of heat necessary to raise the temperature of one gram of water one degree Celcius.

Not a hint of morality. Maybe this is why French Women Don't Get Fat?

Food calories, however, are actually kilocalories, or kcal, or Calorie (capital "C"), and it was first used to measure energy in food in the 1940s. It's use as a unit of human energy needs first appeared in an 1894 human physiology text by JH Raymond. However, Raymond's contribution wasn't the most important in terms of the popular understanding of the Calorie. Rather,

The Calorie began to enter popular American vocabulary after Atwater explained the unit in his 1887 article in Century magazine. The most important avenue was probably the USDA Farmers' Bulletins, which provided the first U.S. food databases to be used in dietetics. Then, as now, American audiences were interested in managing weight, and the Calorie was soon introduced in articles and books. For example, Dr. Lulu Hunt Peters' best-selling "Diet and Health with Key to the Calories" specifically cited Farmers' Bulletin 142 as a source of information. Eventually, the Calorie was adopted for the nutrition facts panels on U.S. food labels. At present, there does not seem to be a movement by policy makers in the US to replace the Calorie with the kJ on nutrition information panels.

It was Dr. Peters' book, however, that ultimately turned a Calorie from a unit of energy into a unit of morality. A wave of Calorie-counting hysteria swept the nation, and hasn't really left. Of course, people weren't content to only count calories- they started counting carbs and fat grams and fiber and sodium and cholesterol, until your day's worth of food can seem more like an Excel spreadsheet than an enjoyable experience.

Well, I went back to the podiatrist and things are looking pretty good. My stress fracture is healing, though it's not 100% healed yet. However, the doc said I can start taking The Boot off in the evenings and walking around with real shoes on to start, and slowly extending the time I'm out of The Boot. He said as long as I'm not having any serious pain (achiness is to be expected), then I should be Boot-free by next week!

Too bad the damn thing is plastic. I would love to see it combust.

The New York Times' Well blog picked up on Rachel's excellent coverage of the use of diets as a torture technique by the Bush administration. Huffington Post blogger Sam Stein wrote that:

In a footnote to a May 10, 2005, memorandum from the Office of Legal Council, the Bush attorney general’s office argued that restricting the caloric intake of terrorist suspects to 1000 calories a day was medically safe because people in the United States were dieting along those lines voluntarily.

“While detainees subject to dietary manipulation are obviously situated differently from individuals who voluntarily engage in commercial weight-loss programs, we note that widely available commercial weight-loss programs in the United States employ diets of 1000 kcal/day for sustain periods of weeks or longer without requiring medical supervision,” read the footnote. “While we do not equate commercial weight loss programs and this interrogation technique, the fact that these calorie levels are used in the weight-loss programs, in our view, is instructive in evaluating the medical safety of the interrogation technique.”

Rachel had this to say in the "comments" section of her post:

The overall point is the same for terrorist or woman: Wean their caloric intake down so far to keep them alive, but in a state where they’re body’s defenses kick in and all they think about is food. They will then be more docile and retractable so that you can gain — and sustain — power over them.

And this is, I think, where so many seemingly "average" Americans are likely to miss the point: dieting changes brain chemistry. It's not free of side effects and the potential for harm. Sure, once all of your bones are sticking out, people might tell you to knock it off--but some will also ask you for diet tips.*

People dramatically underestimate the effects that dieting and even mild malnutrition have on the brain. Many women and men cut their calories to levels even below that of the detainees. In the Minnesota Starvation Study, where the men at about 1500 calories each day, they essentially went nuts. They obsessed about food, lost interest in women and sex, became depressed and anxious. One man even chopped some of his fingers off.

Food restricting changes neurochemistry. Some people survive a diet okay. Some get trapped. It's no more safe whether it's "approved" by Jenny Craig, an ex-president, or a doctor. It's no more safe whether it's imposed upon a prisoner or embarked upon by a teen. Dieting can be risky. It changes your brain.

Remember that.

*No joke. The day before I was hospitalized for AN back in 2001, a girl asked me how I did it because she was having "a little trouble with Atkins." I was practically at death's door, with blue fingernails and covered in fur and she wanted to know how I did it.

A post titled "10 Ways to Celebrate Earth Day" on PsychCentral really got me tweaked. Most of the suggestions were good ideas and had a legitimate environmental focus. However, suggestion #3 caused my blood pressure to spike just a bit.

3. Talk with your doctor about alternatives to prescription medication.
Yes, I know this isn’t an option for everyone, but for some alternatives like exercise, talk therapy, and natural remedies work just as well as what comes out of those little bottles. Need some ideas? Check out yoga and sports therapies.

Certainly medication isn't the only option to treat depression, nor should it be. Both exercise and talk therapies have been proven effective against depression; as a rule, I steer clear of "natural remedies" unless they've been thoroughly researched. So I get that people should consider ALL options for treating depression, including medication.

What got me was not the suggestion of alternatives. What really got me tweaked was that this would only be suggested for a mental illness. You wouldn't tell a diabetic to try "insulin alternatives" to try and save the planet. Or screw the statins, Dad, just do some yoga. And chemotherapy might not be so Earth-friendly, either, so let's go play kickball instead. People wouldn't say this.

I am really sick and tired of people pooh-pooing treatments for mental illness that we know work. The author technically said "I know this wouldn't work for everyone but..." but it's the idea that no one would say this for any other type of illness. These are specifically blogs about psychology. Shouldn't they know better?

It seems that people who take medication for mental illness are almost seen as less-than, for not being able to "tough it out" and "pick themselves up" without the help of a pills "in little bottles." I don't like this. At all. Because it's just not true.

I recently stumbled across the word "narritization." I love it. It puts into a simple word the process of giving your experiences context and meaning. I've written about narritization, though I called it "Narrating anorexia" at the time.

I came across the word in a post from Mind Hacks, on a post about choice blindness. In it, the author brings up philosopher Daniel Dennett's concept of narritization, which is

"the ability of the mind to make a coherent story out what's happening, with you as the main character, even when it's clear that the outcome was determined externally. In a well-known article, Dennett cites this process as the key to our understanding of the 'self'."

It is, in short, how you write your own story.

How I understand my eating disorder now, right at this moment, is different from when I was first diagnosed (eating disorder? I don't have no stinkin' eating disorder!) or when I first began to accept the idea. Much of this understanding is predicated on my background as a scientist, my gravitation towards research and evidence.

And how I might have understood anorexia ten, twenty, fifty, a hundred, five hundred years ago is certainly going to be different yet. The actual neurochemistry was certainly almost identical no matter when a sufferer might have lived. Some researchers have been examining the importance of narritization in the actual disease process by asking if EDs are "culture-bound" syndromes.

I wonder, often, how much our culture's understanding (or lack thereof) of eating disorders influences what we attribute the illness to. In other words, how do we understand why we got sick? If you've read this blog before, you'll know I believe that eating disorders are biologically-based mental illnesses that are often triggered by mild malnutrition in the form of a diet or healthy eating or even just weight loss during the stomach flu. I also know that many other people disagree with this view and so understand their illness quite differently from me.

In non-Western cultures, people with anorexia are less likely to express a fear of fatness. So is this fear a Western concept, the result of steeping our brains in the Language of Fat? Or is it, like food restriction and hyperactivity, a more basic part of the illness? Fasting medieval saints couldn't blame supermodels and didn't express a desire to lose weight- yet they almost certainly suffered from anorexia. So how do we separate this? Can we?

I don't have any firm answers on this, no witty zinger to end the post. Not all that long ago, I would have attributed my epilepsy to demon possession. Not all that long ago, I wouldn't have been able to look at neurochemistry as a possible cause to my anorexia. This, I think, is progress. This is the core of my narratization.

I cheered a little when I read this op-ed piece in the New York Times today: To fight stigmas, start with treatment

Writes Sally Satel:

Altering public attitudes toward the mentally ill depends largely on whether they receive treatment that works. This, in turn, sets in motion a self-reinforcing momentum: the more that treatment is observed to work, the more it is encouraged.

We see this in some of the more recent trends in treatment promotion: Psychiatric medications are routinely advertised on television. The military is taking meaningful steps to make treatment for combat stress standard. And last fall, President George W. Bush signed a law that prohibits health insurance discrimination against patients with mental illness.

Antistigma campaigns are well-meaning but they lack a crucial element. No matter how sympathetic the public may be, attitudes about people with mental illness will inevitably rest upon how much or how little their symptoms set them apart.

We talk a lot about stigma and eating disorders at conferences and meetings, amongst families and professionals. Research has shown that biological explanations of eating disorders help reduce stigma, yet most of the time, people still blame anorexics for their "behavior."

I'm not going to say that the less-than-optimal treatment outcomes, especially for adults with eating disorders, are solely to blame for the stigma against EDs. Eating disorders have a wealth of sociocultural baggage to carry as well. However, Satel raises a good point that isn't often broached when the discussions about stigma arise: we need better treatments. It's too easy to see someone with mental illness as "damaged" or "defective." That their illness is permanent- not to mention that it might be a character flaw instead of a real disease.

If we can start seeing eating disorders as treatable--if we can start actually developing and applying those treatments to sufferers--maybe some of that stigma would start to evaporate.

(Read all of Satel's article- it's worth it.)

I couldn't help but think about eating disorder recovery when I read this article: Diabetes? Some beat it, but are they cured?

Some people with Type 2 Diabetes are able to control their blood sugar through the euphemistic "lifestyle changes," namely eating "healthier,"* losing weight, and exercising, to the point that they no longer need medication.

"For right now, we're not saying they're cured, but the bottom line is ... good glucose control, less infections," said Sue McLaughlin, president of health care and education for the American Diabetes Association. The organization has no estimate of how many people fall into that category...

Doctors caution that, for some diabetics, lowering blood sugar may be only temporary. Stress, weight gain and other factors can push it back to unhealthy levels.

"Blood sugars can come down to normal. Then the issue is how long does that last?" said Dr. Sue Kirkman, vice president of clinical affairs for the diabetes association. "Sometimes people start putting weight back on and their blood sugars come back up."

In other cases, patients are diagnosed so late that blood sugar levels can't be brought back to normal, even with weight loss, she said. As the disease progresses, even those who made diet and lifestyle changes might eventually have to go on medications.


That's one reason Wagner and some other diabetics who've managed their disease through diet and exercise are also reluctant to consider themselves "cured."

"American culture, our environment, is not conducive to having good health," said Wagner. She believes diabetes will always be lurking in the background, waiting for her to slip.

And, though it sounds a little ominous, I think an eating disorder will always be waiting for me to slip. I don't believe recovery is all doom and gloom, but I'd be really stupid to forget that I am and will always be vulnerable to an eating disorder. American culture isn't conducive to eating disorder recovery, either, which only adds to the need to remain vigilant.

Here's the thing: we don't know how many people recover from an eating disorder only to fall back down the rabbit hole decades later. We know relapse is common and recovery can be a long and difficult road. We know that malnutrition is almost always the first step both in the initial descent into an ED and into relapse. We know that normalizing eating habits goes a long way in treating ED thinking. But we don't know about "cures," if there is one, if there will ever be one.

For me to stay healthy, I can't brag about how little sleep I'm getting or how stressed I am. These things make me nutty, which tends to lead to food restriction. Food restriction leads to overexercise and overexercise leads to stress fractures and The Boot. I can't go on a diet and expect a positive outcome. I can't be carefree about food and eating- I need to make sure I'm eating enough of EVERY different food group and that I'm getting enough fats and proteins.

In spite of this, I do believe that it's possible to go on and life a happy and fulfilling life. I don't think I will be dealing with food phobias and urges to exercise myself half to death forever. I tell myself it could be worse. I have people to support me on this journey, to get my back when Ed starts calling again.

*A "healthy diet" isn't one specific thing, hence the quotation marks.

Diagnosing an eating disorder usually involves a measurement of height and weight, and then some basic questions: how much do you eat? Do you binge? Do you purge? How much you exercise? Do you think you're fat? If you're seeing a therapist, you may have to fill out a questionnaire, like the EAT-26. If you're seeing a doctor who is decent, they may check your bloodwork and if you're really lucky, do an EKG.

The problem is that this doesn't always catch everything. Why? The DSM-IV isn't foolproof. It's more of a description than a diagnosis, made more for people in their late teens and into adulthood than for younger sufferers, and even some older ones. Many young children with EDs may not express a phobia of fatness, and this is causing many GPs to miss the diagnosis. Nor do people from non-Western cultures always express a weight/fat phobia, although this phobia is slowly increasing. Furthermore, the amenorrhea criteria for diagnosing anorexia has become increasingly controversial, and recent research suggests that we scrap the criteria entirely.

Moreso the questions about how much you eat and how you feel about your body may not always elicit the most honest of answers. Many sufferers (myself included) think they eat just freaking fine, dammit even when their calories are less than 1/4 what is recommended for healthy women. And even when sufferers do realize that their eating habits and body weight give them an eating disorder diagnosis, many don't want help or are deeply ashamed of their abnormal behaviors. Eating disorders do not lend themselves well to honesty. A brand new study is looking at what particular feelings and emotions help distinguish between women with EDs and women without them.

So when I see research about diagnostic brain scans for PTSD and depression, I get excited. Although these brain scans are still a long way off from being used in eating disorders, there is an increasing discussion about their potential use in research and diagnosis. These scans can bring a level of objectivity to the diagnosis. They let both treatment providers and sufferers see what's going on. They might relieve the sufferers of the compulsion to lie about ED's torment.

With the growing awareness of PTSD in the military, some psychiatrists are beginning to wonder at how well current criteria for PTSD are capturing the actual cases of PTSD in the military. Do the current standards exclude too many sufferers? Or could they be too inclusive, lumping people with sub-clinical symptoms into a full PTSD diagnosis that becomes a self-fulfilling prophecy?

I wonder the same about eating disorders. So many times, the media speaks of an "epidemic," yet we don't have the cold hard numbers to indicate this. Certainly, EDs are being diagnosed more frequently in younger children, in men, in minorities. But we don't yet know whether they were there to begin with and we just missed them.

There is so much we don't know about eating disorders, and a good place to start would be better, more comprehensive diagnostics.

Indeed, Aria is now 6 years old, which is about 35 in cat years. I adopted her five years ago, when she was about one year old. She had already had a litter of kittens, which I never got to see and really wish I had. When I first got her, she was terrified and skittish. Her bed was under the couch, the only place that she seemed to stay.

I'd almost never recognize her now.

She lets people pet her--not only me, but also visitors and their 11-year-old sons. Sometimes she'll hide when my parents come to visit (like they did last night) because she associates their presence with a long drive in her kitty carrier. But she will come out and be her usual diva self.

Aria has also acquired a slew of nicknames, which may help explain why she rarely comes when she's called (the other explanation being, of course, that she's a cat). The current batch include: Aria, Fuzzybutt, Scooby, Sweet Pea, Babes, Shmoops, Stop Scratching the Couch, Dammit!, Sngglebunny, Fluffy, Fuzz, and so on. She is enormously expressive and can make the most pathetic sounding whine that always results in my giving her tuna.

She sheds, she farts, she whines- but she also snuggles and loves and licks. Aria is phenominally curious and brilliant, yet shows breathtaking stupidity at times.

Most of all, she is mine.

Happy birthday, Aria!

When I first saw this article, I laughed a little bit:

Managing anxiety in eating disorders with knitting

It struck me as a bit odd at first, a little off the wall. But the more I thought about it, the more I realized that this idea kind of made sense.

The researchers provided a group of women who were hospitalized for an eating disorder, taught them how to knit, and provided them with supplies. The study found that

Patients reported a subjective reduction in anxious preoccupation when knitting. In particular, 28/38 (74%) reported it lessened the intensity of their fears and thoughts and cleared their minds of eating disorder preoccupations, 28/38 (74%) reported it had a calming and therapeutic effect and 20/38 (53%) reported it provided satisfaction, pride and a sense of accomplishment.

And I thought: how lovely. How simple, in fact. I myself learned how to crochet during treatment, and many of my friends also learned how to knit/crochet. I could never get the hang of knitting--my hand-eye coordination is terrible, and I could never get both needles going at the same time--but I did greatly enjoy crocheting. This then lead to my jewelry-making, and so on.

What's more, I loved the goals of the study. They weren't to reduce ED symptoms. I am not worried about any press releases or newspaper articles touting "Knitting cures eating disorders!" It was just the simple idea that knitting might help ED patients deal with anxiety better. I wish other sorts of alternative therapies, whether its yoga or the Magic Ponies that so many centers are so fond of (and love to charge you heaps of money to ride), would be predicated on this aspect: they may help relieve anxiety. I don't see them as an ED treatment per se, but they might help with some of the distressing emotions that go along with eating and gaining weight.

Do you knit/crochet? Did you learn in treatment? Was it helpful? What other similar mindful/creative activities have you found helpful?

I don't know any good knitting books, but if you're interested in learning how to crochet, my favorite book is The Happy Hooker. The same woman also published a knitting book called Stitch n Bitch.

I switched around some of my psych meds today, as the previous combo had lost a bit of its normal "oomph." And they messed with my sleep habits (however un-habitual they are), so I decided it was time for a change.

I'm starting back on Prozac. My psychiatrist presented me with several options, and part of me initially shied away from Prozac because it seemed so cliche. Girl gets sad. Girl takes Prozac.

Except, of course, sadness ain't depression. Not by a long shot.

I don't want to have to take meds and know that I will likely need to keep taking them for the rest of my life. I don't do well without psych meds. That being said, diabetics don't do well without insulin and while it might be a pain to stick yourself with a needle several times a day, the alternative sucks. Same here. For me, it's more of the idea of being dependent on some little pill, a little organic molecule, just to get out of bed in the morning.

And this got me thinking: I'm lucky enough to have treatment providers and family and friends who understand that my depression, anxiety, and anorexia are biologically based mental illnesses. Granted, it took some of them quite a long time to understand this and even longer for some of them to get beyond the "you can just snap out of this" mentality as well. I'm also lucky enough to be able to understand and access some of the latest research.

If I'm having this difficulty accepting my illnesses and the need for medication, what must it be like for other people?

Maybe Prozac is cliche. Maybe it is overprescribed- I don't know. But that doesn't mean it's not necessary for me and for others like me. I am trying to be grateful that effective treatments for depression and anxiety and anorexia exist, period, however cliche it may be and however much I may resent needing the treatment.

Really, it's just a pill. It's not a judgment of me or my ability to cope. Nor is depression a reflection of my character. It's the hand of cards I got, the genetic luck of the draw, and sometimes you just have to suck it up and start playing the hand you've got.

ED behaviors are obviously way more than just a bad habit, but they can be habit-forming. I buy a certain brand of cereal because that's simply what I buy (and choosing a new brand is complicated, plus I like this cereal). I exercise at 8pm because that's just what I do.* Or the weighing rituals I used to have. Though ED-driven, they are still habits. I do them almost without thinking.

Of course, humans are creatures of habits and we all have these things we do without thinking. If we had to think about every little thing we did, we would never be able to process all of the information we needed in order to survive. Habits can be useful.

And new research shows that although we can break old habits, we never forget them. (h/t Lola via Twitter)

"There's an expenditure of energy involved in changing behavior," says Dr. Nora Volkow, director of the National Institute on Drug Abuse in Bethesda, Md. "That's where motivation comes in."

Scientists theorize that in acquiring a habit, be it good, bad or innocuous, you typically start out with "goal-directed behavior," meaning you perform a certain action in a certain situation because you expect to reach a certain goal. But if you repeat this same action in this same situation over and over, you get to the point where you take a particular action in a particular situation simply because you're in that situation. Your goal has dropped out of the equation.

The findings [from animal studies] also show that once you have a habit, you may break it -- but you don't forget it, says Graybiel, senior author of the study. "The minute you put the reward back, it's back."

Which helps explain why avoiding relapse in eating disorders can be so difficult. In our diet-centric culture, we are literally bathed in the triggers that set off our ED habits, and the "rewards" of these behaviors (eternal happiness! less anxiety! weight loss! perfection!) are thrown in our faces. These cues can take our brains back to ED central and recovery can be literally flushed down the toilet.

I don't know how to peacefully live with all of this. I ignore it as much as possible, but I'd have to be a modern day hermit to avoid it entirely. There's something to be said for learning to see through the garbage, of understanding that people want to make a quick buck and that every diet ad is essentially bogus.

Our brains are built to overvalue the rewards we can get right away and undervalue those we might only receive later. Similarly, we tend to avoid any small unpleasantness we'd have to face now even if we know it may mean bigger difficulties down the road.

So if ED behaviors are the immediate reward our brains crave, what are we to do?

Three words: develop new habits.

I may never not get a starvation high when I stop eating, so I need to find really good reasons to keep eating. I need to get new habits (waking up 10-15 minutes earlier to eat a proper breakfast, taking rest days from exercise) to replace the old ones. It's hard, when ED served its purpose so well, and those rewards will never disappear, not entirely. But good things exist outside of the monotony of the eating disorder, rewards that give life rather than take it away.

*Well, not since I got The Boot.

I did something fairly unusual for me last week: I went out to lunch. I had a coupon for a buy one get one free item at a casual sit-down chain restaurant that sells (essentially) sandwiches, salads, and soup. So I asked my co-worker and we had a nice lunch. Both of us ordered entree salads.

We were sitting and eating when he made a comment that really stuck with me:

I feel so virtuous when I get a salad. It makes me want to go home and do something not-so-virtuous this evening.

I'm kicking myself for not asking: like what? I'm assuming he doesn't mean decapitating a small animal, as he doesn't strike me as the type. To many people, especially dieters, this kind of thinking can lead to eating a package of cookies in the evening because you were "good" at lunch.

Except neither my coworker or I were "virtuous" or "good" at lunch. We just ate a salad.

At the heart of these kinds of statements, aside from the good/bad food issue, is self-control. And self-control typically doesn't come natural to humans. You exerted "control" at lunch, so you can let loose later. If you feel you overate last night, you can show your "self-control" today and eat lettuce. Or so say the diet/nutrition columnists, anyway. In an obvious irony, I have problems with self-control of my self-control, letting my controlling behaviors run amok.

Some have proposed teaching kids better self-control as a way to prevent obesity. Researchers found that those kids who could wait for a longer period of time before obtaining a food reward had higher BMIs. Maybe it's a problem with self-control, or maybe these kids were just hungry. We don't know.

I find it ironic that the solution to supposed "lack of control" around food (as if that could be the only reason that anyone had a BMI above 25!) involves more self-control, when we know that humans, as a rule, suck at this. When we also know that imposing self-control leads to out-of-control behaviors later. Why not remove the "control" aspect entirely? No one over-consumes oxygen. Outside of obvious medical pathology, people really don't berate themselves for producing too much urine. It might be a trifle inconvenient, but no one measures their self-worth or self-control by how much they do or don't pee.

It is the human intervention and need to control that people start dieting, which typically ends in net weight gain, not weight loss. People can and do self-regulate around food. No really. They do. Our environment doesn't like to give them that chance. There's too much money to be made on diet products, obesity prevention and the health scare du jour.

But the healthiest eaters I know are the ones that don't show deliberate self-control around food. A salad lunch doesn't lead to a doughnut binge later on. They eat when they're hungry and stop when they're full. The rest takes care of itself.

So many times, the choices given to us by our eating disordered thoughts are false choices. A recent post from the blog The Happiness Project really illustrated how common these thoughts are, and how Ed can make it seem like these two options are the only possible outcome, when in truth, they're not.

For instance:

I'd rather have a crappy life with ED than a crappy life without it.
Now, without recovery, I can virtually guarantee that life will be crappy. And while recovery may seem crappy at first, it's the only shot you've got. What about the possibility that your life will turn out "okay"? Or at least less crappy than if you stayed with ED?

If I don't exercise, I will go crazy.
These are not the only two options: you can do something else. I've found coloring to be a good stress reliever. You can learn how to tolerate those unpleasant feelings. After all, if everyone who didn't exercise went crazy, we'd have quite a different population in the psych units!

I never eat cookies because I will eat the whole box.
I've been there. When I was first normalizing my eating after falling into more bulimic habits, I found that, indeed, keeping large quantities of binge foods around the house was a really bad idea. But now I can keep these foods around and eat fairly normal servings. It's not an either/or question. A happy medium exists. It takes time to figure this out, but it's definitely possible.

Blogger Gretchen Rubin writes:

I think false choices are tempting for a couple of reasons. First, instead of facing a bewildering array of options, you limit yourself to a few simple possibilities. Also, the way you set up the options usually makes it obvious that one choice is the high-minded, reasonable, laudable choice, and one is not.

But although false choices can be comforting, they can leave you feeling trapped, and they can blind you to other choices you might make. “Either I can be financially secure, or I can have a job I enjoy.” “I have to decide whether to marry this person now or to accept the fact that I’m never going to have a family.”

A lot of these false choices strike me as a form of black and white thinking, and many times, life can be lived in the middle. ED thinking makes it seem like these are the only two options--and that the eating disordered option is the correct answer!

What are some false choices you've found yourself facing? Did you ever find that you had more options than you were aware of?

So here's a confession: until Friday, I had never ordered a pizza.

The most obvious reason was the eating disorder. If you could come up with the biggest "fear food," it was pizza. I did eat pizza during treatment and during refeeding, but it was never ever my idea. In the past year or so, I have eaten pizza over at friend's houses and at work functions and so on, but again: never my idea. I never made the call.

Another contributing factor was the fact that I went to college in a really small town where there weren't many options for pizza delivery. My friends and I just never really got into that. Most of us had our own little stashes in our dorms, or we had eating disorders (see above paragraph).

When I was much younger, pizza was something my mom usually made. We did order pizza sometimes, but I never made the call. I hate talking on the phone and making phone calls--an interesting fear for a freelance journalist, but there you have it--so I always let someone else take care of that.

This past Friday, however, Laura Collins and her 11-year-old son* came for a visit. Seeing as I was just getting home from work and wouldn't have time to cook, Laura suggested we order pizza. It was a good solution, so I said okay. As I was thinking about what to order, which was probably more accurately described as "obsessing," I realized that I had never called and ordered a pizza.

I'm almost 30, and I've never ordered a pizza. How incredibly weird.

So on Friday evening, I got to savor some of the most freeing words in the English language: "Hi, I'd like to order some pizza..."

And the pizza was pretty good, too!

*He liked Aria. Aria liked him. It went well. :)

I love analogies and metaphors. Love 'em. So when I saw a post titled "How depression is like the X Files" on the World of Psychology blog, I was kind of intrigued.

Before I get too much further, let me add a full disclaimer: I have never seen The X Files. It doesn't seem that interesting to me, and my innate skepticism keeps the whole "aliens are amongst us!" part of the plot from getting me hooked. But even I understood this post and found the metaphor quite wonderful.

Blogger Erika Krull writes:

They [Mulder and Scully and co.] can’t tell anybody, they don’t know who to trust, and whoever they do tell surely will think they are crazy. Really, who would ever believe that the informant who is trying to feed the agents helpful information really has the scar from a metal chip in his neck because he’s an alien hybrid? Even though all the viewers and the key cast members know all about this threat, the agents never seem to know who they can trust. They live in a world of worry, peril, secrecy, and confusion.

Ta-da. There’s my connection. I have often said to myself that my depression felt like an alien had taken over my brain, though the takeover wasn’t complete because I still knew that I was me. I was just disabled enough to have little control but aware enough to realize I wasn’t able to get the alien out by myself.

I needed help. This wasn’t normal; I knew something was different. But what? And how do I describe this? Would anyone believe me? And would I wish I would have kept my mouth shut once I said something? How will this affect my job, my kids, my marriage? I can’t keep going on like this, but I don’t know if I can tell anyone either. Which is more dangerous?

This perfectly describes my experiences with basically any mental illness that I've had (and the list is long, kids. The list is long). For me, though, the "alien takeovers" where I've felt the most bewildered and confused have been with OCD and with anorexia. When I first developed full-blown OCD in middle school/high school, I had mostly obsessions. I was paralyzed by anxiety, and yet I didn't feel I could tell anyone. My fears were either correct, or they were wrong and I was crazy. I knew my obsessions were bizarre- who would believe me? Half the time, I didn't even believe myself! But I was so worried that I could be right that I kept on obsessing, and later added the compulsions.

When I first got sick with anorexia, I didn't realize I was in an "alien takeover" situation. I thought I was fine and dandy- everyone else had those problems. I would imagine that my parents felt an awful lot like Mulder and Scully, trying to convince people that I did, indeed, have a problem. Many other caregivers have probably had this same situation, especially in the first days before the eating disorder becomes patently obvious to anyone who cares to look.

Now that I'm more healthy and more aware, the anorexia is much more frightening. Not always, of course, but I think that fright is healthy. I can perceive when I am starting to loose control a little bit quicker. I am trying to identify which thoughts are from the healthy (or trying-to-be-healthy) Carrie, and which are the voice of Ed. They're not always that different, which is also really frightening. That's probably how I got in trouble with the exercise this past time.

I ultimately have to keep the "aliens" at bay, and learning how to respond when I sense they're trying to take over my brain is probably going to be a key part of that.

Numerous studies have shown links between eating disorders and perfectionism, and helping sufferers learn to cope with and manage their perfectionistic personality traits may be useful in helping to maintain recovery.

A recent article in the Boston Globe describes perfectionism as

"...a phobia of mistake-making," said Jeff Szymanski, executive director of the Obsessive Compulsive Foundation, which is based in Boston. "It is the feeling that 'If I make a mistake, it will be catastrophic.' "

Striving for perfection is fine, said Smith College psychology professor Randy Frost, a leading researcher on perfectionism. The issue is how you interpret your own inevitable mistakes and failings. Do they make you feel bad about yourself in a global sense? Does a missed shot in tennis make you slam your racket to the ground? Do you think anything less than 100 percent might as well be zero?

So how do you treat perfectionism? CBT is typically the gold standard, helping people recognize and change their ideas that everything must be perfect, the black and white thinking ("If I'm not perfect, I'm a failure"), among other things. The Globe article summarizes a basic perfectionism treatment program as follows:

• Get to know your perfectionism: become more aware of your perfectionistic patterns of thinking and behavior, and their effects on your life and those around you. What are your triggers?
• Challenge your thinking and question your beliefs: Is it really so important for every book on your shelf to be placed even with the one next to it? What would happen if they were uneven? Do you know anyone with uneven books? What are the costs and benefits of spending time making everything "just so"?
• Change your behavior by exposing yourself to what you fear: Practice making mistakes, though not if they will lead to terrible consequences. Send a letter to a friend with typos in it. Burn dessert a bit at a party.

My first thought? Deliberately making a mistake? Are you joking? Obviously, I have issues.


I've always been a perfectionist, practicing my handwriting (in the days before you typed everything) in a little journal, organizing my bookshelves, and let's not even discuss school and grades and test scores. Most studies have found this is true for many sufferers of eating disorders, that perfectionism exists before the ED and persists long after recovery.*

That being said, perfectionism isn't all bad. Though it is distressing to me at times, it has also helped me in some areas. I got a writing gig once because mine was the only pitch letter without any typos. And good grades and test scores have been useful as well. The point is to try and figure out what types of perfectionistic thoughts and behaviors are causing you serious distress, and which provide a more positive role in your life. Two key attributes of perfectionism have been linked to higher levels of distress:

One, he said, is "concealment," the need to hide mistakes and imperfections. The other is "contingent self-worth," the feeling that "in order to be a worthwhile person, I have to perform in such and such a manner, I have to behave perfectly."

Have you been able to tame the more distressing aspects of perfectionism? How? Any suggestions?

(h/t Mind Hacks)

*This result was recently challenged by a paper stating that, in recovered women, perfectionism scores were no higher than in healthy controls. I'm not surprised that recovery helps reduce levels of perfectionism, and maybe a part of recovery is learning to manage your perfectionism.

The eating disorder world really needs something like this. On NPR, I read about a new website serving the autism community, known as the Interactive Autism Network (IAN). This website links researchers studying autism with the sufferers and their families who so desperately need treatment and answers.

Like so many conditions, autism research is hobbled not just by lack of funding but also by a lack of participants in research studies. Without enough participants, studies can't go forward. So two years ago, the Kennedy Krieger Institute in Baltimore partnered with Autism Speaks to create IAN, a research oriented website that contains a database with information on sufferers and their families. And families can mark interest in particular studies, whether online or in person.

And so far the database is paying off. It's helping find participants for a current genetics study based in Chicago by locating people in the surrounding area, resulting in more than 30 families signing up. What's more:

The vast database helped reveal a link between depression in mothers and autism in their children. Researchers had known about high rates of depression among these moms, but thought it might have been a reaction to their child's problems.

But information from IAN showed that "more than half the mothers were diagnosed with depression before they ever had the child with autism," Paul Law, of the Kennedy Krieger Institute and who runs the network, says. That suggests some of the same genes may be involved in both problems.

Brain researcher Helen Tager-Flusberg says it's one of the quickest ways for a researcher to find study participants. "IAN plays this wonderful role of facilitating the connection between researchers and families," she says.

Would it be great if some of the large ED clearinghouse websites had such a database? Where parents and sufferers could go and provide information* and help further research and get better care and treatment?

I'm adding that to my wish list.

*Obviously, proper security is a must, and only researchers with the proper credentials and approvals should be able to access the information.

Their eyes might have been watching god, according to Zora Neale Hurston, but my eyes were watching Lisa.* Lisa is one of my co-workers. I work in a moderately large office, although I don't always interact with other people on staff a whole lot. The times when I do tend to be, alas, in the kitchenette.

Some of my co-workers have a dysfunctional relationship with food. It's obvious--to me, anyway. Some appear more outwardly normal. And then there's Lisa.

She's almost like a breath of fresh air. It sounds cheesy, and maybe it is, but that's really how I feel when I'm in the kitchen with her. The most revolutionary thing about her? She never apologizes for eating. Or makes any excuses. None of this "I shouldn't but I'm gonna," or laments of how much she'll pay for this at the gym, or saying she was "good" yesterday so why not?

She'll just look at the tray of whatever someone brought in, say something like "That looks good," take it, and leave. Or just look, think for a second, and leave. No drama. No Second Book of Lamentations. No calorie counting abacus going clickety-clack in her brain.

Mostly what astonishes me about Lisa is her coffee. She goes to Starbucks pretty much everyday, and she gets a latte, extra hot. After she finishes her latte, she makes a mocha using supplies in the kitchenette, namely hot cocoa mix, a packet of Splenda, two coffee pouches,** and two little tubs of flavored coffee creamer. Not the plain Mini Moos, but the actual flavored kind.

This boggles my mind. Absolutely boggles my mind. The hot cocoa mix has calories, and ditto for the coffee creamer. And yet there she is, drinking them nearly every day. Drinking them and enjoying them, as they were meant to be enjoyed.

When I make my coffee, I use the actual coffee pouch, some sweetener, and I hesitate at the box of Mini Moos. I know each little tub has 10 calories (it's printed on the box they come in), and I sit there and think through everything I have eaten or have planned to eat and try and determine if those 10 calories will make a difference. I do the mental gymnastics of calorie counting: will this little tub of creamer push me over the line into "too much"? Will it make my totals come out to a "not nice" number? Am I being greedy? Gluttonous? Is this stupid little tub of creamer just simply too much?

Yes, sez my brain. Yes it is. So I go without.

Rationally, this makes no sense and I think I even understand on some level that this makes no sense. That when you're moderately hypermetabolic, 10 calories is like pissing on a forest fire. It's nothing. And that my body doesn't "count" calories in the way that my brain does, that my ATP synthase enzymes don't really give a crap about the OCD hocus pocus that makes my anxiety just a teensy bit better.

Except eating disorders aren't rational. And I fear saying yes far more than I fear saying no. I fear the process of deciding and having to live with my decision even more. I'd rather deny myself than deal with the invariable guilt that comes from opening the creamer and putting it in my coffee. I'd rather deal with regret than live with guilt.

Why guilt over coffee creamer? Maybe the answer is as simple as I have an eating disorder and it's part of the territory. Maybe it's as complicated as wanting in a culture that systematically denies your appetites, or finding it easier to say no than yes.

To Lisa, it's just coffee creamer. And that's why I stand back and just drink it in, hoping that her spirit will rub off on me, just a little bit.

*Not her real name. And not any of my other co-workers' names, either. I just felt weird using her first initial throughout the entire post, so I made up a name.

**We have a Flavia machine that brews individual cups. It's a bit of an environmental disaster, but seeing as no one can remember to refill the water cooler, I'm not thinking a communal coffee pot would be successful.

Computer gaming technology straight out of Second Life and World of Warcraft is now being used to help treat a variety of mental illnesses. Scientific American did a nice write up on the use of virtual worlds in treating children and teens at risk for violence and trouble with the law. The computer program, known as Simulated Environment for Counseling, Training, Evaluation and Rehabilitation (SECTER), allows children and therapists to interact virtually and choose avatars and display emotion, like high fives and a swaggering walk.

In the case featured in the article, the therapist (Heather Foley) acts as the patient's (13-year-old Joe, in a residential mental health treatment facility) adoptive mom and tries to interact with Joe in the virtual world. The breakthrough occurred "when she used SECTER's "after action review" feature, which replays role-playing sessions from any avatar's point of view. In this case, she wanted Joe to see the interaction from Foley's—or his adoptive mom's—perspective. She says the feature helped Joe recognize that his behavior in the virtual world—and by virtue of that in the real world, too—"was inappropriate and hurtful." "

While this is certainly interesting, virtual treatments are now being used to help treat eating disorders and specifically the body dysmorphia that frequently accompanies them. The idea is that these virtual treatments will give sufferers a better idea of how to experience their bodies in the real world. Other researchers have attempted to modify body sensation through sensory stimulation using a neoprene suit (okay, it's not exactly VR treatment, but it seems like a similar idea to me). The Frontal Cortex blog had a good write up of the last bit of research here. (h/t Cammy)

I think all of this is very exciting, but Laura brings up a good point in her comment on the Frontal Cortex blog: many times, the severe body image distortion that accompanies eating disorders does retreat after someone returns to normal body weight and eating habits. Many times, but not always. I fall into the "not always" category. Perhaps it's a function of having an ED for longer. Perhaps I have sub-clinical BDD. Perhaps there's no real explanation for it. Research shows that people with the restricting subtype of anorexia didn't show any significant improvement in body perceptions at the end of treatment, although those with other ED diagnoses did.

I think these treatments can have great utility in treating the symptoms that remain after restoration of weight and normal eating habits, though more study is clearly needed. What do you think? Would you like to try virtual reality treatment? Do you think it would work?

I know I'm not the first to blog on this subject, especially due to the fairly wide-ranging coverage of some new research that shows a relationship between vegetarianism and eating disordered behaviors in teenagers. Those current and former vegetarian teens showed higher levels of both binge eating (with loss-of-control) and "extreme unhealthy weight loss behaviors," respectively, than those teens who were never vegetarians. Young adult former vegetarians also showed higher rates of unhealthy weight loss behaviors.

The authors of the study, published in the Journal of the American Dietetic Association, said that current vegetarian teens had "healthier" diets than non-veggie teens, "with respect to fruits, vegetables, and fats." They also had lower BMIs. The problem is that if this lower BMI is due to unhealthy eating (into which category does fall too many veggies at the expense of fats and other macronutrients), then it's really not all that "healthy," is it?

Except no one really mentioned that.*

That vegetarianism can be a mask for eating disorders is pretty well-known, although not all vegetarians have eating disorders. What I didn't see mentioned--and what prompted me to write this, since others did a pretty good job of covering the subject--is the chronological relationship between these unhealthy behaviors and vegetarianism. What the authors implied seemed to be that the ED behaviors likely preceded the decision to become a vegetarian, which certainly happens. What is also possible is that a teen decides to cut out meat for ethical reasons (or for whatever reason that's not related to weight loss), and then slides into the eating disorder.

If he or she isn't eating enough (calories, fat, other micro/macro nutrients), they could be more likely to binge as the body responds to malnutrition. For those genetically predisposed to anorexia, it could trigger further restriction. Yet this idea wasn't really mentioned or even proposed as a possible hypothesis, and I really wish it was.

I'm not saying that vegetarianism is wrong or bad or any of that. I'm not especially carnivorous myself. But the relationship between vegetarianism and EDs may go both ways, and I think it is really important that people begin to recognize that.

It is important to note that the study didn't measure eating disorders, just the associated behaviors. However, many teens who engage in these unhealthy behaviors go on to develop full-blown eating disorders, so the findings are still significant.

*Granted, I couldn't get ahold of the full text of the article, but this question wasn't posed in any of the news coverage that I saw, either. Not that this always says very much.

I've read a fair bit on the history of anorexia, of the fasting saints of the Middle Ages, of the initial medical reports in the 1600s, followed by the formal medical diagnoses in the mid-1800s. Clearly, anorexia is not a new disease.

The history of bulimia and binge eating disorder, however, is much fuzzier. There were the Roman vomitoriums, yes, but otherwise the history is vague until about the 1900s.

However, a new article in New Scientist writes about a famous composer who likely suffered from binge eating disorder (and also lead poisoning). Could Handel's suffering have helped inspire his great works, such as The Messiah, the article asks?

The year 1737 marked a turning point for England's most celebrated composer. George Frideric Handel had been entertaining London society with his Italian operas since 1720. Each season he staged several, for which he wrote the music, hired the singers and directed 50 or more performances. Then he abandoned opera and wrote the type of music he is best remembered for, his English oratorios. Handel's operas had been peopled by gods and heroes, played by strutting superstar singers. Now his themes tended towards the tragic, his characters mere mortals and his music more personal. What prompted the change? Ill health, says Handel authority David Hunter.

Handel's contemporaries were well aware of his binges, and they were not afraid to ridicule his food intake or his weight.

Handel was clearly obese. According to friends and admirers he "paid more attention to [his food] than is becoming in any man" and was "corpulent and unwieldy in his motions". Others were less kind, making him the butt of jokes and mocking verses. "He consumed what even by the standards of his well-fed peers were embarrassingly large amounts of food and drink," says Hunter. His odd behaviour indicates something other than simple greed: Handel couldn't control his eating, even if it meant losing friends or facing ridicule.

One secret binge caused a rift between Handel and one of his oldest friends, the painter Joseph Goupy. In 1744 or 1745, Handel invited Goupy home for dinner, warning him that business wasn't going too well so the meal would be frugal. Dinner over, Handel excused himself. He was gone so long, Goupy went looking for him - and found Handel stuffing himself with "such delicacies as he had lamented his ability to afford his friend". Furious, Goupy left, and had soon produced a new portrait of Handel, one in which he was caricatured as an organ-playing pig (above).

This loss of control over eating certainly characterizes binge eating disorder, and Hunter tentatively diagnosis the great composer with BED, though he speculates Handel may also have been suffering from other conditions, such as lead poisoning and heavy drinking. But even in the 1700s, without the thin-is-in culture, fat and overeating were derided.

Certainly Handel's diagnoses, whatever they may be, do not detract from his music. I've sung parts of the Messiah in various choirs, and it's a lovely piece of music. But I never knew that Handel might have struggled with some of the same demons that I did, which makes it all the more poignant.

Image courtesy New Scientist.

I've been wearing The Boot for several days now, strapping it on each morning, and only taking it off for bed. This has also meant full exercise restricting so that my foot can heal, which is far tougher than dealing with the quirks of having the lower half of your leg covered in plastic and Velcro.

My mood this week has taken a definite downturn, without the (fleeting) boost it received from all of those endorphins. And I feel restless, edgy, anxious...lazy. All of these are signs of exercise addiction, which is hard for me to accept. I don't want to believe it, but that doesn't make it any less true.

I fit the profile of a person who would struggle with compulsive exercise, not the least due to the compulsions in other areas of my life. And yes, this does appear to be true in others, as researchers have suggested that AN with compulsive exercise shows many characteristics of OCD.* Furthermore, people who exercise in response to negative moods show more eating disordered behavior and psychopathology than those who don't.

Which makes sense. That endorphin rush doesn't last forever, but our memory of it lasts quite a bit longer. The solution? Exercise more, again, harder. And eventually, the system spirals out of control and you end up with a busted foot.

Of course, lots of people regularly perform high levels of exercise (professional athletes come to mind), that don't result in exercise dependence or addiction. What seems to separate these people from those with an exercise addiction is this:

The experience of intense guilt when exercise is missed and exercising solely or primarily for reasons of weight, shape or physical attractiveness, were the exercise behaviours that most clearly differentiated between women with eating disorders and healthy women.

Ummm...check and check.

This is clearly something I have to deal with and figure out a way to fit in healthy activity without overdoing it. I will probably always have to be vigilant about my activity levels from now on, just like I have to for food. Right now, I'm doing okay with not exercising because I have The Boot and there's this external validation. But I worry about the emotional backlash once I get the all-clear.

There's time for that later, and also time to figure out a way to cope with that. I think it's time for a new hobby.

*If anyone has access to the full text of this article and wouldn't mind passing it along to me at carrie [the little at symbol] edbites [dot] com, that would be great. Sorry for the convoluted email address, I just get heaps of spammers trying to sell me drugs for another condition that can be abbreviated "ED."

When a doctor says "take two and call me in the morning," how do we know this is the best course of action? Some of this is, of course, from the doctor's own judgment. He or she has probably seen this problem before and knows what to do. For rarer cases, she might consult the scientific literature, or a more experienced colleague.

Although many treatments have withstood the test of time because they really work, some continue to linger despite evidence that they aren't effective. David H. Newman writes of "Believing in Treatments That Don't Work," where he "explores how medical ideology often gets in the way of evidence-based medicine."

Writes Newman:

In the early throes of a heart attack, caused by an abruptly clotted artery, the stunned heart often beats quickly and forcefully. For decades doctors have administered “beta-blockers” as a remedy, to reduce consumption of limited oxygen supplies by calming and slowing the straining heart. Giving these drugs in the early stages of a heart attack represents elegant medical ideology.

But it doesn’t work...Remarkably, the medical community has continued to strongly recommend immediate beta-blocker treatment. Why? Because according to the theory of the straining heart, the treatment makes sense. It should work, even though it doesn’t. Ideology trumps evidence.

Newman gives several other pertinent examples, such as the use of cough syrup (no better than a placebo, for both children and adults), back surgeries, and the use of antibiotics to treat ear infections.

Although Newman didn't mention any mental health conditions in his list--an unfortunate occurrence, although as a fellow writer I do realize you can't mention everything--I think they would apply. We continue to treat eating disorders the same as we have for years, despite recent advancements in science and treatment protocols that indicate much more effective forms of treatment, especially for adolescents. Yet it remains very rare for sufferers and their families to be presented with the latest treatment options- indeed, any options at all!

Why? Why, when the information is disseminated in the literature and increasingly at conferences? When studies have been done. And done again.

I believe there are several layers of answer to this question. One layer stems from the fact that treatment providers are human, as are doctors, and core beliefs are typically not changed all that easily in spite of evidence to the contrary.

Another part of the reason has to do with a general lack of effective treatments, especially for adults. That "treatment as usual" feels like doing something, whether or not it actually is. Developing new methods to treat eating disorders, and then doing the rigorous scientific tests, can take years. And in all of the cases that Newman named, I'm betting that medical dogma prevails because no one knows quite what else to do.

Then we have dieting, weight loss, and obesity prevention, which is quite possible more blindingly stupid about failing to give up dogma than the ED world. The fact remains that we don't know how to get people to reliably lose weight and keep it off long-term. Still we tell people to lose weight, that you just need to burn more calories than you eat, that you're not trying hard enough, you're eating too much fat, too many carbs, shit- you're just eating too much, you're eating period.

For people who see weight as a behavior to be "fixed," I would imagine those same feelings of helplessness creep right on in. How harmful can a trip to Weight Watchers be? Right?

We all have our own prejudices, even scientists. But by actually using science, we can start to jettison the things that just aren't working so we can make room for the things that might finally make a difference.