So it's the last day of National Eating Disorders Awareness Week. I'm guessing most of my blog readers are aware of this, and I think improving awareness of eating disorders is a Very Good Thing. There is still so much misunderstanding about eating disorders, and it kind of irritates me. Some things about NEDAW irritate me, too. For starters are the atrocious headlines in ED stories, such as "Anorexia: Starved for Love." Yes, people with anorexia are starved, but they're primarily starved of food. That can cause sufferers to starve themselves of other things besides food, true, and love can go a long way in recovery, but lack of love isn't an eating disorder.

And I'm left with very mixed feelings about the ways in which we try to prevent eating disorders. Much of the information out there is about loving your body and improving self-esteem and why you shouldn't diet--all of which is good information, but I'm not so sure how it prevents EDs (excepting the last bit). The irony is that explaining what EDs are and what the symptoms are and how to help a friend can trigger ED behaviors. Yes, dear, starving yourself and puking are very bad and you shouldn't do them.

No kidding.

I had a friend with anorexia, and I remember distinctly thinking when I first started on my new healthier eating/exercise program that I didn't want to become anorexic. I knew what anorexia was and I knew it was a bad thing. I was aware of eating disorders. Not like I am now, but I knew that looking at fashion magazines was considered Bad for Women and that if I let my (hypothetical) children emote freely and didn't let them have Barbie dolls, then they probably wouldn't get anorexia. Right?

I was--okay, I still am--a bit of a do-it-yourself-er feminist. Raised in a rather conservative family, I stumbled across feminism through surreptitious reading in my American history class in high school and learned, quite possibly for the first time, that feminism meant more than bra burning. I was still in this phase when I had my first initial crash course on eating disorders by way of my best friend in college. I didn't do a whole lot of researching, as this friend was in recovery and not in need of huge amounts of eating support, because I'd Heard The Message. I figured that if I could help my friend get over the evils of wanting to look pretty and have the thin, "perfect" body that was required of her by OMG TEH MENZ!!!!1!, then she would finally overcome the last bit of her eating disorder.

I was so naive.

I knew nothing of biology, nothing of the links to anxiety disorders, nothing of any of this. I had heard the message of NEDAW, essentially, because I thought if I would help people love their bodies then there would be no eating disorders.

Yes, in recent years NEDAW has begun to integrate some science, but in many areas, NEDAW is also called "Love Your Body Week." I'm not against having a "Love Your Body Week" but I'm not sure how it will prevent eating disorders. It's like having the theme of the Depression Awareness Week be "Don't Worry, Be Happy." Rastafarians and reggae music is nice, and it might lift your spirits, but its relationship to depression is unclear.

Yes, many people with eating disorders struggle with body dysmorphia, and learning to accept and live in your own personal body is a major task for people in recovery. I'll admit it's one of mine, learning to move through the world in a body that is chubby round jiggly chunky lumpy not emaciated. It's a major problem for people with eating disorders, and it's not entirely illogical to think that if we can prevent people from hating their bodies, we can prevent eating disorders. Except that extreme body hatred is often the result of an eating disorder (or at least greatly inflated by it), not an actual cause of an ED.

I'm not anti-NEDAW. I'm not anti-Love Your Body messages. If there was a little less overlap between the two topics, I probably wouldn't be quite so bothered.

What NEDAW message do you want people to hear?

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Cathy (UK) said...

Carrie, I agree that the ED story in Psychology Today is irritating, and rather 'yucky'...

An important point is that when a person is starved and fixated on ED rituals they are like a zombie and lack much capacity to love or to be loved. Lack of love is rarely the cause.

As for the 'Love Your Body' campaigns... Well, they're well-meaning, but IMO they're pointless with a capital P. I made a YouTube video on this subject a couple of months ago:


Again, IMO, body image disturbances are a SYMPTOM of anorexia nervosa; not the CAUSE.

What do I want people to hear?


Lets stop seeing EDs - and especially anorexia nervosa - as 'disorders of body image'.

EDs will not be prevented or cured by encouraging people to love their bodies.

mariposai said...

I totally agree with some of your points, but at the risk of being shouted at by others and accused of being mis-informed, I still believe that learning to love my body was a big part of my recovery.

I totally agree that body image issues are a symptom and not a cause, and that much of EDs are rooted in biology, but I think for some people body image is more of an issue than for others.

I think it depends on how individual sufferers interpret their disorders and how the symptoms are manifested. For me body image was a big part of the narrative I used to frame the onset of and recovery from my illness.

I appreciate that others will disagree with me on this, but I do think it is important to value how different people interpret their experiences, even if there is no scientific basis to these interpretations.

Sorry I probably didn't make my point very clearly, but the point is, I tried! Hehe

Sarah x

balancingontwofeet said...

I agree with the frustration regarding prevention of eating disorders. I believe that body image and dissatisfaction can initially have a role in fueling an eating disorder, as it did for me, but I don't believe that it has much to do with an eating disorder following the beginning. Loving your body can again come into play during recovery, but true prevention and education of eating disorders needs to have a different focus. I think that taking away the shame of the disorder can go a long way in helping those affected get treatment since shame causes the stigma that helps people stay in their disorder.

After the death of a student where I teach I am realizing more than ever that I want my life's work to be about education and prevention of eating disorders. And if we can't prevent them (thank you biology!) perhaps we can get people into treatment faster and work with insurance companies to help them STAY in treatment.

Cathy (UK) said...

Hi Mariposai/Sarah

I don't think that anyone would 'shout at you, or accuse you of being mis-informed'...

Everybody's experiences of EDs are personal. I don't believe in a 'one-size-fits-all' approach to explain or treat all people with (e.g.) a diagnosis of anorexia nervosa. Our illness doesn't and shouldn't define us - even though it is rather inevitable that when we are sick, our ED does become part of us - i.e. part of our identity.

For some people, the ED identity relates to being thin, whereas for others (like me) it is the behaviours that are important. Thinness was a 'side effect' of my anorexia and not the goal.

The point I was expressing above applies to my narrative - which may be different to others' narratives. I just feel that the (now dominant) 'body image paradigm', although applicable to some people, doesn't describe everybody's experience...

H. said...

I am always amazed at how different everyone experience with ED's are...but yet how there are always a few golden threads that run through each of our stories to tie them together.
I do agree that poor body image is GREATLY exacerbated by an ED, but I also believe that having a poor body image can lead one down a road to having an ED that she/he might not otherwise head (granted that that person have certain personality factors and other vulnerabilities.) I also strongly believe that there should be no tolerance for "normative discontent" with our bodies! I don't think any woman should hate her body and people call it part of the normal female experience, no. sorry, it's not. (breaths...)
Ok, that said, I don't think that promoting healthy body image is anywhere near enough to prevent eating disorders. Sometimes I feel overwhelmed, exhausted, and hopeless trying to figure out if larger scale prevention is even possible. The just "Body image" and weight message also over simplifies EDs, which I don't like. The problem is that the complexity of EDs is far to difficult to communicate to the masses in an "awareness week." I'm sure there are user friendly ways of communicating simply and clearly about the roots of ED's, but the fact is very few lay people, and people who's lives have not been touched by ED's are just not going to 1)care 2) really get it and will simplify any message you give them in their heads.

Abby said...

I completely agree that trying to boil awareness down to media influence and body acceptance make it seem like the disease is one of purely physical motivation. I want to be skinny, so I have an eating disorder.

However, this never applied to me, and being lumped into this incorrect perception is what frustrates me to no end (this week especially). It's not always about little "love notes" to myself and the use of "normal" models in the media that will "cure" the onset of EDs.

My inner struggles are manifested through my outward appearance, as I handle my anxiety and depression through ED-related behaviors. Until people understand that it's a mental disorder with many different angles and jags--not a problem with physical perception and body confidence--there will continue to be this generalization.

Katie said...

I don't think eating disorder treatment and eating disorder prevention should be so intimately linked. Therapy for bad body image has a place in ED treatment for many sufferers, but it's not what causes eating disorders and it's not an issue for everyone who has one. Similarly, giving the general public body image related information might help some of them to feel better about themselves, but it won't make a blind bit of difference to those who are predisposed to developing eating disorders. I think having a 'love your body' week is an OK idea but it shouldn't be linked to NEDAW, that just perpetuates the misconceptions about eating disorders. So that was a very long way of saying I agree with you Carrie :P

A message I would want people to hear is that eating disorders are mental illnesses. A recent survey done by b-eat found that only one in five people in Wales believed that. I remember being incredibly upset a few months ago by a comment on an article about a girl who died from anorexia in my area. She was due to go to Cambridge university this year and this random man was saying that someone so vacuous as to die to be thin would never fit in at any university. I wish more than anything that people understood that eating disorders were serious, potentially fatal mental illnesses with large biological components, and have nothing to do with being vain.

Kim said...

Love this. I just posted something similar last week after getting irritated with the "Every body is beautiful" slogan. Eating disorders are not about vanity and poor body image!!! I don't know why this is so hard for people to get. I did get uncomfortable in my body AFTER I got sick. Before that, I never thought about it much. If anything, I thought I was too thin at my normal weight. Of course I think it's good for women to love their bodies, but by focusing on that, specifically in a week dedicated to being aware of what eating disorders REALLY are, we're missing the whole point. Not much is said about anxiety and depression that accompany eating disorders, or about that whole "metal illness" bit that nobody likes to discuss. It is pretty frustrating for me too. Glad you posted about this!

Incredible Eating Anorexics said...

I posted this on a message board in frustration about eating disorder awareness week (uk based)

"I'm finding a contradiction in a lot of the media reports and quotes by professionals this week.

We constantly battle the stigma that eating disorders are about sufferers (I hate that word but I cant think of another) copying models and celebrities, that it is a vanity thing. Which we ALL know it isn't. It actually upsets me quite a bit to think that people consider it a vanity thing, or something we "do" to copy the famous folks.

Yet...this week there are a number of articles about how the media contributes to eating disorders. I'm not saying that it doesn't have a role to play for some, but what I am saying is that I feel it isn't such a major factor for the onset of the majority (please correct me if you think I'm wrong) of our Eating Disorders.

I really feel that its undermining the seriousness of the illness, though the articles do state that eating disorders are very dangerous, harmful, serious etc, that isn't the main message I'm getting.

Heres two articles that include quotes from the Royal College of Psychiatrists.


I also know that it is all well meaning, and it is all to raise eating disorder awareness and such, however it has really touched a nerve with me, the focus on the "size zero" debate."

I think thats what you were saying in your post to right? It is just upsetting me quite a bit. Im glad EDAW is over to be honest.

L x

Dr Ravin said...

I completely agree with you, Carrie. The "Starving for Love" article is misinformed, misleading, and outdated.

While I am all in favor of positive body image and media literacy, I believe that these things have no place in ED awareness or prevention. As many commenters here have already pointed out, the focus on body image and the media does a tremendous disservice to sufferers. People need to know that EDs are severe, biologically-based mental illnesses. The body image focus detracts from that truth and trivializes the illness.

If I were in charge of NEDAW, I would not include any information whatsoever about body image or the media. Instead, I would focus dissimenating ACCURATE SCIENTIFIC INFORMATION about eating disorders to the people who need it most. It is presumed that physicians, mental health professionals, and dieticians are already well-informed about EDs. Sadly, this is not always the case, and awareness/prevention efforts should start here. Evidence-based treatment should be explained and promoted. In addition, parents, teachers, and coaches should be given ACCURATE SCIENTIFIC INFORMATION about eating disorders, the causes, the symptoms, debunking the myths, and evidence-based treatment.

Given that we do not yet know the cause of EDs or how to prevent them, I think we should keep "prevention" out of NEDAW entirely. Prevention efforts must be science-based, and we simply don't have the science yet to back this up. Instead of prevention, I would focus NEDAW on awareness, ACCURATE SCIENTIFIC INFORMATION, and early intervention. While we don't know what causes EDs or how to prevent them, we do know for sure that agressive, evidence-based intervention as soon as possible following the onset of symptoms generally results in the best prognosis. I believe that we can provide the most help to the most people by spreading the word about evidence-based treatment and the importance of intervening immediately and aggressively in order to reduce chronicity and mortality.


I blogged about prevention tips a couple of months ago, and I touched on many of the points you mention, Carrie:


Angela E. Lackey said...

Again, thanks for inspiring me to write about NEDAW/ My main issues with NEDAW are:

a. During NEDAW, media coverage was either limited at best or erroneous at worst.

b. The focus on body image is meaningless for many of us with eating disorders; pre-anorexia, I did not have any significant body image issues, these only cropped up after I developed anorexia and had absolutely nothing to do with my recent relapse.

c. NEDAW pretty much ignored the issue of adult-onset anorexia or other eating disorders. I developed anorexia at the age of 41, and believe that both the manifestations and recovery issues are different for different age groups. I'm not saying fighting an eating disorder is harder for one group or another; just different

It does feel weird to go for four decades without an eating disorder and then suddenly develop one and be plunged into a world of IP, feeding tubes, therapy and the like; it feels like a thief snatched away the real me and left this person who is consumed 24/7 by anorexia. The feeling is often one of unreality - where did the real Angela go? And will she ever come back?

d. Recent work with my doctor suggests that for me, anorexia is most likely trauma-based and fueled by almost relentless self-hatred and self-destructive tendencies. NEDAW ignored the issue of trauma-based eating disorders. According to one statistic, more than 50 percent of people with eating disorders have experienced some type of trauma, such as childhood physical, emotional and/or sexual abuse. I am not saying all eating disorders are caused by trauma, but that is a pretty significant statistic.

My complete thoughts on this can be found at that I posted at angelaelackey.blogspot.com/2010/02/nedaw-awareness-or-hype.html

Thanks for bringing up these very important issues!

Jay said...

I am so glad you wrote this article. Very well expressed.

However, I think “Love your body” campaigns can be useful, particularly with people who don’t have a full-fledged disorder yet. My own eating disordered behavior started when I was a teenager because I felt unattractive. After a couple years, I had myself trained to use these behaviors for ALL of my unpleasant feelings – not just the “vain” ones. So the disorder stuck even after I got over (relatively speaking) my body image issues.

The point is, if I had never been so dissatisfied with my body in the first place, I might not have ever used ED behaviors for the other problems in my life.

Maybe I would have found some other addiction, or just fallen into an ED later rather than sooner, but my food issues absolutely started with body-loathing.

Mine is not everyone’s situation, but I do feel that body-image campaigns can be preventative tools. Like the rest of you, I just wish they were balanced with a campaign to educate people about the deeper issues of EDs.

Fiona Place said...

I believe that body image and weight are almost side -issues. Not that they do not require significant attention, but that the real focus should be on assisting the person to create a sense of self, an identity that has little to do with food or weight but more about who they are and what they want. As the author of one of the few books to explore this in depth (Cardboard: A woman left for dead) I feel very strongly about this and am always championing the importance of the person's voice and narrative in recovery.

jessa said...

What I don't like about eating disorder awareness is that it propagates stereotypes that are just as damaging as the ones it tires to revise. How many times are we going to be told that it strikes primarily middle and upper class young white girls who are smart and good at things? How many people with eating disorders have to be alienated by that? They tell you eating disorders are not about the food, and then they tell you all about the food to the exclusion of whatever it is that eating disorders are really about.

For me, I think the eating disorder shouldn't be treated as a discrete illness, but as a coping skill that I devised to deal with my depression and anxiety. I think that is true of a lot of people, though probably not all. Because my experience doesn't fit the framework that professionals put out to the public, and think within themselves, I have been told that my eating disorder DID NOT start how I say it did. They then treat me as though my eating disorder fits within their framework, unsubtly trying to uncover some instance where a mean boy told me I was fat. I think that before we can get those same professionals to do public awareness in a more accurate and less alienating way, we have to convince them to think outside of that framework and treat patients outside of that framework. If they are really only thinking within that framework, there really isn't any other sort of public awareness campaign the can do.

Fiona Place said...

That is a very good point jessa - it is about anxiety and depression and it is about your story.

elk said...

I have nothing as detailed or insightful to offer as the above comments, but I just had to say, thank you for this post.
I feel there is far too much emphasis on body image (not that it isn't an issue...but it's not THE ONLY issue).
Personally, I never really had a problem with body image. I didn't hate it, besides the usual insecurities as a teenager. I was probably fairly indifferent to it. Even detached, maybe.

It's all very well being told to "love your body", with the assumption everything will work out fine. Objectively speaking, I think my body is ok. It is its own individual entity. If it was someone elses I wouldn't point out its flaws, just like I wouldn't point out 'flaws' in the bodies of friends, because there aren't any. I'd even go so far as to say that I have momentary instants of feeling protective of it, when, say, my belly has expanded a little and I'm observing its little rounded glory in the shower. Because I know that tomorrow I'm going to feel unable to cope with being in it, and that I'm going to be a negative influence on it.
Ultimately, I think I just have a problem being IN it.

Fiona Place said...

I know I am straying off topic - but my other issue is the current clamp down on letting readers know about books that have for one reason or another been labelled as 'trigger' books - sometimes without anyone bothering to read them! Why? For a start all books can 'trigger' either a relapse or a recovery. All books can be used differently by readers depending on where they are in the process of recovery. Whether the book is a first person account, fiction or non-fiction it deserves a place in the literature.

Angela E. Lackey said...

Good points about anxiety and depression. I have dealt with both since a small child, and was formally diagnosed when I was 16. I always think that when I developed anorexia, I finally found the 'perfect' way to both deal with these twin illnesses (it was much better than any drug I had been given over the years) and to destroy myself after years of unrelenting self-hatred and self-destructive tendencies. Sometimes it almost feels like an addiction.

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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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Have any questions or comments about this blog? Feel free to email me at carrie@edbites.com

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


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