Pressure to be thin?

On Facebook today, I read a status update from a friend of mine who asked us to honor the memory of a girl who died from her eating disorder five years ago today. Which is tremendously sad, and I hope that her story will help others pursue the treatment they need and deserve. But that's not the point of my post. The point of my post is that my friend said the girl died from "the pressure to be thin."

No. She died from an eating disorder. Big difference.

I didn't comment on my friend's Facebook status because I didn't want to take away the importance of honoring this girl's memory, nor do I like Facebook arguments because I can't be concise. Also, even despite my friend's statements, we still remain friends and this hasn't changed that.

But "the pressure to be thin?" Seriously?

I'm not saying that the pressure to be thin is irrelevant to eating disorders because it does play a role in some people's triggers, and certainly in obstacles to recovery. But an eating disorder isn't a pathological and deadly response to the pressure to be thin; it's an actual mental illness that involves a life-threatening inability to self-regulate around food. Furthermore, by saying that an eating disorder is "caused" by the pressure to be thin, it excludes all of those with eating disorders who don't have body dysmorphia, those who developed EDs in cultures that didn't place a high value on thinness, and those who developed EDs long before there was a widespread cultural pressure to be thin.

So. Now that we've got that out of the way...

For most of the people I've talked to with eating disorders, being thin is usually the least of their motivators when in the thick of it. I did have a phobia of gaining weight (a massive phobia of weight gain, for that matter) but it wasn't a cultural pressure. It was me. It was from the eating disorder--I didn't feel that pressure before, and I don't really feel it now. I didn't decide to lose weight to look like a model. It was an attempt to eat better, exercise more, maybe lose 5 pounds and pull out of the awful depression I was in. Without my predisposition to anorexia, I'm fairly confident everything would have stopped there. But it didn't.

Did I use our culture's obsession with dieting and thinness as an excuse while in my eating disorder? Yes. And to some extent, it would have felt more sane to tell myself I just wanted to look like some famous waif than to actually understand that I was terrified of food and eating. I never thought of my eating disorder as just "being on a diet" or "trying to be skinny." It was just this single-minded obsession to eat less and exercise more that really had no explanation.

I did think that if I could lose enough weight then maybe I would stop hating what I saw in the mirror. And I'm not going to say that culture had nothing to do with that, but I was well aware that everyone else saw me as too thin. It was my own messed up standards that didn't really kick in until after I had already started walking down the yellow brick road to anorexia. In other words, the intense body hatred was as much a result of my eating disorder as it was a cause.

Saying this girl who died from "the pressure to be thin" minimizes the true, serious nature of eating disorders. It takes a very complicated issue--the interplay of nature and nurture--and so over-simplifies it that the truth is lost. Not that feeling pressure to be thin has nothing to do with eating disorders, but to say that this pressure to be thin is the same thing as an eating disorder is a rather big misstatement.

32 comments:

Anonymous said...

Carrie

This is brilliant. I am going to try and make everyone who is involved with our family and the recovery of my daughter read this. Myth busting of the highest order.

Thank you

Anonymous said...

Saying this girl who died from "the pressure to be thin" minimizes the true, serious nature of eating disorders.

My sentiments exactly.

Melissa said...

Thank you for writing this and managing to capture the complexities of eating disorders so astutely. Thank you also for differentiating between the pressure to be thin and a phobia of weight gain. Despite my multiple treatments I've never quite managed to make that distinction so clearly. Hopefully this post will help people to understand EDs better and so explore the real causes and understand the experience rather than focusing on something that can be a symptom and then a block.

Cathy (UK) said...

Well you know my thoughts on this Carrie...

My frustration with almost everyone viewing my very long history of anorexia nervosa (AN) as being caused by cultural pressure to be thin was what led me to write a 'Viewpoint' paper published in European Eating Disorders Review. I was just sick and tired of 'media crap' as well as 'feminist theories' of AN relating to culture and body image.

Let's face it, the majority of women dislike certain parts of their body and would like to change their shape/weight. However, the majority of women do not develop AN. The lifetime prevalence of AN is less than 1% of the female population. Plus, as you explain, some people with AN can clearly see that they are too thin and don't have fat phobia.

The common denominator amongst ALL people with AN is that they fear behavioural change (i.e. eating more, exercising less, refraining from purging etc.). AN is about getting stuck in a pattern of behaviours and having rigid, inflexible thinking. The desire to be thin may or may not be present.

As a recovered anorexia sufferer I volunteered to participate in a study examining my thinking styles/cognitive function at Institute of Psychiatry in London (last week). The tests had nothing to do with food, eating, weight, body image etc. Rather, they were computer-based puzzles involving numbers, cards, geometric shapes (etc.). Guess what? I scored very highly as an inflexible, rigid thinker, who has difficulties adapting to changes in learnt rules. I also have difficulties recognising emotions and am distracted by angry faces. That is the way my brain functions and is probably largely genetic. Starvation increases rigidity, so I became well and truly stuck in AN for many years.

The best way to describe my AN is that I developed rules (around eating and exercise) which stuck. My brain became fixated on adhering to my self-created rules, because without them I felt inbearably anxious. I honestly feel that cultural pressure to be thin is a 'red herring'.

James Clayton said...

Right on. Every single person I've encountered has ended up with an eating disorder for more complex reasons than simply "I feel pressured to be thin". To see it as just some fad centred around just eating undermines all the psychological aspects, anxiety, self-esteem and so on.

It's like saying that someone who overdoses died of a pressure to get high. Excellent post and here's hoping that these misconceptions continue to be eroded.

Anonymous said...

Carrie this is an awesome post. I hope you consider fleshing it out a bit (haha) with some more background and sending it in as a commentary to the Journal of the AMA or one of the major nutrition journals. Because, unfortunately, this myth persists among professionals too and it prevents those with eds from being taken seriously and getting the help they need.

Laura Collins said...

Thank you.

I find it helpful to compare this to the "pressure to be clean" with contamination OCD symptoms.

Sure it doesn't help that the media is filled with alarming hygiene stories and has unrealistically clean houses, but that doesn't cause OCDs or make a sufferer a victim of cleaning standards.

Abby said...

I believe we have this same Facebook friend, so please take this comment as directed towards the FB status and not the person.

With that said, I agree with you completely. You described me to a tee in that it was never about a pressure to be thin for me, it was exactly what you described. When I hear a majority of theories based on the fact that society created eating disorders, body image is the focus, it's all about external perfection, etc. I get so annoyed and frustrated that it makes me want to scream (or go overexercise and restrict, ironically).

Anyway, it may have been this particular person's desire to be thin that helped exacerbate her eating disorder, who knows, but for most of us, the pressure is instead an internal drive to quell anxiety from something else, something deeper.

It can't be simplified as "wanting to be thin," as that's the last thing that motivates me. It's just a side effect.

Maddi said...

I have to agree. My parents thing I have a choice and am just being vain. :/ Ya, maybe not being happy with my body is a little vain, but it is not the reason of the disease, nor, as you said, the cause. I wish that they would see that...
Maddi
xxx

CG said...

I always find it interesting when you write about this, because it is the exact opposite of my own experience. All the group sessions, outpatient programs I have participated in over the past seven years have been full of women (yes, mostly women) who had begun using behaviors to lose weight, and had then become addicted to those behaviors. Almost all were resistant to weight gain and how it would make them look. I, too, began starving/throwing up in order to lose weight I had gained...I no longer fit the thin ideal and had to do something about it. This seems to be very common. -CG

Anonymous said...

I think this is very individual. I have been motivated by pressure to be thin because, to me, thin is perfect and my ED is much more about perfectionism than it is fear of eating. In a different culture, which does not accept extreme thinness as ideal, I would probably still be mentally Ill but I don't think it would take the form of striving for thinness. Even if one adopts a purely biological view, it's the first diet that triggers AN in most cases - would we still diet without the pressure to be thin?

I don't discount that "pressure to be thin" has nothing to do with AN for some people, but for others, it does. For me, it is a big part. Maybe it was for your Facebook friend's friend as well?

Melissa said...

As far as other reasons go...did anyone else experience this?

When I was sick (and for over two years after I began recovery), hunger was a physically pleasurable feeling for me. Like many people, I think it started as a weight loss thing, and maybe the positive associations of "feeling" like I'm burning calories, but it quickly took on a life of its own. A lot of the time I would starve just to get that good feeling of being hungry. (And again, it was a physically good feeling, not just an emotional one).

Was/is that the case for anyone else?

(BTW, now, ten years later, hunger is back to being an uncomfortable feeling. Which is, I think, as it should be.)

Cathy (UK) said...

Melissa (above):

Yes, I found hunger pleasurable when I was stuck in anorexia nervosa. Nowadays, after substantial weight gain and therapy, I no longer find hunger pleasurable, but uncomfortable. However, I also find fullness uncomfortable and I have to make an effort to ensure I eat enough...

Alley Cat said...

Amen sista! I never use that expression. Such misconceptions help to fuel the illness, so it's important to clear them up.

It's definitely a double standard deep into the disease, feeling so ashamed (and boy does the disorder thrive on that) but at the same time so phobic of change!! When I first experienced the full-blown disorder, I remember trying to differentiate between the two, but my (old) therapist couldn't help me.

If this notion that couldn't be further from the truth were less common, I truly believe more lives would be saved. The disease would have a harder time convincing its victims to isolate and proper treatment would be provided sooner!

I am so sorry about the loss.

Anonymous said...

Carrie, I love your perspective. My eating disorder started as me feeling, yes, pressured because I didn't fit people's standards; (including my family--who tried to bribe me with money to lose weight) and my own shame with failed weight loss efforts. It developed into... voila, an eating disorder. The pressure to be thin may fuel maladaptive behavior, but this is called an eating disorder.

The sad part of it all is that someone is dead.

We are alive and must get on with the business of living. NOW.

molly b said...

I love this post. When my anorexia started I was already underweight. I didn't want to lose weight. In fact, I didn't even realize my restricting was causing weight loss for a while. Once I was in my ED, I became obsessed with losing weight, but a pressure to be thin definitely did not cause my eating disorder. Did it contribute to it? Probably. Did it make gaining the weight back hard? Definitely.

Mindy said...

I slightly disagree...I do think eating disorders are a mental illness. But I think from a bio psycho social approach, to limit the causation to just biological and psychological would be eliminating a whole component: social.
I agree wholeheartedly that eating disorders are not just about "being skinny" and wanting to lose weight. I agree that there are genetic factors that influence eating disorders, just as other mental illnesses are genetically influenced. But I do think triggers and circumstances can "pull the gun", and the tendencies in one's brain to obsess, to be ritualistic, to be controlling and perfectionist, are suddenly launched into the eating disorder.

I think the pressure to be thin did influence my eating disorder. Not even so much culturally as it was familial for me. Yes, I did hang posters of anorexic celebrities all over my bedroom in high school, but I also felt extraordinary pressures to be thin from coaches and family. I feel to say those didn't contribute to the development and continuation of the eating disorder would be to miss a huge boat.
Also, for years into my eating disorder, I denied the fact that it was a problem (common of course). I DID think I was just being "fit", or "I just watch what I eat" was my ever popular answer to questions about my weight and behaviors around food. In my mind, I was being "healthy", and also managing my weight in a way that was pleasing to myself and that I would be "enough" if I was thin.

So YES I think eating disorders are biologically and psychologically influenced, but to say the "pressure to be thin" wasn't there would be false.

ex ana said...

Carrie,
Splendid post. It was my case some dacades ago (bones were not 'cool' at that time). I will add a link to your post.
Melissa,
Yes I had that experience of having pleasure (it was not just a 'good feeling' it was a real pleasure) of being hungry. After many many years I am full recovered. I must add that I would like to know if it is a general feeling or if it applies only to few individuals. If it is general, is difficult to me to understand why it is more or less ignored in the literature.

Anonymous said...

this poetry came out of all this ...

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Carrie Arnold said...

Mindy,

I do agree with you that the pressure to be thin can be part of an eating disorder. Lord knows I've spent many an afternoon curled up in my room and howling "I look like a f*cking WHALE!!!" My issue is that the pressure to be thin isn't the same as an eating disorder, just as the pressure to have a clean house isn't the same as OCD.

Mindy said...

carrie--you're clarification makes a lot more sense. Thanks :)

Andrew said...

Anorexia nervosa is psychological problem that should be treated & everyone should learn the quickest way to lose weight the healthy way to lose weight

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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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