This next post in my summary of the 2010 International Conference on Eating Disorders, in which I'm taking you back to the opening keynote talk by Kelly Vitousek of the University of Hawaii. I could blog for days on the full talk, but instead I will focus on the uber-thought-provoking parts. I'm starting these several posts with a subject rather closely related to yesterday's "Oh, sod it!" post.

In her talk, Dr. Vitousek pointed out the similarities between eating disorders and other extreme behaviors, like competitive birding, extreme mountaineering, even competitive Scrabble. Dr. Vitousek said,

"Anything that many humans value, some will vastly overdo. Can these comparisons help us understand aspects of anorexia we've found persistently obscure by making them more accessible and understandable?"

I love metaphors, and I do think that these comparisons can help people better understand some of the bizarre and baffling behaviors that go along with eating disorders. Both eating disorders and extreme behaviors involve obsessive behaviors that the person often embraces and even seeks out. These behaviors--whether eating disordered or not--ultimately form a large part of the person's identity and sense of self. Often, a thriving subculture develops around people who engage in these behaviors. And I think both people with eating disorders and those competitive birders and the like have trouble saying "Oh, sod it!"

The problem with using such comparisons is the wide gulf of impact that exists between competitive Scrabble players and those with eating disorders. Sure, your life can revolve around competitive Scrabble to the detriment of personal and professional relationships, but it likely won't kill you. And although extreme mountaineering can be deadly, participants often know what they're getting themselves into; as well, the issue of choice is much higher than in eating disorders (i.e., eating disorders are frequently anosognostic; mountaineering isn't).

I think we also need to be careful about saying "Wow, there are a lot of similarities between eating disorders and these other extreme behaviors" rather than "An eating disorder is just like competitive Scrabble." Because that's just not true. I know that Dr. Vitousek didn't imply this, but I'm also well aware of how media can mangle things. The comparisons aren't meant as a dismissal or minimization, but rather a different way of looking at eating disorders.

My other issue is with Dr. Vitousek's "overvaluation" comment. Granted, part of the diagnostic criteria for anorexia and bulimia is an overvaluation of weight and shape, and I certainly wouldn't deny that this is a large feature of EDs for many people. However, there is a big difference between shape/weight overvaluation being a feature of an eating disorder and that being the root issue of an eating disorder. Research has shown that the desire to stay underweight seen in some people with AN isn't an overvaluation of thinness as much as it is a phobia about getting fat. This is not to say that our culture's overvaluation of the Thin Ideal is irrelevant to eating disorders, but that doesn't appear to be what's going on in the brains of people with anorexia.

It has helped me to reframe my own body dysmorphia as a phobia of gaining weight rather than silly little Carrie wanting to look like a supermodel. Because that wasn't really what my thinking was like. It helps me to reframe the issue with my OCD: my cleaning rituals weren't an "overvaluation" of cleanliness, but a way to reduce the anxiety that came with not cleaning. For me, then, weight loss was as much about relieving the anxiety about gaining weight as it was about "looking" a particular way. I had similar anxieties about eating too much or not exercising enough, and so I've slowly started to reframe this behaviors as compulsions rather than a simple desire to eat right that just got out of hand. I still have the desire to maintain a healthy diet now that I'm in recovery, and although I probably think a lot more about it than most people, it doesn't always rule my life.

Eating disorders don't exist just because our culture overvalues thinness. We wouldn't say that mania exists because our culture overvalues happiness. Or that schizophrenia exists because our culture overvalues a rich, inner dialogue. Certainly people with eating disorders can be prone to overvaluing something, but there's a difference between that and saying that eating disorders are an overvaluation of something.

Still, I think the comparison was rather interesting, and it can provide some new ways of thinking about eating disorders.