How to know if you've got a problem

I love the blog F*ck Feelings. It always provides a great perspective and very useful advice for dealing with what the authors call "the shit sandwiches of life" (their advice: ask for ketchup). They've never really addressed eating disorders, and I was always curious to see how they handled the subject. One of the most recent blog posts gave me my answer.

A woman had written in about being very dissatisfied with her weight, and asking why she was having these problems if she was already on the thin side.

Dr. Lastname ("because doctors always go by their last names") had this to say:

Most people aren’t happy with the way they look or how much they weigh, and all people spend at least a little time each day being unhappy, but many still manage to live normal, albeit slight chubby/grumpy lives.

As to the source of your insecurities, your guess is as good as mine and the many other scientists, clinicians, and desperate-for-a-topic writers who explain this phenomenon. It could be your ex, or it could reading too much Cosmo.

These experts assume, for the most part, that you wouldn’t be so self-critical if you didn’t listen to magazines, celebrities, or your critical-yet-well-meaning grandmother, and just believed in your self. They tell you that self-esteem will conquer all. Of course, they’re wrong.
There’s lots of evidence that self-hating body thoughts can happen to people with perfectly good self-esteem, nice families, and normal bodies. Instead of obsessing about why you feel this way the same way you obsess over calorie counts, stop and ask yourself, first, whether these thoughts are doing you much harm.

I know they’re causing you pain, but ask yourself whether they’re affecting your health or relationships. Right or wrong, you can think you need to lose a few without hiding major parts of your personalities and or being a bad friend or parent.

If you think your body-hate isn’t doing too much harm, try ignoring it. Certain kinds of psychotherapy may help, but watch out if you find yourself becoming more self-obsessed and blaming yourself for not getting better. The mark of good psychotherapy, like good coaching, is that it gives you ideas and motivation for managing a problem without increasing your expectations of control.

If body-hate is hurting your health or relationships—if you purge, have become anemic, or acquired any number of the dire symptoms that come with an eating disorder—assemble a treatment team, including a primary care physician, a psychiatrist and dietitian, and don’t hesitate to put yourself into an around-the-clock “eat-your-food” camp if it’s necessary. It can save your life.

In any case, don’t pin your hopes and self-esteem on self-control, or self-hating thoughts will just get worse. If you make it your job to keep trying and regard the illness as you would the weather, it can’t touch your sense of who you are.

You need never see yourself as a food nut or anorectic; you’re simply a person with eating issues, which puts you in the same camp as 90% of the population. You might feel like shit, but you are truly not alone.

Aside from their perspective on intensive treatment (an around-the-clock "eat your food camp" is an apropos enough descriptor), their benchmarks for determining the difference between disordered eating and eating disorder is pretty darn accurate. Because so many people are obsessed with food and weight, it's often hard to determine where this cultural obsession leaves off and where an eating disorder begins. If your obsessing about food, weight, exercise, etc, are causing any health problems (purging, anemia, marked/unhealthy weight loss) OR if these obsessions are hindering other areas of your life, then you've got a serious psychological problem. Not that you can't or shouldn't address disordered eating, but feeling like crap after reading Cosmo is not, in and of itself, an eating disorder.

It should, however, be a really big sign to stop reading magazines that make you feel like crap.

What do you think of "Dr. Lastname's" assessment of eating disorders in general and this woman in particular? Share away in the comments!


Cathy (UK) said...

The ever vociferous Cathy will happily comment...

I agree with this doctor that disordered eating and (clinical) eating disorders are not the same thing. I also think it is important to determine whether eating behaviours (and the thoughts that underpin these behaviours) disrupt health and the ability to live a happy (and safe) life.

Personally, I feel that the main differences between clinical eating disorders and disordered eating are that with clinical EDs:

1. The person gets completely stuck in a pattern of dangerous eating/purging/exercise behaviours - such that they feel unable to cope without these behaviours.

2. The behaviours of the ED extend way beyond control of body weight or shape and the person does these behaviours to regulate emotions/mood.

3. The root of the ED is not body dissatisfaction (or 'body hate'), but a more global dissatisfaction of oneself as a whole, identity confusion, social difficulties, anxiety, fear of change, fear of failing, obsessions and compulsions.

If reading the average (dreadful) woman's magazine makes any person feel insecure then I agree: stop reading the magazines! I have never bought women's magazines because they bore me. I'm not very interested in reading about fashion, 'beauty' or relationships. I prefer science and wildlife magazines.

Despite my general lack of interest in fashion and beauty I still had AN for many years. EDs can develop in the absence of body image problems, something I keep emphasising....

Katie said...

I've often thought that doctors and therapists would do better to give up on the previous criteria for diagnosis of EDs and just ask clients questions about how badly their problems are affecting their lives. Obviously the distinction needs to be made between AN/BN/BED/EDNOS for research purposes, but it serves little to no purpose in treatment. It's just another way for sufferers to torture themselves - if they don't meet the weight criteria for anorexia, or they never lost their periods, or they purge infrequently, or they never had poor body image and so feel isolated and freakish even amongst other people with eating disorders. I've always thought that if someone's problems with food and weight are having a big negative impact on any one or combination of their functioning, health, work, education, relationships and/or mood, they clearly have a problem and deserve treatment.

I like Dr Lastname. Despite being a terrible nihlist he/she is still empathic, which is more than can be said for most of the shrinks I've seen!

Anonymous said...

regarding the difference between disordered eating and eating disorders I agree with the article and with Cathy above. although I would say that some people with eating disorders can and do have body dissatisfaction ;) but agree that 'global dissatisfaction' would apply to them too but possibly not to disordered eaters.
the rest of the article totally depresses me though. I mean 'just deal with it even if it makes you feel like shit?'...why? I mean, I was one of those people who blew off treatment and didn't have therapy while I was in recovery, and still I'm a) happier and b) more importantly, like my body a hell of a lot more at a healthy weight than I did while really emaciated. and I'm sure there are hundreds of people with stories like mine. so, sure I had more incentive to make those changes, but I don't see why 'normal' people who hate their bodies should have to live with that and accept it as unchangeable. it seems like a pretty sad indictment of society and an admission that we're powerless over its effects on us, which I don't believe is true. and I'm not sure the problem is only magazines either. I read them, watch movies in which some of the actresses are way thinner than I am, see random underweight girls in the street all the time, but it doesn't make me hate my body or want to change it. the problem I suppose is more the culture that suggests happiness means buying into this fantasy of being a size 6 with D cup boobs, a glamorous job and owning every fashion item the minute it's released. the whole concept makes me kind of sad. I suppose a lot of us recovered from eating disorders have had to erase all the weight prejudice so completely from our minds because the stakes for us were higher. but as I said, normal people should do this too! I have so many friends who seem to carry their own body hangups around their necks like a grindstone, despite being well adjusted and functional otherwise. I can't say I know a solution, having never been that kind of 'normal person'. but it's a pretty depressing situation...

Kate said...

yesterday i had lunch with a group of people who should read this post. or maybe i should read this post 6 more times, because they're still on my mind.

basically, the whole lunch (at panera, of all places - it's not like we were eating at mcdonalds) was a calorie list. why would someone get lemonade when they could have a calorie free tea? no, i can't eat that. no, i can't eat that either. sure, i'll have a bite of your bread. holy shit, i just ate your entire piece of bread - why would i do that?

it was like i was observing wild animals. i just watched it all happen, you know? i used to be there. i used to be that person, but today i just wanted to get out.

but i have to remind myself that they, probably, are just "normal." ugh. it makes me a little bit crazy, to be honest. but i suppose we already knew that i was a little bit crazy.

Ari J. Brattkus said...

Carrie, thank you for turning me on to this Doc's blog -- he is hilarious and very down to earth!

HikerRD said...

Great post! I think the MD said it beautifully. I often remind my patients with EDz to use reality checks when their body image issues escalate. Did they really increase in size? Don't their pants still fit them? And finally, if their eating and resulting size remained the same, then the question they need to ask themselves is "what's REALLY" bothering me?" Rarely is it truly about their weight or eating!

Lori Lieberman, RD, CDE, MPH,LDN

Wondering Soul said...

Yes Carrie, I think Dr Lastname makes some very 'down to earth' comments about the differences between EDs and a natural 'I'm feeling fat and crap' state of mind.
There IS a point where it is very hard to tell the difference because the line becomes very blurred and perceptions can become increasingly skewed...

There is a link (apparently) between Anorexia and BDD..? So I'm not sure that I agree that it's nt about body hate... Certainly, my sister (who grew up suffering SEVERELY from Anorexia, DESPISED her body so much that, as it was developing, she used to harm it as much as possible in an attempt to make it stop.
If that's not body hatred then I don't know what is.
Have you heard much about this kind of thing?


Anonymous said...

Hi - I really like your blog lots... but can you please continue writing about that beautiful kitty Aria? I love cats and have one of my own adopted from a shelter - she's not as pretty as Aria (shhh, don't tell her I said so), but I love her like my own child.

Mindy said...

I see I'm a little late on the comment. I think that this Dr has some good points, especially being that of course, eating disorders and body image issues are different. I think sometimes I'm hyper sensitive to these articles, so I did have some things that I didn't really like, namely this:
" I know they’re causing you pain, but ask yourself whether they’re affecting your health or relationships."

In my opinion, that's just the problem--they're CAUSING HER PAIN. It's great that it may have not gotten to the point of binging, purging, starving, relationships effected, etc. But body image issues are still serious.
I think a lot of women "settle" in regards to body image, like "oh, its ok, everyone hates their bodies!"
I don't think that's ok. What about a radical recovery or radical freedom? I truly think it's possible. If 90% of women hate their bodies, that isn't ok--that really sucks, actually. I think of friends that I have that have never crossed into an "eating disorder" but just "don't like their weight", and I think those girls and guys are just as deserving as talking about it and searching for freedom-because hating your body is a shitty place to be.

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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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