The mad skillz of anorexia

I have been following an email discussion between eating disorder professionals, and the issue came up when Therapist A referred to those with anorexia as having an "unusual ability" to go without eating.  Therapist B said that this is more of a disability than a skill; people with AN are afraid to eat, not unusually skilled at starving themselves.

Therapist B has a point.  A lot of how people think of anorexia in popular culture (besides fetishizing thinness, which is another story) is that people with anorexia are, like, super skilled at not eating.  It explains why people have told me they wished they could have "a little" anorexia, or asked me for diet tips.  We can learn skills from others.  We can spend time with talented people and hope that it rubs off.  We can study with the best teachers and practice and...

Food restriction is a behavior.  That's just a fact.  But is it a skill or ability?

There's definitely a biological component to this "skill," but research has shown similar things for musicians and athletes.  That doesn't mean that Mozart wasn't talented because of some genetic blessings.

Where things get muddled is this: so many people engage in deliberate food restriction on a daily basis. I'm not talking about people with food allergies (though this is true for them), but about all the people who are dieting or trying to lose weight.  From the outside, a strict diet looks an awful lot like anorexia.  In western cultures, people with eating disorders and dieters often use similar terms to describe their thoughts and feelings about food and weight.

Some people are really good at dieting.  Others aren't.  I would hazard a guess that someone with anorexia would be really good at dieting.

But anorexia isn't a diet.  It can look like a diet, but it fundamentally isn't.  It's like saying that someone who is manic is really good at being energetic or that someone with OCD is really good at cleaning the house.  They might be, but it's not because of some sort of inherent skill.  It's part of the illness.

Often, when an eating disorder starts, it does appear that sufferers have an improved ability to restrict their diet (for whatever reason).  They can override hunger cues.  But as time goes the illness deepens...that skill doesn't go away, but it ceases to be the main reason or motivation for ongoing food restriction.  That "natural skill" morphs into an illness.

What do you think? Share your thoughts in the comments.

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Anonymous said...

as i'm in recovery again i'm reminded of how crippling this disease is in body, mind and spirit. i wrote that i would be glad to tell someone about the numbers part of this disease because i never talk about that part. and then when it came time to write that down as part of daily therapy i was freaked. and then when numbers were said out loud i was more freaked. and then i remembered i thought it would feel better. i didn't. AT ALL.
my mom is on a diet. she is happy to tell me numbers. she is happy to be losing. she is getting healthier. she is not me. i am not her. talking about it for me is like sitting on my chest and telling me to play the tuba.
so yeah, it's a lot different. do i think it's a skill? no, i personally do not think it's a skill and i'm not positive that's what Therapist A is saying. i'd need to see the context. because what HAS happened every time i've gone down the anorexic rabbit hole is that it gets easier to not eat or harder TO eat. but ALL of it stops being easy at some point and begins to debilitate and that's where i hear these two therapists parting company. and that's where i'd have to go with Th. B. because even though i have a general idea how long that takes and so do most sufferers so i won't go there, the longer it goes on, statistically speaking the harder it is to just physically resume 'normal' eating. personally speaking, this too is very, very true.
my mom doesn't cry because she is eating a bowl of cereal on her 'diet' and the calories or quantity or whatever about it is so terrifying. she puts the dish in the sink and moves forward with her day. it doesn't take her two hours to eat a meal, EVER, let alone part of one.
so the title of your post speaks the truth- the skill is 'madness' not really skill at all. it's just that today madness is known as mental illness.

Cathy (UK) said...

I absolutely, 100% agree with you Carrie. I never, ever viewed my 'capacity' to restrict as a 'skill', or of being deserving of praise. I was not proud of my restricting behaviour or of my thinness. I hid my emaciated body from others (and myself) as much as I could. I also hid my restricting behaviours because I didn't want others to intervene and to force me to eat.

I didn't restrict to lose weight or to feel successful in any way. That's why I have always been puzzled by the notion of 'the best anorexic'. A couple of people (with EDs) suggested to me that I wanted to be 'the best anorexic' on a couple of occasions and I wondered what, on earth, they were talking about.

So why did I restrict food, and eat in a very rigid manner that involved counting every single calorie I ingested in food? I did it because it made me feel in control of my anxiety. I had severe childhood anxiety and OCD, and my anxiety levels increased around puberty - perhaps in part because of hormonal changes, but also because I had experienced bullying by my peers and sexual abuse by an adult outside of my family. Restricting and controlling my food and energy intake provided an illusion that made me feel as if I had 'all my ducks in a row'.

I hate the notion that anorexic behaviours are performed consciously to instil a sense of skill or success within the person, or to control other people. These behaviours are more like an act of desperation. At least, that was how it felt for me.

Jessi said...

brilliant carrie and very interesting and informative as always!


Unknown said...

An important discussion to be having. I was so caught up in the mechanics of it all it didn't even occur to me to question the skill vs disability language. I think of it as both, more in the way you described the housekeeping skills of OCD. But the language matters, and I plan to give this more thought.

Part of the appeal, I confess, of Guisinger's Adapted to Flee Famine hypothesis is that it re-frames the thoughts and compulsions of ED into something positive - in another context. I'm all into positivity, so it appealed to me and felt like a less accusing and pathologizing way to explain the symptoms.

Dr. Ravin said...

I believe that therapist A and therapist B are both correct. Some symptoms of AN are almost superhuman abilities to deny hunger, withstand pain, perform athletically while undernourished, and complete tasks perfectly. These symptoms can be advantageous AND they can cause extreme suffering and disability.

Many brilliant artists and writers and musicians suffer from Bipolar disorder. Mania and hypomania provide intense energy and creativity and productivity, resulting in fantastic works of art. Mania and hypomania also cause suffering and disability and death.

I do believe these mental illnesses have persisted in the gene pool because they can be advantageous in certain contexts, despite the immense pain and suffering they cause.

Cammy said...

Some of the ways in which anorexics can carry on restricting are physiological, too, your metabolism slows to a crawl, your hunger cues are shot to hell, your body switches into the same starvation survival mode that allowed concentration camp victims to make it through on such small rations, as just a single example. I have the same genes, brain, etc today as I did when I was 14, but I can't fathom on how I subsisted on so little at the time. I'm sure part of it was purely psychological (fear, determination, obsession), but I do think there is a strongly physiological component to it as well. I remember saying one time, "It's really scary how little you actually need to get by." During slips today it still disturbs me. maybe some people switch into that survival mode more easily than others, due to various hereditary/developmental factors, but I do think it plays a role in the "skill" of making it on what should be sub-subsistence resources.

Of course, starving is just dying very very very slowly, so in a sense you're not "making it", you just haven't reached the end point, but it does seem the body tries to create an asymptotic approach to the End as it gets closer and closer by slowing systems down and prioritizing whatever resources there are.

Ok, Saturday morning pre-coffee ramble of a biologist stops...NOW! ;)

hm said...

Skill or ability? How about- skill or compulsion???

I'm skilled at playing a musical instrument. I have a natural embouchure and a good musical ear. Plus I can be disciplined about practicing. BUT I can put the damn thing down if I want to. For 5 years at a time, if life demands it! Then pick it back up when life allows for it again. THAT's a skill.

Try asking an anorexic to put down their anorexia for a few years.

I thought I was so self-controlled. People would tell me they wished they had as much control as I do, or even just half as much. (See, Carrie? We get our share of undue praises too- just not in sports magazines.) It made me cringe inside (somewhere in there I must have known I didn't deserve those compliments) but it also reinforced the behaviors. I have to do this. People agree that I have to do this. This is the right thing to do. I'm making good choices by restricting.

Never thought I had an ED. I lived in the illusion that I was making all these choices myself. Till I was told I was going to die.

As I fight for recovery, I realize that what I thought was "skill" was in actuality... compulsion. I find that my hands write down numbers in my food log that are not true to trick me into eating less. I find that my mind lies to me for the same reason. I find that the illusion that I am "self-controlled" around food evaporates pretty quickly when I'm trying to exercise enough self-control to make myself EAT it.

Not a skill. A compulsion.

Louise said...

I'm not really sure on this one... Its hard to look at it as skills when most people with eating disorders would give anything to be able to give up these so called "skills", they don't choose them. I understand all the biological basis behind it all, but I think the psychological aspect (which may well be influenced by our genes aswell), is where the difference lies between those who restrict for dieting purposes, and those who suffer from an eating disorder. As has already been said, often those with eating disorders don't intend to lose weight, and there is usually an underlying reason, that manifests itself in the eating disorder behaviours.
Another point is that although I don't consider them skills. there can be an unhealthy sharing of information between those with eating disorders. This is especially true online with all the horrible 'pro-ana' things out there. The eating disorder part of us can become competitive, and look for 'tips'.

Anonymous said...

this is such an intriguing discussion. Thinking in the context of my current situation - I'm inclined to believe that restriction isn't necessarily a skill or ability, but an innate fear from the 'philosophies' an ED person believes.
I don't think of not eating for prolonged periods of time to be a skill or ability - it's a fear that takes a strong hold on me that keeps me from recovery or eating.

Erica said...

This is a great question. When I was at my sickest, I believed myself and other anorectics to be superior and in possession of extraordinary will-power. Everyone else tried to lose weight, but could not, and here I was dropping pounds every hour. But the truth is that for most anorectics, myself included, starving was the easy thing and working towards recovery - especially when a person is physically (and subsequently mentally) very ill - is what takes strength and will-power.

In my current stage of recovery, I am maintaining my weight and battling eating disordered-thoughts, and even if I tried to get back down to my lower weights, I couldn't. That driving force, the deep-rooted anorexia, is no longer as present as it was. Now, most of the time, it is easier to eat than to starve.

I think that people struggling with anorexia are not really good at starving themselves; rather, the eating disorder is starving them. It's like how any normal person wouldn't talk to someone across the room who wasn't really there, but a delusional person would. This doesn't mean the delusional person is especially skilled at imagination, but is being driven by his or her illness to behave in that way.

Holly said...

I have read that it is a common sentiment even among those suffering from other eating disorders--wishing they could "just not eat" like anorexics. I certainly remember hearing it from my days in a pro-ED community.

deborah said...

Interesting point that I will think about more. I just want to quibble with your guess that someone with anorexia would be good at dieting. To me, being "good at dieting" has to do with restricting, sure, but it also means setting realistic short-term and long-term goals and sticking to them WITHOUT going too far. My understanding is that such moderation is difficult for anorexics, so I would hazard a guess that most anorexics would not be good at dieting.

Ace said...

well.... i have anorexia, and i sure as hell wouldn't call it a skill.
I struggle not only with myself, but with my family, to lose weight. it's true some ana's may be good at losing weight and can drop the pounds just like that, but it takes me months to lose a few pounds and i hate it.
So no, it's not a skill. its a characteristic of the illness

EvilGenius said...

I agree with most of the above - I don't think you can categorise something as a skill unless you can control it. Also, from my restrictive AN days I mostly remember feeling as though I had the same 'drive' to eat as normal people would while starving, it was just that my fear was greater than my survival instinct. which I wouldn't exactly define as an ability.

Anonymous said...

It can be viewed as a skill I suppose...A horrible, unhealthy, tortuous skill. With that being said a skill is usually viewed as a "good thing" which an ED is defiantly NOT! It's sad that some people think it's a "good skill to be able to starve yourself". Fear of food is not something I would ever wish upon anyone. It goes against everything our body needs to survive and is a terribly painful existence. I just dont like people referring to it like a skill because it sounds as if it is something "good" and helpful...

Melissa said...

I'm always floored by people who find out I was anorexic and then take that as some kind of indication that I'm going to be a fountain of useful diet tips. Anorexia is definitely not a "skill." That said, one of the things about restricting that appealed to me was the fact that it felt like something I was good at. Dieting is hard for most people; it's easy for me. I liked feeling like there was something I could do that others couldn't...something that other people find difficult but that I was great at. So in that way, the whole "skill" thing does seem accurate...but then again, since when do we take the way a diseased brain perceives something to be scientific truth/fact?

j.m.r. said...

I tend to think of it as a specific form of OCD or an addiction. It's not something that I cultivate so much as it is something that I am afraid to stop doing. Treating it as a skill is "triggering" and counterproductive to recovery. Very few people know about my anorexia, but everyone knows about my knack for remaining skeletal. (Though, were I a girl, I think more people would suspect ED.) Many of these people compare/contrast this "ability" with their own efforts. There is something both unnerving and encouraging about a co-worker's "That's really impressive" description of my carrot/tomato/cauliflower plate at the company barbecue - "healthy" fare, which, even still, I nibble reluctantly. After all, it's not part of the daily routine. (Hard to get out of going to the company BBQ.)

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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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