Most of you have probably noticed by now that it's Eating Disorders Awareness Week. For the first few days this week, my Facebook feed was inundated with message about loving your body and talking back to the media, and so on. It was like being at a high school pep rally, only about not wearing lipstick! and accepting our natural beauty! and loving our bodies!

I don't really like pep rallies, if for no other reason than I really don't do peppy all that well.

Rallying people and getting them motivated are great. Most of these war cries have to do with preventing eating disorders: that if we label digitally altered advertisements, we will decrease eating disorders. Or that people need to accept their natural sizes, which would eliminate eating disorders. They're nice thoughts, and they seem like really good ideas. It's why they have so much traction. People without eating disorders can relate to not liking how they look. They can relate to looking at beauty magazines and then feeling seriously ugly. They understand about dieting and wanting to be a Size Negative Eleventy Billion but not being able to lose those last XX pounds. Cindy Bulik calls this the "I just wanna look like a model" model of eating disorders.

The problem is that eating disorders aren't just extreme diets and treating them as such gets us nowhere. Writes Autumn Whitefield-Madrano, a recovering (?) eating disorder patient:

I just know that by the time I was discharged from Renfrew, I’d finally begun to learn that my dissatisfaction with my body wasn’t causing my eating disorder; it was merely a symptom of my disease, like restricting my food intake or binge eating...I’d begun to understand that loving my body wasn’t the point. The point wasn’t even to like it. The point was to learn how to eat.

I personally find body image--how the brain figures out what we look like--a fascinating neuroscientific and philosophical issue. My own body image issues long predated my eating disorder, but they didn't have anything to do with lipstick or models.My brain had a hiccup in figuring out what size I really was, likely due to problems in the insula and somatosensory cortex. Ridiculously altered images don't help, but they weren't a cause.

Others take a different approach towards eating disorders prevention. If we can educate people about how dangerous and pointless eating disorders are, then maybe people won't start. It's an attitude I had myself for a while, and the well-meaning philosophy feeds into tell-all newspaper articles and discussions about just how few lettuce leaves you survived on at your worst.

I never ceases to astound me just how many people give a shit about that sort of thing.

Except that this type of thinking essentially posits that eating disorders are choices, or voluntary behaviors. Perhaps that first step can be, I don't know. The problem is that most people who take that first step don't think they're going to develop an eating disorder as a result. So telling them that eating disorders are dangerous is kind of pointless, since they're not going to get an eating disorder from adding a little bit to their athletic training or cutting out junk food or whatever. By the time they have an eating disorder, it's too late.

To wit: a recent study on weight history in bulimia was just published, and researchers found that women suffering from bulimia ultimately gained weight as the result of their disorder. The Atlantic magazine wrote:

"Most patients lose a lot of weight as part of developing this disorder, and all dedicate significant effort, including the use of extreme behaviors, to prevent weight gain," said researcher Jena Shaw. "In spite of this, we found that most women also regain a lot of weight while they have bulimia," she continues. Maybe tell that to those kids with their pro-bulimia "ana-mia" Tumblrs?

{{Emphasis mine.}}

Nice thought, but it probably won't work to actually prevent an eating disorder. It's like telling someone who's sad to cheer up lest they get depression, or working to prevent bad moods everywhere! (Like pep rallies, unbridled optimism also makes me stabby, so I'm not sure I could tolerate this world for long...)

I'm not against the prevention of eating disorders, I'm just not sure that we have any clue how to do it yet.

Yesterday was the start of National Eating Disorders Awareness Week--the flurry of news stories and blog posts and tweeted statistics is pretty hard to miss if you're hooked in to the ED community.  The stories are all over the place, not just in quality, but also in message.  I started to think about NEDAW not from the perspective of a person with an eating disorder, but to try and think about it as someone who didn't know a thing about EDs.

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?

Harriet originally posted this article, and it touched me so much, I wanted to reprint parts of it.

The piece was written by Rosalie Yan at Duke University in honor of NEDAW. She says:

I feel incredibly lucky for having friends and parents whose support knows no limit and I'm grateful for them beyond words. I am including a list of ways I have been helped, with the hope that you will reach out to your loved one with an eating disorder. Don't talk about appearance or eating. Offer to listen, don't interrupt and don't give advice. Let go of stereotypical notions. Spend time together doing fun activities. Recognize that it is not her or his fault. Encourage him or her to get help. Understand that this is when your love is needed most. Stay patient.

Throughout the past four years with an eating disorder punctuated with intermittent bouts of recovery, I have come to the following understandings about healthy relationships with eating. First, pay attention to your diet, but don't worry about it. Second, take pride in your body, but don't allow it to define you. Third, having an eating disorder takes strength, but recovering from one takes more strength. Finally, happiness doesn't come with a certain body shape; happiness comes with acceptance.

Thank you for the reminder, Rosalie. You inspire me.

With National Eating Disorders Awareness Week in full swing, there have been a heap of stories on eating disorders. Some of them good, some of them not, and some of them downright depressing.

"Once an anorexic, always an anorexic"? Well if that doesn't leave you jumping for joy...

I mean, I would be very very stupid to forget that I had an eating disorder. When I was first diagnosed (before it turned into the 8 year drama that it has), my mom would say that she hoped I could "put this all behind me" one day. Forget about it. Move on. Except to forget that my brain chemistry changes when I don't eat properly would set me up for a relapse.

Working through lunch isn't good for anyone; for me, it's playing with fire. And I will get burned.

But that doesn't mean I'm going to be anorexic forever. It doesn't mean that I have to obsess about food and weight and exercise every day. It just means I have to be mindful.

The other pet peeve of mine in stories on eating disorders is that they aren't about food; they're about control.

Ah, yes. Control. That beautiful, wonderful word we all have come to know and love. Many people with eating disorders are control freaks. It tends to go along with perfectionism. But that doesn't mean that eating disorders are about control.

Yet eating disorders are about food when you're malnourished or engaging in ED behaviors. The "why" isn't so important when your brain isn't functioning properly.

Even then, I wonder: why food? Why weight? Could that be part of the cultural context for eating disorders? The fear of fatness? Everything is low-fat this, "will help you achieve a healthy body weight" that. How could you escape without some sort of food-related neurosis?

On the other hand, most people don't develop eating disorders. So there's a brain thing going on in there, too.

How I see the control thing is this: you're trying to control your fears, your anxieties, your phobias. That's the "control" part. Most people with eating disorders do NOT see themselves in control of their food. They feel tremendously out of control- which leads to increased restricting, purging, exercise, bingeing- as a way to regain control. Only this doesn't work, and lather, rinse, repeat.

I see many parallels between anorexia and OCD* because OCD involves a tremendous need to control certain fears. With OCD, it's with neutralizing rituals. Have a bad thought? Pray for forgiveness. Leave the stove on? Check the knobs. With anorexia, there are similar kind of neutralizing rituals. Eat too much? Go for a run. Do a bazillion situps. Throw up. Eat less tomorrow.

I don't know that they are the same disease- and because they can exist independently, I would say they're not. But I think they are similar neurochemically, and there is certainly huge overlap in populations of sufferers.

OCD is an illness. Anorexia is an illness. Bulimia is an illness. EDNOS is an illness.

*and if you do a PubMed search of "anorexia nervosa and OCD" you will see that I'm not the only one who thinks so.

I didn't do a Saturday Smorgasbord this week for several reasons:

1. Most of the news stories out there this week simply weren't all that good. I blogged about the ones I felt like blogging about, and the rest don't make me say anything that I haven't really already said.

2. Today marks the start of National Eating Disorders Awareness Week.

With that, I had an idea. Many of us have noticed that the media coverage of eating disorders is less than optimal. I'm not just talking quantity of attention; I'm talking quality. Subjects crucial to eating disorders- like biochemistry and genetics- are glossed over or omitted entirely. Or the articles only focus on young, white females. Or on emaciated anorexics- when the majority of ED sufferers are at "normal" weights.

So why don't we make the news, instead of just taking it in? Tell people your truth. Tell them looking okay doesn't mean feeling okay. Tell them that this illness isn't your fault. Tell them the latest research. It doesn't have to be a reporter- it could be a friend or family member. It could even be a quiet acknowledgement to yourself.

What can YOU do to celebrate NEDAW? Post your ideas in the comments section. I look forward to hearing them.

As many of you know, National Eating Disorders Awareness Week starts on Sunday, Feburary 24. Over the past year, I have been using The Gold Fork Project to help raise money for eating disorders research.

What is the Gold Fork Project?

The gold fork is the logo used by Laura Collins in her quest to promote effective treatment of eating disorders. To me, it is an example of how food -- and the love of it -- can be golden and healthy and wonderful. It's a reminder of how food is so crucial to both physical and mental health. And how proper eating is the first step to recovery.

I've raised almost $150 for the National Eating Disorders Association over the past year by selling these necklaces (half of the purchase price is donated to NEDA; the rest is materials and labor cost, shipping, advertising, etc). The necklaces are tasteful and classy, and you can share as much about your personal experiences with an eating disorder as you would like should you be asked about your golden fork.

And I ship as soon as I receive your order, so there's still time to order and have a necklace for NEDAW festivities.

Check out my Etsy jewelry shop for more information on the Fork You, Eddie! necklace.

Yes, I do realize this post is a day or two after the end of National Eating Disorders Awareness Week, but our Internet connection was down. So there. ::sticks out tongue::

But I was thinking- what do people really need to be aware of about eating disorders? I would wager a bet that most Americans know, on some level, what anorexia and bulimia are. They are plenty aware of eating disorders. Anorexics want to look like models and bulimics want to have their cake and puke it too. Right? People with eating disorders have crappy parents who just need to butt out of their lives and then they will be able to manage their symptoms and remain obsessed with the size of their ass for the rest of their lives.

Though I have not conducted any sort of scientific polls (nor, having studied the process in grad school, would even try to attempt such a thing), that seems to be the general understanding of the general American on the street, courtesy all of the tell-all stories in the media. Essentially.

But that ain't what an eating disorder is, or is about. In fact, anorexia isn't really about anything. It's no more "about" something than cancer. It's an illness. It's a biologically-based illness. It is not a choice. It is not a bunch of skinny chicks wishing they could be (insert name of super-skinny celebrity here). The model-wannabe syndrome is both culture-wide and a symptom of anorexia. It's the pot of gold at the end of the rainbow, the promise of the ending of food and weight anxieties. But it's not the cause, and it's not what even promotes the continuation of eating disorders.

We live in a culture that promotes eating disorder symptoms. We do. Flat-out. My co-workers in the "Big Fat Loser" contest are proof of that. Our culture holds those with anorexia up as some sort of role-models. If they can starve, so can you. If they can lose weight, so can you. Models look like anorexics, whether they actually are or not. Our culture also holds food restriction and malnutrition as a normal way of life through dieting. An eating disorder is, in no way, a diet. But it sure does look like one, and it sure can be swept under the rug as one.

Eating disorders are genetically-based. Though I have no evidence of full-blown eating disorders in my family, there is plenty of evidence of mood and anxiety disorders, along with substance abuse. All of which alter serotonin and dopamine and all those other cool neurochemicals, even from birth. Could there be an eating disorder somewhere in our family tree that I don't know about? You betcha. But what's more likely is that the triggers weren't there (dieting, emphasis on thinness as a culture, the promise that losing weight will lead to happiness, eating "healthy", etc). I view the anorexia as an extension of the OCD, from which I also suffer. The similarities are too striking for me to brush aside. The obsessions. The rituals. The mind-numbing, mouth-frothing fear. The hopes that if you can do everything just right then the fear will go away. That my brain latched onto fears about germs and weight (among other things) could be entirely random. I wouldn't have been afraid of AIDS before 1980. We didn't know about it. In another time and place, I might not have been afraid of food and weight. Because no one gave a shit.

I also want to know that you can fully recover from an eating disorder. If I were to become completely blase about food (so I didn't eat breakfast...no biggie), I would be an idiot. I don't have the luxury of skipping meals. My brain doesn't allow it. But that doesn't mean my life has to be ruled by thoughts of food and weight. It's like a bout of skin cancer- you may be cured, but you can almost be damn sure that you'll religiously use sunblock. An eating disorder changes your life, and the lives of all those who care about you.

Lastly, I want you to know that an eating disorder is not a choice. I never "chose" to become anorexic; it just sort of happened. I can't explain it. For years, I chased after the "why", hoping that if I could untangle the reasons behind my illness, then I could solve it. I've learned that there is no "why," that anorexia and eating disorders don't make a whole lot of sense. I'm moving on from that. My anorexia may have begun with an innocent decision to eat healthier, exercise more, and lose five pounds, but it was not perpetuated by conscious choice.

But those of us with eating disorders and other mental illnesses need the support of our family and friends. We need our family and friends to be educated on the topic of eating disorders, for them to know all of the things about which I just wrote. We need support, not condemnation or judgement.