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.

As I mentioned in the Lipstick post, I received an email about a study conducted about women and makeup use by the Renfrew Center Foundation.

I emailed the PR rep, Jennifer, with the following:

I have a question for you, Renfrew, and Dr. Ressler: I'm curious why an eating disorder organization is studying makeup use in women. I don't see the connection, nor do I see what going without makeup has to do with eating disorders awareness week.


I have a blog post here: http://ed-bites.blogspot.com/2012/01/lipstick-connection.html


I really am interested in hearing a response from you guys. Thanks so much.

Jennifer's response:

Thank you for your response, Carrie.  Attached please find a copy of the full press release which further explains the survey that we conducted as well as our campaign, Barefaced & Beautiful, Without & Within. 


Barefaced & Beautiful, Without & Within is a call to action - an opportunity for women to join together and go without makeup in order to celebrate their natural beauty and start a healthy dialogue about body image, self-confidence and self-esteem.  


It is our goal that through this campaign, we will get people talking in broader terms. For many, negative feelings about one's self-image can set the stage for destructive behaviors, such as addictions or disordered eating.  It is our hope that Barefaced & Beautiful - a community of supporters sharing natural photos of themselves - will promote a greater understanding of how beauty and confidence come from within.


Upon your review, please do not hesitate to contact me if you have any further questions or if you would like to schedule a time to speak with our expert.

The press release was a Word document, which I've copied here:

So, to some extent, Renfrew isn't trying to deliberately link lipstick and eating disorders. They mentioned disordered eating, not eating disorders, which is very good. But it still rubs me the wrong way for some reason. I guess what I really want to know is why the Renfrew Center is studying makeup use. It just doesn't compute.

Jennifer's email ended with an invitation to speak with Dr. Ressler. I would like to ask her directly the question in the above paragraph. And since I'm going to be sending her the question via email, there's plenty of room to add other questions.


What other questions would you like to ask Dr. Ressler? Feel free to suggest away! I may edit your question slightly for clarity, brevity, or to combine several questions into one. I can't promise that I will submit every question asked, either, but I will do my best to make something comprehensive but not overwhelming.

As I've mentioned before, I get lots of email from PR people. Mostly, they neither bother me nor really attract much of my attention. One from this morning, however, did.

First, the pitch:

Dear Carrie,


It’s no surprise that most women wear makeup, but what drives the desire to wear bright red lips on a trip to the grocery store or a face full of foundation to the gym, beach or pool? And how does wearing makeup influence a woman’s self image? I thought you might be interested in covering this on your blog.


The Renfrew Center Foundation, a non-profit charitable organization dedicated to advancing the education, prevention, research and treatment of eating disorders, recently conducted a survey which revealed that nearly half of all women have negative feelings about their image when not wearing makeup and equate a “bare face” with feeling unattractive and insecure. Additionally, more than a quarter of the women surveyed began wearing makeup before age 13.


We’d love to work with you on a story revealing the results of this survey and are happy to provide nationally renowned body image expert, Adrienne Ressler of The Renfrew Center Foundation, to discuss the findings.


If interested, I’d be happy to send a full press release on The Renfrew Center Foundation’s survey on women’s attitudes towards makeup. The release also provides information regarding The Renfrew Center Foundation’s Barefaced & Beautiful, Without & Within campaign, a national call to action for women to go without makeup on February 27th in conjunction with National Eating Disorders Awareness Week (February 26- March 3).


Let me know if this is of interest.

The only thing I can think is: what the HELL does makeup have to do with eating disorders?!?


I know that body image obsessions are common in EDs, and I know that makeup can be part of that. But I almost never wear makeup, and I still got an eating disorder. So I'm just wondering how going without makeup is related to Eating Disorders Awareness Week. It's kinda maybe tangentially related, maybe, if you lump body image distress in with eating disorders.

But really? Makeup doesn't cause eating disorders.

Men get eating disorders, too. A British organization by the same name has a website and Twitter account by the same name. Eating disorders information can be found at the website for the National Institute of Mental Health, and also on the website for information on women's health. It implies that eating disorders are just a women's issue.

As the Kartini Clinic blog pointed out last week, one of the very first medical descriptions of anorexia was of an adolescent male. In 1689, believe it or not. So the idea that eating disorders are "just" women's issues is actually quite wrong.

The problem is that after Richard Morton first described anorexia in 1688, later medical doctors lumped anorexia in with "hysteria." Hysteria is derived from the Greek word for the uterus (which is why you get a hysterectomy), which means that men automatically can't be "hysterical" in the nineteenth century, technical usage of the word. Which is where we started to go wrong.

Later conceptualizations of eating disorders continued to exclude men, because eating disorders were seen as a female over-concern with one's looks, or a diet gone wrong. Men, it seemed, didn't face these pressures and/or were too smart to fetishize the size of their asses. Since men didn't face the body image pressures that women did, men couldn't get eating disorders.

It's bollocks, by the way. If you're human, you can get an eating disorder.

I'm blogging about this not just because I've been reading stuff about eating disorders in males, but also because I got a press release emailed to me this morning about a symposium on male eating disorders at the 2012 IAEDP conference this spring.  The tag line was:

Our latest news shares the sad and startling fact that one in three men are willing to shorten their lifespan just for the sake of better meeting society's image of the "ideal" man.

Huh?

I mean, there are just so many things wrong with this. First of all, eating disorders have existed long before current body ideals evolved, so that can't be the cause. Second, an eating disorder isn't being "willing to shorten your lifespan." That's like saying someone is willing to develop cancer so they can lose weight from chemo. Eating disorders aren't choices. They aren't about vanity or looks. They're a real biologically-based illness that kills, not because vain and vapid people of all sexes and genders are too self-absorbed to stop harming themselves, but because they have an illness that we generally suck at treating.

Also, I'm not sure of the scientific validity of a hypothetical "would you rather" question in assessing body image issues or eating disorders in any population. Nor are people with eating disorders actually making these decisions. Like I said, it's an illness, you idiots.

Of course, what I got was a press release and promo information. I don't know exactly what the presentation is going to contain. The email I got did say that they were also premiering a male-specific eating disorders assessment, which could be a very good thing. I haven't seen it, so I can't say for sure.

It's just that perpetuating these myths about what causes eating disorders doesn't do anyone any good in the long run. Yes, issues of eating disorders in males does need more attention, but could we at least get the facts right first?

...for dieting, that is.

Most of us learned about the four seasons when we were younger, about spring, summer, autumn, and winter. Considering I grew up in Michigan, there were really two seasons: winter and three months of bad sledding. Now that I'm an adult, and living south of the Mason-Dixon line, there are many more seasons than I experienced as a kid in Michigan. To everything, there is a season, and to every season, there is a reason to diet.

Winter: It's your New Year's Resolution to have a Totally New You by developing those Buns of Steel. (I'd settle for buns of cinnamon, but then, that's me.)

Spring: It's going to be Bathing Suit Season soon, and you had better fit in that Itsy Bitsy Teeny Weeny Yellow Polka Dot Bikini you wore when you were three. So it looks like a thong. So what. I hear they're popular these days!

Summer: It's Bathing Suit Season and EVERYONE IS GOING TO SEE YOUR FAT ASS IN THAT BATHING SUIT SO YOU BETTER STOP EATING, YOU FAT PIG.

Autumn: Do NOT gain weight over the holidays, and here's how (you can start by not celebrating the holidays at all).

Ta-da! The year in dieting. Winter season is the worst, and right now about all I seem to hear commercials for are end-of-the-year car sales, cigarette cessation aids, and diet products. It makes me almost pity the poor guy who's trying to hawk replacement windows so that people can get their tax credit.

Almost.

Jeopardy!, the game show for grandmas and geeks like me, Jeopardy! for crap's sake, is now sponsored in part by a colon cleanser (aka, an overpriced laxative that just really dehydrates you and then you take a drink of water and bloat from here to Timbuktu. Trust me, kids, don't try this at home).

The Diet Survivor's Group blog has a list of alternate dieting headlines for magazines to use. Start with these examples and then you might just have a fun game to play in the checkout aisle at the grocery store.

Self Magazine:
The Food Lover's Diet - 31 Tiny Tricks That Peel Off Major Pounds
My Edit:
The Food Lover's Diet - Eat What You Love and Savor Every Bite

Allure:
The Easiest Diet Ever: Drop 600 Calories A Day Without Feeling Hungry
My Edit:
The Easiest Diet Ever: Eat When You Are Hungry And You'll Never Feel Hungry (duh!)

Shape:
How We Lost 477 Pounds Together: 6 Women Share The Diet Secrets That Worked For Them
My Edit:
How We Raised Our Consciousness Together : 6 Women Share Their Wisdom And Empower Each Other

Fitness:
Your Best Body Ever
My Edit:
Your Body Is The Best Body Ever

O Magazine:
How To Get What You Really Want This Year: Weight Loss That Sticks - Dr. Oz's Simple Secrets For Keeping The Pounds Off
My Edit:
Keep Working Toward Getting What You Really Want This Year: Body Satisfaction That Sticks - Dr. Oz's Simple Secret Is That There Is No Secret For Keeping The Pounds Off.

Seventeen
Total Body Confidence - Great Abs, Butt & Legs By New Year's
My Edit: (I got kind of hopeful with the first part...)
Total Body Confidence - Enjoy Your Body In Its Fullness All Year Long

Us:
The Biggest Loser - How I Did It!
My Edit:
The Biggest Winner - How I Did It! Tips To Love, Respect, And Honor YourselfWoman's World:Break Through Ohio State University BELLY FAT CURE! Discovery - Two Spoonfuls Of This Oil Will Block Fat Storage! Melt 5" Of Belly Fat - No Diet Required!
My Edit:
Woman's World Announces Bankruptcy As Readers Boycott Magazine Due To Outrageous Claims!

I guess this game beats hibernating...

{{brought to you from the archives...}}

I remember going to a therapy appointment quite a few years ago, flinging myself into the chair and promptly launching into a ten-minute-long tirade about how fat this complete idiot was making me. Didn't she see how huge I was? And she still wanted me to gain weight?!?

After I came up for air, my therapist looked at me and said with a voice that can only be described as overly saccharine, "Now, Carrie, we know that bad body image really isn't about how we look. Why don't you tell me what's really going on."

The reframe sent me further into a rage. Don't patronize me, I said. I'm feeling fat because I am fat and that's it. There's nothing more to it. Period. End of story. So why don't we talk about what we're going to do about my need to lose weight now that you've porked me up.

And so on. The session would not be classified as "productive."

With time, maturity, and proper nutrition, I've come to realize that my therapist had a point. I remembered her point today, when my work schedule can only be described as a game of Whack-a-Mole on meth. I'd send one email, and other editor would ask for art. I'd send some potential images, do the changes on the previous email. While making those changes, editor #2 would write back and say those images don't work, do you have any more? So I'd search for some, and then editor #1 would write back and...well, you get the idea.

I was stressed and on edge, almost ridiculously so. Perhaps not surprisingly (to my ex-therapist, at least) the feelings of body dysmorphia, body hate, and generally feeling "fat" came back. It got me thinking to something my friend Charlotte said about her daughter. Maybe the "fat" feelings weren't really about fat at all. Maybe it was anxiety that she was trying to translate the best way she knew how. Given our culture's general angst around food and weight, maybe this is how we make sense of anxiety. It's got to be about food and weight, right? What other explanation can there be?

Obviously, this isn't the only explanation, but the more I think, the more I'm beginning to understand the validity of this. My stress today had zero to do with food or weight. Zilch. And yet I immediately started fretting about what I was eating and what I must weigh. Logically, I know my weight is probably the same as it was yesterday, and the day before that, and... I know that emails from editors don't magically make my thighs expand (seeing how many emails I get each day, that's probably a good thing). But that didn't stop my brain from diving into those old, familiar depths.

I don't think that this is the sole explanation for body dysmorphia in eating disorders--one of the emails today was from a piece about body dysmorphia that's will publish shortly--but I do think it explains why stress is such a trigger for so many of us. Our brains are just trying to make sense of something we can't explain, so we do the best we can with the vocabulary we have. My own vocabulary happens to be marinated in the larger culture of diet obsessions. Maybe Catherine of Siena would have worried about her abilities to be holy if she were in my shoes (and they had email and Whack-a-Mole in the Middle Ages). That might have been how she made sense of her compulsion to starve herself. I have the same compulsion, but a very different culture that provides a very different vocabulary.

It would have been nice--and much less patronizing--if instead of just saying "We know bad body image isn't about our bodies..." with an unavoidable patronizing undertone, my ex-therapist had said that sometimes our brains don't translate anxiety properly. That sometimes we get confused and attribute worries about something else to worries about food and weight.

I don't know if you've seen the headlines (the story has been making the rounds in the psychology circles for the past day or two), but a study just came out that looked at the relationship between body dysmorphic disorder and nose jobs. The study found that one-third of people who wanted a nose job for cosmetic reasons had moderate to severe symptoms of BDD. Of those who wanted a nose job for medical reasons (to improve breathing, etc), 2% had been diagnosed with BDD.

Except that's not how the study was reported. Instead, headlines like "Nose job patients often mentally ill, study says." An excerpt from this piece below:

Of patients who were seeking the procedure to correct a breathing problem, only about 2 percent showed symptoms of BDD. But of those who wanted a nose job for cosmetic reasons, 43 percent showed symtoms of the disorder.


BDD was especially common among people with a history of mental illness, as well as those who had already had a nose job and were seeking “revision” surgery.

The problem, as John Grohol pointed out on the World of Psychology blog, is that "symptoms of BDD" aren't the same as being diagnosed with BDD. It's a subtle difference in words, yes. But it's a major difference in what we're actually talking about.

I had symptoms of the flu several winters ago. High fever, muscle aches, chills, feeling utterly crap, all with a sudden onset. Classic flu symptoms. Except a flu test revealed that whatever I had wasn't the flu. It looked a lot like the flu, it had the same symptoms as the flu, but it wasn't caused by the influenza virus.

Someone can have symptoms of depression (low mood, feeling hopeless), but not actually have clinical depression. Same with BDD. Same with EDs, too. The scales and questionnaires used in research aren't diagnostic tools. They can give you an idea whether you should see an actual living, breathing professional for evaluation and a potential diagnosis, but they don't say whether you actually have the condition.

It's not the public's job to know this. I'm not saying scientists shouldn't use these measures simply because they are so frequently misinterpreted by laypeople and journalists alike. But I am saying that journalists and editors need to know the difference. It's responsible reporting.

It happens with eating disorder stories all the time. Most commonly, it happens when people conflate disordered eating with eating disorders, or the scores on a survey with an actual diagnosis. The problem is that most people don't know there's a difference between these two things, or that the difference really matters.

Of course we would expect that people seeking nose jobs have higher concern and focus on their appearance. They are, after all, dropping thousands of dollars in an attempt to, you know, look better. But focus on your appearance isn't the same as BDD, and it's offensive to those who are suffering to make the two things equivocal. It's like saying someone who is obsessed with their weight has an eating disorder. They're not the same. At all.

We need to start distinguishing between these two things so that we stop trivializing deadly mental illnesses as little more than cultural fads.

I posted a few weeks ago that my weight had dropped a bit since my move, and although I've managed to stop the slide, I haven't been able to put any of the weight back on.  I got the smack down from my treatment team this week, and so I've been pushing the food over the past few days.  I can feel my body kicking into hypermetabolism (hot flashes, etc), but I also feel like Twitter's infamous "fail whale":

Yeah, that big.

I know the chances I've gained more than a pound or two in the past few days is probably miniscule.  So I can't really been significantly larger than I was a few days ago and feeling (relatively) normal.  But there you have it.

EDs aren't rational, and I suppose there's no point in trying to rationalize any of it.  I know the feeling will eventually pass, and I also know why I hate the weight gain process so damn much.  It's mentally and physically uncomfortable.  I'm functional, unlike other times I've had to gain weight, although I have significantly less weight to gain than before, which helps.

I know I shouldn't waste time kicking myself and thusly bruising my ass.  I had been doing a good job juggling many aspects of recovery, but keeping all of the recovery "balls" in the air was beyond my capability at the time.  Dr. H suggested that I come up with not only a food and exercise plan to keep me in recovery, but also to come up with a social plan.  When I'm more stable, I want to volunteer at a cat rescue or something.  I have a weekly crochet group and a monthly book club, which is good.  I also need lots of "me" time, so it's hard to balance both needs.

I know the fail whale feeling will pass, and that I will get back on my feet.  But in the meantime, it seriously sucks.

So this whole life-size Barbie doll created a spark of discussion not just on my blog, but also on the Today show.  Take a look at a clip from this morning's show via Hulu:



Did you notice that one word was absent from this discussion of eating disorders? One aspect of the discussion that is so frequently ignored, here and elsewhere?

Biology.

I'm not trying to ignore culture and the ins and outs of people's lives that can have a significant effect on the development of an eating disorder. I'm not trying to say that an eating disorder is "just" biology, because the idea that anything is either biological or cultural is pretty ludicrous.

But biology is pretty much absent from our discussions about eating disorders in the mass media. Sure, people will mention that genetics influence eating disorders, but the discussion stops there. Of course, biology is being mentioned, which it wasn't just a few short years ago. Still, the notion that eating disorders are rooted in biology and have an actual neurological basis is rarely mentioned in most stories about eating disorders.

So often, media stories file eating disorders under one or two major causes: unrealistic beauty images and control issues. There might be lip service to ideas about neuroscience and genetics and biology, but it doesn't get much discussion. And that bugs me. I don't want a slew of cookie cutter stories on eating disorders, blathering on and on about DNA and nothing else. Eating disorders are very complicated and biology is one aspect of the story.

But it's a big aspect. It explains so much about why people get sick and why they have such a hard time getting better. And we (as a community, as a culture) basically ignore it.

It's something that continues to baffle me.  We talk about biology in lots of other contexts--why are eating disorders so different?  Why are we so resistant to bringing up the biology factor?

It's nice to think about preventing eating disorders.  I'm not saying we can't do it or we shouldn't try.  But I'm wondering how teaching kids about "loving your body" and the dangers of eating disorders is actually going to help.

In a recent Huffington Post article, therapist Judith Brisman writes:

•Talk about eating disorders and how dangerous they are. Talk about it in the same way you talk about lung cancer and smoking -- or death and drunk driving. It's that dangerous. It can't be ignored.


•Help your kids pay attention to their inner life. What are they feeling inside when they turn to the third batch of cookies, or when they are skipping breakfast and lunch? Be genuinely curious about their fears, thoughts and worries about their body. And educate them! They may not know that skipping breakfast and lunch disrupts metabolism.

•Help your kids be responsible for what they are eating. Allow them snacks. For example, it's okay to eat cake -- but how many times a day? And what should portion size look like? Talk, be curious, instruct and pay attention. Kids need to know that if they get too skinny or become anorexic, they won't be able to be in the school play or on the hockey team. Kids should be as scared of anorexia, binge eating and bulimia as they are of smoking and drunk driving. They also should know that there are many things that can be done to help if they worry they are in trouble with food.

I don't think that these things are bad.  Open lines of communication between parent and child are very important.  And I do think that kids should be taught about eating disorders the same way they are taught about smoking, drunk driving and cancer.

My question is this: do we know that this will actually prevent eating disorders?

I'm guessing that most people who develop an eating disorder today probably know what one is.  I knew eating disorders were dangerous before I got sick, and it didn't really stop me.  One, I thought it would never happen to me. Two, I didn't realize I had anorexia until I was already stuck. 

I wish more kids (and adults!) were taught about the dangers of dieting and that "healthy eating" can go too far.  I want more people to know about exercise--too much and not enough.  I can believe that these things might help.

But explaining to someone how dangerous eating disorders are isn't going to prevent someone from getting sick.  It's like telling someone that cancer can kill you and expecting that this will make cancer rates go down.  It's a nice thought, but that's not how cancer works.  And that's not how eating disorders work, either.

Eating disorders are baffling and scary, and it's probably nice to think that if we just don't complain about our butts and if we tell little Susie and Sammy that EDs can kill, then surely they won't be stupid enough to get sick.  After all, my mother once told me (in all seriousness) that she never thought I would develop an eating disorder because I was smarter than that.  As in, I knew it was dangerous so why would I "dabble" in anorexia?

Because I didn't know I was dabbling in anorexia when I first got sick.  I just wanted to eat "better."  I was actually trying not to get anorexia.  It happened all the same because an eating disorder isn't a choice.  It's not logical.  It's an illness. 

Earlier this week, Pepsico announced a makeover for its Diet Pepsi.  The problem wasn't the taste of the soda, or the colors of the can.  No, the problem was the shape of the can.  Now, instead of being short and squat just like all of the other soda cans, Diet Pepsi is going to be tall and sleek and skinny.  And, so the ad campaign would like us to think, we can be too if only we chug cans of Diet Pepsi.

I find the whole thing offensive and annoying.  Yes, yes, I know the big wigs on Madison Avenue would like us all to think that thin is better, but um, can you guys be a little more creative with your message?

Not surprisingly, eating disorder groups have been up in arms about the can and the message that it sends.  In one article, a NEDA spokesperson said that the ad campaign was "thoughtless and irresponsible."  In a more in-depth interview with the Wall Street Journal, NEDA CEO Lynn Grefe said:

“I could care less about the shape of the can,” Lynn Grefe, head of NEDA, tells the Health Blog. “They could make it doughnut-shaped for all I care.”


It’s the Diet Pepsi media campaign that’s the problem, she says. The campaign celebrates being skinny and suggests that strong, confident women must be so. That the Skinny Can campaign is being paired with Fashion Week, an event put on by an industry that has had to address eating disorders among its model ranks, is particularly problematic, says Grefe.


This campaign won’t cause anyone to develop an eating disorder, but could trigger someone who is already vulnerable to negative body-image issues to start dieting or become more extreme in their dieting, which could eventually lead to disordered eating, says Grefe.


...And recent evidence shows that hospitalizations for eating disorders are on the rise, calling attention to the messages that are being perpetuated about thinness and dieting. “It is exactly that kind of thinking that has truly caused the increase in people feeling bad about themselves,” says Grefe.

But there's quite a leap in logic there.  No one's quite sure what is causing the increase in eating disorder hospitalizations.  It's likely that EDs are on the rise in younger adolescents, yes.  At the same time, most young people feel bad about themselves in some respect or another.  Yet very few develop eating disorders.

All of Grefe's statements were technically correct.  Yet I'm not convinced of the direct link between skinny can --> body image issues --> eating disorder.  I had body image issues my whole life, yet I only developed anorexia after I was depressed and thought that eating better and exercising more would make me feel better. Okay, yes, I wanted to lose 5 pounds, but that wasn't the real motivator.  Nor do I know that my body image issues wouldn't have been there in a non-diet-oriented culture.  More and more studies are linking body image disorders with deficits in neurological functioning.

These efforts sound good on paper, and I don't think protesting the skinny can is bad in and of itself.  Like I said, it's rather obnoxious.  Frankly, if I'm going to buy one of your products, I'd like to be respected a bit lot more.  I'm just not sure about the fact that so many people take for granted that there must be a connection between skinny things (jeans, cans, models) and eating disorders.  I do think that these messages are definitely a part of the cultural milieu in which eating disorders exist.  But eating disorders have existed long before the advent of Size Zero supermodels and (apparently) Size Zero diet soda cans.  I'm guessing that if all of this skinny model nonsense went away, another cultural issue would fill the void and be used as a scapegoat for eating disorders.

This "prevention" work sounds good. It's hard to oppose it and not sound like some sort of misogynistic skeleton-lover. It's not that I like these images, approve of them, or even think they're healthy. They're not. I'm just wishing more people would question the connection between these messed-up ads and their impact on eating disorders.

In the end, Laura said it best:

Somewhere in here, in the headlong and well-intentioned efforts, is also a confusion of ideas: disordered eating and eating disorder; and body image distress and Body Dysmorphic Disorder. There is an assumption that preventing body image distress will prevent BDD, and that preventing disordered eating will prevent eating disorders. That assumption needs to be questioned as well: do we really know that these are true? If so, how strong is the effect? One kid in 20? One in 1,000? One in 100,000? Not that one in a million isn't a good thing, but is that where our efforts should go? Or is preventing eating disorders the only reason for these efforts?

I just started reading Richard Dawkins' The Selfish Gene tonight.  It's considered a science writing classic, yet I still hadn't read the book.  It was either checked out of the library, or I forgot to look for it, or I could only find the super-duper deluxe anniversary edition at the bookstore.  But I stumbled across it at the library a week or two ago, and so I eagerly checked it out.

The idea of the book (if I can boil it down to a sentence or two after reading the first three chapters) is that plants and animals and microbes are really just genes' way of making more genes.  I haven't read enough of the book to know whether or not I totally believe it, but the book's thesis isn't really the point.  One of Dawkins' comments was that

A body is the genes' way of preserving genes unaltered.

Or, in non-Oxford University PhD speak, a body is the genes' way of making more genes.

As part of my eating disorder treatment, I learned a lot about how people viewed women's bodies over time.  They were objects or trophies.  Something to be subdued.  Something to be ignored.  Something to be feared.  And we discussed how we viewed our own bodies.  In my case, it was something to be conquered and tamed. Literally mind over matter.  I wanted to not need sleep or food or water or any of that.

It is one view of the body.  A skewed and not all that healthy one, granted, but it's a view.  Many of my therapists in treatment told me that I should think about what my body does rather than how it looks.  That my body should be my temple.  That I should love my body.

Mostly, I'm ambivalent about my body.  It does most of what it needs to.  It is what it is and I generally don't think about it too much.  No, I don't like how I look but whatever.

This quote struck me because it was such a different way of looking at a body.  Not wondering whether it was larger or smaller than me.  Or exercised more.  Or whatever.  Just that a body was what our genes used to make more genes.

The simple practicality of that statement--whether you agree with it or not, and as I said, I haven't finished the book, so I'm not going to say--was really eye-opening for me.  A body is functional.  Maybe the key to body acceptance is to stop making it so damn complicated.

My latest story for Scientific American, More Than Meets the Mirror, is actually relevant to this blog (it doesn't happen very much!).  It's about the relationship between body image and what's known as interoceptive awareness.

Are you cold?  Thirsty?  Hungry?  Short of breath?  Whatever your answer, you used interoceptive awareness to answer the question.  Previous research has linked interoceptive awareness to the insula, and people with eating disorders have been shown to have deficits in both of these areas.  But that didn't mean the two were necessarily related.  After all, I have red hair and green eyes, but my green eyes didn't cause my red hair (for that, I thank Garnier Nutrisse Honeydip).

So a neuroscientist at the University of London devised an experiment where he tested students' interoceptive awareness by having them measure their heartbeat without taking their pulse.  Then he used a trick known as the rubber hand illusion to trick the students into thinking that a rubber hand was actually a part of their body.  Those students with low interoceptive awareness were more susceptible to the rubber hand illusion.

From the story (I do feel a little weird quoting myself, but whatever):

"People with low interoceptive awareness might have a less strict distinction between what is 'my body' and what is the external world," Tsakiris says. "They might be ruled more by vision, rather than by internal sensation." Previous studies have also found that people with anorexia have an impaired ability to sense internal cues, making the results of this new work useful for understanding and potentially treating severe body-image disturbance.

To be sure, the study used a small sample size and has not yet proved causation, but "if we can train people to sense their interoceptive states," Tsakiris says, "it might make a change in their body image. An interesting avenue for future research would be to see if improving interoceptive awareness impacts different areas of these disorders."

As much as I love keeping up to date on ED news and research, I sometimes cringe when I click on a link.  Is the author of this news story going to screw it up?  Will they have done their homework?  Much of the time, the stories are a mixed bag--some bits are okay, some could use a bit of tweaking.

Every once in a while, though, someone knocks it out of the park.  With these two stories, though, the authors didn't do so in a good way.  It was awful.  I don't know whether I blame the journalist more, or I blame the people they interviewed.  Or both.

So for the first one:

Is Victoria's Secret Peddling Eating Disorder Porn?

No, Victoria's Secret is peddling overpriced unmentionables.  They're also peddling sex and clothes that make your partner want to do you.  They're peddling an image.  They're peddling an image of a sexualized, idealized women with huge boobs and a tiny waist.

It's very common for people with eating disorders to compare themselves to these idealized images and find themselves wanting.  It's also very common to try and lose a few pounds or get breast implants.  All of which are a waste of time and money and form a tremendous drain on society.  But really?

Eating disorders existed long before women with gigantic breasts and push-up bras paraded around on national television. In the Middle Ages, women with eating disorders compared themselves to holy women and other saints.  Those were the idealized images of what a woman could be, if she tried hard enough.  Part of that trying involved fasting for religious purposes. 

Today, some people with eating disorders fast for cosmetic purposes, or to be better at a sport or it just sort of happens.  It could very well be that women in the Middle Ages had a variety of reasons that motivated their behaviors.  They probably did.  The world may very well be a better place if Victoria's Secret disappeared. It would definitely be a better place if we stopped promoting only one body type as beautiful or sexy.  But whether there would be fewer eating disorders?  I'm not entirely convinced. 

These images, and our society's obsession with food and fat, are the cultural backdrop against which eating disorders occur.  We use and co-opt this language to help explain what we're going through.  Although exactly what motivates an eating disorder is far from irrelevant, motivation doesn't always explain causation.

Which brings me to the second article.

Butler Hospital Physician Too Familiar With Eating Disorders

Based on this doctor's quotes, however, I might advise a little more familiarity before saying such things as this:

Qualls said the disease usually arises from a person’s unhappiness with their appearance.

The media play a role in the equation, he said, providing a model of the body that may not be realistic or healthful for people to strive to imitate.

...Diseases such as compulsive purging or not eating tend to occur during transitions in life, he said. Among them: girls going from eighth grade to high school, “which is a triggering event because all of the sudden boys become more important,” he said. “The next change is when they go into college. Once they experience [a disorder], they are at risk of this recurring at any point for the rest of their lives.”

*headdesk*

In case this isn't obvious by now: my eating disorder had nothing--nothing--to do with wanting to look good or attract men.  Nothing.  I thought that eating better, exercising more, and yes, maybe losing 5 pounds would help me feel less depressed.  After a while, I knew I looked atrocious.  I thought nothing about sex and dating.  I knew that the ED was destroying my health and appearance, and yet I couldn't stop.

The concept of "re-education" sounds very Soviet, and maybe it is, but I kind of want to have an intensive training program for these journalists and especially these doctors before they are allowed to even see another ED patient.

Last night, I had a fat attack.  My old therapist back in Michigan would have preferred that I reframe it as a "bad body image attack."  Well, maybe.  But this feeling was very different than looking in the mirror and saying "Ewwww..."  Which I've also been known to do, but not last night.

For starters, I was laying in bed and not looking in the mirror.

For seconds, it wasn't a visual issue.  It was a more physical, visceral issue. 

I wanted to claw my way out of my own skin.  I felt huge, uncomfortable.  I couldn't stop thinking about my body.  I wanted to do something, anything to get rid of this feeling.

Somewhere through the anxiety, I started thinking, "You know what this reminds me of?"

OCD.

I had the stereotypical germ OCD when I was in high school.  Mostly, I obsessed and worried over every little thing.  Either I was harboring some nasty germ that was going to kill everyone I knew or saw or had contact with, or everyone I knew, saw, or had contact with had a germ that was going to kill me.  I would wash my hands or reply scenes in my mind to make sure I hadn't touched something "bad" or coughed wrong or whatever.  I would inspect every inch of my skin to make sure I didn't have any cuts that could get or receive germs.

Therapists call these contamination fears.

I felt like my skin was crawling with germs.  I washed my cracked, pathetic hands in bleach to try and make this feeling go away.  No, I couldn't see the germs. I wasn't always 100% positive they were there, but I was sure that I could feel them.  All I wanted to do was make that feeling go away.  If it meant screaming in pain from bleach, so be it.  I was so distressed and terrified that nothing else mattered but making this feeling go away.

Which brings me back to the fat attack.

I didn't feel that my skin was crawling with germs, but it did feel like it was crawling with fat cells.  And in moments like that, it suddenly doesn't seem so foreign/stupid/pointless to do something like purge or overexercise.  I didn't, but nonetheless.  Thinking of these fat attacks as another manifestation of my OCD has made a lot of sense to me.  Yes, I have significant body dysmorphia above and beyond the fat attacks. 

Yet any time off exercise or eating something "unsafe" or "forbidden" would bring about a fat attack--just as touching something dirty would set off a contamination attack.

I don't think this totally explains my eating disorder.  Not at all.  But it does explain parts of it.  It helps explain why I would do such crazy things.  To escape the distress.  To keep the calm.  Vanity and sticking to my "diet" wouldn't--couldn't--explain this.  If you're scared enough, you will do some crazy things.

I never was able to recover on my own as an outpatient because the fears and the feelings were just too strong.  It meant living in a non-stop fat attack for months with no sense of relief.  Considering the crazy stunts I pulled to avoid the feeling just for a few hours or days, is it really any wonder that I tried to avoid refeeding and recovery?

Seeing fat attacks as OCD helps me calm down in the moment.  It's just the OCD talking.  The OCD was wrong about me spreading or receiving the plague, so it's certainly wrong about this.  What's more, I know the awful feelings do pass.  Eventually.

I have the Arnold Family Thighs^TM. It makes jeans shopping an absolute nightmare, and let's not even start in on my body image issues.

But I'm not going to bore you all with an entire post about how much I hate my thighs.  I think about it enough.  Instead, I'm going to write about a time this past weekend when I didn't totally hate my thighs.

I've written about my love for my bike and how cycling has really helped in my recovery.  This past weekend, I did a longer ride as part of a group outing to a local national park.  The trip was really, really fun.  I was rather proud of myself that I kept up with the fastest in the group with no problem (except for the one self-proclaimed Speed Demon).  It was a mixture of road and paved and unpaved bike trail.  The weather was perfect, and I had a great time.

While I was riding, though, I wasn't cursing those Arnold Family Thighs^TM.  I was thinking that those thighs--my own damn thighs!--might be one of the reasons I was so good at biking.  Instead of being a liability in jeans and a bathing suit, my thighs were an asset.

I still hate how they look.  I still think they quiver so much when I walk that you could reasonably measure the vibrations on the Richter scale.  Cycling hasn't made me love my thighs, but it has made me appreciate their function.  I'm not going to get all sappy on you and write a long thank you note to my thighs.  That's not the point of this post, nor could I handle that much cheesiness all at once.  The point of this post is learning to appreciate something you don't like, of turning your liabilities into assets.

I've probably mentioned this before, but my OCD habits and behaviors have gotten me a writing job (that I ultimately turned down for other reasons).  My proposal was the only one without any typos, so the person picked me--I don't think I was supposed to see that email, but there you have it.  Most of the time, my OCD is a huge drain on me and the stuff I want to do.  I can't do things because I'm too busy checking and counting and double-checking.  I don't like my OCD stuff.  It annoys the crap out of me.  But as much as it has been a tremendous liability, it has also been an asset.

The liability of my thighs is probably mostly in my head--and in a few screaming hot pairs of jeans I had to leave behind.  But my thighs aren't universally bad or useless.  They help me ride my bike.

TNT is starting a therapy group, and she wants me to go.  The group is CBT-based, and it's sort of an "Advanced Recovery Skills" group.  In order to attend, you need to be asymptomatic in your ED and at least decently into recovery.  I fit the bill, and TNT wants me to come.  She says "it will be good for you."

I think all therapists say this when they know you're going to object to their advice.  It's in the Therapist's Handbook that provides scripts like "Tell me about your mother," and "How does that make you feel?"  Okay, I'm being somewhat sarcastic, but still.  I definitely have mixed feelings about group therapy.

I agreed to go, and I had to commit for the first month.  So four Mondays, 1.5 hours each week, 6 hours total.

But still I worry.

I worry I will have nothing to say or contribute.  I worry I will be either too utterly mental or too normal.  I worry the group will turn into a competition-fest.  I worry that no one else will think I should be there.  I worry I will waste everyone's time.

And yes, sad to say, I worry a lot that I will be the fattest one there.  I've already gained over my target weight--significantly over my target weight.  Whether that means the initial target was wrong or that my body wants to hang onto some extra weight because of the years of starvation, I'm not sure.  So yes, I am very uncomfortable with my weight right now.  It's worse because I have no idea of my actual size (I know, I can look at the tags on my jeans, but unless I know everyone else's pant size, I have no real way to compare), and so all I can do is obsess about how large I really am.

I know EDs can come in any shape and size.  I know that.  This comparison is much more of an internal thing.  It's competition combined with body dysmorphia combined with the fact that I have no real idea how big my ass is.  When I see pictures of myself from New York two weeks ago, all I can see is how huge I am.  It blots everything else out.  I get panicky and start to feel ill. I'm HUGE compared to everyone else.  And I'm so disgusted I kind of want to throw up.

This is the part that TNT thinks would be really good for me to deal with in group.  That would be a fantastic group icebreaker: "I feel like the fattest one here. Let's discuss." 

So, yeah, group therapy.  This should be really interesting...

Writer Naomi Wolf was the keynote speaker at NEDA this year, and I honestly wasn't sure I was going to hear her speak.  Not because I'm anti-feminist (I'm not) but because I've read her book "The Beauty Myth" and I didn't find it that relevant to my own experience of an eating disorder.  I'm glad I went as a) it wasn't as bad as I feared and b) I found that many people had a similar response to what Wolf had to say.

I've heard Wolf speak before, and she is a phenomenal, engaging speaker.  She's super-articulate, very intelligent, and she knows her stuff.  I very much respect her and what she has to say.

However...

Although I think our cultural ideas and beauty obsessions and diet mentality are absolutely toxic, I don't think that if you eliminated them, you would eliminate eating disorders.  Most women feel bad when they're looking at Photoshopped models.  Most women diet at some point.  Most women don't have eating disorders.

(Not to mention, what about men?  What about people who live in cultures when thin isn't overvalued?  What about people with non fat-phobic anorexia?)

It's not uncommon for an eating disorder to start with an effort to "tone up" or "lose a few."    Yet once the disease process starts--once it kicks in--appearance is the last stinking thing most people with EDs are really thinking about.  People told me that my ED was making me look atrocious.  I was aware, on some level, that they were right.  By that point, the ED had a life of its own.  I was terrified of eating.  Even if it didn't have calories and exercising didn't burn any of them off, I would have still felt compelled to starve and exercise.  I couldn't stop.  That's why it's an illness.

I'm aware that the only evidence based prevention programs for eating disorders have focused on improving body image, and I'm not saying they don't work.  The research literature shows they do work.  But in a survey of 6000 eating disorder sufferers, no one said that their eating disorder had anything to do with vanity or cultural ideas (I heard this in a presentation by Susan Ringwood, the CEO of the UK charity B-EAT).  They did say that cultural ideals made it harder to recover, something I definitely endorse.

Eating disorders existed before thin was in, and they will probably exist after Size Zero seems as antiquated and misguided as chastity belts and foot binding.  The cultural language of fat and thin and dieting are what we have to put our experience into words.  They are how we frame what is happening to us.  People in the Middle Ages framed anorexia has an effort to be more spiritual.  Now, we look at it as an effort to be thinner or look like some supermodel.  But the way we make sense of an illness is different than the illness itself.

It just fundamentally bothers me that fighting eating disorders is seem as (in large part) fighting the fashion and cosmetics industry.  They use our obsession with being thin and such to sell products, it's true.  They make lots of women feel insecure about their looks, and then go on whackjob diets.  The body dysmorphia that accompanies an eating disorder isn't just a really bad version of wondering if these pants make your thighs look fat.  Being beheaded isn't just like a really bad paper cut, either.  An eating disorder isn't a really extreme diet.  It might look like that, but it's fundamentally different.

Wolf mentioned nothing about underlying vulnerabilities like anxiety and depression to eating disorders.  She did say that restricting in and of itself is crazy making, which is good.  Although she said that "parents don't cause eating disorders," she also said that her own mother's bitching about her thighs primed her for anorexia.  None of her other siblings developed an eating disorder, yet I'm sure they all heard the kvetching and comparing.  Why Naomi?  Why only her?  It's fundamentally not okay if your mother is diet-obsessed and tells you you're too fat.  Not okay.  And that sort of environment is certainly conducive to the development of an ED, but it's impossible to say that had this person grown up in a different environment, they never would have developed an eating disorder.

It was...frustrating at times to hear no mention of science and biology.  My friend Sarah Ravin asked Wolf afterwards why there was no mention, and Wolf said "I don't really do that science stuff."  I understand that science might not be everyone's little pet, but seriously?

The emphasis on beauty images only reinforces the idea that EDs are an expression of vanity, or just a bunch of beauty-obsessed kids who need to stop reading magazines.  And they're not.  Our focus on this does everyone a disservice.

I leave for the NEDA conference in about 8 hours.  I've rehearsed my talk numerous times, made sure there are no typos in my slides, and I've broken in my new shoes.  My suitcase is mostly packed, and I am just about ready to go.

My presentation is at 4:15pm on Saturday afternoon, which leaves me about 42 hours until I have to speak (not that I'm counting).  I am more than a little nervous.

Of course, because of my ED history, the nerves don't stop at my talk itself.  As I step out into the public as an advocate and person in recovery (which doesn't happen as often as some of you might think), I have all sorts of worries.  For one, I worry that people will look at me and think, "You? You had an eating disorder?!? You're way too fat to have been anorexic!"  And the issue of trying on clothes I haven't worn for a while doesn't make the body image issues any easier.

But I'm not going to NEDA to "look like" an ex-anorexic (if, indeed, an "ex-anorexic" can be said to look like anything...), I'm going to share my wisdom and re-connect with friends.  I'm going to make new friends and meet people I've only known through the internet.  These are not people who are going to be judging me.

It's nerves about travel and being in public and putting myself out there.  I'm packing lots of snacks and I have books and my phone, so it will all be fine.  Just fine.

Breathe.

I joined an outdoor club in my area and went to my first gathering, which was a mountain biking excursion, followed by dinner and beers. I've gotten pretty good at road cycling, and so I thought I would try it out both for the physical challenge and for the opportunity to meet people.

Let's just say that although I anticipated that this bike ride would be physically challenging, I in no way anticipated just how physically challenging it would be. My shoulders and biceps are sore because I was holding onto the handlebars for dear life. Several times, my legs just about gave out from exhaustion. I ate a slightly bigger afternoon snack than usual, but it wasn't quite enough.

But during the entire ride, I wasn't thinking about my fat ass or my jiggling thighs. All I was thinking was "Don't fall. Don'tfalldon'tfalldon'tfall." Or "Please, lungs, give me one more liter of air. Fine, a milliliter. Or even just a couple molecules of oxygen." I was stark bloody petrified and had to concentrate intensely on the path in front of me. It was sandy and there were tree roots everywhere- any lapsed attention would have meant that I ate a faceful of dirt.

It was, in short, an exercise in the function of my body over its "form." I'm not much for the adrenaline rush, but I did enjoy the challenge. And I met a very nice group of people who do this every other week.

Will I do it again? Probably. I know I prefer biking on a road (or at least packed dirt) compared to off-roading, but it's fun enough. And it was nice to totally not think of the ED for a while.