Defining an Eating Disorder
January 21, 2010

scale

Hey all!

It’s already Thursday? This week has been intense, but (thankfully) swift.

I’d like to call all of your attention to Abby Ellin‘s thought-provoking and candid article in Monday’s Times about the way scientists and doctors are being forced to refine the language they use to classify eating disorders. The jist of the article is this: the majority of eating disorders do not, contrary to common belief, fall into the neat categories of either anorexia or bulimia. Nor can they always be classified by the standard criteria of disordered eating: low body weight (85% or less than the minimum of the normal BMI range), loss of menstrual period, hair loss, skin dryness, weakness, terror of weight gain, and body dysmorphia. Women with disordered eating may display some of these symptoms, but they often don’t present with low body weight or amenorrhea; conversely, there are women with low BMIs who are more sound in their eating patterns and psychology than women who have a normal body weight, but deeply disordered behavior and psychological patterns.

Most eating disorders, in fact, can be classified as Ednos, or “eating disorder not otherwise specified.” The problem with this vague classification is that it’s too broad and too variable for most doctors to cope with or understand. Ellin writes,

“For now, though, Ednos remains the nation’s most common eating disorder. A September 2009 study in The International Journal of Eating Disorders found that Ednos was often a way station between an eating disorder and recovery or, less commonly, from recovery to a full-blown eating disorder.

While traveling with a scale in your backpack is not one of the criteria, preoccupation with weight and food is. So are severe chronic dieting, frequent overeating, night eating syndrome, purging disorder and possibly compulsive exercising. If that sounds a little vague — find me one woman who isn’t preoccupied with her body size — psychologists make a distinction.

“The eating has to be disordered in some way, as does the behavior relating to eating,” said Ruth H. Striegel-Moore, a professor of psychology at Montana State University. “Also, it has to lead to some kind of impairment. For instance, some women will not go to parties because they’re worried about eating.

“If you’re restricting yourself so much that it affects your work negatively, you would meet the criteria for Ednos.”

Even so, many clinicians say the diagnosis is just too roomy.”

I’m thrilled that attention is being called to the slipperiness of the language we use to talk about disordered eating. A great many of my female clients are women who either do, or used to suffer from disordered eating patterns. Unfortunately, many of them have a hard time even uttering the words “eating disorder.” This is sometimes because they have yet to come to terms with it, but most often because they feel ashamed of using the expression to describe behavior that didn’t meet worst case scenario standards. They’ll be quick to remind me that they were “never skeletal,” never in in-patient, never near death.

But of course, that doesn’t mean they didn’t have eating disorders.

Many of these women struggle terribly to accept their bodies; many had severe body dysmorphia. Many never lost periods, but did lost significant amounts of weight; many describe years or even decades of utter fixation on food, fear of eating in public places, attachment to food routines and habits, or binge and restriction cycles. Many overate and abused laxatives subsequently, or exercised to burn off their closely tabulated caloric intakes. In short, they had habits that, while not necessarily “enough” to classify as anorexia or bulimia by medical standards, were absolutely disordered. And the fact that they never hit rock bottom doesn’t mean that they did not suffer.

Clearly, the time has come for us to redefine the standards we use to diagnose disordered eating. Eating disorders do, it’s true, manifest themselves in a set of real symptoms: weight loss, cold, weakness, cachexia, fainting, hair loss. But they also manifest themselves as ways of thinking and being: fixation with one’s daily weight; fear of being wrested from one’s food habits; binging and purging; obsession with food, meal planning, and calorie counting, laxative abuse, over exercising, and so much more. Body dysmorphia, of course. The less we acknowledge that eating disorders are a frame of mind, as well as a set of physical symptoms, the more we do a disservice to the many women and men who are suffering. This is not only because we invalidate people’s concern for themselves–that is, we encourage women who are developing disordered eating patterns to ignore the problem because they aren’t necessarily matching clinical criteria–but also because we supply eating disorder sufferers with an excuse to ignore the issue. Alcoholics are famous for pointing out that they’re “not as bad” as so-and-so (the guy who passes out or falls over drunk); people with eating disorders will often justify their behaviors by thinking “it’s not as though I’m skeletal, like that girl who had to go to the clinic for a month of school last year.”

If you or a loved one is showing any signs of truly disordered psychology about food–fear, anxiety, strange and socially isolating habits, etc.–please don’t be afraid to speak the words “disordered eating” aloud. Of course, most women struggle with low self-esteem at some point in their lives, and it’s wrong to liberally diagnose everyone as an eating disorder candidate. But use your gut: if you believe that your fixation with weight or food has surpassed the norm, realize that you deserve help. Just because you haven’t reached worst-case-scenario depths, it doesn’t mean that you can’t, or won’t. Now’s the time to face the problem.

It’s never easy to say the words “eating disorder” — or to say them about someone you love. They’re scary words, loaded with overly rigid associations. But fearing the language, or avoiding it because you don’t seem to fit a textbook definition, may keep you a step away from healing. Forget the image that “eating disorder” conjures up in your mind; anyone who suffers from disordered ways of thinking about food is worthy of help and compassion. We all deserve self-care.

Phew. Thanks for bearing with that sermon. I really encourage you all to read the article.

And when you’re done, and you want to read something lighter, check out this fun article, in which I’m interviewed by Mimi for her college newspaper. It was a delight to connect with her!

Have a great night.

xo

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    80 Comments
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  2. Just found this website and this was the first article I read. It was an amazing read and I will be a long time follower of your posts. This issue gets far too little attention, as the “norm” is pushed down our throats it seems we cannot talk about eating disorders at all.

  3. I just found this article and I am so close to tears (and that doesn’t happen often).
    The way you write and especially WHAT you write takes my breath away. I am forever grateful for finding your blog.
    Love, Lara

  4. This is a great article and describes my situation so well. I too was never an in-patient or lost my period but I did have disordered eating. I think it is definitely time for the medical community to recognise that there is a wide scale of disordered eating and EVERYONE should get the chance to get help. I’m not taking anything away from people who are truly ill and at rock-bottom but I feel EDNOS doesn’f differentiate enough between different stages of disordered eating. Thanks for writing such a great article and help bring this important issue to more people’s attention.

  5. What a great article! so many more people are affected by disordered eating than we realize. Indeed, one does not have to reach rock bottom to deserve some professional help! I’m glad that people are starting to raise the awareness of this psychological disorder!

  6. Thank you for touching on such an important issue. It is true that many women in the raw/vegan community have struggled or are struggling with an ED, but, as I myself have encountered the same issue, I truly think it is possible to overcome THROUGH a novel, mindful approach and healthy eating. This needs to be said, thank you for saying it.

    PS: Mind if I add you to my blogroll?

  7. THANK YOU! Just found your blog as I research the healthiest diet for my RA. My daughter, who is now 21, has suffered from ED/disordered eating since she was 15 (although technically her weight never fell below the established guidelines). I have read numerous books and articles as well as had numerous therapist consultations for my daughter. NONE came close to nailing it as you did. Those posters who said there was a fine line between someone who strives to eat healthy and maintain a healthy weight have no idea what they are talking about. The misery and emotional pain, impact on daily life, strained family life, and the ruined relationships as a result of the disordered eating doesn’t begin to compare to striving for nutritional excellence. It’s very difficult to deal with when no one understands. Thank you for putting it into words.

  8. wow, Gena this was an amazing post! a bit late on the commenting, but i found this very profound and interesting and sooo true, i have known soo many girls as i have been in inpatient numerous times for my anorexia/eating disorder, who say they dont have an issue bc they never hit “rock bottom” etc…but so untrue, and this was great to raise awareness.

    xx
    maya

  9. Thanks for posting this article and your response, Gena.

    I wonder if the distinction between “eating disorders” (such as those defined in the DSM) and patterns of “disordered eating” might be relevant to the kind of treatment provided for each of these problems. For me and my therapist, it was helpful to understand my disordered eating – EDNOS in this context – as a symptom of other anxieties. I started noticing the context for my rumination/worry/obsession with food, and I was able to pinpoint other problems that were manifesting themselves in my behavior around eating and exercise. Seeing my eating/exercise behavior as a set of symptoms rather than a disorder in and of itself was really liberating. I imagine, though, that if my disordered behavior had progressed – to a “disorder,” we might say – and placed my physical health in jeopardy, then I wouldn’t have had the luxury of exploring situation and context. In this case, medical treatment and perhaps behavioral therapy would have been necessary and would probably have preceded other forms of talk therapy.

    I’m just speculating here based on personal experience, so I may be off base. But it does seem necessary to keep the relationship between diagnosis and treatment in mind when discussing some of these ambiguous disorders.

  10. Hi Gena, I found your website a few months ago, and after reading your posts it has inspired me to try incorporating more raw foods into my diet. I always thought it would be really expensive or difficult, but your meal ideas are always simple, so it really is easy!

    Keep up the great work!

  11. Part of the reason why the DSM definition is as broad as it is is because broadening it TOO much can result in over diagnosis.

    The fact is, not everyone who has some disordered eating patterns has an eating disorder. Its similar to how someone who may be obsessive about locking doors to the point that they would drive home from work to be sure their door is locked has OCD. While disordered eating habits are common, it takes something above and beyond some “food issues” to have an eating disorder. While I’m not saying the DSM definitions are perfect (they aren’t, and a friend of mine did some research for one of the foremost ED researchers in the country that I found interesting), there are some legitimate arguments in favor of keeping them a bit on the broad side.

    I’m not saying you’re entirely off base (you aren’t), but by telling every single person who has ever gotten a little caught up counting calories or cutting out things that they’ve had an eating disorder there is a really slippery slope we risk walking. And really, if you use broad enough definitions I think a good percentage of food bloggers could be categorized as disordered based on fear of gaining weight, eating certain foods, etc. Hell, a majority of women and MEN have probably had an eating disorder if you get too broad…

    Finally, please pardon the anonymity of my reply. I am neither trying to be rude nor be a pure devil’s advocate, but for various (including but not limited to graduate research and personal experience) reasons I’d prefer to keep it that way.

  12. I enjoyed this post, as well as the comments. I agree with much of what has been said about social influences, the state of our society, whether or not food blogs are healthy, and questions about what ‘normal eating’ is any more.

    Much of the focus here seems to be on AN and Bulimia. I’d just like to point out that people with eating disorders are not all underweight. Disordered eating extends to the other end of the spectrum as well, to people who are overweight – or even average sized – because of their eating disorders. Even those with bulimia. There are all kinds of unhealthy relationships with food, body image, etc. I have disordered eating issues, as do other people I know. But for me it’s never manifested itself as being too skinny. Food addiction and over eating are just as real and just as damaging, with many of the same issues: Avoidance of social/food situations, obsessing about food, etc.

    In some ways, I think that eating disorders at the “fat” end of the spectrum are more taboo (and often less talked about, which is why I wanted to mention them) because in our society rarely is anyone going to compliment you on looking good while being overweight. There is much more of a stigma at having a big gut, than having your spine poking out of your t-shirt. Let’s face it: Hollywood is rife with jutting collarbones, but has very few muffin tops. But both situations, so long as they’re fueled by disordered relationships with food, are equally as heart breaking.

  13. The amount of men and women who deal with disordered eating, who have a love/hate relationship with food, who starve/binge/guilt themselves is astounding. It breaks my heart.

    I was one of them.

  14. This is so true. Thank you.
    Just to let you know, I mentioned you in my blog as the creator of (the very divine) banana soft serve :]

    dudenudefood.blogspot.com

  15. This is the sort of trouble that springs from trying to use physical diagnostic criteria on a mental disorder. :\ Sad irony being that all too often (at least, I know I wasn’t alone in this) the particularly hard-hit teen-struggling-with-identity demographic sees that according to the medical profession, their eating disorder ‘doesn’t count’ or ‘isn’t good enough’ and use that as an incentive to ‘work harder’ to ‘earn’ the diagnosis.

  16. Gena, thanks for this. As someone with EDNOS, it’s really hard to tell people. One of the reasons is because I don’t fit into an easily explainable category: hating my body, obsessed with my weight, yo-yoing between restricting food and eating too much, the stress of social situations involving food, going grocery shopping, and anytime I eat, exercising like a maniac, debating whether or not I “deserve” to eat, knowing that I am an intelligent person who should be so much “above this” and not able to understand why everyone else doesn’t have this same relationship to the body and food.

  17. Well, this is an interesting post. Truthfully I have a lot to say…but no patience or attention-span to type it all out ! Interesting. The comments of readers are interesting too. I have conflicted thoughts about the whole thing truthfully. I plan to do a post soon (maybe tommorow , or near future) with some questioning issues. With regards to EDNOS though, yes it is a real diagnosis. And also I do believe a ton of people have disordered eating in some way…some way or another….a lot of people deny it (which to me is a bit aggravating). But individuals are individuals.
    By the way, I am definitely not raw or vegan. But you post some interesting things Gena. Causes of great debate I think for sure on several things.

  18. i really loved this post and think it’s so important to remember that eating disorders aren’t always clearly defined- i think far more people far into the fuzzy gray area known as ednos. i really think the media and weight-loss advertisements have helped to instill fear and encourage disordered eating in our society. it’s sad, really.
    hope you’re having a lovely weekend and thank you for (yet another) wonderful and thought-provoking post.
    xoxo

  19. Wow! What a very thought provoking article for you to share. I’ve noticed just how many women have or at one time in their life has had this type of disorder. It affects men too. One of my brothers best friend in high-school(great guy and very cute), was hospitalized due to anorexia. It was a shock to all of us because we never heard a male with this disorder before.

    I agree with what the Voracious Vegan. I really believe that most of these disorders are caused by what society had done. We have the actresses, magazines etc and look at these women! When we are teenagers we want so much to fit in and if we feel we aren’t we think we don’t look right or are too fat. Next thing you know we have some type of food disorder. I can say this because I had issues back then as well. I realized later it had nothing to do with looks or weight, I was extremely shy and that played a huge part. Now as a vegan, before vegetarian, I don’t want to have the medical problems that are in my family and I don’t want them for my son. I don’t need to worry about weight because what I put into my body is good for it and when I’m hungry I eat because I know It’s telling me it needs nourishment. I hope that more people can come to realize what I’ve come to realize.

  20. Gena nice article. Very well explained. Many of todays teenagers are suffering from this disorder and they need help!!

  21. Great article Gena thank you so much for posting it!!! I suffered from bulimia in my early teens and also had what i guess it was some kind of “exercise bulimia” this year..i obsessively count calories and when my mom suggested i “got help” i got really angry because i thought i was cured and didn’t need it.

  22. Thank you for another masterpiece post, Gena. You are so incredibly insightful and wise and you are such an eloquent writer it’s hard to believe you are still in your 20’s. You are an old soul!

  23. I think there’s a difference between disordered eating and an eating disorder. I think most Americans struggle with disordered eating — I mean, what IS normal eating anyway? An eating disorder I tend to think of as much more consuming — obsessive thoughts and behaviors, something that really controls your life (one example: not wanting to go out with friends because food may be involved). While EDNOS isn’t very well defined, I do think it is a good option and completely understand the “relief” that may come with a diagnosis — like THERE, I knew something was wrong, and since there is a name now I feel like I can legitimately ask for help. Hope my thoughts make sense here! 🙂

  24. how wonderful that such issues are being brought to light. its so odd how the world seems afraid to discuss these things…same with psych disorders. mental illness is a reality, and maybe if we werent all so nervous to say such hot topic words there would be brilliant progress.

    ps the meat and potatoes post was fabulous…must have been something in the water, since we both had simultaneous non-potato recipe ideas…

  25. “The less we acknowledge that eating disorders are a frame of mind, as well as a set of physical symptoms, the more we do a disservice to the many women and men who are suffering. This is not only because we invalidate people’s concern for themselves–that is, we encourage women who are developing disordered eating patterns to ignore the problem because they aren’t necessarily matching clinical criteria–but also because we supply eating disorder sufferers with an excuse to ignore the issue.”

    I wish this part had been bolded in the post because I feel that it is *so* true and cannot be emphasized enough. When it comes to psychiatric disorders, many of them are diagnosed simply through a cluster of symptoms. But the symptoms themselves–whether they be physical or psychological–can be manifested in individuals differently, so there is a lot of grey area, a lot of variability. Not meeting what seems to be a hard, fast rule in a clinical diagnosis doesn’t mean nothing is wrong.

    Thank you so much for writing about this topic and for sharing that article and your insights. I hope (and believe) it will help at least one individual who has read.

  26. This is very insightful Gena. I suffered for years with disordered eating that didn’t fit into a category. Thank you for inspiring me to focus on nourishing my body, and making it beautiful on the inside first!

  27. Good post! I’ve certainly fallen into that Ednos category during periods of my life, when I turned to diet pills and skipping meals to stay skinny in college. I still count calories to ensure I don’t gain more than a pound or two of water weight. And I plan meals and snacks. But I feel like those things give me control so I don’t have to worry about getting fat. Luckily, I’ve stayed the same weight now for nearly 10 years…and that’s made me feel more comfortable letting loose sometimes. When I do binge, I totally binge … eating everything in sight (like say at a potluck). But then I follow a strict healthier eating routine in the days that follow a binge.

  28. Fabulous, Gena. Thank you for this. Unfortunately I think we all know far too many people, I know I do, that suffer with undiagnosed disordered eating. Most women I know, in fact, have an irrational fear of gaining weight, talk constantly of ‘guilt-free’ food or feeling ‘sinful’ after indulging, etc, etc. It is heart breaking the things that society has done to women and the self-hatred we have been convinced to internalize.

  29. I read the article in the Times as well and am really happy you brought it up. I feel like many of the people I know think that the constant discussion about their weight, how they need to deprive themselves one day so they can splurge later or how they “just want to lose a few lbs, so they’re planning on only eating lean cuisine for the next few days” is totally normal and it’s not! Sometimes my co-workers pick at my “healthy eating” and kind of project their own insecurities on me and it’s a bit uncomfortable. Lots of people, myself included at times, are uncomfortable with themselves in some way or another. However, it’s important to realize it and try to fix your thinking instead of just hiding behind the thought that “I’m not disordered because I haven’t hit any kind of extreme”. Really great post – thanks!

  30. Maybe we need to move away from criteria such as BMI and so on (according to BMI charts I am still “underweight”) and simply ask questions about the role of food in one’s life (source of stress? source of mental preoccupation? obsession?). I’m not 100% raw, but I don’t think being 100% raw signifies any kind of eating disorder. While I’m grateful that eating disorders are being redefined so that folks needing help can get it, we have to be careful not to go about diagnosing eds where they don’t exist. Don’t forget – what looks restrictive from the outside, may not feel restrictive to the person following the lifestyle. My diet looks very restrictive to people (I don’t eat meat, or corn, or soy, or gluten, or anything overly processed or packaged … not because I’m restricting, but because those things might as well be rat poison … I have zero desire for them). I also skip lunch more than I eat, not because I’m denying myself, but because I’m not hungry. Anyway, my diet raises all sorts of questions, but believe me, “restrictive” is not even in my vocabulary. I eat what I want, when I want, in what ever quantities I want. No one believe this but it’s the absolute truth, and I’ve been eating this way for 15 years. Long before I went raw.

  31. While I am not a raw foodist by any means, it’s posts like this that make me love this blog. This is the sort of topic most everyone can relate to through personal experience or through knowing someone who falls into this category. Great topic Gena!

  32. Wow, not only to your post but to all the comments that have followed. I’m a little misty on behalf of all these readers! And ok, on my own behalf too. I squirmed a lot while reading this because I didn’t expect to see so much of myself in it, which of course was the whole point of your writing this. While I do still firmly believe I am recovering from my disordered behaviors, being able to recognize them for what they were in the first place, even if they weren’t worst-case-scenario, only strengthens what I do for myself in order to keep them from returning.

  33. Great post Gena. I think there is such a fine line between disordered eating/behaviors and being aware of what and how you eat. A lot of people don’t even recognize which group describes them better. Hopefully this post will bring some awareness to the subject!

  34. This is an incredible post — thank you. As a twenty-something I know (and knew in college) so many other women who suffer from disordered eating, but it is never brought to light because they are not suffering from either anorexia or bulimia. But body dismorphia and the restrictive-binging cycle are also damaging mentally and physically. I have believed for a long time that more thought and care should be put into these diagnoses,

  35. P.S.

    “Alcoholics are famous for pointing out that they’re “not as bad” as so-and-so (the guy who passes out or falls over drunk)”

    Could not be any more true! I thought I was the only one who heard that..that is the favorite phrase for someone I know (and you know). Thanks! XO!

  36. Great post Gena! Sadly, a really common, personal and sensitive subject in the blog world, and among all of us women….The comparison to alcoholism is rrreally interesting, especially since unlike alcohol..food is a whole different beast since you can’t “abstain” from it. It’s so sad to think that so many people spend their whole lives battling an unhealthy relationship with something that can be so enjoyable, while others simply do not develop that kind of thinking. I know from personal experience that people who are trained to deal with and help with recovery from an eating disorder can save lives, so thank goodness for that.
    On a lighter note!! Ha love that u love the tudors, i don’t find too many people that indulge in it and my roommate and I are blazing through the season on a weekly basis 😀

  37. Wow, Gena, thank you for posting this. I suffered from an eating disorder in high school and during my early 20’s.. actually probably until I got crohn’s and it became a bad thing to lose weight. I was never diagnosed, but I was very underweight and my school nurse would weigh me (I know HORRIBLE, only made things worse). It is hard not to go back to that thought process, especially after gaining so much weight on steroids, but I focus on my health which is more important then weight loss right now. Anyway, I’ve seen distorted eating my whole life, with my mother, friends, sister and myself. It is so common. I wish more people were brave enough to talk about it, like you!

  38. Thanks for posting this Gena! I struggled with disordered eating for many years. While on the outside I never appeared sick, inside I was a wreck.
    I’m happy to say I’ve finally overcome that for the most part, but it still sneaks up on me sometimes.

  39. I have so much admiration for you right now and want to hug you over the internet!
    Oh wow Gena you are so brave for going public and sharing that you have an eating disorder with so many. I know that with such an influential blog, your admitting it will help SO MANY OTHERS like me who also struggle and who haven’t been as brave to admit it yet, even to ourselves.

    • Hi, inspired!

      To be clear, I don’t have an eating disorder, or disordered eating. I did have an eating disorder in my early teen years (I’m 27 now) and a short relapse my junior year of college, and at the time, the fact that I wasn’t a worst case scenario did make it very hard to discuss or come to terms with. Today, I’m so glad that I can honestly embrace the struggle in my past, and call it by its name.

      I am so glad that my words are helping you come to terms with your struggle.

      Gena

  40. that was really moving Gena! great post…i think its hard to hear for many people but its something that we need to face and not be ashamed of. its interesting that the world has so many fixed attitudes of how we look like and now even fixed attitudes on what defines a disorder. Its great that society is coming to a realization that nothing ever is ordered in neat little categories.

  41. thank you for this post, gena. i think it’s important to stress the shame many people feel in the label. there are a host of judgmental connotations that are attached to the term. so many who suffer from eating disorders have such low self-esteem, that actually using the label to describe themselves only contributes further to that feeling of failure and lack of confidence.

    i also think there is a huge discrepancy between what is viewed as “normal” in terms of eating. and when that is ambiguous, how can we define “disordered?”. i know women who think they are healthy but have some habits that remind me of myself at my worst, but i’m not in their heads, and i don’t know if it is consuming them in the same way. it’s a complicated topic. i suppose the most important thing is for awareness to continue building in the mainstream – which is why that article you linked to is nice to see.

  42. I think we need to be careful about labeling. As someone in the mental health field, I am slow to label people because that can bring in a whole host of defeatist, victim behavior and can create more depression. Labeling really only serves two purposes anymore, for insurance and for funding. A properly trained professional will be able to spot when someone is out of balance, and that is what truly matters. The eating is just a symptom of a larger problem.

    Thanks, Gena!

  43. Funny that for me there was never shame… partly because it came after losing almost 60 pounds, about 40 of which were healthy weight loss. I had enormous pride in my accomplishment, my control of eating, and ability to accomplish my goals. It was always about becoming normal and looking normal, so when I realized I was too unhealthy I recovered in a very controlled way. Hence a lack of shame… the shame entered only when I regained all the weight (until I discovered detox/raw and took it back off!). When I was fat I wanted everyone to know I had had an ed, because it was so unbearable for me to feel so fat and out of control. In essence I wanted everyone to know that I could be thin, could control myself, and was not happy with myself. Eating a hi-vegan raw-inspired diet has helped stabilize my appetite and relationship with food a lot, so that I can have both my love of eating AND not have those terrible feelings of fear and dread about the consequences. This is evidenced in the fact that I have not told anyone about my former ed since starting grad school. I almost did today, but the point is that it doesn’t feel crucial to tell anyone. For me this is actually a positive sign- that what I am now is roughly what I want to be- no need to convince anyone that I am not as I appear- and that’s a wonderful way to live! We had an anoretic patient in the lab today and she estimated her width to be 200% of her actual width (manipulating photo dimensions). Whatever the causes, body image becomes severely distorted. I agree that the definitions we have are terrible (although a framework is usually better than none) and that the mindset should be the primary diagnostic factor. I was mentally anorexic while still overweight when I started my whole journey. BMI is a whole other rant of mine… it really messes with ones mind to have a diagnosis of anorexia while not having the technically required BMI. The fact that the diagnoses is still made attests to the flimsy nature of our categories and understanding of eds overall. I ramble…

  44. Great post, very insightful and so true. I think a lot of healthy eaters have suffered from disordered eating at some point. It’s tricky with so much media attention on rising obesity for already health conscious eaters not to be affected.

  45. I saw this article too. It’s always hard to deal with someone how has either an ED or DE – eating is such a visceral part of life, and it’s never easy to admit or confront such a personal issue.

    I liked your interview! You promote a very healthy raw foods mindset 🙂 (unlike some others!)

  46. Wow, this is incredibly powerful. I also find it liberating. I find that I am struggling with “disordered eating” and to be able to actually label it as such is quite empowering (reminds me of another one of your another posts?). I think it’ll help in being able to get past it.

    I too, am glad that this is coming to light. I used to be part of the community at Calorie King and women used to fight over who had a *worse* eating disorder. REALLY. And some would say that some couldn’t call what they had a binge because they didn’t eat enough BUT the feelings that go with a binge are *exactly* the same-no matter if you ate 200 calories or 2000 calories.

    Thank you for talking about this.

  47. Oh Gena. Marvelous.
    “And the fact that they never hit rock bottom doesn’t mean that they did not suffer.”
    and
    “anyone who suffers from disordered ways of thinking about food is worthy of help and compassion. We all deserve self-care.”

    Wow. You outdid yourself. Thank you for addressing these issues. Thank you for speaking it aloud. The words Eating Disorder is still filled with shame, judgment, and a million other negative connotations, I believe; and so every chance that someone like yourself (intelligent, articulate, respected) un-villifies it, humanizes it, brings compassion to it, I think we are moving in a healthier direction.

    I also wonder if reading food blogs all day long, or ever, is good for us. I mean, really, should we care what someone else ate? I started my blog to share recipes. I seriously had no idea there was so much other stuff out there and associated with food blogging.

    Anyway, wonderful post. Off to read your other interview. …

    • Averie,

      All I can say is I’m glad there was no internet during the EIGHT years (from age 19 to 27) I suffered from anorexia, not really hospitalizable, but underweight enough to get stared at (funny how people stare at thin people but avert their gaze at fat people – but that’s another story) and to not get my period even once. I’m glad because strangely, during that time, I had an obsession with cookbooks! And food magazines! I rarely tried my hand at the recipes (I know a lot of anorexics get into cooking for others, this is not something I ever did). The pictures, the recipes, the lore behind them, fed me in a strange way, in a way the food available to me did not. Anyway, I would have been one food blog junkie back in the day …

      The cookbook author Deborah Madison writes the more intact a culture is, the fewer cookbooks it produce. I think the plethora of cookbooks (and food blogs) says a lot about the extent to which our culture has deteriorated. I’m not talking books and music. But one can argue that food is something that connects everyone to culture. Or at least it did traditionally … it doesn’t any more. You have to seek out and find food grown locally, food grown with integrity, food that connects us.

      I think this is why I didn’t like Gena’s article “it’s just food” (I don’t remember the title of it but it was all about not asking food to do anything other than nourish us physically). It is my belief – and am completely recovered, no relapses, going on 15 years – that a big cause of eating disorders is precisely this – our food no longer feeds us (emotionally, spiritually) in the way food traditionally did. The food that comes to us via factories, or factory farms, only barely nourishes our bodies, it doesn’t come close to feeding our spirits, our souls.

      I believe our deepest hunger is for connection. And food, food grown organically, sustainably, on a small scale, carefully chosen and consumed, prepared with love, does go a long way to fulfill this deep hunger.

      And when it doesn’t, there are the food blogs. 🙂

      • this was a wonderful post, and everyone’s comments are so well-thought out and thought provoking.
        all eating disorder’s aren’t just about food. there’s a whole slew of outside factors that contribute, most of them dealing with self-perception, and control.
        Re: Elizabeth makes a really good point though about food not feeding us the way it used to, and when we lose the cultural connections to food we lose a lot of the nourishing aspects of it. She also mentions a previous obsession with cookbooks. obsession with food/cookbooks/ (foodblogs?) is normal in many ED. The the 1940s the Minnesota Starvation Experiments took a group of conscientious objectors, healthy, war-aged males, and fed them a starvation diet. These men not only became wasted, and lost energy as they lost weight, but they exhibited most of the signs of a AN patient. they became obsessed with food-they would walk into bakeries just to smell. they would buy food and then give it to children in the streets, they would savor food magazines and cookbooks.
        I also like the point made by Jess about are eating disorders the new norm. why i hate to think that, i think the majority of american women have minor ednos, and exhibit a lack of self-respect for their bodies.
        So how do we fix this? Can we as food bloggers be a cure rather than further perpetuating this obsession? i think blogging can be a very powerful tool-how do we use our powers for good rather than evil?
        love to you all-you are amazing, beautiful people!

  48. Thank you so much for writing this. I have had an eating disorder in my past, and certainly have disordered tendencies still, but have found that “going raw” has made a large part of my life simpler. I can know that all that I’m putting into my body is nutritious “fuel” as opposed to no- or empty-calorie, sugar free or fat free, filling non-foods. I am continually working to improve myself and my health and really am looking at it as a journey.

    Thank you again…what a great topic to bring up.

  49. I think this is a really interesting post…I completely relate to Jess’ post above…I think most people have disordered eating so is it really disordered anymore?

    • to clarify, I think it still is, but I think a lot of people don’t/aren’t willing to, and that it’s sad that we have reached this point.

      • in the intro to their raw book, someone spoke of the overwhelming popularity of the atkins diet causing bakeries and bagel shops to go out of business practically overnight as indiciative of a nationwide eating disorder, your comments reminded me of that. unfortunately while i remember the quote, i can’t place it and google didn’t help me out with an author!

  50. Awesome post, Gena! I too, like many other women, have struggled with various forms of “disordered eating” since my teenage years, and am now watching my 16 year old sister struggling with the same things. At age 14, when I was the most severely disordered, I still was only classified as EDNOS, because my BMI was 19 instead of 18.5, even though I fit all of the other characteristics of anorexia. At that time, I thought I didn’t really have a problem, since I wasn’t officially diagnosed as “anorexic.”

    I think that the EDNOS umbrella term seems to make the problem seem less severe or legitimate, which is certainly not true. There definitely needs to be more descriptive terms on the “disordered eating” spectrum other than simply anorexic, bulimic and EDNOS.

  51. “Unfortunately, many of them have a hard time even uttering the words “eating disorder.” This is sometimes because they have yet to come to terms with it, but most often because they feel ashamed of using the expression to describe behavior that didn’t meet worst case scenario standards. They’ll be quick to remind me that they were “never skeletal,” never in in-patient, never near death.”

    The sentiment above continues to resonate. An eating disorder (there I said it) is a continuous battle. The worst symptoms and behaviors may go away, but the ability to turn on that mental switch is an urge which must be suppressed periodically. So thank you, Gena, for not only shedding further light on such a complicated subject but also for your guidance and advice. Choosing a high-raw vegan lifestyle has done more for my mental and physical health than any nutritionist’s food-guidelines.

  52. Great article. I and several of my friends have all fallen under the Ednos umbrella at some point in our lives, and at least one has had to go in-patient on more than one occasion for full-blown AN.

    Frankly, it’s scary. I look at myself and think I’m fat. I know, in my head, I have never actually been fat. But I’m terrified to weigh myself (I always have an idea, of course), I’m terrified to watch what I eat for fear I’ll start obsessing (and restricting or purging) again, but conversely, I overeat with no reason except I want to eat. It’s a seesaw, but has never been enough to do something about. My body dysmorphia seems no worse than most women I know.

    Which leads to my question/observation. Can the majority of a society’s women have disordered eating, and is it then still a disorder? it seems to me that ED is just becoming the ‘norm’, if you’re female you’re expected to be that way, and if you don’t more power to you, but hey, nothing wrong if you do have it, so does most everyone else! there’s not a lot of incentive to want help in a society like this. Which is really tragic.

  53. precisely what i had in my head, well summed up in a blog post! a year ago i restricted my eating and overexercised so much that i lost my period for 10 months, and even though i was never under my normal range bmi, i lost 23 pounds of fat in a month and a half. my disordered eating resulted in such an emotional trauma (stressing out over weight) that i developed irritable bowel syndrome a month after i started to gain my weight back. since the IBS, i’ve lost and gained 25+ pounds four more times that i’m no longer sure what’s even my “happy weight” anymore.

  54. I actually read the article this morning and have been mulling over the reassessment of eating disorder terms a bit. While I’m reticent to over-diagnose people (especially since i’m not a therapist), I do agree that more accurate terms are needed. When women feel they can identify with a condition or disorder and thus legitimize seeking the help they so desperately need, then I think the system is working as it should.

  55. Very well said Gena! I wrote many papers on binge eating disorder in grad school, and I knew I never fit the criteria exactly, but I clearly had a problem. It’s hard to know how to talk about something that doesn’t fit into a specific label…

  56. I’ve recently come to the realization that many individuals in the raw community have struggled with disordered eating in the past. But I hesitate to say past, because with the extremes of raw food and the labels that many are SO quick to toss around and misuse, I can’t say that I wouldn’t view a person who was 100% as eating disordered. Of course, I don’t think being 100% raw necessarily means someone is eating disordered, but I really grapple with that.

  57. That was deep and very powerful. Something many professionals skirt and people are mum about, since who isn’t a little warped with the insanity that is body image in our era. Great post!

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