Monday, April 21, 2008

The many faces of ED

When the media covers stories of eating disorders there is usually the stock photo of a severely emaciated young girl. Sympathy pours out from all corners of the globe for these young women. How do you think the majority of people would feel seeing me and learning I have suffered from an eating disorder for over 30 years? Most would not believe it.

Anorexia defined by the DSM definition must meet the 85% body weight loss criteria. I personally think that is flawed. I know many people who exhibit the same behaviors as those diagnosed with anorexia but they remain overweight or of "normal" size.

Those suffering from an ED come in all shapes and body sizes. Ranging from emaciated to morbidly obese. While the emaciated are offered sympathy those who are larger are shunned. They are blamed for not having any self control. Most are encouraged to go on a strict diet to lose weight. How's that for illogical thinking? Prescribing eating disordered behavior to someone already suffering from an ED. Here's a classic example from the Fathealth website: First Do No Harm: Binging? Purging? Vomiting blood? Try dieting…

This is about a young women who is overweight ending up in the ER for vomiting blood after a years of binging and purging. She was seeing her own doc the next day. Here is just a small portion of that doctors visit:

I explained that recently I had lost about a bunch of weight starving and puking nonstop and that now I was restricting much less but still bingeing and throwing up constantly; I told her that I’d had an active eating disorder for about four-five years and I filled in the details of the previous night’s ER episode. She asked about my highest and lowest weights—despite several times losing dramatic amounts of weight quickly and unhealthily, I’ve never been “thin,” and when I told her my highest weight, she said it was “great” that I’d lost the weight, even though I told her I’d only lost it restricting and purging.

This doc is applauding her weight loss efforts---when her "diet aide" is bulimia.

She goes on to tell me that what she wants to do is put me on a modified Weight Watchers plan and have me come back in a month and weigh me again. (I am 5’4” and 145 pounds—which is 30 pounds less than I weighed six months ago, though I lost the bulk of it in six weeks—and I am so sick with an eating disorder I am barfing up blood and she’s talking about a DIET?!)

I tell her that I’m really not interested as I’m already working with a nutritionist. She then asks me, in a hostile tone, what exactly I want from her; I’m at a loss for words since I figure it’s pretty self-evident that, um, she’s a doctor and I want her to…monitor my health?

There are no words...... you need to read the whole story. While you are at it read the whole blog. It's a serious wake up call.

To further prove that EDs strike anyone, read about the 69 year old man with bulimia, former Deputy Prime Minister John Prescott.

My own ED has been active for damn near all my life. Yet my weight has fluctuated over the years. Just because someone doesn't show the "typical" face of an ED doesn't mean it's not there.

Common Misconceptions

Below are some of the most commonly held misconceptions about the behaviors attributed to Anorexia, Bulimia and Compulsive Overeating.

"I cannot be Anorexic because I do eat when I have to..."
Restriction of food and calories does not mean complete restriction for every sufferer. For some this means restricting certain types of foods (each individual sticking with what they perceive as "safe foods") and limiting calories to below normal on a daily basis. For others this means fasting for a certain number of days and then eating "normally" for the next number of days, and repeating the cycle continuously.

"I don't fit any category... I only eat when I absolutely have to (but I don't binge) and then purge whatever I do eat..."
Those suffering Anorexia do not always completely restrict. Often times when they cannot avoid a meal or food they will follow any consumption with self-induced vomiting or laxative abuse. This is considered "Anorexia, Purging Type." You should read the definitions of Anorexia, Bulimia, Compulsive Overeating, and Binge Eating Disorder, as well as "Eating Disorders not Otherwise Specified".

"I am above/on the high end of my healthy weight range... I cannot possibly have an Eating Disorder..."
People suffering with any Eating Disorder can be of any weight. For most sufferers weight will continuously be going up and down. The weight of a person's body does not indicate their overall health, nor does it change the danger each sufferer may be in! There are more dangers involved in the disordered eating patterns themselves, rather than in each person's actual weight.

"I eat a lot of candy, and can't possibly be Anorexic..."
Many Anorexics and Bulimics are junk-food addicts. There is little nutritional value to junk food but they serve as a false sense of energy. They also appease extreme cravings... for example, a sufferer's system may be depleted of Sodium so there may be a strong craving for something salty. A bag of chips would seem to satisfy this craving. It is not uncommon to find a person with Anorexia or Bulimia who lives solely on candy (or junk-food), and like any Eating Disorder sufferer, this puts them in great danger. Other common "replacements" are drugs, alcohol, coffee, tea and/or cigarettes.

"Only middle-class, white teenagers suffer..."
ANYONE can suffer from Anorexia or Bulimia. Regardless of previously held beliefs, it is not only young, middle-class white teenagers or college students who can suffer. African-American, Hispanic, Asian, or white, women or men, rich to poor, from their teen years well into their fifties, there are sufferers from every age-bracket, class and culture. Don't rely on the "written statistics" - they are based on reports made to government agencies and if a country, state, or province doesn't require that doctors report the cases, the statistics will not be accurate. Keep in mind as well, the more shame a person feels, the less likely that they will come forward and say they have an Eating Disorder... so if we keep perpetuating the idea that only "young white women" suffer, less and less people who suffer that don't fit this ideal will not come forward, be acknowledged, and get the help they deserve.

"I eat three meals a day (or I eat a lot during the course of a day) and never purge. How can I have an Eating Disorder?..."
Disordered eating doesn't always mean restricting, binging and/or purging. Sufferers sometimes eat 3 meals a day, or eat continuously throughout the day and through this can disillusion themselves into thinking that all is fine. If these eating patterns or meals consist of only lettuce, salad or yogurt (or other comparably low calorie, low fat food), and the calorie intake overall is far below normal (and is combined with emotional attributes), this would be considered Anorexia. A person suffering may not be "starving" themself of food per se, but of any real calories, substance and nutrition. (The same is illustrated above in the example of eating candy.)

"I don't make myself vomit or use laxatives, I cannot be Bulimic..."
There are other methods of "purging" following a binge. The person suffering with Bulimia will eat an unusually large quantity of food in a short period of time and follow it with purging; In addition to using laxatives or inducing vomiting, purging can also be compulsive exercise or complete fasting. This is one of the attributes that can be present in a person suffering both Anorexia (restriction and purging without binging) and Bulimia (binging and purging).

"My family member/friend eats normally around me. He/She can't possible have an Eating Disorder..."
It is not uncommon for those with Anorexia, Bulimia and Compulsive Eating to eat "normally" around others. This type of sufferer may look forward to their time alone, to be able to "make up for" the time they've spent eating "normally" around others. Anorexics will completely starve themselves, Bulimics will binge and purge, and Compulsive Overeaters will overeat or binge once they have gotten back into their solitary environment. Sufferers may even look forward to being alone so they can partake in disordered eating patterns.

"This is just a phase..."
Anorexia, Bulimia and Compulsive Overeating are not phases a child, teen or adult goes through. Some may go through dieting phases but this is far different from having an Eating Disorder. You should visit the other sections on the website to learn more about what having an Eating Disorder means.

"I take vitamin/mineral supplements so I know
I will stay healthy..."

Vitamin Supplements will not protect anyone from the harm an Eating Disorder will expose the body to. Vitamins and Minerals are absorbed into the body much more efficiently through their source food, and work in harmony with one another to ensure the highest level of effectiveness and absorption. While taking vitamins and minerals may help to provide a sense of security, or even prolong certain aspects of health (like warding off infection), they will not protect you from the dangers associated with having an Eating Disorder, such as: the bowel or kidneys shutting down, shrinkage of the brain, dehydration, diabetes, TMJ Syndrome and misalignment of the teeth, tears in the esophagus, ulcers, joint pain and arthritis, digestive and absorption problems, acid reflux disorders, cancer of the mouth and throat, low or high blood pressure, heart arrhythmia and cardiac arrest, loss of menstrual cycle, infertility, dilation of the intestines, or depression and suicide.

"Everyone who is overweight or fat has
Compulsive Overeating..."

What defines the illnesses of Compulsive Overeating or Binge Eating Disorder is more than just the weight range of the individual. Emotional eating, eating to fill a void, stuffing down feelings with binging, isolation and pushing others away are just some of the traits. There are also those who suffer from Compulsive Overeating or Binge Eating Disorder who are not extremely overweight, as well, there are other reasons an individual can be overweight (including medical reasons or genetic pre-dispositions to a larger body size). The overall symptoms that help determine if a person suffers from any disordered eating are how their eating relates to a lack of self-esteem and ability to cope with pain, anger and stress.

"I can't die from this..."
Anorexia, Bulimia and Compulsive Overeating can kill those who suffer from them. Eating Disorders have the highest rate of death out of any other psychological illness. Up to 30% of the sufferers of Eating Disorders (and maybe higher) will die as a result of a complication caused by the illness. Be sure to see the Physical Dangers sections to read about all the complications associated with Anorexia, Bulimia and Compulsive Overeating.

Info courtesy of
If you recognize yourself in any of the above---head over to Weighing the Facts. She has lots of helpful links and resources listed.


Medusa said...

Absolutely superb post, Bama. Kudos to you!

MrsMenopausal said...

Absolutely excellent post, Bama. Very informative. I hope you don't mind, I've linked to it in my blog: My blog: Weighing The Facts

Avenue Girl said...

I am absolutely blown away. Thanks Bama.

Danielle said...

Great post!!! It is comforting to know that some people truly UNDERSTAND. It seems the only ones who do understand eating disorders are the ones who have them. It is so tiring to try to correct people or listen to the crude comments that are so wrong and all the myths associated with eating disorders. I struggle daily but it is nice to know I'm not alone. Thanks for writing this for others to see!