How Do I Talk to a Friend or Family Member With An Eating Disorder? (Or You Suspect They Do)

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This is 2017’s National Eating Disorders Awareness Week, and I’m excited to be writing a few posts based on requests.

My first post is how to talk to a friend or family member with an eating disorder or who might have one… from my perspective as someone in recovery. While I was struggling through the years, I heard from friends and family that they felt powerless. It was like watching a sinking ship and not knowing if they could do anything to stop its demise.

While it is impossible to cure another person, friends and family members are NOT powerless. I think about the camp counselor who talked about her own eating disorder openly without shame while I was symptomatic but not yet diagnosed; the friend who reached out to the school administration when she was concerned about me; my mom who spent countless hours trying to understand why I wouldn’t eat. I might have resented them at the time, but now I know that they planted seeds that would bear to fruition later. I didn’t enter recovery in their timing, but it did happen.

I will forever have memories of friends, family members, professors, and co-workers expressing their concern to me over the years. If you think that your words don’t make a difference or impact to someone deep within an eating disorder, you’re wrong.

I will give a cautionary note, however. For every good friend who expressed concern and gave me unconditional love during my journey, there was another who met me with insensitivity and stigma.

Talking to someone with an eating disorder can be a tricky endeavor. On the one hand, you want to express love and concern, but you don’t want to do so in a way that is off putting or hurtful.

In this blog post I will be outlining some “do’s and don’t’s” derived from years of experience of what has and hasn’t helped me.

  1. Do ask about it…

… but try not to probe or make assumptions.

Bringing up your concerns with someone you believe to be struggling can be anxiety provoking. It is a whole lot easier to pretend everything is okay. However, if you have a sinking feeling that something is wrong, and you are close enough to the person to broach the subject, by all means consider it.

Before you do so, consider these two things:

a) Don’t push it– If you bring it up and are met with defensiveness, it might not be the right time to talk. People with eating disorders can be highly secretive. In my deepest stages of denial and shame, I avoided all conversations about how I was doing. I remember how one time prior to admission to residential treatment, a teacher asked if I had an eating disorder. Taken aback, I mumbled something about having a rare digestive disorder. I wasn’t ready to admit how out of control or scared I was. Eight years later, I still remember that conversation as formative. She did not push the issue but expressed concern, and that meant a lot. Even though I wasn’t in a place to talk about it at the time, I respected her for bringing up the subject.

b) Check your assumptions– In society, we tend to associate eating disorders with “thinness” (whatever that means), but that’s just not accurate. Most people with eating disorders are not underweight. Anorexia is the most rare eating disorder, and bulimia and binge eating disorder are more common. People with eating disorders often fluctuate between periods of restriction, bingeing, and purging. I know some of my most symptomatic, out of control times were when I looked healthy. Don’t automatically assume that someone’s thinness is anorexia. It might as easily be a thyroid issue, an autoimmune disease, drug abuse, or simply body type. Similarly, don’t assume that someone doesn’t have an eating disorder because they appear to be healthy.

I have a “spidey sense” in my judgments about whether someone has an eating disorder, but I can be wrong. I am also careful about bringing up the subject of a possible eating disorder. Far before I bring that topic up, I make sure to talk about my own experience, normalize the reality of eating disorders, and check the facts.

. . .

2. Do seek consultation…

… but avoid gossip.

I can’t tell you how horrible it feels to know that people have been talking about you in the whispers you slightly overhear as you pass by and in hushed conversations you know have happened. I think by all means people learn more about eating disorders if they suspect a problem in a family member or friend. Education is important. Talking to a dietitian, therapist, or an organization like the National Eating Disorders Association can be a great move. HOWEVER, when that trickles into gossip and shaming, it stops being helpful.

Sometimes a family or friend group might need to get together to discuss how best to broach the subject with a loved one, but as soon as it turns into judgment and teasing, it can become toxic.

A note about consultation: It is strangely easy to read an article from BuzzFeed or some other reputable source (joke, but in full disclosure, I love BuzzFeed) and think you’re Dr. Phil or something. “Is it about control?” I’ve had people ask me in condescending tones. As if that comment is unique and your therapist hasn’t talked about control 900 times. Eating disorders *can* have an element of control, but it is ALWAYS much more complex. Eating disorders are associated with a cluster of things that may or may not be related: psychological factors, personality types, presence of past trauma, significant stressors, biological predisposition, family history, etc. A cursory look at a non-scientific article or watching a horrible Lifetime movie about anorexia cannot make anyone an expert.

. . .

3. Do express concern about eating habits…

… but don’t do so during meal time. 

Eating with someone you’re almost sure has an eating disorder is difficult and uncomfortable.

It is SO tempting to reach across the table and critique a meal choice, or say something like, “Is that all you’re having?”, or, “Why aren’t you eating more?” In my experience, those conversations are never helpful. The person with an eating disorder, who is likely anxious from the experience eating out, is on guard and gets defensive fast.

I get it– meal time seems like the most logical time to express concern. After all, it is commonly thought that meal time is in fact the problem. When I was deep into my eating disorder, going out to eat was SO MUCH more than an hour at a restaurant. It was the fasting before and after; it was the fear of eating in front of people; it was planning a binge later in the night so I didn’t have to eat in front of people; it was looking up the menu online beforehand; it was counting calories hours before I stepped foot in the restaurant.

It is better to bring up the specific behaviors later in the day when meal time is over. Stick to the specifics about behavior and don’t make it personal. An example: “I noticed when you were at dinner tonight, you ordered a low calorie entree, and you kept putting parts of the meal in the napkin on your lap.” –> I know, easier said than done!! I’ve been the recipient of a lot of insensitive mealtime comments, but I’ve also given some insensitive mealtime comments to friends I knew were struggling. I get it: Frustration can mount in the moment at mealtime, but try to hold off until later. You’ll end up having a much better conversation.

. . .

4. Do focus on food…

… but look at the greater picture, which has a whole lot more to do than just food.

Someone I knew in graduate school said something to the extent of, “I don’t know why families don’t lock the family member with an eating disorder up and force the person to eat.”

While that is absurd, I have heard so many comments that are similarly invalidating and off base:

“Just eat.”

“It’s not that hard.”

“Don’t make this such a big deal.”

That approach doesn’t work.

Eating disorders are both about food and not about food. Of course, eating disorders are highly related to weight and food habits (that’s why they’re called eating disorders) but in some respects have little to do with food.

Restriction was my teenage coping mechanism to deal with a lot of internal chaos– undiagnosed generalized anxiety, crippling OCD, existential anxiety, depression, and feelings of hopelessness, and worthlessness.

In my years of being symptomatic, I was way more likely to talk about those things than my eating habits. I hated when people would make it seem like gaining weight or eating would solve all of my problems. My eating disorder served multiple functions in my life, and until I dealt with those, I didn’t get truly better.

On the other hand, eating disorders are necessarily about eating.

If someone is underweight or malnourished, it is impossible to look adequately at the big picture. Medical, nutritional recovery is a precursor to psychological recovery.

Sometimes in more psychoanalytic approaches to recovery, it is conceptualized that when a person deals fully with the psychological parts of the eating disorder, the symptoms will dissipate. That also doesn’t work.

If you are bringing the subject up with someone, consider the rather paradoxical statement that eating disorders are about eating, but they don’t give us the full picture of what’s going on.

. . .

5. Do take action if necessary

… but think it through first.

Eating disorders are dangerous.

Period.

It is well-known that anorexia has one of the highest mortality rates of all mental health issues, but it is definitely possible to die of bulimia or binge eating disorder too.

The first thing I tell people who haven’t gotten into treatment is: SEE A DOCTOR.

Eating disorders can be associated with some serious medical complications that can kill including (not an exhaustive list): potassium/ electrolyte imbalance, low heart rate, low blood pressure, and general heart abnormalities (that’s why people with eating disorders must have regular EKG’s).

I will reiterate here that someone of average weight, overweight, or obese can die of an eating disorder as well. All of the above medical problems can happen to a person at 70 pounds or 370 pounds.

That is why if you truly suspect a loved one or friend has an eating disorder, don’t stay silent.

In all three of my three major anorexia tail spins, the initial descent into the illness and two subsequent relapses, I needed intensive medical intervention to get back to normal. Two of those times, it was not of my own choosing. Friends, family, and even my school had to intervene on my precarious downward spirals, and thank God they did. Otherwise I might not be here right now.

With that said, if you are seriously concerned about someone who is NOT getting treatment for an eating disorder, there might be cases in which you should advocate for medical consultation or even hospitalization.

For someone with a SEVERE and UNTREATED eating disorder, it could be that lovingly suggesting a trip to the doctor or ER for a medical evaluation is what is needed in the moment. Or, perhaps looking up residential treatment options and calling the person’s insurance company for help.

** Now: Before you attempt this kind of conversation with someone, heed caution! Most people who are diagnosed with an eating disorder have a treatment team or are getting support of some kind. If that is the case, step back and offer support in other ways. Suggesting hospitalization or a doctor consultation additionally has a high likelihood of pissing off the person’s eating disorder, so be prepared that you will likely be met with resistance.

There are some cases when this kind of conversation happens more organically: For example, if a friend passes out or complains of heart palpitations.

. . .

I think the reason many people don’t express concern to a friend or family member about what they’re seeing is out of fear. I get it– it’s scary. People don’t inherently know how to bring it up or what to say.

You are brave and caring to consider having a conversation that might save a life. Sometimes simple comments can go a long way, things like:

“I love you, and I’m concerned about you.”

“It seems like you’ve been struggling lately, and I want to help.”

“If you ever want to talk more about what’s  been going on for you, I’m here for you.”

For more information or to take a free screening, check out NEDA’s website.

In keeping with the National Eating Disorders Awareness Week slogan for this year, I’ll finish with this: “It’s time to talk about it.”

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Bikini Season, Body Shaming, and Other Stupidities

Bikini season is coming!

We know what that means… Lots of bikini/ fitness/ diet Pinterest boards leaving people feeling horrible about themselves. Article titles like, “How to get ‘bikini ready”. Or, articles about kale smoothies and how good they taste and while you’re at it,you should exercise like 18,000 calories a day. Pictures of “best/ worst” celeb bikini bodies. It’s already begun with “shocking” pictures of Tara Reid in a bikini and talk show hosts telling Kelly Clarkson she “could stay off the deep dish pizza” after she… gained weight (WHAT!!!!) after having a baby (um, you’re supposed to lose that weight in 2 weeks, maybe less, everyone knows that *heavy sarcasm*).

I don’t know what is more sad: 1) That a bunch of tabloid dipshits judge and mock people’s bodies, how much they eat, and their weight struggles/ triumphs/ how they’re “letting themselves go,” or 2) That somehow these magazines are selling! People are reading articles by said dipshits.

I just have to ask: What is this world?

What kind of weird society do we live in that deems terms like “fat,” “dessert,” “seconds,” and “full” shameful? What is so disgusting about women’s bodies? Side note: my focus for this post will be about body shaming women because I am one and have more to say on the topic, but men are also victims of body shaming.

All of the mean twitter posts… the cyber bullying… the incessant fat shaming… WHY? The stigmatizing body shaming comments casually zinged about, they hurt. We may not acknowledge that body shaming comments hurt inside, but they do.

Body shaming hurts.

There is endless interpersonal and internalized shame about what we look like– that number on the scale what we eat what we don’t.

Culture tells us appearance defines our worth.

People are ashamed of their own bodies, and then collectively, we shame the body of others. With all this body shaming going around, it is no wonder that the diet industry is so prominent. And here’s where things get more disturbing. In 2014, the U.S. diet industry raked in $60.5 billion. More disturbing yet: that astronomical number is a DECLINE from the year before.

This video is a good visual of how much $1 billion really is. So take that video’s visual and try to wrap your mind around $60.5 billion. This is, by any standard, a lot of money. How many social ills that much money could solve in the world? Water sanitation, poverty, racial, sexual, policy to promote gender equality, and so much more! Maybe we could even put a dent in the United States’ massive debt.

Let’s just sit here for a moment and realize how fucked up this all us.

People are spending more money than the GDP of many countries on diets that become popular and unpopular as fast as hashtags or the latest in social media… Atkins is old school (the N’Sync of diets), but kale is in (the Taylor Swift of food). People are going Paleo, organic, and gluten free. Egg white omelettes are the new black. Diet pills remain comparable to the quirky and questionable relative at many family gatherings. Constantly changing options for people who are essentially wasting their money considering that DIETS DON’T WORK!!

Body insecurity is a given in today’s culture. Between 40 and 60% of young girls ages 6-12 are already expressing concern about their weight or are worried about being fat. The body-shame cycle starts so young. The same girls memorizing Let It Go and wearing Elsa costumes around the house might be considering going on their first diet. Maybe they already have.

In our culture, we are not at peace with our bodies, and how can we be with all this propaganda and equating body size and looks to worthiness? We think, maybe that next fad diet will make us enough. Maybe, then, we can feel okay and good about ourselves. Maybe, then, we’ll be worthy.

I follow an Instagram page called “Bye Felipe” which was created to call “out dudes who turn hostile when rejected or ignored.” The site usually focuses on people who are interacting on dating web sites. You can see for yourself the number of fat-shaming comments doled out to girls on this page. It is horrifying to open up my Instagram and seeing how guys degrade women by playing on body insecurities and playing the “fat” card.

These comments hurt, and they are dangerous.

So here is my message, and I wish I could put this in size 200 font:

LET’S PUT DOWN THE SWORDS.

Let’s stop shaming ourselves and others about the way they look.

Let’s treat our bodies with acceptance and compassion.

Let’s humanize each other’s bodies. Let’s humanize our own bodies.

Do we have body flaws and faults? Do some people need to gain or lose weight? A resounding yes. But can that be okay? Are we still worthy? An equal and resounding yes. It is possible to take care of our body struggles with a posture of love and self-care.

When people talk about how so-and-so is too thin/ skinny/ fat; what’s with her butt/ boobs/ nose/ ears/ mouth/ teeth/ hair, they don’t know who they’re affecting. Little girls (AND little boys) see the disgusting way people are body-shamed, and we’re breeding new generations of body-shamers.

An app exists in which you can “fit the fat girl crown”, and there was an app (thankfully it was TAKEN DOWN) that was designed to “rescue the anorexic girl.” All this when some reports suggest that incidences of eating disorders may be on the rise.

Disgusting, disgusting, disgusting.

You don’t know what the person across the street or next to you or in the cubicle over from you is dealing with, body-wise or life-wise. Be kind, for everyone you meet is fighting a hard battle. Often you know nothing about it, and it is better to be KIND and COMPASSIONATE, rather than shaming and potentially triggering. This spring marks the 14th year of my eating disorder, and frankly, I think people have to mind their own fucking business. I realize this does not sound kind, but one negative comment can set off a slip or relapse or a passive-aggressive text to my therapist about how much I hate her guts. NO ONE wants to hear a passive aggressive, “Do you really need that slice of cake?”, or, “Wow you look huge in that picture!” And especially not someone who has struggled with an eating disorder.

PUT DOWN THE SWORD.

So in conjunction with this blog post’s title, I’m going to tell you a secret about bikini season. Here is how to have a bikini body:

People are at war with their own bodies and the bodies of others. It is a war that no one will win, but there will be many casualties.

So, in sum: be kind, compassionate, and please:

The 25th Anniversary of The Little Mermaid and The Demise of Mark Driscoll

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I know, how could I possibly pair seemingly unrealistic topics of my childhood favorite Disney movie and Mark Driscoll? Continue reading. It shall all make sense in due time.

My blogging rants have previously spanned to the topics of Mark Driscoll and Disney (e.g., here, here, and here).

In the last few months, a lot has gone on in the world of Mark Driscoll (MD) and Mars Hill, Driscoll’s Seattle-base mega-church. While the purpose of this blog post is not to summarize what all has transpired, I will catch you up to speed here:

The quick summary: Shit went down. MD resigned and Mars Hill has disbanded.

The longer summary: The trouble started when MD got into some trouble regarding posts he made 14 years ago under the pseudonym of William Wallace II to attack “emerging-church-type feminists and liberals.” Why this happened to resurface after 14 years I have no idea, as Driscoll’s last year has hardly been clean, including controversies with possible plagiarism and allegations of paying off NYT best-sellers list. Somehow, the conglomeration of controversy spiraled in the last few months and resulted in the following: Acts 29, the church-planting organization Driscoll himself started, kicked out Mars Hill from its organization (major burn to MD) –> MD resigned from Mars Hill, saying he didn’t want to take away from the church mission, yada yada –> Mars Hill chose to disband.

This is HUGE in evangelicalism.

HUGE.

MD has been (with some exceptions) America’s evangelical, manly-man, neo-Reformed, social-media-savvy sweetheart. He captured the lives and hearts of thousands of Mars Hill goers. I myself, as I admitted in previous MD posts, used to listen to his podcasts. He is a captive speaker, quick with words, quick-witted, and relevant. Churches were planted. Good things happened. I do not want to negate the good things.

Do I believe that MD loves Jesus? I think that he does.

Do I think that MD bettered the city of Seattle and beyond? I think he did.

Now onto why I’m really writing about this story.

I am going to try really hard not to kick MD when he’s down. MD has long been controversial, and specifically what gets me going, are his homophobic and sexist comments that have been plentiful and sadly influential. Anyone who mocks effeminate worship leaders on Twitter is going to get a mouthful from me.

I saw the way this impacted others. Attending a Mars Hill campus in person in 2011, I was horrified to find every other woman pregnant and blonde and gorgeous. Every guy was ripped and strangely Driscoll-like in physical appearance. Everyone was white.

My own church when I lived in California preached out of MD’s book Real Marriage, a book filled with questionable antidotes such as one regarding a woman’s haircut pleasing her husband. This was the book also associated with a  plagiarism/ NYT best-sellers list scandal.

When MD resigned, Mars Hill leadership wrote the following: “Pastor Mark has never been charged with any immorality, illegality or heresy. Most of the charges involved attitudes and behaviors reflected by a domineering style of leadership.”

Uh…….?

How exactly are we defining immorality?

What is to be said for so many previous MD followers in therapy from attending Mars Hill and being subjected to degrading “church discipline” for being, for instance, a stay at home dad!!!! (GASP)?

What is to be said for the numerous controversial, hurtful comments that MD has said via Twitter or in personal conversations?

Those are moral because… MD believes that Jesus is God? And his doctrine is in line with certain standards?

Rachel Held Evans, in a typically eloquent post on Facebook yesterday, wrote the following:

It surprises me sometimes how people who are cruel and unkind get a pass on rude behavior from Christians because “at least their theology is sound.” But your theology is only as sound as the fruit of the Spirit it produces. Love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, and self control – both Jesus and the apostle Paul taught that THESE are the things to look for when assessing whether someone is preaching the true gospel or a false one. I am so much more inclined to listen and learn from a teacher who exhibits these traits than those who may be highly credentialed whose fruit is bitter.

I think we as the church need to take a long, hard look at what fruit we are producing and the ramifications it has on others. There is this archaic idea that heresy means what you believe or cheating on your wife. I think this blog gets it. At the end of it, the writer, Kristen Howerton, says:

“It’s time we examine the negative ramifications to long-standing microaggressions, misogyny, and verbal abuse as seriously as we would embezzling or sexual misconduct from a church leader.”

Exactly.

More later but first…

NOW ONTO THE LITTLE MERMAID. 

The 25th anniversary of everyone’s favorite classic was this week. Growing up, I was obsessed with Ariel, as was every late 80s-90s girl. I had my Ariel Halloween costume and Ariel dolls and barbies and Ariel EVERYTHING.

I LOVED THE LITTLE MERMAID. Who didn’t? Cute, clever, catchy, adorable. A success for Disney, a success for mankind.

It wasn’t until I saw this Second City clip several years ago that I got to thinking:

What messages was this movie really teaching me?

Maybe not the 1st… or 100th… or 1000th… time that I saw that movie at age 4 would I think differently, but I wonder… what kinds of things did I implicitly learn?

I wonder… what we would find if we did a study on young girls before and after watching The Little Mermaid? Specifically, I wonder whether we would find that little girls are less likely to want to be a woman president or the effect a movie such as that would have on their ambitions and views of womanhood.

And as someone who has had an eating disorder for 13 years and is sensitive to weight-based discrimination, this movie is SO FRUSTRATING! Ariel is practically a mass-disseminated cartoon pro-ana figure, so much so that this PERFECT “Realistic Movie Trailer” renames the movie, The Little Waistline. And how fitting that the villain is a fat old woman. Perpetuating decades of stigma against older women and showing young girls that FAT IS BAD.

I read the host of perky articles that come out on the day that The Little Mermaid turned 25, and I tried to relive my childhood love of this movie. It didn’t work.

I know too much. I’ve been through too many years of therapy. I’ve battled too many companies selling pro-ana shirts, and we still haven’t had a woman president, and eating disorders are existing in unprecedented numbers. I have battled my entire life the voice that tells me to sell myself for society.

That started in childhood. THESE are the messages young girls get!!!!!

It’s not The Little Mermaid‘s fault, but does this movie perpetuate these messages, in my opinion? A resounding YES!

BRINGING IT TOGETHER

I told you I would bring it together. Now what could a middle-aged pastor from Seattle have to do with a movie about a mermaid?

Turns out, a lot (in my opinion).

Media, my friends, is an important thing. We are not untouched by what we fill our minds with; we are not untouched by what we watch or see or listen to or by the venues and organizations we attend.

Media is powerful, sometimes so subtle, you don’t realize how it’s slowly seeping into your consciousness, changing the way you see the world.

Both to Mark Driscoll and The Little Mermaid perpetuate some ugly stereotypes about the objectification of those who are different, whether it is those of different genders, sexual orientations, physical appearance, or anyone who you label as “the other.”

Sadly for evangelicals, Disney is stepping it up. Movies like Frozen and Brave are FAR (X 1000) better than movies like The Little Mermaid. I think Disney is learning their lesson. I am hopeful for today’s young girls, that they will be empowered to do WHATEVER it is they want to do, including achieving equal pay and other problematic society ills. I am hopeful that the movie Miss Representation and The Representation Project exist. I am hopeful because activist movie clips like THIS are going viral.

For evangelicals, I am not so sure. The oppression and discrimination of women and LGBTQ people is still prevalent is so many churches. And while The Little Mermaid turns 25 this year, MD JUST resigned. Apparently mocking stay-at-home dads and effeminate male worship leaders is still kosher in evangelicalism. So I guess the evangelical church is at least 25 years behind the rest of culture. Probably more than that.

I am not trying to be a hater, or promote a boycott of Disney/ Mark Driscoll. Like I admitted, I listened to Mark Driscoll. I loved (LOVED!!!!!!!!!) The Little Mermaid. If you like MD or old-school Disney movies, you know what, have fun. I will probably show my future daughter The Little Mermaid.

However, I think it’s well within my rights as a human to be critical of culture. I am in the field of mental health as a career, and I am an activist regarding body image, eating disorders, and gender-related concerns. And some of these things don’t sit well with me.

I am all too familiar with the scars that life leaves, and I am a fan of changing things so that people in the future can have a few less scars in life. So I’m going to leave you with the following thoughts:

For Disney lovers who show their little girls The Little Mermaid: If you must show your little girl this iconic movie, please have a discussion about it with her. She is SO much more than her body and selling and starving herself to please some hot dude (per the realistic movie trailer “white Aladdin”).

For evangelicals: Think before you preach, attend church, talk to others, and use the Bible to condemn. We need a movement based on love and acceptance, a movement that honors differences, and minimizes support groups needed for people in church. I mean GUYS how crazy is it that people should need to be in therapy or band together because of an oppressive church experience that leaves them feeling like scum. How much do you think Jesus is weeping because of that? MD’s popularity shows me how much we evangelicals are under the sea-– and many people don’t even know it.

Myths About Eating Disorders: Debunked

Knowledge is power, but when it comes to eating disorders, there is a lot of misinformation that is out there. Sadly, this lack of knowledge of accurate information about eating disorders can even extend to health care professionals. With conflicting messages about what is true, it can be hard to sort out what information is accurate.

Because I have lived now over half of my life with an eating disorder, I’ve learned a lot of stuff (mostly out of necessity), and I have become aware of some eating disorder myths and stereotypes that exist. In this post, I am going to go over a few of these myths and debunk them.

 

What are eating disorders?

Myth:

Anorexia means starving yourself and being emaciated. Bulimia is bingeing and purging. And… that’s all.

Reality:

Eating disorders are most commonly described as complicated biopsychosocial mental health conditions that impact all bodily symptoms, the brain, and can have devastating consequences such as death. The most commonly recognized eating disorders are: anorexia, bulimia, binge eating disorder, and EDNOS/ OSFED (eating disorder not otherwise specified/ other specified feeding or eating disorder). Eating disorders involve some type of dysfunctional behavior(s) around food, including restricting food or caloric intake, fasting for long periods of time, using compensatory behaviors after eating such as purging, laxatives, diuretics, or overexercising, and/ or bingeing, or eating a large amount of food (of course there is social construction around what is considered “large”) in a discrete period of time.

Many eating disorder behaviors overlap. People who have suffered from an ED for a considerable length of time frequently experience diagnostic cross-over. Thus, these symptoms are neither clear-cut, nor are they necessarily noticeable. Eating disorder behaviors are often done in secret. Also, people with bulimia or binge eating disorder may not be over- or under- weight. Similarly, those who struggle with anorexia may not be emaciated.

It is important that people educate themselves about the impact of eating disorder behaviors and rely less on stereotypes of how eating disorders are culturally portrayed… namely how someone with an eating disorder “should” look or behave.

 

Who gets eating disorders?

Myth:

Privileged white adolescents.

Reality:

Anyone! While eating disorders are most represented in the media as occurring in Caucasian women of upper or upper middle class SES in a Western country, people of all races, sexual orientations, genders, economic statuses, and ages can develop eating disorders. There is a serious lack of representation of other eating disorder voices, which is why I’m really happy that this Marginalized Voices Project exists. We need to get better media representation of what eating disorders are like and who they affect.

Males, older women (40+), as well as people who are gay and of other racial groups, who have EDs are getting increased attention because—well, they get eating disorders too. Sadly, treatment is not necessarily tailored to them, and it needs to be.

 

What are the causes of eating disorders?

Myth:

Eating disorders are caused by Western media, trauma, families, or other environmental factors.

Reality:

Eating disorders cannot be pinpointed as being caused by one given factor. If you’ve ever taken a statistics class, maybe you’ll remember that correlation does not imply causation. Just because eating disorders exist (or are identified) in predominantly Western-influenced cultures, that doesn’t mean that culture CAUSES eating disorders.

Similarly, any risk and precipitating factors—a traumatic situation, an unhealthy family system—cannot be said to CAUSE an eating disorder. Perhaps these factors may increase the likelihood of an eating disorder developing, or they could be precipitating factors, but they are not the cause or fault of culture, or a family, or trauma.

I would also heed caution in that there has been an increase of media coming from companies such as Dove challenging cultural perceptions of body image. This is all good. I am a fan of challenging the oppressive body-image status quo. However, there is a difference between eating disorders and disordered eating or general body image issues. A girl might have negative feelings about her body from reading fitness magazines, but that is completely different from that girl developing a serious eating disorder.

Also, there is a significant biological basis of eating disorders that is still being explored. One study by Bulik and colleagues in 2006 suggests that anorexia is among one of the more heritable psychiatric disorders (0.56 as reported in her study).

All that to say, in general, there are a lot of unknowns when it comes to a cause or causes of eating disorders. My stats 101 lecture for the day: Be very, very careful about language pertaining to causation. Eating disorder research is being conducted because so little is understood still. There is not enough available knowledge to determine that something is a cause (or even causes) of an eating disorder. Talk about risk factors, talk about precipitating factors, talk about comorbid conditions, that’s fine. But talking about a cause suggests that 1+ factors completely explain the manifestation of someone’s eating disorder, and that is not something that can be said at this time.

 

What are the treatments for eating disorders?

Myths:

Once you have an eating disorder, you never get over it.

or 

You just need to eat.

Reality:

Eating disorders can be treatment resistant. I am living proof of that. However, treatment can also be effective. Recovery is possible. People don’t have to struggle with eating disorders forever and ever until they die. Recovery is not easy, and it may take time… a lot of time. Like years. Maybe more. But it can happen.

While eating disorders can be difficult to treat, certain treatments have been shown to be effective: CBT, DBT, family-based therapy, perhaps even acceptance and commitment therapy. I have more thoughts pertaining to this, but right now I will just say that there are some good options out there. I have been privileged to have seen a lot of great therapists who specialize in eating disorders, and I have been a part of treatment programs that have used all of the above treatment modalities.

People with eating disorders are not lost causes. They are not resistant, difficult, or frustrating. They are hurt and scared. They are in desperate need of empathy and understanding.

Notice that none of the treatment I have mentioned involves locking people up and force-feeding them. I had an acquaintance who once said, “If I got an eating disorder, my parents wouldn’t have put up with it. They would have just locked me in my room until I ate.” Honestly, good luck with that. Because I’m pretty sure that’s not addressing the problem. As in, I’m totally sure. That’s not going to work.

For whatever reason, people can have this mis-perception that the problem is the food, and all we need to do is make these people freaking eat. I both agree and disagree with that– it both is and isn’t about the food. I do not think that people can delve into root causes of their eating disorder while engaging in eating disorder behaviors, but I also don’t think that magically eating will fix everything.

So: there are some treatments that exist for eating disorders that work. Maybe the treatments that exist could be improved, but eating disorders are not untreatable.

 

 

8 Things You Shouldn’t Say to Someone With An Eating Disorder

In 13 years of having an eating disorder, I have heard it all– the good, the bad, and the ugly. I have heard some “jokes” about my weight or struggles that make me want to chuck a bottle of Ensure at them and then text my therapist with lines of angry emoticons.

Sarcasm aside, the ugly comments sting.

While people are often well-intentioned and lack adequate mental health education about eating disorders, an inappropriate comment can dig deep into the shame, anxiety, and terror that lurks underneath.

Speaking from personal experience of hearing all of these things (many friends have too), I am telling you: please, please, please don’t say these things to someone with an eating disorder. Please.

1. “You don’t look like you have an eating disorder.” Okay, there is not a “look” of someone with an eating disorder. Culture glamorizes the ultra thin ideal and focuses on (glamorizes? objectifies?) people who are extremely sick with anorexia. However, emaciation is not the eating disorder norm. In addition to the fact that problems with binge eating and bulimia are more common than anorexia, consider the huge diagnostic crossover between anorexia and bulimia/ binge eating disorder.

Regardless of the fact that this comment doesn’t make sense, when someone says a comment that taps into that stereotyped ideal of how someone with an eating disorder “should” look, my feelings of shame and panic about my body (which are already present) are intensified.  I already have to mourn the loss of my eating disorder identity on a daily basis, and I don’t need any more reminders about how I look.

2. “When are you due?” In general, people shouldn’t say this to a woman in general unless they’re sure. For someone with an eating disorder, they should be SURE. Not sure as in, “It might be a hamburger or it could be a baby.” If in doubt, don’t say anything. When people are in the stage of weight restoration, they often gain weight in their stomach, and it can stay there for a while. Chances are we are sensitive about this noticeable bloating, and a pregnancy oopsie comment is just the worst. Even if weight restoration isn’t a contributing factor to the bloating, it’s possible that we could (gasp) just have a stomach. I know, revolutionary. Side note: our culture’s weird obsession with spotting baby bumps ASAP is strange. Chillax, people. Pregnancy is a beautiful, wonderful thing, and if we’re pregnant you’ll find out when we’re good and ready.

3. “Wow, you must be hungry today!”/ “Aren’t you hungry?” Please do not comment about what I’m eating when I’m eating about what I’m eating. Whatever you say, chances are I’m going to feel disgusted and panic. Meal/ food comments can be appropriate, but if you must clarify or express concern, do so after a meal… significantly after. Eating can suck when you have an eating disorder anyway, and public shaming just exacerbates the general icky feelings.

4. “Have you lost/ gained weight?” If I’ve lost or gained weight, I will know about it. So will my dietitian and therapist. But do you know who doesn’t have to know? You! Why? Because it’s none of your business. For whatever reason, women just say, “You’ve lost weight,” as a compliment on par with “You just won a million dollars!” That’s just absurd in general. People need to find other ways of amusing themselves besides commenting on weight.

5. “I wish I could be anorexic.” And I wish I could be a unicorn. Just kidding, that would suck. And so does having anorexia. Don’t even go there with me.

6. “It’s just food (or insert specific food).” I know, it’s just food. It’s hard to understand if you haven’t walked a day in the shoes of someone with an ED. Speaking from experience, when I’m deep into my eating disorder, it feels like the world will end if I eat x, y, and z. Getting out of that mental block requires time and intensive treatment. Do you know what does NOT help with getting over that fear? People saying “It’s just food.” I know it is, okay, but my eating disorder can be strong and whisper that I cannot cannot cannot cannot have x, y, or z. Pointing out the obvious here is not helping me.

7. “Is it about control?” (pity glance) Please do not try to guess the reason for my eating disorder. Just because you learned on Dr. Phil that eating disorders are about control doesn’t mean that I want you to ask me, condescendingly, if my eating disorder is about control. I’ve been in therapy for a while. It’s not just about one thing. And to be honest, after some point, it stops being about one thing. My neurobiology has changed and I. cannot. stop. It’s not like I can realize I have control issues and throw pixie dust in the air and I’m better. It is WAY more complicated than that. Don’t mention control to me.

8. “You’re eating 3 meals a day right? So you’re fine.” Not fine. Not. Fine. Three meals includes so much variability. It is not about the number of meals, it is about the quality, quantity, and variety of food consumed. I learned in treatment that I should have at least 2 or 3 snacks in addition to 3 meals each day. So if I’m eating only 3 meals a day, it means I’m headed towards relapse. And you not taking me seriously is adding fuel to my ammunition.

 

Now a few caveats: these comments are not inherently bad, nor are the commenters inherently bad for saying things in innocence. An appropriately placed comment about a hypothesized pregnancy when you know the person has been trying to get pregnant is totally fine. Sometimes meal time comments are social conventions, and most people are fine receiving them. The issue here is saying such a comment when a person has an eating disorder. It has also been my experience that people are often oblivious when they have said something that I find hurtful or insensitive. A lot of times, an eating disorder can be a silent, invisible struggle, so people are not aware when they have been damaging.

You have to think how your comment will be interpreted in light of someone’s eating disorder. I cannot pretend my eating disorder thoughts are nonexistent. A comment about my size/ what I’m eating can send me into a destructive spiral. You don’t know the eating or weight struggles of the people with whom you interact. Think twice about saying something that can be taken the wrong way.

People don’t understand the effect stigmatizing or triggering words can have. Be kind and compassionate, and question your own stigmas about eating, weight, and eating disorders.

Why I Hate Insurance Companies

Insurance companies have a special place in my heart. A very, very special place. A special place that is shared with Megyn Kelly saying that Jesus is white, snowstorms in March, and the day that holiday drinks go away at Starbucks.**

I didn’t think twice about insurance companies until I developed an eating disorder. Since that time almost 13 years ago, my experience with insurance companies have coincided with anger 99% of the time. In fact, in my life, there has been a strong positive correlation between insurance company communication and deep hatred about humanity.

How shall I paint a portrait of how I came to feel so strongly? I will start with stories. One of my friends’ parents sold money saved up for her wedding to send her to treatment. Another friend was diagnosed with Bipolar Disorder at age 18, and as a result, she was denied insurance coverage for almost a decade because of her “preexisting condition.” Last year, after going through a hard time, I considered doing intensive outpatient treatment for my eating disorder. However, I “didn’t qualify” (aka I wasn’t “thin” enough). After probing, the insurance representative admitted that if I lost more weight, I would have a more “compelling case.”

These are only a few of the examples I have. I could list dozens more– people who have been kicked out of treatment because they no longer meet the criteria for anorexia (because when you’re 86% of your ideal body weight that’s “better”???), people who are dying because they cannot get treatment for their eating disorders. People whose families have taken out second mortgages, spent life savings, taken out loans– just to get mental health services. People who have to be at a life-threatening weight to qualify for insurance coverage of treatment.

When I developed an eating disorder, I had no idea how costly it would be to recover. An outpatient team is supposed to consist of a psychiatrist, general medical doctor, therapist, and dietician… that’s a lot of money. When you look at residential treatment, the picture gets way worse. It can cost about $1000 a day to be at a residential treatment facility, and if you have a severe eating disorder, you might need to stay for 4-5 months. The costs accumulate… $100,000, $200,000 for a residential treatment stint, $30,000 a year for outpatient treatment, and recovery can take 5-10 years. Plus relapses.

You should not have to be rich to recover from an eating disorder. 

Our system of mental healthcare is unacceptable. When I see people having to call Blue Cross or Aetna or HealthNet or whatever, bawling their eyes out, because they are refusing coverage for them to be a healthy, functioning member of society, you know there is something wrong. When an insurance agent is telling me that I need to get sicker because at my weight, my case doesn’t warrant treatment, you know there is something wrong.

How messed up is this? Let’s just pretend for two seconds that the diagnosis is cancer– can you imagine an insurance company saying, “Well, sorry, you’re in stage 2 of cancer, and you have to be in stage 3 before we cover treatment.” No!!!! You need to beat the cancer, and the earlier the recognition, the better! Why are mental health issues somehow viewed differently?

This boils down to something much greater– and much more complicated– than individual coverage. It relates to our priorities as a country and what we prioritize as a “right.” Do people have the right to recover from a mental illness, or do they have a right to receive the services they need? What do we value?

The answers to that question get deeply philosophical, political, and personal. Obviously my thoughts on this topic are far from innovative– mental health parity has been a subject of legislation for quite some time, and parity has culminated in 2 recent acts- the Mental Health Parity Act of 2008 and the Affordable Care Act. Discussion especially about the ACA is polarized. Even in my mental health policy class, talk about the ACA was politically charged. People are angry, happy, relieved, upset, furious– depending on one’s political ideology, the range of responses span across a spectrum of strong emotions.

I am not going to try to cover the entire topic of mental health treatment, parity, and coverage in our country. That could be a novel– or 10 novels. What I will do is speak to my personal experience of an eating disorder and emphasize humanizing people with mental illness, including eating disorders. Other conversations about coverage, and cost, and parity need to happen, but that is for future posts.

Stigma about mental health conditions is predominant, and at least in my experience, I have internalized a sense of self-stigma. I have this internal voice that taunts me, You are too much. Then how am I supposed to feel when my society, my government, is telling me that I am not good enough? Forget the cost, that message of de-valuing, the reminder that I need help, is so painful. I put so much on myself, why does society have to put that burden on me as well?

With all of the out-of-pocket costs I have paid over the years, I could probably have taken multiple world cruises. I have been privileged in having received help, but independent funding sources should not be a pre-requisite of the right to recover.

If I could boil what I want to do with my life, one social ill that I would like to see solved, it would be this: that people with mental health issues, invisible issues, would receive the coverage that they need. They would not need to get sicker or end up committing a crime and in prison or have to justify– beg– to third parties. They would be met as individuals– as humans– as members of society who deserve our help.  In our society, cash is king. Costly people and things are to be avoided economically. Even that label is stigmatizing. It denotes the idea that certain people who need help are burdens.

You cannot know someone’s story based on their scars. You don’t know what goes on behind closed doors– the pain the exists underneath. Invalidating that is invalidating that person’s right to exist as an integrated whole of a lifetime of experiences. Just because pain is invisible doesn’t mean it is less real, nor does it deserve to be treated any less than other diseases.

Why are people with eating disorders not given insurance coverage? Is it because the cost is a burden on society? Is it because eating disorders are increasing in our society? Or is it something deeper and more systemic about education and beliefs about eating disorders? I hear it in comments that “slip out” about eating disorders, often from well-intentioned people, “Why don’t you just get better on your own?” “Why can’t you just eat?” Is that a mistake, or lack of education? Or is there a deeper stigma that is underlying that is so embedded into our infrastructure, a sense of judgment around mental health issues?

I don’t know.

However, I do know that we make value judgments every day on who is “worthy” and “unworthy” of help and services. Our government does it, our world does it, our policies do it, families do it, and individuals do it. Groups do it, cities do it, and states do it. We need to cognizant of those choices and the implications that has on the humanity of the other.

In my lifetime, I would like to work so that the following words not need to come out of my mouth, “I want to move to Minnesota because their eating disorder coverage is really good since someone sued x insurance company.” It is so pathetic that law suits so that insurance companies “cave” and cover treatment for eating disorders (okayyyyy fineeeeee you’re dying of bulimia and anorexia, I guesssssss you can get help… but it better be cheap) is our primary modality of achieving parity. The fact that we have law practices designed to sue insurance companies about eating disorder coverage is good, but the fact that we need to have that at all is absurd.

I am not hopeless about our prospects of our country. I am reassured that we are working toward achieving parity through recent policy. The increased research, awareness, and education about eating disorders will penetrate into the system as long as we do not remain voiceless. In sharing struggles and advocating for each other and ourselves, I think we will find justice and healing.

 

**Disclaimer: I don’t actually hate insurance companies and those who work for them. Actually, my uncle works for an insurance company, and he is a great person. When I say “insurance companies” I am mostly referring to the systemic forces that underly America’s healthcare and our current system of private insurance.

Why The Biggest Loser Sucks… But Why It’s Way Worse Than That

I watched The Biggest Loser in its infancy. I remember Jillian Michaels and Bob Harper personal training the shit out of contestants, but pre-Jillian Michaels making 500 fitness DVDs. I might also note that I watched The Biggest Loser in the worst of my eating disorder. Watching a TV show centered on weight loss seemed like a natural outflow of systematically starving myself. In recovery, I was told that it wouldn’t be a good idea to watch something like that anymore. So I stopped. In fact, I stopped engaging in any pro weight-loss media. Much to my shock, I did not miss reading about what Nicole Ritchie ate for breakfast every day. Because, all those articles are basically the same when it comes down to it anyway. Frankly, I haven’t thought much about The Biggest Loser for several years.

… until yesterday. The internet has been blowing up with controversy about the last Biggest Loser winner, Rachel Frederickson, who went too far in her quest for weight loss. Not only did she win but she became unhealthily thin. People have been freaking out left and right. OMG this person on The Biggest Loser is too thin. She might even be anorexic. Has this gone too far?

I don’t disagree. Competitive dieting can for sure lead to anorexia. I know first hand. My own attempt at dieting resulted in a life-threatening eating disorder. I think that other articles that friends have posted (e.g. this one) have expressed that well. And yes, it is a horrible show. More on that later. I am not disputing any of this.

However, my response is more of a broader commentary on our culture, more along the lines of Carrie Arnold and my friend Lauren.

Why is this the first public outcry we’ve had about this show? Oh sure, let’s starve, shame, and publicly humiliate FIFTEEN SEASONS worth of people, and then when someone is considered too thin, “Oh, maybe that was a little too much.”

Does anybody else find this insanely ironic? Shaming public weigh in’s, people working out until they vomit or pass out, and verbal abuse by the hand of personal trainers for goodness knows how many people, and someone who wins gets too thin… and now it’s too far? The whole freaking point of the show is to lose as much weight as possible. Maybe there is not something wrong with Rachel and maybe something more wrong with the show, and more importantly, our culture.

It reminds me of tabloids. I see these things as I check out at the grocery store, and the stories are always the same: this person is too fat. They are overweight! Let’s have 20 unflattering pictures of them going to the grocery store. Then, actresses who might meet the criteria of anorexia have pregnancy rumors spreading because they drank some water or ate a piece of pizza. There is a very narrow window of pop culture satisfaction with a woman’s body. For the most part, all fat is a matter of repulsion to our modern media. BUT, when someone gets too thin, there is this surprising amount of mock alarm. This person is too thin, mass chaos ahhhhhh.

Our culture has a phobia of fatness. Anyone who is overweight is considered disgusting. That’s why we’ve created a reality TV show that gives them money for becoming “less lazy and more self-controlled” (note: public sentiment, not my own). When someone who is 350 pounds is publicly shamed, yelled at, and forced to vomit to get through a workout, that is acceptable to our modern American consciousness. So much so that it has been picked up for 15 seasons because of popular appeal of the show.

 And yet someone who ends up losing too much weight has gone too far, which is no longer appropriate, and the news story is so popular that is on the trending section of my Facebook page? It is such a weird double-standard. Once you get thin, you don’t deserve mockery and shaming anymore? That is too far. But if you’re “fat,” let the games begin. Vomit during your work out, if that’s what you need to do.

It is interesting how our culture legitimizes and makes value judgments about certain eating/ weight struggles. Anorexia has been in the public eye since the 1980s, but the newest eating disorder, Binge Eating Disorder (BED) is a relatively recent diagnosis (I mean it was recognized before by basically everyone in the field, but now a bunch of psychiatrists said it was legit, so now it’s officially legit). Binge Eating Disorder is thought to be the most prevalent eating disorder in the country. It affects 2.8% of people over the course of their lifetime and can often lead to obesity and other serious consequences such as death. While I haven’t watched The Biggest Loser in years, I would bet that some participants of the show have at some point struggled with this eating disorder.

As a part of eating disorder treatment, I hear over and over, Listen to your body. Love your body. Honor your body. Pretty sure that applies across the board. While I don’t specifically know best practices for treatment of BED, somehow I think that public shaming and fainting during dangerous work outs maybe are not the best strategies for treating a serious biopsychosocial disorder. People with BED can suffer with self-hatred and loathing at their propensity to eat, and behaviors can cycle. One eating disorder can be replaced with another. Are we really that surprised that someone went too far?

I am not trying to minimize the health ramifications of obesity. I understand that people can have serious health issues or prematurely die because of obesity. However, The Biggest Loser enterprise is not the right way to go about addressing this issue. Stigmatization and public shaming of people based on weight is never okay. Eating 500 calories, working out for 6 hours a day, and humiliation are never acceptable. It doesn’t matter what weight you are.

We need to take a step back and realize that the entire way that our culture views weight, eating, and exercise are deeply problematic. Can you imagine a country like France making a show like this? Neither can I. In this country, weight loss sells. Our diet industry rakes in $20 billion per year. So, the network produces season after season, and the abuse and shaming is never questioned.

 I feel badly for Rachel. I really do. I hope that she reaches a stable equilibrium. But Rachel is only one contestant– and victim– of this show. What about the other Biggest Loser contestants who “lose” the competition but develop harmful habits toward eating and exercise that might last a lifetime as a result of the show? Or they are self-conscious about their weight and feel ashamed for the duration of their lives? Yet, their unhealthy habits are discounted because they are not “thin enough” to warrant attention. No one makes stories that go viral about them.

I am concerned about Rachel, but I am also concerned about everyone else on this show, and frankly, I am concerned about the messages people get from watching it. And I am concerned that there are people whose voices are being ignored because they are not close enough to some cultural ideal. It reminds me of this Huffington Post article that was really eye opening to me. Jennifer Lawrence is applauded as a “body image hero,” and I mean, like the next person, I am enthusiastic about anyone who says, “If anybody even tries to whisper the word ‘diet,’ I’m like, ‘You can go fuck yourself.’ “

However, when I read the article, I realized that Jennifer Lawrence is a white, small Caucasian woman who meets a conventional standard for beauty, and she just happens to gloat about eating French fries. But– would a larger actress who says she likes eating be applauded as a body image hero? The author contrasts Lawrence with Melissa McCarthy, an actress with a different, bigger, body type. Melissa McCarthy is quoted saying, “I don’t know why I’m not thinner than I am.” What if Melissa McCarthy went on record saying that she loves French fries? Would there be gifs and tumblrs dedicated to her? Somehow, I don’t think so.

The author, Jenny Trout, wonders: “At what percentage of body fat does a woman earn the right to be a person?”

What is saddest to me about the whole Biggest Loser controversy is that this is what it takes for people to speak out. We should give attention and concern where attention and concern are due– this entire franchise. Rachel is not a far cry from what every other contestant has tried to do– lose as much weight as possible, and if you need to starve or almost kill yourself on the treadmill to do it, so be it.

This show is not okay, but in leaving the critique there, we are missing the public stigma and shaming associated with weight issues. We are missing the fact that millions of people are on their couches eating popcorn watching people almost kill themselves for a quarter of a million dollars. “You can never be too rich or too thin,” as the popular adage goes. The Biggest Loser attempts to handle both.

In my opinion, enough is enough. This show is a horrible outflow of our fat-phobic and paradoxical culture, and it is time that people stand up and call it out for what it is: Bullying. Shaming. Abusive. Unacceptable. It loses. And so do we.