I’ve done it. In just a few sessions I made my mark on a
future generation of nutrition providers—an intern interested in eating
disorder treatment, no less. She was, like most, biased by the sensationalized
images and the media’s descriptions of emaciated anorexics; of teenage girls
who ‘just wanted to be thin’; and of visibly unhealthy looking bulimics. Those were people with eating disorders,
she believed.
Yet in the few days she has spent with me, she’s seen
anorexic men, normal weight binge eaters, and women in their 40s, 50s and 60s
struggling with eating disorders. Some developed their disorder recently, some only
recently presented for treatment, having struggled with their relationship with
food for decades. All are pained by their condition—no one chose to live with a
disorder. Really, there are places they’d much rather be than in a medical
office on a nice summer day.
Yet what they all have in common is that their appearance is
not a give away. Most look just fine, I must say. (Although I’ll admit that without
their layers of clothes some would be viewed as significantly underweight.)
Yet most carry their disorder on the inside.
It’s unfortunate, really, because as a result, they have
suffered silently. Their doctors and health care providers never knew to direct
them for the necessary expertise and failed to support recovery. And often they
put their foot-in-their-mouths with inappropriate comments about weight or “healthy, runners’ blood pressures.” If
only they could have seen it. If only it was as clear as the media portrays it.
If only they knew that most people living with eating disorders don’t look like they have an eating disorder.
If you didn’t know to ask, you’d have no idea that perhaps 95%
of their thoughts are spent perseverating about when they will eat next, and just how much; about whether their
stomach is still flat, or whether they will have access to a bathroom after
eating to purge; or whether they’ll have an opportunity to binge without anyone
to witness it. If only medical providers thought to evaluate food intake and
behaviors before the comprehensive, costly GI workups which fail to identify
the cause of the chronic distress from hunger or slowed motility, or the reason
behind the heartburn—namely, the chronic purging.
How helpful it would be for primary physicians or the referred-to
neurologist seeking an answer to the puzzling chronic headaches. No, no one
considers inquiring about the time between eating and the food restriction.
Yes, migraines and other headaches occur more often with under eating.
Hope comes with new DSM
Fortunately, the new DSM-5
guidelines may help. They’ve changed the criteria for defining anorexia,
removing some of the requirements that kept individuals from getting the help
they needed. And, from misleading health providers about what eating disorders really look like. Now, rather than defining
anorexia by using a specific weight change (such as the previous 85% of normal
weight) it appropriately offers a broader definition. A low BMI is not a
requirement for diagnosis!
The guideline states “the
clinician should consider available numerical guidelines, as well as the individual's body build, weight history, and any
physiological disturbances". In other words, an individual who is
objectively overweight or high BMI can now, fortunately, be fairly labeled as
anorexic if he/she has restricted intake resulting in significant weight loss
together with physiological signs of starvation together with
meeting all other criteria for the diagnosis. And, missing a period is no
longer a requirement for diagnosing anorexia. That certainly may impact the
many men out there struggling with feeling like an imposter with a ‘women’s
disorder’!
No, you don’t have to fear
that your weight isn’t low enough for your disorder to be acknowledged. And you
don’t have to look like an adolescent poster child for anorexia.
No longer should you feel you need to lose weight to fit the
anorexia definition to enable treatment or, for that matter, to validate your
suffering. No longer does EDNOS—that vague ‘not otherwise specified’
diagnosis—need to be used for those restricting, nor for those suffering with
Binge Eating Disorder (BED). Yes, you are
sick enough.
Anorexics are 60 lbs. And individuals with anorexia are also
200 lbs. Dropping weight with severe food restriction is no less serious if your
30 lb. or 50 lb. weight loss brought you to 130 lbs. or to 90 lbs. Thank you,
Deb Burgard, PhD, an AED member and blogger for HAES, for making this point
loud and clear.
Having a BMI in the healthy
range is hardly healthy if you are compulsively exercising, purging or
restricting to maintain this place.
I’m so glad the intern gets it. It will make her a better
provider when the time comes to practice, as she will now know to ask the
questions to help identify and ultimately support recovery from an eating
disorder.
But have I made my point strongly enough for you to hear?
Please pass this along to increase awareness—to your friends and family members
who you’d never know might be suffering—and to your medical providers who never
thought to ask.
