What Makes Eating Disorders so Different

Every eating disorder starts with a diet. Most diets peter out when the person gets too hungry, but sometimes it leads to a different kind of hunger, one that triggers a cascade of largely physical reactions that can result in an eating disorder. But the hunger can be of many kinds. Perhaps it is a type of high, emotional but also psychological, from feeling as if one has mastered food. Or maybe it is an all-consuming hunger that makes one want to eat and eat and eat. Maybe the hunger becomes irrelevant because it feels so good to lose weight. For these people, once the hunger takes over, there is no turning back.

What other mental disorder starts with a choice, a seemingly innocuous choice, that spirals out of control? Maybe it even starts with a thought: I want to lose weight. Moreover, what adolescent girl--and, more often these days, boy--doesn't try dieting at some point? Does that mean everyone is exposed to the trigger for an eating disorder? Does that mean anyone can get an eating disorder?

It's hard to imagine having this discussion about any other mental disorder. Psychiatrists talk about a prodrome, a cluster of symptoms which appear to herald the onset of a psychiatric illness. The prodrome for an eating disorder could just be adolescence. Our culture extols the ability to remain thin and eat little in a world of abundance of all kinds of food. No one is more vulnerable to cultural mores than teenagers. When everyone is exposed to an environment ripe for developing an eating disorder, it begins to feel like everyone who is predisposed to get one will.

Although the mental health world has adapted over the last century to different conceptual frameworks for illness, psychiatric symptoms have remained fairly consistent: anxiety, depression, delusions, hallucinations. They have all been documented under one name or another and can be traced through the evolution of psychiatry, but eating disorders only entered the mental health lexicon in the last few decades. The almost meteoric rise from newly described illness to national obsession occurred within a generation, or perhaps two. The discipline is still trying to catch up on all levels: diagnosis, treatment programs and even basic treatment success.

Sometimes, I even wonder if eating disorders are really mental disorders. Maybe they belong to a whole different class of illness, the result of a broader national miscalculation which has exploited a cornerstone of human survival. Our food supply has been transformed in recent decades. Agribusiness and processed food, primarily using corn and soy, has provided our society with an abundance of food for the first time in the history of humans. The US makes almost twice as much food as the people living here need. We have gone from a people seeking enough food to survive to a world with, in theory, more than enough for everyone. Food changed from an urgent necessity to a continual choice. We can find anything we want to eat at any time. This means survival on a global scale but at what price? Our hunger was adapted to a world with a more limited supply of food, and we are ill-equipped to cope with such a plentiful environment. Hunger was a visceral, physical signal to the body to get food. Now many people experience hunger infrequently. Instead we are pushing new boundaries: either how much we can eat, what is our capacity, or how much can we withstand hunger with food all around us. There never has been the need before to adapt to times of plenty. Like it or not, this is our grand experiment.

Every person born today lives in this new world. Each person and each child has to learn how to balance hunger and fullness in the constant presence of food. No one knows how an entire country will handle hunger when faced with more than enough food, and not just food but all types of tasty and tempting food. This is food an entire industry spends enormous amounts of time and money developing to appeal to our most basic senses. The industry has worked hard to find food that will override any rational desire to stop eating. The result has been disastrous: rising rates of obesity, a steep increase in eating disorders, ineffective government iniatives to promote nutrition, and the exploitative food industry.

Re-reading this post, I realize there is a lot more to discuss in each point. The next few posts will explicate these thoughts in more detail. If these are the current conditions which exposed our evolutionary weaknesses to food and hunger, who among us ends up with an eating disorder? What makes those of us susceptible? Look for the next post.

1 comment:

  1. a woman in residential treatment, sick of hearing "why dont you just eat" from those people in treatment for drug or alcohol addiction finally had enough. One day at lunch, in front of the entire community, she stood up and said "none of you know what this is like for us in the eating disorders program. imagine having to sit down, five times a day (including our snack times) and face your "drug." For those of you here for alcoholism, imagine sitting down to a beer five times daily and being forced to refuse it. For those of you here for heroin addiction, imagine being offered a needle five times a day and having to electively chose to not inject. Would you be able to do it? For those of us here for Anorexia, we have to sit down five times a day and chose to place a fork to our lips. For those of us here for Bulimia, we have to chose five times a day not to dispose of the food we have consumed. Unlike those of you who have come here to find safe haven from your drug of choice, there is no place that exists like that for us. Our drug is a staple of life, necessary for survival. We will never be able to "avoid or abstain" from our problem. In order to get better, we have to chose every day to look at our "drug" and overcome temptation.... even here, even now while we are safely tucked away from the real world. So the next time one of you wants to say to one of my group members "you don't look thin enough to have an eating disorder" or "why don't you just eat," maybe you will think twice about what we are facing and begin to comprehend."
    The room went silent.
    Your post here reminds me of just how different this is from other illnesses. While there are many similarities to addiction and other diseases, this illness, as you said, deals with a "cornerstone of human survival." An alcoholic can survive without alcohol, a heroin addict without heroin, a sex addict without sex. Those with an eating disorder, no matter in what form it manifests, cannot survive without food.