Why Someone with Anorexia Should See a Doctor

For people with anorexia, one irony is that getting medical help often reinforces the illness. I will frequently hesitate before referring these patients to their primary care doctor, and this conundrum presents a complex path towards getting better.

The anorexic thoughts repeatedly tell people that they just eat a little less than others and that their medical symptoms are exaggerated. The fact that they cannot see their bodies realistically means that they think they are fairly healthy when they are actually severely malnourished.

How else can people who wear very small clothing sizes or get weak and dizzy from walking down the street believe they are healthy?

As their health continues to deteriorate, the eating disorder thoughts strengthen and convince the person their health is normal. Even abnormal tests, worsening physical health and increasingly debilitating symptoms don’t change this delusional thought. 

A confusing factor for these patients is that the human body is programmed to adapt to periods of starvation. Centuries of intermittent famine have built this protective mechanism into our DNA. Accordingly, blood tests often remain normal even when someone is severely starving. This does not reflect health but instead the body’s resilience.

Also, modern medicine is not designed to diagnose the medical problems associated with starvation. Outside of anorexia and end-stage cancer, people don’t experience chronic starvation in the first world. Thus, doctors aren’t trained to treat malnutrition and modern medical tests don’t pick up on the problems associated with starvation, especially the common cardiovascular ones which look for heart problems of the elderly, not the starved.

Because of these complications, seeking medical help often reveals little: blood tests and imaging are usually negative. Instead of receiving useful medical attention, people with anorexia end up without any useful information which then reinforces the eating disorder thoughts and leads to further slips. Unfortunately, a medical work-up can just as often lead to a relapse and hospitalization as it can medical findings.

The Flawed Messages to Parents about Food and Weight

After recently talking to an acquaintance about her daughter’s eating, I was reminded of the pressures on families to adhere to the societal mores around food and weight. It’s no wonder that so many children are essentially raised to have eating disorders.

The biggest disservice our culture provides is couching these pressures in hackneyed science and medicine. There are several examples that trick even the most well-meaning parents into questionable practices. 

The erroneous research into sugar as an addictive substance has created communal terror of this component of food. Yes, the human body is not designed to process the added sugars in all sorts of foods, but sugar is not the new cocaine or oxycodone. Understanding the risks of consuming too much sugar while also figuring out how one’s own (or one’s child’s) body reacts to sugar is important, but using this information to ban sugar from your child’s diet is troublesome. It only reinforces the child’s desire to eat sugar and creates a mystique that makes sugar the forbidden fruit and the most desired food.

The increase in children’s weight in recent years has become a public health obsession. However, the guidelines pediatricians use to manage weight as a medical indicator for health risk do not take into account the child’s overall health. As a result, many children are branded overweight and parents are charged to change that child’s eating and exercise habits or else fear the shame of a fat child. The line between fat phobia and sound medicine is not so clear. Often the well-intentioned doctor only encourages the possibility of an eating disorder.

Last adults who likely discourage peer pressure at school condone the shaming of fat children. Since being fat is considered a personal flaw or weakness, parents expect their fat children to be teased and, perhaps subconsciously, blame the child for the situation.

It’s easy to see how a child can internalize these messages about weight when they come from doctors, science, adults and peers. The message is clear: being fat is a personal flaw and losing weight is the only way to rectify the situation. Parents need to be focused on their child’s emotional and psychological well-being and not the number on the scale.

Hope: the Cornerstone of ED Treatment

Too many people with chronic eating disorders feel like they run out of options. It often takes quite a bit of time to summon up the courage to look for help and then actually get to an appointment. The shame about the illness and the fear of discussing the disorder—making it real—are overpowering. But after that first difficult step, what’s happens next?

Too often, people end up very frustrated and disappointed. Perhaps they see a clinician without much experience treating people with eating disorders. Perhaps they see someone who shames them for their illness. Perhaps they feel blamed for being sick. Or perhaps they go to treatment for a while and make no progress at all.

If that pattern happens a handful of times over a few years, it’s easy to see why someone would become demoralized and expect that the eating disorder is likely a chronic condition. As time passes and opportunities are lost, a sense of hopelessness grows even larger.

I have seen many people 10-15 years into an eating disorder in this frame of mind, devoid of hope and stuck in a cycle that feels like it will swallow their lives.

I don’t pretend to have all the answers to help these people. Sometimes they need behavioral intervention just to break the eating pattern. Sometimes they need education to understand the difference between their own thoughts and eating disorder thoughts. Sometimes they need someone to believe in them. Sometimes they need to see that love is the antidote to an eating disorder.

Most of all, the one component of treatment that is critical is hope. What these people who have struggled for years without any true progress need is hope. They need to see there is a way to recovery and that people who have been sick for years can fully recover. They need to see that the path may be hard, but someone has an idea of what that path might look like.

My wish for the many people struggling with chronic eating disorders is to know that help does exist for you. Look for the right kind of guidance and maintain hope that wellness and recovery can be in your future.

The Political and Social Biases of Eating Disorder Treatment, Part III

The difficulty with fully understanding the eating disorder epidemic of the last forty years is distinguishing between the clinical and social aspects of the illnesses. Psychiatry has historically created disorders aimed at marginalizing minority groups such as pathologizing homosexuality or hysteria as a form of invalidating women’s emotions. However, eating disorders are real psychological and medical problems that need treatment but which also just happened to begin a few decades ago. These two facts make them unique in the field.

In this blog, I have written extensively about various components of eating disorder treatment. Clearly, these are serious illnesses that demand medical attention. That must be clear.

However, unlike other psychiatric illnesses, eating disorders are relatively new and have only become a problem because of social pressures largely aimed at girls and women. No other psychiatric disorders are directly caused by the social construct of our society. No other psychiatric disorders affect 90% women.

Although there are genetic and psychosocial factors that cause eating disorders, the number one risk factor is dieting. Without dieting, people very rarely develop eating disorders. Before dieting and thinness became social and cultural norms, these disorders did not even have a name.

The pressure to diet comes from our culture of thinness. The mass marketing of the diet industry, exercise industry, the pervasive images in the media and the false information spread by the medical establishment have created a culture that says thinness is superior and healthy. Any increase in weight is failure. And this information is mostly aimed at girls and women.

The result is a society that condones dieting and starvation and ignores the enormous risk for girls and women.

One aspect of combatting eating disorders is treatment. That machine exists despite the issues discussed in the prior posts. 

The second aspect is preventative. It is necessary for those knowledgeable about eating disorders to start to speak out about the pressures that continue to foster dieting among girls and increase the risk factors of developing these illnesses.

The founders of residential treatment programs were often charismatic and were in the process of starting the groundswell of support that could buoy a social movement to combat dieting pressures. However, the financial companies that have absorbed these programs have also silenced their leaders.

Girls need to learn and understand the pressures they face and the risks they endure. Dieting is not a rite of passage. It’s a form of subjugation and potentially a cause of life threatening illness.

The Political and Social Biases of Eating Disorder Treatment, Part II

The shift in eating disorder treatment needs to take into account the historical patriarchy of psychiatry. From the earliest days of the psychoanalytic theory, women’s emotions and experiences were marginalized. This trend remains central to the recent history of eating disorder treatment.

The spike in the incidence of eating disorders during the 80’s triggered a response by a handful of psychiatrists to begin hospital-based programs led almost exclusively by men. These revered psychiatrists were known to have created mini-cults of vulnerable, sick women who had nowhere else to turn for treatment.

Largely in response to these treatment models, several women who had recovered from eating disorders themselves began residential programs outside the hospital systems using a new model based largely on addiction treatment.

These strong, outspoken women created a concept for treatment aimed at full recovery, largely taken from their own experiences, rather than the previous approach of maintenance of chronic illness. The programs were for women and run almost exclusively by women. The program philosophy was organized around empowering women to accept themselves and accept the support and love needed to live a full life. Embedded in the idea of recovery was freedom from the tyranny of thinness and beauty society has burdened on women in recent decades.

The downfall of these programs was their success. Seen as potential moneymakers, financial firms run by men bought these programs and have spawned a multitude of new ones throughout country with the aim of making a large profit for their investment. There is still a hint of the old treatment philosophy, but the individualized approach offering true help has morphed into a corporate strategy with much more limited compassion for the people they treat. The ultimate aim is to build a company and sell it at a profit.

As a man in the field, I am hard pressed to insert myself into this dynamic. The current treatment options are no longer aimed at curing the societal ills that essentially create eating disorders. Instead corporate greed has infiltrated the ranks.

The true way to fight these illnesses is to promote a new way for girls to see their bodies through their own eyes, not through the eyes of boys and men. The leaders of the residential programs when they first began were creating a path to teach girls these critical points.

If the health teachers across this country are saddled with this teaching point, there is no way to insert a new message into the heads of the next generation of girls about to suffer from anorexia, bulimia or binge eating.

Educating adults with eating disorders will help recovery but won’t stem this set of psychiatric illnesses aimed to silence women’s voices, emotions and anger. The future needs to cut off the message at its head. When girls are inculcated in this false belief about who they are, the incidence of eating disorders and the cynical corporate machine that profits from it will only continue to grow.