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

Not much has been written about why most people with eating disorders are women. The standard explanation is that the pressure of thinness and dieting is much stronger for girls and women. Since undereating is the number one risk factor for developing an eating disorder, this explanation has some merit. However, it feels like a facile and elusive way to understand a much more complicated situation. 

Psychiatry has often used certain diagnoses to explain women’s emotions. Hysteria, fainting spells and erotic fixation are examples of ways the mental health establishment has attempted to silence and pathologize women’s human reactions, whether emotional or sexual.

The question psychiatry and the eating disorder treatment world needs to address is whether eating disorders represent the newest way to silence women.

First and foremost, I know these illnesses are serious and real, much as the other illnesses I mention above are real. In no way do I doubt the severity of these disorders.

The problem is how psychiatry uses these illnesses to quiet women and explain away valid emotions women express.

For instance, most psychiatrists can compete their entire residency training program learning very little about how to treat people with eating disorders. This is odd considering how prevalent eating disorders are in this country. Accordingly, most eating disorder treatment exists as privatized business outside of the medical establishment and one that very often excludes the treatment of men. In fact, many eating disorder treatment programs openly endorse a feminist slant to their treatment, politicizing the existence of eating disorders. 

Sometimes, as most laypeople assume, eating disorders stem from a desire to look a certain way in order to invite attention to physical appearance. Much more frequently, eating disorders serve as a way to be more invisible either by being very underweight and resemble a young girl or by being overweight and effectively invisible in a fat phobic world.

I have written extensively about the treatment of eating disorders and said multiple times how the core of treatment involves close personal connection and that the antidote to an eating disorder is love.

These facts and treatments are very different from the treatment of any other mental illness such as schizophrenia or bipolar disorder. Clearly, there is a strong social component to this illness, and one aimed specifically at women.

The difficulty with these revelations is how to address them. I’ll write more about this in the next post.

Facing Eating Disorders as True Medical Illnesses

By considering the reality that eating disorders can be fatal, it’s hard for a loved one or clinician to ignore the severity of these illnesses. It’s too easy for people to minimize eating disorders as extreme diets or a passing phase to lose weight, but there is a stark difference between some weight fluctuation and serious medical illness. 

People with eating disorders find that their lives are taken over by the thoughts and behaviors. Attending to work or schoolwork becomes more difficult. Friendships tend to go by the wayside. One’s personality fades in order to accommodate the eating disorder. Any life goals that seemed important don’t matter in the same way anymore.

Someone may get distracted by a diet or weight loss plan for a few weeks and become upset once the period ends, but that person isn’t likely to lose track of everything and everyone that matter in life. The obsessive focus on eating disorder goals is all that is important to a sick person. This singleminded goal combined with the loss of everything relevant to that person are the key distinctions between an eating disorder and a diet.

Once that line is crossed, loved ones and clinicians need to stress the severity of the condition. Without adequate treatment, eating disorders can be chronic, even life-long illnesses, and compromise quality of life and longevity.

Treatment is not a guarantee of health and recovery and tends to take time, but minimizing the illness and avoiding necessary steps to get help can be dangerous. The risks to health and living a full life are great. Stressing this reality can make a difference in the long run.

Mortality and Eating Disorders

Eating disorders are so often misunderstood by laypeople. It’s too easy to chalk up the food behaviors to a desire to lose weight and disregard the severity of the symptoms. 

What’s even harder to comprehend is how these illnesses are not only debilitating but can be lethal.

I focus more often in this blog on the eating disorder behaviors and the psychological component of these disorders. Just as important in managing eating disorders is taking care of the medical complications. 

Purging and laxative abuse can lead to electrolyte abnormalities which cause two serious long term medical issues. The first is an abnormal heart rhythm from a low potassium level which can lead to death. The second is kidney dysfunction and even kidney failure necessitating kidney transplant. 

Starvation can cause poor function in many organ systems: metabolism, temperature regulation, heart function, brain function including cognitive symptoms and emotional dysregulation, bone marrow suppression leading to susceptibility to infection and anemia and the list goes on and on. The true takeaway is that starvation can cause any system to shut down. Whichever part of the body is more vulnerable is the one likely to shut down first. 

And even more central is the hopelessness many people feel when in the throes of an eating disorder. Being so trapped makes many people feel helpless enough to consider or even attempt suicide.

The combination of the myriad medical consequences of eating disorders and suicidal thoughts makes an eating disorder much more than a desire to lose weight. It’s crucial to take these illnesses very seriously and understand how often an eating disorder can take a life.