Anorexia and the media

February 22, 2015 9:12 AM

"My Eating Disorder Had Nothing to Do with Barbie or the Media"

When I was ten years old, I had a Barbie doll. I had VHS copies of every Disney movie ever made, and a stack of Cosmo magazines I'd stolen from my older sister. Six years later, I had anorexia. None of these things are related ....

"A lot of people don't see eating disorders as actual illnesses," Carrie Arnold, a 34-year-old freelance science writer, author, and recovered anorexic tells me. "They see them as choices. And thinking that eating disorders are caused by images of thin models really serves to drive home the point that they're all about vanity." ...

In my opinion, the real way in which the media is damaging isn't in the way it creates eating disorders, but the way it discusses them ...

Previously, previously, previously, previously.

posted by John Cohen (47 comments total)

The implication is that unrealistic body standards lead to eating disorders, which is an argument I believe reduces a severe mental illness to a vain aspiration to be a runway model

I think that's only one implication and a even for those who believe it, it's hypothetical one, at that. There are plenty of reasons to decry unrealistic body standards placed on women without linking them to anorexia in particular. Anorexia is a multifactorial illness that many medical and psychological experts see as a very complex puzzle. Though it may not be true for this OP and for other sufferers, many people with anorexia do experience beauty standards as a causal factor or exacerbating factor or element in the disordered thinking, and because standards of female appearance are also an obsession of the general society,they're easily available to be interpreted in extreme ways as part of more complex pathologies. Also, the categories and expressions of mental illness are at least in part socially constructed. One of the largest meta-reasons I have come across is that anorexia may be at least in about issues of fear, power and control in the family, but that's not inconsistent with the way societies culturally construct mental illnesses (eg, as one of my professors said in a slip simplification for illustrative purposes, "don't go crazy, but if you're going to go crazy, do it in this way.")

It also seems odd to me to tell the story of the sexually abused women as though it contains no intersection with social standards of beauty and attractiveness.

The OP's experience is real, and it's serious, and her point that we should not trivialize an obsession with weight and intake as shallow is an excellent one. I do think that her experience doesn't reflect all experiences of anorexia, and would kind of turn this thesis on its head: concern about not meeting social standards, even when it is not a mental illness, is a deeply distressing experience also not to be made fun of, treated as simple, and shallowly expressed.
posted by Miko at 9:46 AM on February 22, 2015 [47 favorites]

I don't believe that my eating disorder was caused by the media: that would be stupid, because many people consumed the same media and didn't get eating disorders. I also don't pretend to completely understand the really complex genetic and environmental factors that I assume must have worked together to make me get an eating disorder. But I don't dismiss beauty standards or ideas about women's bodies as a causal factor, and I know that they have massively complicated my recovery, because it's really hard to exist in our society at all and avoid unhealthy messages and general triggery stuff that sends my thoughts to places where it's not healthy for them to go. I think in general, anyone looking for simple causes is going to fail to find them, and that doesn't mean that any one factor should be off-limits for discussion.
posted by ArbitraryAndCapricious at 9:48 AM on February 22, 2015 [11 favorites]

This article rings very true to my experience. In fact ...

> " I was so fucking terrified of dying, but not enough to lift a spoonful of yogurt to my lips. It wasn't because I wanted to look like Kate Moss ... It was because my brain was fucked."

Um, wow. It rings true to exactly my experience.
posted by kyrademon at 9:51 AM on February 22, 2015 [13 favorites]

How can we solely blame the media for causing eating disorders

That is quite the strawperson. The media is an easy target for criticism because it is the thing we can most easily understand and change (or avoid). We're still struggling to understand the brain chemistry and genetic factors that go into various mental disorders, and coming up with new ways to treat them. I'm not sure I've heard anyone say that the media is the only cause of eating disorders.
posted by desjardins at 9:51 AM on February 22, 2015 [19 favorites]

Personally my eating disorder was absolutely influenced by body image and the media. Yeah, the root cause was depression, stress, social problems, and a shitty home life. But I expressed it via anorexia/bulimia because at the time I was convinced if I was just beautiful all of the problems I was suffering would be alleviated, if not go away entirely. Beauty equalled control and perfection, and beauty was being thinner. I didn't want to look like Barbie either, nor did I want to be runway-model-thin, but I wanted to look and feel dramatically different than I did and I felt the only way to do that was by losing weight.

I also think that sometimes we are not aware of how society sends us these messages of body image and worth, and so even if we're not consciously thinking "I'm gonna barf to look like Barbie" we still hold these subconscious values about what we should be. I think it is also ridiculous to claim societal expectations of gender does not influence how mental disorders express themselves. The same way men and women commit suicide in different ways (men tend towards more violent methods like guns, women tend towards pills and suffocation), if you've got the idea that your worth is centered around your bodily appearance then that can become the focus of your illness.

Obviously this is not the case for all women and men, it is unhelpful and alienating to try to shove all expressions of a mental disorder into a box. At the same time, I think this Vice article is doing what Vice articles do, which is take a good point and then go on a contrarian streak with if for the sake of clicks.

Anyway here are unrelated thoughts about eating disorders and treatment:

• Using control over eating as a proxy for control over one's own life is a well recognized motivation for eating disorders. It is pretty clear that a number of saints and religious figures celebrated for their fasting periods had straight-up anorexia. Back then, in a society where the only way for a woman to achieve any kind of agency was through religious organizations and recognition for religiosity, it is understandable why someone might start going down that road.
• Given the above, it is pretty fucked that a treatment for anorexics is to take more control from them via force feeding and involuntary hospitalization.
• At the same time, there are real physiological changes in the brain and body that happen as a result of starvation, physiological changes that result in feelings of euphoria, worsened depression, and occasionally hallucinations, and the only way to alleviate these is by putting on weight.
• Also you can have something that starts as psychological ("If I am thin then things will be OK") and becomes physiological ("Binging and purging is relaxing"). At least for me that was the case.

posted by Anonymous at 9:58 AM on February 22, 2015

"don't go crazy, but if you're going to go crazy, do it in this way."

This is perfect. I'm gonna have to remember it!
posted by Anonymous at 10:00 AM on February 22, 2015

The article seemingly picks apart a narrow argument that I don't think anyone is actually making: that media exposure is the direct cause of anorexia in all cases. It is, however, a much easier argument to disprove because all you need to do is drag out a few exceptions.

If I were to attempt to diagram anorexia causation, it would be a big old web of factors and media for sure would be included. Along with a bunch of other stuff. You look for the links and try to figure out how the assorted factors interact. This would still include things like narratives from those with anorexia who don't feel their disease was influenced by media.
posted by mandymanwasregistered at 10:05 AM on February 22, 2015 [5 favorites]

Having known a few women who had eating disorders, I agree with those here who talk about control. Though some talked about being fat, though they were far from fat, dealing with body image issues, this was more a reason for exercising what could be seen as extreme control over one aspect of their life. Something they could control. One woman I knew never talked about body image, instead she saw food in most forms as an allergen and restricted her diet to only a few things. Again control. But overall, a number of women I know always seem to complain that some parts of their anatomy is either too small or too large. This seems to be media related. No one measures up to what society seems to expect.
posted by njohnson23 at 10:07 AM on February 22, 2015 [1 favorite]

Oh. I'm anorexic. I have anorexia? This is quite astonishing.

Since about mid July I've been struggling with a nearly complete loss of appetite. I've dropped between 25 to 30 pounds and it's no big thing for me to go 24 to 32 hours without eating anything.

When this first began, it was like a switch went off. I immediately went to my GP. She frowned, nodded, took notes and scheduled me for a 3-month follow-up.

One night in September I developed an uncomfortable feeling upon swallowing. It didn't go away. After 24 hours I saw my GP. An x-ray study discovered I had severe acid reflux, which was interesting to me because I suffered no other symptoms other than the mild discomfort upon swallowing.

My GP also wanted a follow up endoscopy and colonoscopy. They came back clean as a whistle.

Still not eating, still losing weight. No one seemed to be overly concerned except me. I don't want to be a princess or a doll; I just want to have a few minutes a day where I can sit down and enjoy some food and nutrition and not have it be the overwhelming issue every waking moment.

In October I had what can only be described as a breakdown. Over the course of one weekend out of town I had three separate panic/anxiety attacks. The first thing I did when I got home was make an appointment with my GP. This time she gave me the number for a therapist. I made the call right away, got in to see the therapist within a week of my return.

I've been seeing her for 5 months now? Sometimes we talk about my eating, or rather my not eating, but have talked about it more as a mystery, and how frustrating it is to me that I don't have a definitive answer.

I recently had a annual physical with my GP. When she started giving me pats on the back for sticking to the low fat low cholesterol diet she's been pushing on me since I've been seeing her (WTF) and told me to keep doing whatever I'm doing to take the extra weight off I finally broke out of my passivity and reminded her that my weight loss was due to some underlying issue that isn't normal or typical for me. She finally seemed to take notice.

After reading the linked article, have to say that every single person quoted said something that resonated very deeply with me. Their issues are not my issues and my issues are not anyone else's issues, but it seems pretty clear to me, seeing it all laid out like this with a name attached to it, that I had developed anorexia.

Why didn't anybody else recognize this? Could it be that I didn't fit the image of the established media representation of anorexia?

After preview: Wow. The insights just keep coming. Holy cow. I have a lot to a digest here.
posted by ezust at 10:13 AM on February 22, 2015 [32 favorites]

What's amazing is that despite ample evidence that it isn't unfair images in the media that view persists as dominant to the point where people need to write articles like this.
posted by rr at 10:23 AM on February 22, 2015

I have anorexia too. It's a side effect of one of the medications I take for my epilepsy. I don't have anorexia nervosa, though, which is the thing discussed in this article. I don't feel compelled to not eat and to control my diet - quite the opposite, in fact. I just don't have an appetite to speak of, and if I don't consciously remember to eat, I'll just forget, sometimes for days.
posted by HypotheticalWoman at 10:25 AM on February 22, 2015 [4 favorites]

http://www.ncbi.nlm.nih.gov/pubmed/2602570

In many instances eating disorders are a response to sexual abuse. In the current climate of date rape drug administration, individuals who don't have a specific recollection of rape, have a body memory of it, that may cause all kinds of reactions. The percentage of abuse victims / eating disorder patients is high.
posted by Oyéah at 10:27 AM on February 22, 2015 [1 favorite]

What you're describing doesn't necessarily sound like anorexia nervosa to me, ezust, but it sounds like something that someone should be taking much, much more seriously than anyone currently is taking it. Can you talk to your doctor and therapist and demand a much more thorough medical and psychiatric workup so you can figure out what's going on?
posted by ArbitraryAndCapricious at 10:29 AM on February 22, 2015 [6 favorites]

I think it is very reductionist to say that media that portrays or glorifies sexualized, thin women "causes" eating disorders. People don't get anorexia from playing with Barbie. However, I do think that pointing fingers at the media as a possible cause of the prevalence of EDs is reflective of a shorthand for the idea that all the weird icky socialization (not even necessarily objectification) of women and girls from a very early age contributes to a social and psychological milieu that is, unfortunately, conducive to developing EDs.

Also: I want to second that eating/food-related issues can often be a response to sexual abuse or trauma, as Oyeah mentioned above.
posted by gemutlichkeit at 10:47 AM on February 22, 2015 [1 favorite]

I don't know much about the relationship between direct media consumption or indirect media consumption (other people consume media, it affects their view of what is normal or desirable and they then influence someone in a way that increases their risk of developing an eating disorder). However, I do know about how to use evidence to show relationships between things and this article is filled out the wazoo with flawed logic.

1. Lots of women are unhappy with their bodies and most don't develop eating disorders. True, but correlation (a necessary but not sufficient condition for showing causation), doesn't mean most people who X do Y. It means that people who do X are more likely to do Y than people who don't. For example, we don't use the fact that most people who smoke don't get lung cancer to argue that smoking doesn't cause lung cancer. Instead, we point out that people who smoke are more likely to get lung cancer than people who don't.

2. Men having eating disorders too, and they aren't trying to look like Barbie. True again. However, this would only be a valid point against the argument that media consumption is always the cause and the only cause of eating disorders. It would also be more valid if men weren't also subject to unrealistic body expectations. This one is akin to saying "But people who don't smoke get lung cancer, too!" Yep, other things cause lung cancer. Not news and doesn't absolve smoking.

3. Some women who have eating disorders trace these to reasons other than media, like sexual abuse. Again, if anyone were making the strawman argument that media consumption was the only possible cause of eating disorders, then I suppose this would be a point against that argument. But nobody is making that argument and so this is akin to saying "Asbestos miners also get lung cancer!"

That said, of course the conclusion at the end that ultimately this is about a nuerological malfunctioning in the brain is accurate , but this tells us nothing about what factors increase the risk of that malfunction. To belabour the metaphor, this is like saying "He doesn't have lung cancer because he smoked, he has lung cancer because cells in his lungs have mutated and are now dividing uncontrollably!" Is one of the factors that cause EDs media consumption? I don't actually know. The only actual evidence given in this article (the Fiji TV finding) provides some very limited evidence that it might be. It is surely not the cause for everyone, and even where it has contributed to someone*'s ED development it is surely not the only cause.

So yeah, a logically flawed argument with a strawman. But I'm glad she didn't die of this and I hope we can find a way to prevent EDs in future so no one else has to die and no one else has to go through what I imagine is the hell of recovery.

* I saw "someone" here, a hypothetical individual person, but of course when causation is complex, you never really know what caused the outcome in one particular person. Even when a smoker gets lung cancer, it might not be caused by the smoking -- maybe this person would have had lung cancer even if they had never smoked. It's impossible to now in the individual. All we know is that i the aggregate, people who do X are more likely to do Y. We don't know which of those people who did both (if any) did it because of Y. We don't know which of the people who didn't do Y would have done it if X. All we can ever know is the aggregate pattern.
posted by If only I had a penguin... at 11:17 AM on February 22, 2015 [8 favorites]

"I'm about as good a counter-example to the myth that eating disorders are caused by unrealistic body standards set by the media, Disney, or Barbie that you will find," says Tom*, an executive at a software company in New England, now in is in his mid-50s.

"I'm male. I developed anorexia when I was 14, in 1977. I discovered by accident that, when I withheld food from myself, I got temporary relief from the negative feelings I had about myself. It had absolutely nothing to do with body image. I had no desire to become thinner, and I was only vaguely aware of how thin I had become."

That's kind of like saying a non-smoker with lung cancer is a counter-example to the myth that smoking causes lung cancer.

It would be a counter-example to the theory that only smoking ever caused lung cancer, if anybody was entertaining that theory....

There probably are a lot of people whose only understanding of anorexia is that it is a case of women wanting to look like photoshopped models, and for them this will probably be an important and helpful corrective.

Maybe there are people whose only objection to impossible beauty standards is that they cause anorexia; people who read this article might unfortunately conclude, "look, impossible beauty standards don't cause anorexia after all! Lighten up about them!"
posted by edheil at 11:19 AM on February 22, 2015 [3 favorites]

Can you talk to your doctor and therapist and demand a much more thorough medical and psychiatric workup so you can figure out what's going on?

I feel like I've exhausted all the medical avenues, I'm not sure what more they could look at. But, at my last meeting with my therapist I did circle back to an earlier conversation we had about depression. She suggested I might want to see a psychiatrist and talk about medications. I've been prescribed xanax for the anxiety but, something else I learned reading Metafilter: people with anxiety often are too anxious to take their medications! I'm still adjusting to the realization that I have been suffering from anxiety my entire life, and never knew this was something I didn't have to struggle with. It seems like I have a few more pieces to the puzzle.

I don't have anorexia nervosa, though, which is the thing discussed in this article. I don't feel compelled to not eat and to control my diet - quite the opposite, in fact. I just don't have an appetite to speak of, and if I don't consciously remember to eat, I'll just forget, sometimes for days.

Yes, this exactly. And yet when I try to explain to people, 100% of the time I am told how lucky I am, and how terrific I look (now?).
posted by ezust at 11:20 AM on February 22, 2015 [1 favorite]

When the article talked about the idea that anorexia is identical to looking skeletal, and therefore if you don't look skeletal you don't have anorexia, is the fact that there are fat anorexics. Fat can be incredibly resilient to changes in diet, even to anorexia. Some people essentially cannot lose weight no matter what they do, including essentially ceasing to eat altogether. If they are susceptible to anorexia, being constantly pushed to diet might put them in a place where the illness breaks out. My wife worked in social work in mental health and knew of a case of a fat woman suffering from all the debilitating effects of malnutrition who had not been diagnosed for a long time because it never occurred to anyone she saw that it was anything but a good thing that a fat woman was literally starving.
posted by edheil at 11:25 AM on February 22, 2015 [10 favorites]

ezust, if you live somewhere where medical marijuana is an option, it might be a helpful option. It's used for people with both anorexia and chronic nausea to give them an appetite which they have lost due to their conditions.
posted by edheil at 11:29 AM on February 22, 2015 [2 favorites]

Hey, ezust, not to make the thread all about you, and if you want us to talk about the FPP and not you, please feel free to flag our posts or tell us to knock it off:

But, at my last meeting with my therapist I did circle back to an earlier conversation we had about depression. She suggested I might want to see a psychiatrist and talk about medications. I've been prescribed xanax for the anxiety but, something else I learned reading Metafilter: people with anxiety often are too anxious to take their medications!

I haven't struggled much with anxiety, and I have with depression. Medication helped considerably with getting into a better place at least a little bit at first, but psychopharmacology is tough and imprecise and varies from person to person, so getting a good psychiatrist and trying different drugs is, in my opinion, a good and useful thing for those struggling with mood disorders to try.

And it's been my experience that the way our society talks about dieting and losing weight as morally positive efforts pro se gives some suffering from anorexia or other eating disorders to explain what they're doing in a socially-acceptable way. Improving those public discourses would not likely end anorexia, but it might make it more recognizable, more easily discussed, and more easily treated.
posted by thegears at 11:30 AM on February 22, 2015

_{I'm going to go and hide in a hot bath now...}
posted by mikelieman at 11:30 AM on February 22, 2015

ezust - I have been you, and my doctor was your doctor. In a way, I may still be you, because when my doctor refused to see a problem even when my periods stopped, I decided to "force-feed" my self, and while I finally gained weight and my periods returned, I now have a problem with over-weight. I'm noting that your doctor, like mine, is a woman. I didn't think about it at the time, but she was eventually pensioned and my new doctor is male, and we have a completely different conversation about my health and my weight.

My former doctor was very slender, and when I said I was worried about my weight, she just said that since my BMI was fine, I couldn't have weight issues. The thing was, I was over-training as well as under-eating, so what weight I had was muscle. But if you just looked at me, it was easy to see something was wrong. I was wearing children's clothes, size 12 yo (I'm 5'5'' and naturally full-figured). My severely anoretic best friend and room-mate couldn't fit into my clothes (yes, it is normal for anoretics to hang out). What I'm trying to say is that doctors are people too, and I suspect that my now pensioned doctor had her own body-image issues.
My new doctor is more consistently monitoring my mental health (in a good way), and even though he agrees I am over-weight now, he says that as long as I have no other health issues due to weight, I need to get help for depression and anxiety first. I am very grateful for this new approach, even though there are so many things to deal with, I am not progressing very rapidly.
posted by mumimor at 11:31 AM on February 22, 2015 [3 favorites]

Hey, ezust, not to make the thread all about you, and if you want us to talk about the FPP and not you, please feel free to flag our posts or tell us to knock it off:

While I do feel a little guilty that I may have hijacked this thread, the amount of information insight and introspection I'm getting out of this thread is just kind of overwhelming and encouraging to me, in a very supising way.

mumimor, my GP is also a very tiny woman, for what it's worth
posted by ezust at 12:23 PM on February 22, 2015 [3 favorites]

I am really amazed at the level of insight and discourse in this thread. Just when I thought the internet was awful, something like this pops up and I'm reminded that the internet is people. Metafilter people are some of the best people.

I have never had to deal closely with these problems except in an emergency medical capacity, and I'm really grateful for this insight into your lives. I'm very hopeful that things will improve for all of you, so you have at least one random guy on the internet pulling for that.
posted by poe at 12:38 PM on February 22, 2015

While I do feel a little guilty that I may have hijacked this thread, the amount of information insight and introspection I'm getting out of this thread is just kind of overwhelming and encouraging to me, in a very supising way.

You can always post an Ask to solicit more information about experiences with anorexia if that might be helpful to you.
posted by DarlingBri at 12:42 PM on February 22, 2015 [1 favorite]

I'm reminded of a recent visit to my doctor who's first question on seeing how much weight I had lost was if it was something I was trying to do or not. Even ignoring mental health issues, weight loss can be a sign of some other underlying issue and should definitely be investigated further. I'm a little alarmed that other people's physicians aren't doing so.
posted by jamincan at 1:32 PM on February 22, 2015 [7 favorites]

When I was an alcoholic, I lost so much weight. Really, I'd drink wine, and that was my only source of nourishment. Actual food was like ash in my mouth. If you had told me, it was because of barbie, or cosmo, or some ideal...
posted by adept256 at 1:39 PM on February 22, 2015 [3 favorites]

I see a lot of disordered eating in women that would not be classified as an eating disorder but it's definitely linked to a concern over what society says they look like. A person doesn't have to be starving themselves to still have issues with eating.
posted by KateViolet at 2:14 PM on February 22, 2015 [1 favorite]

Mod note: A few comments deleted; treading lightly is a good idea but I don't think that's really what ended up happening there.
posted by cortex (staff) at 2:21 PM on February 22, 2015

I will try again, because I actually think this is an important point....

There are lots of disorders that cause people not to eat enough. They're not all eating disorders. Eating disorders are, in some sense, about having a disordered relationship with eating and/or body image. There's always lots of other stuff going on, but the food stuff isn't just a secondary effect of other issues. Lots of heroin addicts lose a lot of weight, but heroin addiction isn't an eating disorder. (On the other hand, substance abuse disorders and eating disorders are fairly often co-morbid, and bulimics are especially likely to have substance abuse issues. But you don't have bulimia if you just happen often to drink so much that you puke, unless you're intentionally using drinking too much to make yourself vomit as a purge method.)
posted by ArbitraryAndCapricious at 2:28 PM on February 22, 2015 [3 favorites]

My wife worked in social work in mental health and knew of a case of a fat woman suffering from all the debilitating effects of malnutrition who had not been diagnosed for a long time because it never occurred to anyone she saw that it was anything but a good thing that a fat woman was literally starving.

Yes, and the clinical guidelines don't help. A diagnosis for anorexia nervosa used to require that the client have a body weight 85% or less than expected for age and height. It looks (I haven't done the full training) that the new DSM is less exact on numbers, but still requires the individual to be underweight. Overweight people who are restricting food or binging/purging would previously have been considered for Eating Disorder Not Otherwise Specified, which has now become Unspecified Feeding and Eating Disorder (Binge Eating Disorder only got its own category in this latest edition, too), and there tends to be much less focus on research and treatment for the "not otherwise specified" catch-all categories, which means there's much less awareness of them.

I like the "don't go crazy, but if you're going to go crazy, do it in this way" idea. In the same way that suicide is considered "contagious," in that it can put the idea in people's heads as an actual possibility, I think our shaming "beauty" culture puts calorie restriction, purging, and over-exercise in people's heads as common and therefore reasonable actions. It's unlikely to create an eating disorder out of thin air, but it can certainly, in my opinion, give someone suggestions for methods to try to control anxiety, trauma reactions, or other stresses.
posted by jaguar at 2:36 PM on February 22, 2015 [3 favorites]

They're not all eating disorders. Eating disorders are, in some sense, about having a disordered relationship with eating and/or body image

First off, totally agree, and this is an important distinction that isn't made often enough.

Second, at least in my own experience, this is not always super clear cut. I suffered from what's probably best described as disordered eating for a time. I restrict calories in a way that probably wasn't physically unhealthy, but it definitely was not from a place of wanting to be healthier, but rather from one of wanting to feel control when I otherwise felt I didn't have it in my life.

Part of what made it so seductive, I think, is that I genuinely felt less hungry when I was in the midst of this, since whatever bit of weird emotional state I got myself into definitely suppressed my appetite. Plus it set up some really awful self-judgments based on my weight that made me feel all the worse years later when I was being treated for depression with an SSRI that caused weight gain.

I honestly think I would have figured out that I was doing something self-destructive a lot faster if I hadn't been exposed to messages about "controlling appetite" and the like--and the general framing of body weight as an issue of morality and self-control. (And this has got to be ten times worse for women.) Otherwise it might have occurred to me that eating 800 calories less a day and not feeling hungry was probably a sign something was up.
posted by thegears at 2:42 PM on February 22, 2015 [4 favorites]

First off, totally agree, and this is an important distinction that isn't made often enough.

I think of my eating issues as 'maladaptive behaviours'. It covers a lot of ground, yes, but I think it captures the essence for me that my eating issues are part of a larger problem, and since at the core, it's about my behaviour, and humans are irrational, I don't expect a wholly rational analysis to cover everything.
posted by mikelieman at 3:49 PM on February 22, 2015

My son, who is now 17 and is on the autism spectrum, has had an eating disorder literally since the day he was born. He ended up at Boston Children's Hospital at 6 months old because his intake was so poor it had given him early kidney failure.

Today we have a fairly good understanding of the causative factors in his individual case (which I can go into if anyone cares), but what I wanted to talk about here is how much it bothers me that people, including health care providers- who should know better- jump so quickly to the body image theory of anorexia. I know that really is a causative factor for some people, but I also worry that for other people, providers assume/suggest it must be a/the reason, and other causative factors that could be equally or more important don't get considered appropriately.

I am especially bothered by how patient complaints are not elicited with enough care, and how that can lead to a chain of assumptions that can be damaging for people with eating disorders. For example, providers sometimes ask my son if he "ever feels too fat" or "like he eats too much", to which he always correctly answers "yes", because he has early satiety (the physical sensation of being over-full after eating an insufficient amount). This is not always (or even usually) caused by body image issues, and I wonder if people who don't realize this can become convinced that they have anorexia nervosa due to body image problems- especially if their health care provider says or implies so- when in fact that is not the original/most important causation, but is perhaps one factor among several, or even a non-related coexisting problem.

And beginning way back when he was a toddler, I've spent a substantial amount of time refusing inappropriate treatments that have been recommended based on the anorexia = body image issues equation too (for example, in-patient treatment on a floor specializing in treatment of adolescent girls with anorexia nervosa, when he was an 8 yo boy with completely unrelated issues). It makes me wonder how much inappropriate diagnosis and treatment is really going on out there. It's scary to think about.
posted by shiawase at 5:20 PM on February 22, 2015 [3 favorites]

Otherwise it might have occurred to me that eating 800 calories less a day and not feeling hungry was probably a sign something was up.

I think this is how insidious it is. It's not like I decided to stop eating because I wanted to be skinny because I had magazines as a teenager. But that period, the worst of it--I still struggle sometimes--was marked not only by my own misery but also by the only time in my life before or since that family and non-romantically-involved others offered unsolicited compliments about my physical attractiveness. I'm sure it didn't cause the problem, but it made it crazy hard to get help. I never felt like people thought I was vain. On the contrary, I felt like entering recovery before I was skeletal meant that people perceived the whole thing as a lack of willpower--an excuse for a failed diet. The unreasonable standards of beauty mean that people will be disappointed in your recovery if it starts before you're on death's door, because weight gain is perceived as so deeply shameful. It was a huge barrier.

I still have days I don't eat well, but I have other days now where I eat plenty, and it nets out to pretty stable because I'm not reinforcing it with fear of judgment anymore.
posted by Sequence at 6:44 PM on February 22, 2015 [8 favorites]

because I'm not reinforcing it with fear of judgment anymore

Oh, God, this.

Also known as why I didn't really want to eat in public for several years--a fact that didn't help with social isolation and probably contributed to a moderate episode of depression.

American [and probably Western] culture is so screwed up when it comes to the way we talk about healthy eating, and it really does bother me. We constantly assign moral values to food (even in relatively benign contexts, like "good" and "bad" cholesterol). We nitpick and calorie-count everything to three significant figures, even while we know that that's a profoundly silly way to think about nutrition.

The number of my friends that have repeatedly declared they're doing some random vaguely-orthorectic diet in spite of a complete lack of evidence there's any good reason to frustrates me. But I suppose in the end it's rude, and fighting a lot of culture to just say "please just eat what you like and maybe try to get some vegetables but really just live our life".
posted by thegears at 7:23 PM on February 22, 2015 [3 favorites]

Yet another "my anorexia was about control" person here.
posted by luckynerd at 10:21 PM on February 22, 2015

Though it may not be true for this OP and for other sufferers, many people with anorexia... The OP's experience is real, and it's serious, and her point that we should not trivialize an obsession with weight and intake as shallow is an excellent one...

Hey, I'm the OP and I've never had any eating disorder. I found this article in my Facebook feed, linked by a young woman in her 20s who has been struggling with anorexia since she was 12 and often posts about it on Facebook. She left a comment saying her eating disorder is about control, not Barbie, skinny models, or dieting.
posted by John Cohen at 11:34 PM on February 22, 2015

Just to head off possible further confusion, Miko's use of "OP" in her comment refers to the original poster of the linked article (not you, as the OP/original poster of this Metafilter post).
posted by taz at 3:43 AM on February 23, 2015 [1 favorite]

When I was a kid I happened across pictures of Bergen-Belsen. There was immediate recognition. I saw my Mum. The gaunt projecting him bones, the stringy dead hair, the knobby arms and legs, the concave sunken breasts - it was her. I had never seen women with bodies that looked like my mother before.

My first understanding of anorexia had nothing about Western beauty standards in it. I lived for years with the idea that my Mum had difficulty eating and that this was because she was upset and it gave her indigestion.

I'm pretty sure that being driven to cut back on your food intake during periods of anxiety is a major survival trait. When times are tough there isn't much food to go around and people who can limit themselves help to ensure that what little there is gets shared. There have been plenty of famines through the centuries. If your tribe or village had a thick sprinkling of anorexics in the population you probably had more survivors than if your tribe was populated entirely of people who stress-eat. An anorexic is someone who, during a famine can save some of the food for the rest of the family and doesn't eat the seed needed for the spring planting.

Of course things that are invaluable traits when times are tough are often liabilities when circumstances are different.
posted by Jane the Brown at 3:45 AM on February 23, 2015 [1 favorite]

Two hundred years ago we used to make value judgements on women based on a woman's modesty and chastity and sexual fidelity.

Then came the feminism and women became person's under law, able to make their own contracts and decisions and to hold employment instead of essentially being the property of her father or husband.

Now we judge women by what they eat and what they weigh.
posted by Jane the Brown at 3:51 AM on February 23, 2015 [1 favorite]

Related from today: "You are basically assuming that I'm doing things wrong because of what I look like, and that I must never have heard good advice before, so it's your job to impart this wisdom unto me." (JSPowerHour)
posted by thegears at 5:12 AM on February 23, 2015 [2 favorites]

I guess I just really strongly resist mono-causal explanations for my anorexia. (I usually talk about "my eating disorder," not "my anorexia," because it started out as anorexia and then morphed into bulimia and then morphed into a binge/starve thing that was probably sub-clinical but that made me miserable for a long time.) It was definitely about control, but I don't know that I would have manifested my need for control as anorexia if I'd lived in a society that wasn't quite so obsessed with women's bodies. It was definitely, at least at the outset, about trying to run away from adult sexuality. I have really big breasts, and I developed them really early, and I wanted my little-girl body back so I could stop getting really confusing and upsetting sexual comments and advances from older boys and men. At some point, it became my identity: it was a lot easier to focus all my energy on my diet than to confront all the difficult questions that everyone faces as they grow up about who they are and who they want to be. And it was, to be blunt, a really positive identity. I went from being a total freak and loser to being the best dieter in the world, which was a position of respect in my high school. It was a really heady feeling to be the absolute best at something that was really valued. (Of course, then I got hospitalized, and there was no way to be the best dieter among that crowd without being dead.) It was really complicated, and I think that the idealization of thinness was probably part of the mix. It's entirely possible that I would have gone off the rails in some other way if I'd lived in a society that didn't put such a premium on thinness, but I don't think I would have become anorexic.

And finally, while I didn't get this vibe from the linked article at all, I think that sometimes people who are adamant that anorexia isn't about beauty standards are adamant precisely because they're arguing for their right to uphold those beauty standards. And while I'm not entirely clear on the extent to which our cultural obsession with thinness caused my anorexia, I absolutely know that those standards have complicated my recovery and that fat-shaming comments are triggering to me and make it hard for me to stay out of eating-disorder head-space. So even if you don't believe that anorexia is caused by society's obsession with thinness, I still wish you would be careful about how you talk about weight and bodies, because you're never going to convince me that this stuff is completely unconnected.

Also, and I think someone has pointed this out above, anorexia is not the only or the most-common eating disorder.
posted by ArbitraryAndCapricious at 5:22 AM on February 23, 2015 [9 favorites]

One thing I learned in treatment for my eating disorder (over 25 years of active ED - now 4 years without purging) was that what ever it's about, it's not about the food. It's never about the yogurt or the apple or even the candy. It was/is about control for me as well.

I also want to make one quick addition to the definition we're all working from.
Anorexia nervosa is the illness that is in the DSM.
Anorexia, however, without the nervosa - simply lack of appetite - can be diagnosed by doctors and can caused by certain medications, illnesses, etc. These are not necessarily linked.

A few posters above sort of hinted at this, but I wanted to make sure that we all knew what we were talking about.
posted by Sophie1 at 6:51 AM on February 23, 2015 [3 favorites]

Two hundred years ago we used to make value judgements on women based on a woman's modesty and chastity and sexual fidelity.

Then came the feminism and women became person's under law, able to make their own contracts and decisions and to hold employment instead of essentially being the property of her father or husband.

Now we judge women by what they eat and what they weigh.

Unfortunately, anorexia has been around a lot longer than feminism, so it's doubtful that there's a causal relationship as you imply here. But you'll be interested to know that food restriction has for centuries been a method by which women publicly demonstrate their modesty, piousness, and virtue, allowing the controlled appetite in one arena to symbolically evoke another.
posted by milk white peacock at 9:18 AM on February 23, 2015

There is quite a lot of literature on the link between religious asceticism and anorexia.
posted by Sophie1 at 9:48 AM on February 23, 2015 [1 favorite]

Yes. Control. Thin doesn't feel beautiful to me (I'm not especially attracted to thin people myself) - it feels safe.
posted by missrachael at 12:38 PM on February 23, 2015 [1 favorite]