A Brief Overview:
Eating disorders are pervasive in our society yet remain largely misunderstood. This article will give a brief overview of the different formal diagnoses for eating disorders described in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM 5; American Psychiatric Association, 2013). In order to fight back against these diagnoses, it is important to gain an understanding of what they are and how they trap their victims. Read more about how they trap their victims in this post (link to Understanding Eating Disorders article?)
Probably the most recognized or discussed eating disorder is Anorexia Nervosa, more commonly called Anorexia. This disorder is characterized by restricting food to the degree that it leads to significantly low weight. In addition to the act of restricting, this eating disorder is also characterized by intrusive thoughts regarding weight, intense fear of weight gain, and/or a persistent denial regarding the dangers of low body weight. Although these characteristics are generally present, each person’s experience of this disorder is unique. Some suffering from this eating disorder only restrict, while others engage in restricting, bingeing, and purging behaviors.
Bulimia Nervosa, or simply Bulimia, is another diagnosable eating disorder. This disorder is characterized by episodes of binge eating which consists of eating an abnormally large amount of food during a relatively short period of time where the person feels out of control. One suffering from this disorder then engages in recurrent harmful behaviors in an attempt to compensate for the food that was eaten. These compensatory behaviors can include self-induced vomiting, the misuse of laxatives, over exercising, or fasting. Like Anorexia, Bulimia is also often characterized by one’s self-worth being centered on weight and body image and by intrusive thoughts regarding weight and body size.
Binge-eating disorder is also characterized by the sufferer eating an abnormally large amount of food during a distinct period of time. During this episode of eating the person feels that they are out of control and that they are not able to stop eating. These binges also often involve the person suffering from this disorder to eat much faster, eat until they are uncomfortably full, eat when not hungry, eat in secret, and to feel guilty or disgusted afterwards. Unlike bulimia, binge eating disorder does not involve compensatory behaviors. However, like Bulimia Nervosa, it involves marked distress and immense disturbance in one’s thoughts and self-esteem.
Two additional diagnosable categories for eating disorders in the Diagnostic Statistical Manual 5 (DSM 5) are labeled Other Specified Feeding or Eating Disorder (other) and Unspecified Eating Disorder (unspecified). The diagnosis of Other can cover those suffering from most, but not all, of the criteria for Anorexia Nervosa, Bulimia nervosa, or Binge-eating disorder. Other Specified Feeding or Eating Disorder also includes Purging disorder, which is characterized by compensatory behaviors without binges, and Night Eating Syndrome. Night Eating Syndrome is characterized by food consumption at night when one wakes after sleeping or after one is done with the evening meal. This eating does not meet criteria for a binge, but does cause the person significant distress. An unspecified diagnosis includes any additional disordered eating that causes significant distress but does not meet criteria for the other listed diagnoses. These final two diagnostic categories demonstrate the unique experiences that disordered eating causes for each person.
Although this brief overview describes the actions and some of the thought disturbances, it cannot convey the amount of distress that these eating disorders cause for their victims. From the outside, the actions of a person suffering from disordered eating do not make sense. However, to the one suffering, these dangerous actions often become a sort of rule or law that they feel they cannot break. As mentioned previously, each person’s experience will be different, however the presence of rules that make promises, are almost always present. In order to break free from these diagnoses one must identify the rules and learn to recognize the danger in following them, as opposed to being lured by their promises.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Understanding Eating Disorders:
I once heard an account of a man who owned a Bengal tiger and lived in a New York apartment. The man had gotten the tiger when it was a kitten. This baby tiger did not seem dangerous, it was cute, it was cuddly, there were many positive aspects of owning a tiny tiger. Perhaps the man thought that he would give the tiger up before it got too big. The man even developed the habit of sleeping with his tiger kitten. Obviously, the tiger grew and became dangerous. The tiger was discovered because the man ended up in the emergency room after being attacked by his own tiger. The man reportedly made up a story about being attacked by a dog because he did not want to give up his tiger, who by now was nearly 500 pounds and capable of killing him easily. From the outside, one might say that this man was not using common sense, a tiger is dangerous! However, this man had a relationship with the tiger that started before the tiger became hazardous. He had difficulty seeing the tiger clearly because he still had the perspective of it being a harmless (relatively) baby tiger. This story has similar themes to how an eating disorder that seems so dangerous to outsiders can take hold of a person. It starts out as a cute tiger kitten but grows into something capable of destroying its’ owner.
Eating disorders wreak havoc on individuals, families, and loved ones. Read more about the different categories of eating disorders in this post (link to Eating Disorders: A Brief Overview). From the outsider perspective, they make no sense. Why would anyone want to own a Bengal Tiger in a New York apartment? Why would anyone want to starve themselves by restricting or purging? However, the eating disorder started out as something much smaller, something that promised companionship, acceptance, maybe even love. It is important to take a closer look at how an eating disorder traps victims because the more the eating disorder is understood by the one fighting it, and by those around the one fighting it, the more freedom can be gained against these invasive and life-threatening struggles.
Although each person’s experience with an eating disorder is individual to that person, there are some characteristics that seem to be largely universal. An eating disorder seems to create in one’s mind specific rules or laws that the person must follow. These rules, or the voice of the eating disorder, use the person’s own values or dreams for its own purpose. The promises of following these rules can be about anything that the sufferer values. Potentially the promises are that one will lose weight, but the promises can also be about being stronger, being perfect, having control, being healthy, being accepted, or a general idea of being good enough. The sufferer begins to feel extremely guilty if they do not follow the rules, often one’s self-worth becomes based in how well they have followed the rules that day. However, the person that is trapped trying to follow the rules to achieve these promises has been tricked. The rules keep changing so they never make it to the freedom of being skinny enough or perfect enough. It becomes something like running a race where the finish line is moved each time you think that you are going to cross it. The sufferer is always left with the feeling that they did not perform well enough. It does not take long for this feeling of failure to become the lie that they are not good enough. Because the sufferer feels they are not good enough, they must try harder to follow the rules, and their tiger continues to grow.
Once the eating disorder has become apparent to the sufferer’s loved ones the rules and promises of the eating disorder often increase. There is pressure from the outside to stop the behaviors, but the pressure from the voice of the eating disorder continues to intensify. No matter where they turn, the one suffering feels that they are receiving the message that they are not doing it right, that they are not good enough.
Here is an example of how a goal gets twisted and the rules change. Let us pretend that a college student decides she would like to eat healthier, maybe that she wants to have a diet with less processed foods. This is not a bad or dangerous desire it is a healthy living choice. However, the voice of the eating disorder can twist this desire to be healthy into a rule that one should not eat anything other than salads. Over time, this rule may become more stringent and the eating disorder will not allow protein or salad dressing, or perhaps only a small measured amount of the lowest calorie protein or salad dressing. A nutritionist can teach the sufferer of this lie that to be healthy one needs more than lettuce, but because of the guilt and the promises that the eating disorder has enforced, this rule can be extremely difficult to break. The sufferer is often left feeling stuck and distressed that no one is pleased with her. Unfortunately, the sufferer often turns back to the promises of acceptance from the eating disorder and continues in her distress. This was a very simplified version of what can happen. Most often there are countless rules that grow and develop, countless opportunities for guilt and entrapment.
Another example of how an eating disorder can take hold is by utilizing someone’s stress that they are experiencing. Life is often chaotic and feels out of control. The eating disorder can twist someone’s desire to control an uncontrollable situation into controlling one’s food or calorie intake. There can be much comfort in knowing that something is under your control. However, the eating disorder’s promises for peace are lies because the sufferer then becomes trapped in the rules and laws of the eating disorder. They become controlled by it, instead of receiving comfort by controlling something.
In order for the man to give up his tiger, he has to see it clearly. It has to be exposed to him that the promises of a cute, cuddly, loving companion are no longer truth. Apparently, for this man, going to the Emergency Room was not exposing enough to get him to admit that his tiger had become dangerous. Often one suffering from an eating disorder will be blinded to the danger because he or she is still believing the promises of the eating disorder. One becomes trapped and believes that the only way to freedom is to try harder to follow the rules. However, true freedom comes from admitting that the promises of the tiger are no longer truth and banishing it from their life.