Category Archives: eating disorders

Celebrating the Day that I Chose to Live

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TRIGGER WARNING.

This article contains before and after photographs of someone who has previously suffered with an active eating disorder, and also names eating disordered behaviours that they previously engaged in. This article could be triggering for vulnerable people, those with eating disorders, and those recovering from eating disorders.

Today holds an extortionate amount of significance for me: four years ago today I made the decision to make the first steps towards recovery from my mentally and physically destructive and severe mental illness: atypical anorexia. It didn’t feel like much would come from the vague, half-hearted decision, but it was a monumental moment that put me on the road to recovery. That moment has gotten me to where I am now: a healthy, happy woman who has been in remission from an eating disorder for over one and a half years, after an intense two and a half year battle in which I emerged victorious.

I’m well aware that I wrote a post last year which will probably be very similar to this one, but the topic isn’t an insignificant one: this day four years ago saved my life in many ways, and celebrating it is, in reality, celebrating the day I decided not to die slowly, and to fight tooth and nail for my health, my happiness, and ultimately, my life.

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Four years ago today I was entirely, unequivocally, weary of being sick and miserable. I was weary of being in a living hell. I was weary with the despair and the darkness and the anger and the devastation. I was weary of watching my hair fall out in clumps in the shower; of watching it become thin and dry and brittle; of being dizzy; of living in a grey world where my senses were dulled as if my brain was smothered in cotton wool. I was fed up of the insomnia; of the nightmares; of the calories circling around my head all day and all night, leaving little space in my mind for much else. I was tired of counting down the minutes until I was “allowed” to eat; of the starving and compulsive exercising, and eventually, the purging; of the intense fear I felt at going anywhere near food; of the absolute and utter desolation of my mind and body that meant that I lived in a starving shell that could not function, and a mind controlled by  a single focus: lose weight lose weight lose weight. A focus that meant I could not think about anything else; could not deal with anything else. A focus that meant that I did not have to confront the emotions and experiences that had caused my eating disorder in the first place. A severe mental illness caused by a combination of genetics and my environment was my way of handling the world and myself, but finally, after 8 years, I had decided that this could not go on. At first, I viewed death as the only escape from the torment my eating disorder wreaked upon me, but moments of clarity started to push their way to the forefront of my mind, until the possibility of recovery developed from rejected thoughts to cautious actions. And over time my strength grew, and grew, and grew.

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I know: you’ve heard it all before. You’ve read my posts or the posts of others, you’ve watched a loved one battle an eating disorder, or you’ve experienced it first hand. But today I also want to talk about where my recovery took me and how it might differ from that of others.

I have come across a lot of people who live under the title of “recovered”. It may be a title they have given themselves or a title a professional has given them. It doesn’t matter. What I see are a lot of very slim people who use the word “recovered”. Some of those people will be naturally slim – people whose natural, healthy weights are down the lower end of that “healthy” BMI category. And that’s great! All weights, shapes, and sizes are fab, as long as the person is at their natural, healthy weight and is healthy and happy. However, I tentatively would suggest that there are those that maintain a certain weight by closely monitoring and restricting their intake and controlling their exercise. And if that is where you end up at in recovery because you are unable at that point in time to go any further or feel that that is all you can manage, then I applaud your progress and your strength and bravery in getting to that point – you are amazing and strong and wonderful. Some people will manage their eating disorders and live with it in a state halfway between being free of their eating disorder, and being utterly consumed by it. That is absolutely okay, and if you want to call that full recovery, who am I to decide that it is not by your own personal definition? But I also want to stress that that is not where you have to be if you want to choose differently. You can push further. Whether that is now, or in the future, there is the option to press on forwards to a life where you live pretty much entirely free of your eating disorders influence. I know, because I decided to take the path to that place.

I decided to reject the idea of an “ideal” body. This took me a very long time. It took years of research into health at every size and weight set point theory. It took getting involved with feminism and the body positivity movement. It took learning about the impact of diet culture and how the diet and weight loss industry intentionally make us hate ourselves for profit. It took deciding to be as healthy and happy as I could possibly be in both body and mind. It took deciding to let go of the importance that I had placed on being a certain weight.

I turned out to be one of those people who naturally have a higher body weight than others. It can mean dealing with increased stigma around weight and size, and comes with knowing that I am at a weight where some people will look at me and decide that I am unhealthy/lazy/greedy, whilst knowing nothing about my lifestyle, or indeed myself as a person. Some people will look at me and see me as a weight/shape/size. I am also aware of my own weight privileges in that there are people at far higher weights than me that suffer a hell of a lot more stigma and discrimination. I am aware that although I am far from society’s “ideal” body weight, shape, or size, I still wear “acceptable” clothes sizes (as in, the clothes stores that I shop in cater for my size, even if it is a size some feel shameful about). It is also a size that I maintain effortlessly eating a balanced diet (and by that I mean I eat what I want, when I want, which leads me to eat a wide variety of foods from all food groups), and with physical activity that I do for enjoyment rather than to alter my weight, shape, or size, or any other disordered reasons. It is the size that I can live my life as a healthy and happy person. If I wanted to be smaller, I would have to focus on calorie restriction and possibly an excessive amount of exercise, and we all know where that would lead. Don’t misunderstand me: I’m not going to lie and say that if I had to option to do all this at a smaller size, then I would choose not to. Because of the importance society places on our bodies, being at a smaller size would mean not having to think about or deal with the discrimination of being at a higher weight, and I would rather choose not to deal with that. But my body and its weight/shape/size is not at fault for those stigmas, and nor am I. I accept my body. It is everyone else accepting my body as happy and healthy and beautiful that is the problem, because not everyone does. But that’s okay, because I choose my health and happiness over the approval of others. I choose me.

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To get to where I am now, I chose to reject the ideas and ideals that are so entrenched in our culture and our society. I chose my actual health over the idea that you have to be a certain weight, shape, or size to be healthy. I chose my happiness over the absolute lie that you have to be a certain weight, shape, or size to be happy. Those lies are fed to us all day, every day, everywhere we look, but I just don’t buy it any more. I’ve seen enough evidence of all kinds to call bullshit. And I have decided to live my life in a way that means working with my body and letting it be whatever weight, shape, or size it needs to be to enable me to be healthy and happy. I will not change that for anyone. I choose me.

Orthorexia Nervosa: The Invisible Eating Disorder

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Orthorexia Nervosa. Have you heard the term before? Many haven’t. “Orthorexia” is a word that is not yet an official eating disorder diagnosis, but is used to describe a particular set of eating disorder behaviours that are distinguishable from other eating disorders, although can be experienced in conjunction with other eating disorders (usually anorexia nervosa). It is also an eating disorder that is easily overlooked in a society obsessed with “healthy eating” and exercise.

Those suffering from orthorexia have an unhealthy obsession with healthy eating and healthy lifestyle, so much so that it becomes extremely rigid and restrictive in regards to food, and can also include compulsive and excessive exercise. Orthorexics can be obsessed with feeling “clean” or being “pure”, and generally fixate more on this than on body weight as a motivation for behaviours. Orthorexics can also feel morally superior for the choices that they make in regards to their lifestyle, and the way they view themselves becomes entangled with the way they live their lives and what they put into their bodies or do with them. Orthorexics can find that their diet becomes so restrictive in both calories and food variety that it can become extremely physically unhealthy as well as mentally. This can also be the case in regards to excessive exercise. Like other eating disorders, it will end up becoming a top priority for the sufferer, and they can end up isolated.

In a culture that celebrates weight loss, calorie and food group restriction, and exercise, it is easy to go unnoticed if you have an eating disorder at a “normal” weight, but even easier if you have orthorexia. In a society that focuses so much on health, those with orthorexia will more likely than not be congratulated for their “healthy” life choices, determination, perseverance, and motivation. Others may aspire to be like them because they appear to work so hard at being healthy, whilst in reality they are driven by a relentless and miserable force that has nothing to do with being healthy and more to do with being mentally ill. That mental illness will be driving that person into the ground both mentally and physically with its extreme rules and restrictions, and that may go unnoticed in amongst the admiration of others.

Eating disorders are terrifyingly common, let alone the phenomenal amount of people living with disordered eating (issues with food, weight, etc, that are not a mental illness but are a problem). Our preoccupation with a “healthy” lifestyle and our celebration of “healthy choices” is misplaced. Living a healthy lifestyle is great, but we are missing the bigger picture: so many people are utterly miserable trying to achieve goals that are usually more about being thin than being healthy, or are driven by guilt and shame about not being “healthy” enough. In trying so hard to be physically healthy, we are sacrificing mental health, which is just as important – if not more so. With our food/weight/exercise/health obsession, and the equation of “health” with morality, no wonder so many eating disorders go undetected. It is a culture for eating disorders to thrive in, and that horrifying truth is something that we need to recognise and address.

So could you recognise orthorexia? Do you think you may have it yourself? The Timberline Knolls website talks about orthorexia and how to recognise it particularly articulately, so I have put it below. If you want to read more information on it, just click the link above.

Orthorexia is the term for a condition that includes symptoms of obsessive behavior in pursuit of a healthy diet. Orthorexia sufferers often display signs and symptoms of anxiety disorders that frequently co-occur with anorexia nervosa or other eating disorders.

A person with orthorexia will be obsessed with defining and maintaining the perfect diet, rather than an ideal weight. She will fixate on eating foods that give her a feeling of being pure and healthy. An orthorexic may avoid numerous foods, including those made with:

  • Artificial colors, flavors or preservatives
  • Pesticides or genetic modification
  • Fat, sugar or salt
  • Animal or dairy products
  • Other ingredients considered to be unhealthy

Common behavior changes that may be signs of orthorexia may include:

  • Obsessive concern over the relationship between food choices and health concerns such as asthma, digestive problems, low mood, anxiety or allergies
  • Increasing avoidance of foods because of food allergies, without medical advice
  • Noticeable increase in consumption of supplements, herbal remedies or probiotics
  • Drastic reduction in opinions of acceptable food choices, such that the sufferer may eventually consume fewer than 10 foods
  • Irrational concern over food preparation techniques, especially washing of food or sterilization of utensils

Similar to a woman suffering with bulimia or anorexia, a woman with orthorexia may find that her food obsessions begin to hinder everyday activities. Her strict rules and beliefs about food may lead her to become socially isolated, and result in anxiety or panic attacks in extreme cases. Worsening emotional symptoms can indicate the disease may be progressing into a serious eating disorder:

  • Feelings of guilt when deviating from strict diet guidelines
  • Increase in amount of time spent thinking about food
  • Regular advance planning of meals for the next day
  • Feelings of satisfaction, esteem, or spiritual fulfilment from eating “healthy”
  • Thinking critical thoughts about others who do not adhere to rigorous diets
  • Fear that eating away from home will make it impossible to comply with diet
  • Distancing from friends or family members who do not share similar views about food
  • Avoiding eating food bought or prepared by others
  • Worsening depression, mood swings or anxiety

You can also read my article ‘Food Is Not A Moral Issue’ here.

 

What People With Eating Disorders Would Like You To Know

Communication

This week is National Eating Disorders Awareness Week. I asked people suffering from eating disorders “what would you like people to know about eating disorders – whether in general or yours personally?” and was met with people eager to share their thoughts and feelings. So I bring to you this post constructed of 32 people’s top things that they would like the public to know about eating disorders and recovery from them. This post illustrates both the different and shared experiences of those with eating disorders and the way they would like to be perceived and supported. Please remember that people with eating disorders are not exempt from your life. They are your husbands and wives, brothers and sisters, sons and daughters, friends and colleagues..you will know someone with an eating disorder, and they may need your help and support. Without further ado, let’s take a look at what they have to say.

“It’s not something we can control. And it doesn’t matter how much weight we lose, it’s never enough.”

neda recovery

“OSFED (formerly EDNOS) is the most common eating disorder. It also has a higher mortality rate than bulimia and at the least the same mortality rate as anorexia – some studies suggest that it is even higher. It would be nice if people stopped thinking that OSFED/EDNOS is not as dangerous or as “real” as anorexia or bulimia.”

neda recovery

“Eating disorders are not about food and dieting, but about control and a distraction away from deeper insecurities and not feeling good enough alongside everyone else. They can’t be turned on and off at will, but then CAN be fought and recovered from. An eating disorder is not a choice, but fighting for recovery is.”

neda recovery

“Eating disorder recovery isn’t just a physical change, but mostly a mental change. Yes, physical changes do happen, but you won’t recover unless you change mentally too.”

neda recovery

“It’s not something someone can just stop. It’s like a constant voice in your head always whispering to you. It’s not some silly phase you just grow out of. It’s not something beautiful. It’s hard, unhealthy, and it tears you apart both inside and outside. It’s always inviting and easy to slip back into and it takes so much effort to not do just that.”

neda recovery

“Eating disorders are not visible from the outside.  Also I think it can’t be stressed enough how triggering any kind of comment about eating behaviours/body can be.”

neda recovery

“I think more information about orthorexia is needed as obsessions with healthy eating and fitness hardly ever are recognised as real problems. I also think orthorexia might be much more common than people might think.”

neda recovery

“Relapse doesn’t mean someone was faking their recovery or that they don’t want recovery. It’s really irritating when someone suggests that I didn’t want it until I hit rock bottom.”

neda recovery

“Now that I’m open about my eating disorder, it doesn’t mean that I am faking or seeking attention now. I just want people to know more about the facts of eating disorders. Also understand it is important for me to tell people to help me get better and not keep any more secrets.”

neda recovery

“Weight restoration and recovery are not synonymous. The way I feel and the amount of pain/difficulty I’m going through is often inversely proportional to how healthy my body looks. I usually need most support at the very times i look healthiest. Don’t assume anything from how someone looks. Don’t confuse physical health with mental health. When my weight is higher, I need way more support than when it’s dangerously low.”

neda recovery

“Please don’t get mad, impatient, frustrated, or annoyed with me when I am struggling with something. I know it may make no sense to you. ‘Food is good, how could you be afraid of it?’ ‘How could you care about something as dumb as this or that?’ Guess what… I don’t even understand the thoughts and compulsions myself sometimes. Just be there for me, try to be understanding, and encourage me to nourish myself. I’m getting better, step by step.”

neda recovery

“My eating disorder is not just a diet, and I don’t engage in these behaviors because I have more self control than you. It’s an illness that is controlling me and eating me alive, and fighting it requires more strength than you could ever imagine.”

neda recovery

“They’re not fun, and the romanticisation of them online is what caused mine.”

neda recovery

“Just because someone is at a “normal weight” now doesn’t mean that they aren’t still scared to eat or gain weight.”

neda recovery

“How many times you do/do not relapse doesn’t determine the severity of your illness or that you are “better”.”

neda recovery

“I’d like people to know that I don’t do this to hurt them, I don’t purposely try to upset the people who care about me, I’m trying to do the complete opposite. All I want is to make people happy and sadly my brain tells me that this is how I can achieve that.”

neda recovery

“Getting angry at me only further fuels my ED, please stay calm and collected.”

neda recovery

“That recovery is never ending. Eating disorders can become a coping mechanism, and so, if you have no other way to cope or if the stress is so severe then the eating disorder gains strength.”

neda recovery

“It’s really not about food. Way too many people see eating disorders as superficial and hold a mentality that deadly diseases are just diets gone too far. I want more people to recognise the seriousness of eating disorders, including the “invisible” eating disorders such as BED and EDNOS.”

neda recovery

“I want to talk abut it and be asked about it. I’m not ashamed but I have found that my friends and family act as if it doesn’t exist/never happened and it makes me feel awkward. I wish they’d just stop making it the elephant in the room! Anorexia is not a swear word!”

neda recovery

“Saying “you’re not fat” or “you don’t need to lose weight” doesn’t help at all, and when you open up to someone they don’t understand what you think of yourself. I think what would help instead of telling them to “eat more” would be to help them love themselves again and enjoy food and exercise.”

neda recovery

“BED is as serious as any restrictive eating disorder. Men develop eating disorders. Recovery means using healthy coping mechanisms to fight disordered thoughts, not getting rid of the thoughts.”

neda recovery

“Ich bin an allen Informationen interessiert da ich mich endlich befreien möchte und in recovery gehen will aber jede Menge angst habe. Mut und Zuspruch wäre das wichtigste und das man es schaffen kann.”
(Google translation: “I am interested in all the information because I finally want to free myself and will go into recovery but plenty ‘m scared . Courage and encouragement would be the most important and it can be done.”)

neda recovery

“It’s not easy. It’s complicated and tormenting and doesn’t receive enough awareness.”

neda recovery

“Just because you are gaining weight and you are looking healthy does not mean that you are okay. You are still recovering. And it’s still hard. And even after recovery and remission, it’s not like all of the recovery problems disappear, they are still there, you just can cope with them better.”

neda recovery

“Commenting on my body in any way is not helpful, even if you mean it with the best intentions, it can be triggering. Find other ways to measure our success in recovery, like how much more we smile.”

neda recovery

“Don’t comment on how other people’s bodies are thin or heavy. Don’t make body size and appearance so important. Focus on happiness and health instead. Don’t blame the person with an eating disorder for being ill. Try not to be angry with the person with an eating disorder; it will make them hide from you even more. My parents, for the first years were so angry at me. They treated me as if the eating disorder was something that I was choosing. They kept asking me to quit acting out and were angry at me for not. They interpreted my behaviour as a personal betrayal. It hurt me a lot. I missed them and being close to them.”

neda recovery

“Understanding that public situations involving food (or even not food, just a lot of people) can be totally terrifying because of how the person with the eating disorder may feel (rightly or not) that their body is being judged. Be understanding that we may want to go out and have fun, and we may plan (depending on where we are in recovery) to be able to “act normally” and eat, but when the moment actually arrives, it’s too terrifying.”

neda recovery

“It’s not about anyone else. And no one in my life can cure me. No matter how I love my friends and family and boyfriend, I can’t just eat and gain weight to make them happy. But I truly do hate how this illness tortures them as well, and I wish it was that simple to take away their pain.”

neda recovery

“My eating disorder is just as serious now as it’s ever been. The only difference is that I weigh more than I used to. Gaining weight never made the problem go away, it just made it invisible.”

neda recovery

“I am not looking for attention. It’s easy to say the wrong thing. How I look is not a reflection of how I feel. This is a disease, not a choice. Nobody made me this way. I want to talk about it. My life has been hugely impacted by this. What I go through may not seem like much to you but to me it has been my world.”

neda recovery

“Everyone has their own natural and unique body shape and size and gaining weight should not be seen as bad.”

 

Do you have anything to add?

Men with Eating Disorders: Suffering in Silence

men and eating disorders

Eating disorders amongst men: we are not talking about it enough. We are not doing enough to end the stigma against eating disorders in general, let alone for the male population that suffer with them. We need to raise awareness. We need to be having conversations about it. We need to be educating the general public about it. We need men on TV, in magazines, on the internet, on every social media platform, to speak out about their struggles and help others do the same so that they can get the help and the support that they need. The thing is, many men don’t feel comfortable talking about it with their closest friends and family members, let alone the public. In fact, they aren’t just uncomfortable: they are terrified, and this is because of the incredibly detrimental stigma wrapped around eating disorders that is magnified tenfold when it comes to the male population. And when people don’t get help, there’s an increased risk of them dying from complications due to their eating disorders.

Out of those with eating disorders, it is reported around 10% of sufferers are male, although these statistics are unreliable due to the fact that so many men do not come forward for treatment and so are not recorded as part of the statistics. A recent study on a large university campus found that the female-to-male ratio of positive screens for eating disorder symptoms was 3-to-1 (you can read more statistics with references in my article Men Get Eating Disorders Too).

For this article, I talked to two men with eating disorders, a friend of mine, Leo*, who is a man in his mid-twenties from the UK, and Joshua*, an Italian-American, who got in touch with me via this website to talk about his experiences with his eating disorder and the stigma surrounding men with eating disorders.

Leo talked to me about how his eating disorder affects him in day-to-day life, and about the one and only time he sought help from a professional.

“I wake up every morning and the first thing I do is check the mirror and look at myself and think I’m fat. I will do it again after a shower and again once I’m dressed. I will do this throughout the day while at work if I go to the toilet as well. I try not to eat to much because in the back of my head is someone saying you’re fat, you’re fat, don’t do it. People at work have joked about me being fat, and I cannot get rid of them saying it over and over again in my head. I want to be perfect, I want to feel normal, and it probably started with the bullying at school and has always sat with me. I went to the doctors and explained that I didn’t feel normal and I hated eating food and I wanted to make myself sick and all I got was the doctor telling me that I need to eat to be healthy and we need food to survive, and that was pretty much it.”

Leo experienced disordered eating for three years, before developing a full blown eating disorder which he has now suffered with for seven years. He struggles with restriction, self-induced vomiting, and compulsive exercise. As you read, when he opened up about it to a doctor, he was met with dismissal. After describing his fear of weight gain, and sustained body hatred, his doctor chose not to explore this further and just told him to eat. I asked him about whether he would consider going back again to see if his experience could be different if he saw another doctor.

“I don’t go back to the doctors because it is embarrassing. I’m a guy and I have to not show weakness. I tried to cry for help and no one cared and so I shut all my emotion off towards it.”

Unfortunately, this is all too common an experience for men, and because of these negative experiences, men don’t seek help in the first place, or don’t go back again after being met with invalidation. Doctors are reportedly less likely to make a diagnosis of eating disorders in males than females (again, you can read my article “Men Get Eating Disorders Too” for references and more information). Not only is there limited training in eating disorders for medical professionals, but the stereotype of eating disorders being an illness exclusively suffered by white, young, females still lingers, and professionals are not exempt from absorbing the myths and stigma that surround eating disorders. Coupled with the damaging pressures from society telling men what they apparently should be like, people seem to have a really hard time accepting that men can suffer from such a debilitating illness as an eating disorder. These societal pressures, which include not showing emotion (or not too much, whatever that means), not crying, not needing help or support, are aspects of being a woman, and they are also supposedly aspects of being weak (because, just in case you are unaware of this entirely ludicrous concept, in our patriarchal society, being like a woman – and therefore being a woman – means that you are weak). On top of that, eating disorders are seen by some as obsessional vanity, whereas they run much deeper than that, and can stem from a variety of things (bullying, abuse of any kind, sense of worthlessness, deep insecurity, trauma, to name a tiny proportion of triggers). They are also a biological illness with genetic links. Your genetics play a part in determining whether you are someone who will develop an eating disorder or not. Those who understand eating disorders already know that developing one is not a choice, but this provides further and solid evidence for those who may not be able to fully comprehend the fact that there is no choice when it comes to mental illness. Still, so many people are still ignorant about mental health. Leo says,

“People look at it as a female disorder. I have mentioned it in conversation with friends and family, and I always get the same opinion – that it’s a woman’s disorder because they are weak or have issues because of how society sees them.”

Leo feels like he can’t talk to anyone about his eating disorder, because they won’t understand. He is terrified of the reaction that he could get.

“I can’t talk to people because they won’t understand. They won’t understand waking up every day feeling the way I do about myself and how I want to fit in and for people not to say I’m fat or chubby. I can’t talk to them or even want to talk to them because my step-dad, my brother-in-law, and I are always in competition in everything we do and I wouldn’t let them know I am weak. I don’t know how they would react. They will see it as a weakness and will think less of me. Even my mum wouldn’t understand.”

I ask if he thinks his mum would view him as weak. “I’m not sure, but I don’t want to risk it.” The concept of men (and women) with eating disorders being weak is so persuasive that Leo sees his own eating disorders as a weakness in him, but says that he doesn’t make the same judgement about anyone else.

Another issue we have to look at is the “ideal” male body that our society has created. Women face a huge amount of pressure to look a certain way thanks to our society, our diet culture, and the media continuously shaming women, telling us to lose weight, giving us diet tips, banging on about “health” 24/7, and showing us a disproportionate amount of slim, beautiful women who have been photoshopped to the nth degree, but whilst we do receive the majority of this pressure, we forget that there’s so much pressure going around that there’s plenty left over for the guys too. Men are being exposed to an increasing amount of images and messages pertaining to what a man “should” look like, and this is extremely harmful. Leo has been affected by this.

“Having 0% body fat and all the muscle in the world is the only way to fit in society for men. Women are seen as having to be skinny but men have to be both skinny and muscular.”

Whilst this is not a reality, and in general only men who are fat or very thin experience stigma around weight, the message has become so strong from the media that for some men, this is how they feel – that they and their bodies will not be accepted unless they look a certain way. The expectations that this is driving some men to have for themselves are unrealistic and unhealthy, and is having a dangerous impact on the mental and physical health of men.

Eating disorders can also be harder to spot in some men because it is more likely for women to have dramatic weight loss, whereas in men their eating disorders can expressed through “bulking up” and hitting the gym, which is not seen as particularly suspect in a society so keen on advocating exercise and showing male body “ideals” as lean and muscular. It is important to note that if an individual is taking performance-enhancing supplements in their attempt to become more muscular and then engages in weight lifting, they are at increased risk of suffering a heart attack or stroke (this paragraph has been taken from my article “Men Get Eating Disorders Too”).

Joshua also talked to me about his experience with an eating disorder.

“My situation largely stems from my cultural love affair with food and how the outside world placed such an unnecessary stigma on what are “good” or “bad” modes of eating. I am an Italian-American, and as such, our lifestyle revolves heavily on cooking and family gatherings that centre on delicious dishes. It is a tradition and rite of passage to learn how to cook for many of us. This is an overwhelmingly positive facet of our heritage, but the media’s obsession with “thin” and “perfection” have demonized any sort of fascination with food beyond what they deem “healthy or fit.” Admittedly, I was heavy as a child and into my teen years – but with changes in my daily lifestyle and just growing, I evened out to what was my normal weight (which was apparently still slightly “larger” than the projected ideal). I still enjoyed any type of food that I wanted and never did I have to restrict. Naturally, as I got older, I became interested in finding a meaningful relationship with a girl. This was when the pressure of having to achieve that outrageous image of “true masculinity” began to weigh heavily on my mind, and my interactions with women in my age group reinforced these damaging gender stereotypes.”

Joshua was also influenced by the media.

“The problem is that “having abs” and looking like an actor/model is so much more than losing weight – it is about obsession to the point of illness.”

Joshua was shamed for his appearance when he became very ill during his eating disorder.

“Ironically, I never did achieve the appearance I aspired to even when I was dangerously skinny. I merely became an emaciated mess, which ended up working against me as I was told it “feminized” my looks and made many girls lose interest.”

Although no one should ever reach any weight, shape, or size by unhealthy means, this shows again the idea of an “ideal” body shape and size for men that has pervaded our society. Whilst no one is naturally emaciated, many men are naturally slim and can feel ashamed of being so. In fact, within a couple of weeks of being with one of my partners, he asked me, “Is my body okay? Am I too skinny?” because he was naturally slim. I had never even considered that this might be an insecurity of his, but it is more common than we think. Insecurity is rife amongst both men and women, and whilst this is damaging in itself, this can also contribute towards the development of eating disorders, which are severe and life-threatening. Anorexia has the highest mortality rate of any mental illness, and other restrictive eating disorders follow close behind.

“I find it so difficult to explain to anyone I meet (especially potential dates/prospects) that I am trying to heal from this battle. It is such a strange position to be put in – knowing that double standard of men not expecting to be concerned with weight or appearance (to be outwardly cavalier/macho) but still having to hide their true feelings when exercising themselves into oblivion for muscles/being defined. Gender roles and expectations for men are just as serious [as they are for women] – yet they fly under the radar as something that doesn’t happen and are laughed at by those from older generations.”

These myths, stereotypes, and stigmas need to become a thing of the past. We need to be talking about eating disorders more in general, but we also need to start prioritising the inclusion of men in every conversation that we have about it. We need people to stand up and talk about their experiences, but this should never have to be their responsibility in the first place. We need to educate ourselves and each other about the realities of eating disorders and how they affect men as well as women. We need to dispel the untruths and we need to be more proactive in challenging hyper-masculinity in our society. We need to help our men, and we need to help them to ask for support. If we don’t, we are going to lose them. If you are someone who looks down on men with eating disorders; if you are someone who sees them as weak, put that aside now, and take the time to research eating disorders. Keeping your mind shut to their suffering is costing them their health, their happiness, and sometimes even their lives. These are your sons, your brothers, your husbands, your friends. Each minute we continue to treat our men with eating disorders as weak; each minute we continue to dismiss them, we put their lives in danger.

*Names have been changed for confidentiality

Exercise (pt 2): Exercise and Eating Disorders

exercise addiction

This is the second part to the article I wrote last time, which talked about exercise in general and the way that an unhealthy mindset around exercise has infiltrated our society as a whole.

Today I want to talk about exercise and eating disorders.

Like I spoke about two weeks ago, nearly everyone views exercise as something that is healthy, regardless of how it is used. During my recovery from my eating disorder, I told a friend about my compulsive exercise and about how I was trying to challenge it because I was doing x amount of exercise a week because I felt that I had to, and hadn’t been able to stop myself from doing it even when I didn’t want to. She genuinely replied with “Yeah but that’s fine because exercise is good!” Because we have such a warped view about exercise, many people don’t seem to understand how detrimental it is to those with eating disorders, especially when it doesn’t appear to be severe.

Some people with eating disorders push themselves to the extreme when it comes to exercise. Some people exercise for five hours a day, and some more. Some people never let themselves sit down – ever – except when sleeping (and I’ve even known someone to sleep standing up). It is easier for people without eating disorders to understand why this might be a problem, but when you are someone with an eating disorder who exercises in a way that people might perceive as inspiring and healthy; in a way that people might see as #goals; in a way that people aspire to, you may end up with congratulations rather than concern.

For those who have exercise addiction, you can’t just stop when you want to, or give yourself a day off (unless you already have a “scheduled” day/time, and then it must be that day/time and none other). You will miss social events if it coincides with your sessions. You will feel incredibly anxious before exercising, and after the exhilaration of finishing a workout has subsided, you will feel the dread of knowing that in less than 24 hours you will be repeating the same monotonous and exhausting work out. You will continue with your exercise routine however much you don’t want to do it, however tired you feel, or however sick you are. It is not enjoyment that drives someone with exercise addiction: it is the perceived need to do so.

As well as being mentally draining, compulsive exercise (also known an obligatory exercise or in extreme cases, anorexia athletica) can have a negative effect on the body. Firstly, by working out intensely every day, the body is being put under a lot of strain, and is not being given any time to recover, which is needed. Those addicted to exercise will work out even if they are ill or injured, which could have serious consequences to their health, including damage to tendons, ligaments, bones, cartilage, and joints. When injuries happen and are not given enough rest to heal, this can result in long-term damage. If the body is not getting the nutrition that it needs, muscle can be broken down for energy instead of building muscle. Girls and women could disrupt the balance of hormones in their bodies, which can change menstrual cycles and even lead to the absence of them altogether. It can also increase the risk of premature bone loss, which is known as osteoporosis. The most serious risk is the stress that excessively exercising can place on the heart, particularly when someone is also restricting their intake, or using self-induced vomiting to control their weight. Using diet pills or supplements can also increase the risk for heart complications. In worst case scenarios, restrictive eating disorders and compulsive exercise can result in death.

The reasons behind exercise addiction can be complicated when it comes to eating disorders. For many people it is an additional means of furthering and/or quickening weight loss, or it could be the main part of someone’s eating disorder, in order to get “fit” or muscular (anorexia athletica). It could be about control. It could be, like the rest of the eating disorder, a form of distraction from feeling or thinking certain things. It could be part of orthorexia (an obsession with eating “healthy” or “pure” foods and leading “healthy” or “pure” lifestyle). Athletes, dancers, wrestlers, gymnasts, and other people who are fixated with keeping in shape and keeping their weight down for their careers are also susceptible to developing exercise addiction.

Although it is not listed in the Diagnostic and Statistical Manual of Mental Disorders, exercise addiction is a serious and potentially life-threatening obsession, and needs to be taken extremely seriously. It is not just a strain on the body but a strain on the mind. It is absolutely exhausting, and completely miserable to experience. It can take up a huge amount of your life and a huge amount of your thoughts, and is extremely unhealthy for your physical and mental health. Whether it  is the main part of an eating disorder, a lesser part of an eating disorder, or a disorder on its own, compulsive exercise is serious. It is something that must be challenged and overcome as part of recovery from an eating disorder, and must be ceased until the unhealthy relationship with exercise is broken and remade into something healthy. Only in remission can someone make an informed and healthy decision about whether to restart exercise and how much/what to do in regards to moving their body. Even then, it’s a fine line.

I talk more about a healthy relationship with exercise in part 1.

If you think you may be developing/have developed an addiction to exercise, seek medical help from your GP.

Signs that you or someone you know may be suffering from compulsive exercise include (but are not limited to) the following:

  • Not enjoying exercise sessions, but feeling obligated to do them
  • Seeming (or being) anxious or guilty when missing even one workout
  • Not missing a single workout and possibly exercising twice as long if one is missed
  • Seeming (or being) constantly preoccupied with his or her (or your) weight and exercise routine
  • Not being able to sit still or relax because of worry that not enough calories are being burnt
  • A significant amount of weightloss
  • Increase in exercise after eating more
  • Not skipping a workout, even if tired, sick, or injured
  • Skipping seeing friends, or giving up activities/hobbies to make more time for exercise
  • Basing self-worth on the number of workouts completed and the effort put into training
  • Never being satisfied with his or her (or your) own physical achievements
  • Working out alone, isolated from others, or so that other people are not aware of how much exercise is being done
  • Following the same rigid exercise pattern.
  • Exercising for more than two hours daily, repeatedly

(sites used for reference and more information: 

http://www.brainphysics.com/exercise-addiction.php
http://addictions.about.com/od/lesserknownaddictions/a/exerciseadd.htm
http://kidshealth.org/parent/emotions/behavior/compulsive_exercise.html
http://en.wikipedia.org/wiki/Exercise_addiction )

Oh Yes, Eating Disorders Are SO Glamorous

cloud

(TRIGGER WARNING – Eating disorder behaviours written about)

You’ve probably seen it: the glorified photographs of underweight celebrities and models; the tiny, fragile, delicate girls in movies with eating disorders (think Cassie from Skins), maybe you’ve read the overly simplified and massively invalidating Winter Girls. Anorexia is the “diet” everyone wants to be on. Well, maybe not everyone, but I’ve heard the offhand comments: “I wish I had just a touch of anorexia”or “I’d do anything to have a bit of anorexia for a couple of weeks!” Even bulimia, the less glamorised eating disorder gets a look in: “I tried bulimia but I just hate throwing up!”

Why yes, of course, you’re totally right! Eating disorders are SO glamorous.

When my eating disorder forced me to walk forty-five minutes home with a week’s worth of food shopping every week, I totally felt glamorous. When I had to pause every ten minutes because I felt like I was going to pass out, and when I damaged the nerves in my fingers from the tightness of the shopping bag handles, I totally felt glamorous. When I wet myself a little bit now and again because my body was eating away at my bladder to try and get energy, I felt more glamorous than anyone. When I vomited into the toilet and got splashback on my face, it was so glamorous: even more so when I popped the blood vessels around my eyes. When I drunkenly locked myself in my boyfriend’s bathroom and cut my all over my arms, legs, and stomach, it was as glamorous as anyone would want to be. It was also super glamorous when my eating disorder punished me by making me work out vigorously for two hours straight on a malnourished, weak, failing body, until I was at the point of collapse, and when I made myself throw up at a party and a friend heard the whole thing, and when I cried on the train because the man on the other side of the aisle was eating a sandwich and I so desperately wanted to feel “allowed” to have that; have anything. And when I had to run home from a restaurant after eating something with fats in because I immediately got diarrhoea. And also when I screamed at my partner for putting a dash of milk in our scrambled eggs, and smashing a glass and kicking him out of the house when he turned over my “notices” to myself reading “fat bitch” and “starve yourself” and wrote “you are beautiful” and “you are perfect” on the back of them instead. And even more so when all I genuinely, truly wanted was to be chained to a bed so that I could not access the kitchen and eat anything. When I couldn’t think straight and my relationship was ruined and my body was cannibalising itself and my personality had diminished to nothing so that I had no hobbies or interests bar losing weight – what could anyone wish for than a touch of what I had; a touch of what millions of people suffer with every day? Anorexia, bulimia, OSFED, ARFID, anorexia athletica, orthorexia…what more could anyone want but those restrictive eating disorders that destroy your life, take away your health, eliminate your personality, interfere with your ability to work, and wreck your relationships?

And just so you know, eating disorders don’t necessarily make you skinny. They make you sick, and they make you so miserable that you wish you would just die, and they make you more and more dead every minute, but sometimes you don’t even get to be skinny. And even when you are skinny, you’ll never know it. The skinnier you get the fatter you’ll feel. With every pound you lose, you’ll hate it with more and more passion that you’ve ever felt towards anything else, and that will only drive you to continue to lose more, in the hopes that it will make you feel better. But it never will.

So sure, go about wishing you had just a “touch” of what we have. You know that saying ‘be careful what you wish for’? It could not be more true than when it comes to this.

In addition to the idiotic notion that having an eating disorder would be worth it because you’d get skinny, having these incredibly ignorant opinions invalidates and undermines the severity of an eating disorder, thus eradicating the experiences of those suffering from them. Having those sorts of opinions makes our pain invisible, because you don’t understand that it exists.

So learn more about eating disorders, because you know someone with one. You might not think you do, but you do, trust me. Someone in your life is struggling. Don’t let their experiences be invisible to you.

End rant.

Recovered Does Not Mean Cured

recovery

I like to write positive posts about recovery and what it means to be recovered and all the fantastic things about it. I like to illustrate how amazing it is to go from being very mentally and physically sick to being a functioning human being with passions and interests. I like to talk about going from empty to fulfilled; suicidal to content. But I also want to talk about the realities of recovery, and talk about where the eating disorder goes once you reach remission.

In an ideal world, reaching full recovery would mean that the eating disorder was banished from our brains for good. It would mean that the war, once won, was never to be fought again. In a way, that can be the case. You don’t have to fight that war ever again if you remain stable and strong in your remission, but there will be a few riots to deal with, and the odd battle here and there. The war will be won, but the eating disorder will always try and rebel where it can.

The eating disorder will always be there, in each and every one of us who have been a victim of this deadly disease. It is part of our genetic make up, and worse than that, it’s a part that has been triggered. It cannot be un-triggered, and it cannot be un-learnt. But that’s okay: people who have suffered from an eating disorder and fought it are some of the bravest and strongest people. If you’ve never had an eating disorder you will never know how exhausting and gruelling it is to fight it, but take my word on it: it’s one of the toughest (if not the toughest) that we will ever have to do. With all that strength we have, after beating the eating disorder, keeping it in check is a hell of a lot easier than what we have already been through.But it is important to know that it will be there, and you have to make sure that you are the one that stays in control at all times.

It is a mistake that those who haven’t had an eating disorder can easily make: that once it has been defeated, then it is gone. Sometimes people don’t understand that once a day, or once a week, or once a month, there will be a little battle that we have to fight. And it is fairly easy to win it, but if we give in due to not being vigilant, or feeling too tired to resist it that day, it is something that can quickly spiral out of control.

Take my last 24 hours, for instance. I had to go home from work with a severely upset stomach. My mum told me not to eat for 24 hours (a sensible thing to do in this situation), so I geared up for that challenge. After eight hours, I was starving, so I ate a cracker and smoked a cigarette, and my hunger pretty much vanished. That reared the head of the beast, and a little voice said see how easy it is to make your appetite disappear. I also kept stroking my stomach to see if it felt flatter, because when I was sick and would have an upset stomach, my stomach always felt super flat and I liked that. After 20 hours with only 3 crackers, I tentatively made some toast to test out my stomach. The little voice told me that I could just go longer without eating, and that I’m too sick to eat at all, and I felt resistance to wanting to start eating again. I will fight that small battle every time I get a stomach bug and can’t eat for a while, because for me, once I stop eating, I find it a small challenge to start again. I know that I can fight that, but there is always the possibility that I could give in to it and that the eating disorder would take the wheel and I would fall into the back seat. It is so important to recognise when the eating disorder is trying to worm its way into your thoughts and influence your actions, so that you can roar at it to get back in its place (metaphorically, of course – I’m not sure how those around you would react to that kind of outburst).

Another example is exercise. I enjoy some types of physical activity like badminton, swimming, and walking. I love doing it, but so does my eating disorder. That means that I have to constantly assess how I am feeling towards it. It means that when I can’t do exercise (like now, being ill), I feel anxiety. It means that I have to consistently challenge myself to make sure that I am in control, not my eating disorder. This means that I take rest days where I don’t exercise whatsoever. If ever I told myself to take a rest day or two, and couldn’t do it, there would be a problem. It would not be me taking charge in that situation, and I’d then have to work through that and fight a bigger fight. I think anyone who chooses to be active in their remission and has had exercise addiction will always walk a line with it. If I ever exercise when I am ill or injured, or when I have challenged myself not to, or because I feel I have to even though I am not enjoying it, that is when there will be an issue. I have to watch out for that, and so does everyone else in my position.

There are also bad body image days. In our society this is – tragically – normal, but for those with an eating disorder it can be accentuated, or a trigger and therefore more dangerous. It means accepting the bad day, or week, or month, and not responding to it, which can be incredibly hard as someone without an eating disorder, let alone someone with one.

There are many different things that will trigger different people, and although a lot of triggers become null and void, most people have one or two (or more) that remain with them. Having those triggers, and having the eating disorder itself, means that we are always at risk of relapse. It means that we do still have to fight battles that other people do not have to fight. It means that we have to be vigilant and careful and assess our thoughts and behaviours towards things like food, exercise, and our bodies on a regular basis.

Recovered does not mean cured. Recovered means in remission. It means that it can come back, and it means that we will always be fighting, even if the fight is a million times easier to win.

Counting Calories and Recovery

numbers

It seems like something that would be counter-productive to suggest, but counting calories is a really important part of recovery – especially during the initial stages. Counting calories is very likely a large part of you or your child’s (or partner’s/sibling’s/friend’s et) eating disorder, so it can seem like madness to say ‘continue doing this’, but hear me out.

Whilst counting calories was used as a way to restrict, it now needs to be used as a way to heal. So we are turning around a negative habit and using it to make sure that the person recovering gets enough energy into their body. Getting enough energy is essential for recovery, and it is likely to be something that proves impossible to do unless someone is counting the calories of the person recovering.

For most people it will be you; the recoverer, that counts. Sometimes it will be parents or partners. Either way, those calories need to be counted because after an eating disorder, people have unreliable hunger cues. The body has gone so long without food that it has repressed the signals, and so it can take a long time for reliable hunger cues to return again and for the body to learn to expect food and give signs as to when it needs it. This can mean that eating can feel like a chore to some. It could mean that you will have no appetite and feel too full, but it is important to ensure that you continue eating adequately regardless. It could mean that you feel really hungry sometimes, but other times have no appetite. Respond to any hunger or cravings that you have, and continue eating enough even when you don’t have an appetite. You may have reliable hunger cues straight away, which would be great and would lead you to eat what you need to eat in order to recover. Responding to mental hunger is also really important. Mental hunger is just another signal from the brain to tell you that you are hungry. All signals come from the brain, and it is crucial to listen. So if you don’t feel the physical signs of hunger but are wanting or craving food, then it is necessary to listen to that signal and respond to it – always.

So how are you going to count calories? I would advise staying away from apps such as MyFitnessPal, as they can be incredibly triggering due to the fact that they try to suggest restrictive amounts to eat, and they are an app focused on weight loss. You could just use a ‘notes’ app and count it up yourself and keep the number on record for the day there, or you could write ‘500’ as many times as adds up to how much you need to eat on a sheet of paper or on a notes app on your phone, and just cross it off every time you reach 500 calories. This can mean that you know you are getting closer to your goal but don’t need to count the number if not thinking of the number helps. If your parents or partner are very involved in your recovery, they could do the counting for you if this is possible and more beneficial for your recovery.

Calorie counting can be triggering for many people, but the alternative of under-eating is much more harmful. Under-eating – which many people in recovery will do due to unreliable hunger cues if they do not count calories or have them counted for them – will mean that the body cannot heal. Mental and physical recovery are interconnected, so if the body is not getting enough energy, this will also impact on mental recovery also. Under-eating means that neither mental nor physical recovery will be able to take place, so counting calories until your hunger is reliable is a necessity. This is one habit that will have to be saved until a bit later to break – which is okay, because there are many habits and thought processes to manage, change, and break, and there has to be something that is saved until last (or later on)!

So you’ve been counting calories for a while and making sure you that you get the energy that your body needs. How do you know when you can stop counting and start going by hunger? When you start feeling like your hunger is happening in a reliable way which is consistent with when you should be eating and how much you should be eating, you can start thinking about testing out that hunger to make sure that it is naturally bringing you to the amount you need. A good way to test how reliable your hunger is, is to write out everything you eat for a week (or two weeks), and then count it up for each day, add it all up to get the total amount, and divide it by seven (or fourteen). The average figure should come to around the amount that is suggested as the minimum for you to eat during your recovery (this is around the amount that you should need forever). If it is three hundred to four hundred calories below that total, then I would really suggest that you continue to count calories as your hunger signals are likely to be unreliable. Most people will naturally and intuitively eat the amount recommended for them, or close to it, as this is the amount that an energy-balanced body needs each and every day. Some people do have hunger that is below or above the average (for example, someone who is expected to need 3000 calories for their age, gender, height, and activity levels could find that they naturally eat 2400, or 3600), and that is absolutely okay. However, if you are eating more than three hundred to four hundred less than what is recommended as adequate, it is more than likely that it is your hunger cues that are unreliable and you still have a little way to go before they are back to normal. If, say, 2400 calories is your normal hunger, eating 3000 for while longer will not have a negative effect on your recovery process, and will not have an impact on your weight. Your body will adapt to deal with the excess energy by putting it to good use (e.g. to continue repairing your body) or the metabolism will speed up to burn it off. (As a side note, when you are adding up your calories for those tester seven days, if one day has a really low amount, and another a higher amount, for example, 1000 calories one day and 4500 the next, this is a sign of unreliable hunger cues, even if the average does come to around the amount suggested for you. As a second side note, if you are consistently eating well above and beyond the minimum you require for recovery, your hunger cues are working and you are experiencing extreme hunger or higher energy needs still, which is totally normal for recovery).

So let’s say your hunger cues seemed reliable, and testing this out has shown that they are, now what? You can start trying to eat intuitively, but you will need to keep reassessing yourself to make sure your eating disorder is not sneaking in and manipulating the situation. It is important that you eat what you want, when you want, and don’t let the anxiety of stopping calorie counting come out in other ways, such as restricting certain foods types or resisting eating something you want because you are worried you are eating more now you have stopped counting. It is going to make you feel more out of control, but it is important to continue onwards, and not use any other behaviours.

But how do you go about stopping counting calories? Calorie counting is a hard habit to break. It can become so ingrained in you that it can happen even without consciously thinking. There will be different things that work for different people, but here is a list I put together with some suggestions about how to stop counting:

  1. Get yourself and your family to put labels over the calorie amounts on packets etc. This can deter you from looking and also remind you when out of habit you try to check that your goal is to not look and not to count.
  2. Get your family to serve you at dinner time, to challenge skewed perceptions of portion sizes, and to learn to relinquish control over amounts.
  3. Stop measuring foods or liquids.
  4. Eat intuitively for one day (or even one meal). In a week or so, try doing it for two days (or meals). Work your way up until you can ditch the habit altogether.
  5. Visit cafes, restaurants, cinemas, and other places that are uncaloried to get you used to eating meals where you don’t know the calories to face that anxiety and start to overcome it. You can then start trying to do this at home and challenging yourself there.
  6. Listen to your body and its signals (this is also something you should start doing as soon as you get into recovery, even when you are counting calories). Follow your body and tune in to what it is telling you, rather than going by calories you’ve already eaten today or any other calorie “rules” you are sticking by. Start learning to listen to mental and physical hunger, and also learn that you can also eat when you are not hungry if you fancy it.

There are only six suggestions here, and there will be countless other things that can help. If you have any tips that helped you or someone you know, write them in the comments below so that others can benefit from it too!

Counting calories and not counting calories are both big parts of the recovery process, and both relevant at different stages in your journey. Again, make sure that you are not using compensatory behaviours when you start trying to eat intuitively and stop counting calories, such as eating smaller portions, cutting out calorie dense foods, or not drinking liquid calories, out of anxiety. Learning to eat intuitively without compensating due to anxiety is a big part of recovery. You need to learn to eat what you want, when you want, without letting your ED get on the stage with you. Make sure it is not running the show, or even making compromises with you. It doesn’t have a place in the life that you are creating for yourself. This life is yours, and yours only.

Eating Disorders and Willpower: An Absurd Association

will power

Willpower. It’s something that we associate with strength. It is something that we admire in others, and it’s something we want for ourselves. And in this day and age, it is problematically associated with dieting and weight loss. The association even extends to restrictive eating disorders. I want to tell you how wrong it is to think that the two are synonymous.

I want to firstly consult the dictionary. Let’s take a look at the definition of “will”:

Will
noun

1. the faculty by which a person decides on and initiates action.
“she has an iron will”
synonyms: determination, firmness of purpose, fixity of purpose, will power, strength of character, resolution, resolve, resoluteness, purposefulness, single-mindedness, drive, commitment, dedication, doggedness, tenacity, tenaciousness, staying power, backbone, spine; More
2. control deliberately exerted to do something or to restrain one’s own impulses.
noun: willpower
“a stupendous effort of will”

A person with an eating disorder does not decide to have one. They do not have any power or control when developing or having an active eating disorder. They do not initiate action: the eating disorder does. They have no say in the matter whatsoever. So using “will” in the context of eating disorders is absurd.
Let’s also have a look at the definition of willpower itself:

noun
1. control of one’s impulses and actions; self-control.

Again, there is no control when it comes to an eating disorder. There is certainly no self-control. In actuality, it is the opposite that is true: someone with an eating disorder is completely out of control. They are not deciding to abstain from food or drink. They are not deciding to compulsively exercise. They are not deciding to vomit their meals into toilets and trash cans. They have no control over their ever dwindling intake, the inability to eat ice cream, or the ten miles they feel they must run. The severe mental illness that they are suffering from is running the show, not the person with the illness. Eating disorders are not a choice, and to insinuate that someone with an eating disorder has willpower is to insinuate that they have a choice.

You might be someone who has previously considered an eating disorder to be a choice, and are looking for an explanation of how it is not. Let me first stress: eating disorders have a genetic link. This means that if you do not have the genes to develop an eating disorder, then you will not develop one. If you have the eating disorder gene (which is being researched: the specific gene has not been identified as of yet, and it is most likely a combination of genes, not just one) then it is possible to go through life without triggering it into action. However, if environmental factors trigger the gene (and the triggers are plentiful: dieting, bullying, death of a loved one, abuse, parents divorcing, illness, fasting – you see how these can be both emotional or physical triggers), then you will develop an eating disorder. Genetics load the gun, environment pulls the trigger, the saying goes. So genetics have an important part to play in the development of an eating disorder, and you don’t get to choose your genes.

Here are some examples of how it works inside the mind: if you had to choose between eating a highly restrictive amount of calories and living with aching hunger, or feeling like tearing your own skin off, would you comply with your eating disorder or your hunger? If you had to choose between exercising until you felt like you might vomit and pass out or feeling so disgusting in your body that you would consider killing yourself, what choice would you make? If you had to choose between not eating a slice of pizza that you desperately crave or feeling like such a failure that you punished yourself by cutting you body multiple times in multiple places, what would you choose? And when you see those options, does it really look like much of a choice any more? Each option is torturous and punishing, but one always gets you closer to the goal of losing more weight, or at least attempting to. You’ll feel better when your body is perfect, the eating disorder says. You’ll feel better if you barely eat. You will be more in control, it lies, and there are so many lies it will tell to keep you from fighting against it. 

The more the illness pervades the mind and the sufferer responds to the eating disorder, the more things like food and weight become a source of anxiety. Each time you respond to the voice telling you not to eat or you will feel something unbearable, the more the message in reinforced in the brain. You see, when you avoid something that makes you anxious, the more the brain is told that it is something to be anxious of because it is being avoided, and the more anxious you become of it. Another sneaky way the eating disorder survives is to completely distort the perception of the sufferer, so that their body looks to them to be completely different to what anyone else sees, and in a lot of cases, the thinner they become, the fatter they feel. This way the eating disorder continues to dictate the actions and thoughts of its host (and yes, that is what you feel like: just a host to a demon that is making you diminish in size inside and outside day by day).

I could go on, but let’s get back to willpower.

Meghan Trainor caused uproar with her incomprehensible comment about her apparent lack of willpower to “go anorexic”.

I wasn’t strong enough to have an eating disorder. I tried to go anorexic for a good three hours. I ate ice and celery, but that’s not even anorexic. And I quit. I was like, ‘Ma, can you make me a sandwich? Like, immediately.’

Her comment is one of such extreme ignorance that it makes my blood boil. For one, strength doesn’t come into eating disorders. Strength is something of value. It is a brilliantly positive trait to have; something you use in the face of hardship; to get through something or to defeat it. It is something that you use to fight and beat an eating disorder, not something you use to continue its existence. It does not take strength to have an eating disorder: it takes sickness and misery and intense self-hatred. It takes strength to recover. Secondly, you cannot “try to go anorexic for a good three hours”. Anorexia is first and foremost a mental illness (like all other eating disorders), not something that you can just “try” and then stop because you get a bit too hungry. “Trying” is not part of an eating disorder. You would never in a million years “try” to have an eating disorder if you understood what it entailed. It’s not about having the willpower to “go anorexic”. Any eating disorder is a disease that creeps up on you and slowly invades your mind bit by bit until it has wormed its way into every part of it, and then suddenly you realise that you are drowning in it and there is no conceivable way out. You don’t just “go anorexic” for three hours and then choose to stop. Need I say it again: there is no choice. And no, funnily enough eating ice and celery for three hours only does not mean you have a serious and deadly disease.

Willpower is inextricably linked to choice, and we know that eating disorders are not a choice, so the two cannot be thought of in conjunction with each other. Ever. To talk about eating disorders requiring willpower undermines the helplessness and hopelessness that someone feels whilst being under the control of such a powerful and deadly disease. To talk about eating disorders requiring willpower – a positive trait we all want – undermines the sheer anguish and torment someone suffering from one has to experience every second of every day. To say eating disorders require willpower is to inadvertently say that there is something that tortured person has that you admire. You are looking into eyes full of pain and saying, “I want what you have.

Willpower is a positive thing. Having an eating disorder is a living hell. Willpower is strength and control. Living with an eating disorder is being crushed under a dictator that ultimately wants you dead and feeling unable to do anything but obey and walk knowingly into the jaws of death. Willpower is willpower and eating disorders are eating disorders. Let’s not mix up the two.

Vyvanse and BED: Money-making in Disguise as Treatment?

vyvanse pic

Fairly recently, Vyvanse – a drug known for treating ADHD – was approved to treat binge eating disorder (BED). I was first made aware of this drug via a message sent to my blog from a woman living in the US who was angry about the effects this could potentially have on people who were prescribed it. I did a bit of reading up about it, but soon forgot about it. The topic came up again when a friend linked me to an article about the drug being used for treating BED, which I read, and my interest was piqued. I started thinking about the problems that would arise from it’s approval to treat BED that are both numerous and highly concerning.

In May 2013, the DSM-V was published, with BED being newly recognised as a psychiatric disorder. On the surface, this sounds great: sufferers of BED were finally being recognised and validated, but a further look into this and the subsequent approval of Vyvanse to treat it raises some serious questions.

In a society where almost two in five (37%) women and one in six (18%) men in the UK are dieting “most of the time”, and 108 million people are on diets in the US, a huge amount of us are restricting on a daily basis, and when we “fail”, we feel shame, guilt, hopeless, and anger at ourselves. And failing is inevitable, because diets do not work. Dieters often end up in a restriction/binge cycle, and mistake their dieting for normal behaviour, and so only take note of their binging and see this as a weakness rather than a normal biological response to starving the body. If the body has an energy deficit due to restriction, it will seek to restore balance by compensating later on. So with that in mind, we can now look at the criteria for BED:

  • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
    • a sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)
  • The binge-eating episodes are associated with three (or more) of the following:
    • eating much more rapidly than normal
    • eating until feeling uncomfortably full
    • eating large amounts of food when not feeling physically hungry
    • eating alone because of feeling embarrassed by how much one is eating
    • feeling disgusted with oneself, depressed, or very guilty afterwards
  • Marked distress regarding binge eating is present.
  • The binge eating occurs, on average, at least once a week for three months.
  • The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.

For me, this criteria is extremely problematic. This criteria is pretty vague, and in conjunction with a society that vehemently fears over-eating and weight gain, becomes a fit for a large proportion of people. Let’s take a look at it in more detail:
– “an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances” – this is particularly non-specific, and in our society, many people have a distorted view on what is larger than most people, especially when so many are restricting. It is also normal for someone who has been restricting to experience eating more than normal, because of the body trying to restore itself to being energy-balanced.
– “a sense of lack of control over eating during the episode” – many people feel out of control when it comes to food because we are made to feel that out of control if we are not eating in some strict and regimented way. That feeling is even more accentuated when the drive to survive overcomes the person’s desire to diet, and the body makes up for lost energy by “binging”.
– Eating rapidly is also part of the drive to get energy in as fast as possible when it needs it.
– Eating until uncomfortably full is easy to do when the body requires more energy than the stomach has room. The desire for food is just another way for the body to communicate hunger, and people often do not recognise this as a type of physical hunger (the brain is part of our physical being as well).
– Eating alone when eating what someone considers more than normal, or when someone is experiencing reactive eating in response to restriction, is – unfortunately – normal because of the way our society has surrounded food in a thick layer of shame.
– And if you are dieting, or misinterpreting your eating as a “binge” (because I would argue that many people have a distorted view of what a binge actually is), this is likely to happen “at least once a week for three months”.

“With these diagnostic criteria [for BED], there is huge potential for a false positive. Do a lot of people struggle with binge-eating? Absolutely. Are all of these people actually ill? That is the major question around this diagnosis and the Vyvanse treatment,” said Lisa Cosgrove, a professor and clinical Psychologist at the University of Massachusetts, Boston.

So what we have here is a list of things that those with BED suffer from, but written in a way that it could easily fit someone misinterpreting their eating habits because they have distorted ideas of what binging is, or are not aware of the effects that dieting has on the body. This means that these people could go to the doctors, tick all the boxes, and receive a diagnosis. Our fatphobic society steeped in diet culture would have no problem with that. A quote from Ray Moyniham in  Motherboard talks about this:

“You have to be extremely sensitive to the fact that there are people who are really suffering severe and debilitating symptoms from a condition,” said Ray Moynihan, a senior research fellow at Bond University in Australia and the author of Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients. “But when we put so much energy into medicalizing normality, it takes resources and attention and care away from people who are seriously ill.”

Now on to June 2014, where Shire wins the key patent ruling for the drug Vyvanse. The Telegraph writes:

Shire hopes to increase sales of the drug by broadening its uses into other patient groups, such as very young children and sufferers of the newly-recognised psychiatric problem binge-eating disorder (BED).
The drug maker told investors on Monday that it expected to make $300m from sales of Vyvanse to BED patients by 2020, following a successful clinical trial showing the drug helped control binge eating.

This raises a red flag for me: Shire will desperately want to make as much money as possible before its patent expires, and this means expanding its treatment to those with other illnesses other than ADHD. Shire had already thought of BED as an option, and already had that idea in the pipeline. Is the fact that BED was finally recognised and put into the DSM-V just when Shire needed a new illness to treat a convenient coincidence, or something more dubious?

In January 2015, Vyvanse was approved to treat BED. The fairly vague criteria for BED could mean that BED is over-diagnosed and over treated, with a drug that is an amphetamine. Hang on, what?

Amphetamines became extremely popular in the mid 1900s as a weightloss drug, before concerns about the dangerous side effects caused the FDA to ban amphetamines from diet ads.

The most serious risks include psychiatric problems and heart complications, including sudden death in people who have heart problems or heart defects, and stroke and heart attack in adults. Central nervous system stimulants, like Vyvanse, may cause psychotic or manic symptoms, such as hallucinations, delusional thinking, or mania, even in individuals without a prior history of psychotic illness. The most common side effects reported by people taking Vyvanse in the clinical trials included dry mouth, sleeplessness (insomnia), increased heart rate, jittery feelings, constipation, and anxiety. – take from here.

Vyvanse was approved for treating BED after only two 12-week studies.

“I tried (and failed) to persuade the DSM 5 group that BED was a premature and dangerous idea precisely because I feared it would be a backdoor excuse for drug companies to promote stimulant diet pills,” Dr. Frances Allen, a psychiatrist and frequent critic of the DSM-5, told Motherboard in an email. He has had particular concerns about the new criteria for diagnosing eating disorders. “The rushed approval of Vyvanse realizes my worst fears”

People actually suffering from BED are desperate to get rid of their mental illness, but therein lies the issue: BED is a mental illness. I have severe reservations about an appetite suppressant being used to combat an eating disorder that for a lot of people has roots in trauma, and other deep-seated emotional problems. The appetite of that person isn’t the issue: the drive to eat as a coping mechanism is. And not only are we going to be dealing with actual sufferers, but those misdiagnosed because of the ill-defined criteria, and those faking the illness to get a hold of Vyvanse, either because of its street value, or because of its use as a weightloss drug. Which brings me to the dangers of those with restrictive eating disorders reeling off the list of BED symptoms, and getting a prescription of Vyvanse to continue their downward spiral that only leads closer and closer to death. Because a binge eating disorder diagnosis relies on self-reported behaviour, it means that it is not difficult to fake, and consequently, it is not difficult to get a diagnosis. Pro-ana sites are already sharing their experiences with Vyvanse, and tips on how to get hold of the drug. The consequences of this could be catastrophic.

I received a message to my blog recently when the subject of Vyvanse came up:

I was recently diagnosed with BED and prescribed Vyvanse. My psychiatrist gave it to me because he said I was gaining too much weight. He gave it to me to use as a weightless pill. I don’t think that’s okay. In the past I have suffered from anorexia and bulimia. So of course, I accepted the pill. Hoping it would be easier to not eat at all. I think this may be a problem for a lot of people very soon.

This shows that already Vyvanse is being misused by doctors themselves, who are supposed to be people that we trust with our healthcare. But with the pharmaceutical industry being all about the money-making, it’s hardly surprising.

In my opinion, the inclusion of BED in the DSM-V, the vague diagnosis criteria, the subsequent research into using Vyvanse to treat BED, and the swift approval of that usage, are linked together. The pharmaceutical company have helped themselves to make more profit off both those with BED, and so many without it, with a drug that in my opinion will not successfully treat the disorder it has been approved for. And this drug is likely to have devastating consequences.