Fear, deprivation, morality-based eating

I'm an opinionated cuss, no doubt, but I try not to say things I'm not sure of. And I've not been sure about the relationship of overeating and under-eating.

But I'm closer and closer, almost off the fence, that we are dealing with a spectrum disorder with restrictive AN at one end and Binge Eating Disorder at the other. Spectrum not because of facile visuals, but because I can now see both as a brain problem, one that makes sense in terms of evolutionary biology. It's not about the weight, but the mental imbalance that drives the behaviors. And it all starts with restriction - especially value-based restriction.

"Deprivation only heightens the way the brain values the food, which is why dieting doesn't work"

And this all begs the question: Should we be treating anorexia and bulimia and binge eating disorder the same way? Are they the same illness? Is restrictive anorexia substantially different from purging anorexia? Are we looking at phenotypes, genotypes, different illnesses mistakenly grouped together or the same illness with different symptoms? And more to the point: why don't we know the answer to these questions yet - because despite the lack of answers for all the above every treatment being offered RIGHT NOW is anchored in a specific answer. Every clinician believes one specific answer (or has at least ruled out certain answers). Every client goes into treatment with beliefs about "why" and every caregiver has beliefs about it.

Perhaps the best we can do is remain humble and uncertain while wearing our current conclusions in plain sight. A good theory, a friend of mine so wisely says, is open to change.


  1. I'm glad you brought up this issue. I just had a conversation about this with a friend of mine who has struggled with her weight her whole life. She had bypass surgery and is doing much better. Our conversation sharing our experiences was eye-opening. It felt like the same illness, her binge eating and my anorexia, only on polar opposite ends of the spectrum (like you said). It's sad to me that in our society people tend to look at a morbidly obese person with disdain (i.e. it's all her fault) but a person with anorexia as someone to be pitied and protected. Both individuals need care, concern, and protection. (I'm talking about morbidly obese, not people who are deemed "overweight" by a culture that thinks a size 0 is a normal size). It's hard to argue with the idea that the same mechanism in the brain that controls eating could go awry and cause over or under eating in different individuals. Anyway, I thought I'd share my humble little opinion!

  2. fightingforever3:35 AM, May 10, 2009

    I'm certain that there's a spectrum between the different disorders.

    Take anorexia. You've got the stereotypical restricting anorexia, then you've got a restricting anorexic who purges on the rare occasions when they're forced to eat, then you've got an anorexic who would occasionally eat and purge by themselves, then you've got the full purging anorexic. Where do you draw the line between any of these cases? You can't easily. The two ends of the scale may look different, but there is no clear point where one disease becomes something else.

    Then, what's the difference between a binge/purging anorexic and a purging bulimic? Not a great deal.

    What about non puring bulimia? Here you have someone who stuff themselves, then starves, exerices or whatever until their next binge. At one end of the scale you have a non-purging bulimic who will eat her (or his) weight in food and then spend all day in the gym and swear not eat until it's all burned off. At the other end of the scale, you have a binge eater who hates their weight and occasionally goes for a jog. This person wouldn't be classified as bulimic by any means but, again, there's no obvious line where occasional exercise becomes regular exercise because over-exercise.

    I've spoken to someone who used to have anorexia but when she was trying to recover and was having to eat, she developed bulimia. One disease transformed into the other.

    In my mind, I'm certain they're all the same disease and should be treated with the same seriousness and respect, even though I acknowledge that the physical symptoms of some (non-purging bulimia) are less dangerous than others (restrictive anorexia). The psychologic effects are just as dangerous, maybe even worse for those who remain overweight.

  3. I wrote about this In short, weight loss dieting, contains and generates all eating disorders and disordered eating.

    I know that emotions can trigger these things too, but what I think is fuelling them is desire to reduce or keep weight low, using weight loss dieting .

    "Deprivation only heightens the way the brain values the food, which is why dieting doesn't work"

    It seems to be more the other way around, IMHO. The absolute unsuitability of dieting comes from the threat it poses to our body, that means the body defends itself against them, using all means at it's disposal.

    The above heightening of sensitivity is one of those means, as this mainly occurs through the nervous system, which obviously includes the brain.

    The reason diets fail is because the body is designed to resist them. If diets worked there would be nothing stopping anorexia from occuring. It is the power and comprehensiveness of those defences that make the overwhelming majority of people drop out before they can get to anorexia.

    We have to try and get through our heads that although wl dieting seems logical and benign on paper, we have to judge it not by that but how the body actually responds to that.

    IOW, we must go with what does happen, not what is supposed to happen.

  4. I think we agree, though these interrelationships are probably circular and we might start at different points in the circle. The key is: dieting is an unnatural and unhealthy behavior!


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