Treatment for the former

I've heard from some people in the comments for the apples and oranges post that I should not divide eating disorders into categories.

Actually, I'm not saying there are two disorders. I'm saying eating disorders are a mental illness - a brain disorder. (apples)

I'm saying people who are on unhealthy diets and dislike or hate their bodies don't necessarily have an eating disorder. (oranges)

Does that clarify?

Treatment for the former should not be treated as if it is the latter.


  1. That is crystal clear, Laura, and I agree with you. I also recall some comments from somewhere this week about "disordered eating", and I think we need to keep in mind that someone can have "disordered eating" and not have the serious mental illness of an eating disorder.

  2. If you are saying that eating disorders are all physiologically disorder of brain chemistry that are triggered by dieting, then I agree.

    If you are saying that the disorders that emerge in [some] people who have had parents encourage their dieting/disordered behavior are somehow *not* eating disorders, then I strongly disagree.

    Perhaps the young women who grow up with repeated encouragement to diet in dangerous ways are at increased risk of being exposed to the 'glitch' that triggers the eating disorder. In others, it might be having strep throat or your wisdom teeth out that serves as the initial exposure to semi-starvation & the high that accompanies it.

    I think it's important to realize that hating your body can lead you to starve yourself/go on a crash diet-- if you have an eating disorder [or predisposition, etc] that starving can perpetuate the cycle.

    I don't think they are separate. I took offense to the idea that my eating disorder was somehow not valid by your standards-- I felt as though you were grouping things that had some basis in environmental triggers as less significant, less serious, etc.

    I hope that isn't what you were intending to do.

    Eating disorders have different causes and different presentations, and even in one individual over time as their disorder & self evolves.

    There's something in the tone that seems to be dismissive of women who came from a background where they were taught it was okay, even necessary, to hate their bodies.

    Not every person who grows up in that environment will develop an eating disorder-- but some do, and treatment for their eating disorder needs to address those issues in addition to the standard nutritional issues.

    Some people's experiences push them towards dabbling in dangerous behaviors, and sometimes those behaviors send them into the biochemically driven eating disorder.

    I don't think it's a parent or anyone's fault when someone has an eating disorder. But a parent can cause/encourage someone to diet, even dangerously-- and in *some people* those dangerous diets can react with their unique biochemical makeup to lead to an eating disorder.

    I don't subscribe to the antiquated notion that anorexia is a diet gone overboard or anything of the such, and I hope this reply clarifies that.

    I don't hate my body-- but at times, I have believed that losing weight would fix my problems. Losing weight has a remarkably soothing effect to me.

    When i am actively anorexic, it changes the way I see my body. It distorts everything, and starving seems the only way to feel anything close to okay. I have come to realize that 'feeling fat' is a sign I'm not adequately nourished.

    I recognize that for other women, hating their bodies is a part of life. For me, hating my body is wholly incompatible with life. I am baffled by women who can bitch about their bodies in the locker room & go about their day. I think it's awful that women feel the need to connect this way, and I think it's hideous that body hatred is so ubiquitous in female culture.

    I'm baffled that people could possibly see this sort of dieting as akin to an eating disorder-- so if that's what you're calling 'oranges' [the kind of body hatred that doesn't take over your life, that is awful and sad it its own rite but not predicated on the aberrant brain chemistry that rewards starving, purging, etc] then I completely misread your first post.

  3. Anonymous, I'm going to assume you are the same anonymous as before.

    And also assume you haven't been following my blog for long.

    Yes, I agree with everything you said about dieting triggering the eating disorder.

    But no, I do not in any way feel dismissive of people who have been influenced to diet by parents - the opposite in fact. I'm not sure where you would get that idea.

  4. what do you call someone with other mental illness whn also dislikes their body? A fruit salad? Sorry to be faceicious (particularly as i can't spell it) but it does strike me that with the right (or rather wrong) genetic predisposition some people could easily battle both problems

  5. What would I call it? I would call it a problem to be addressed and solved. No one should have to feel bad about themselves or have others contribute to feeling bad about themselves - ESPECIALLY their loved ones.

    But that is distinct, in my mind, from the mental illness that compels people to self-harm, restrict, binge, purge.

    The difference is the cause (to have the mental illness you could have had zero outside influence or 100% abuse) and the treatment. Talking to people with a mental illness about self-acceptance and media distortions and eating enough doesn't work very well. Because the cause is brain-based and not experience.

    By treating the mental illness the same as we do the pain and damage of experience we serve neither.

    People with anorexia and bulimia and binge eating disorder deserve far more than being talked out of their thoughts and feelings. They deserve comprehensive evaluation, treatment, and follow up based on the best science available.

    People who have come to hate their bodies and get on a cycle of manipulating their bodies with food SOMETIMES TRIGGER THE MENTAL ILLNESS, but even if they don't they deserve help in letting that go and living a full and happy life in their body. People who are abused or neglected or experience "relentless boundary invasion at every level" absolutely need loving, protective, ongoing help and support.

    The issue is that patients fo the real brain disorder THINK they are experiencing the latter - and it is our job as a field and in society to discern the difference and make sure people get the right attention.

    And NOT to assume that someone who feels bad about their body and blames their mother has actually been mistreated.

    That assumption is causing so much harm. And it is letting bad parents whose kids don't get eating disorders off the hook.

  6. Thank you Laura for your amazing answer to a very inadequately put question - I'm not doing well in putting together cogent argements now that I am suffering from the "language impediment" of having very limited access to a keyboard!

    I agree that it's vital to treat these mental illnesses for what they are, and very difficult to do when society at large is so disordered in its thinking and some therapeutic approaches positively toxic.

  7. what do you do (hypothetically I'm not actually asking as if you could give me a plan of action) when you have an ED but your mother has a lifetime of chronic dieting and body hatred fueling her perception? I want to tell my mom about my 10 year struggle with EDNOS but I truly do not think she'd "get it". So I think it's healthier for me to continue to keep it to myself/circle of support.

    (just so you know, I think Maudsley is a great approach for treating anorexia in adolescents and hope more and more families are able to use it)

  8. 700stories, that is a very difficult and painful situation! I'm not sure what to say except that it is okay to say the truth without expecting the other person to understand or agree. Just being free to say what is true about yourself is important.

    Just as family can be one's greatest ally, we can also be a horrible drain. It is good to have friends and family around us who DO get it and help us be the best we can be!

  9. I distinctly remember being 14 years of age. I had a BMI of 17.8 and was asked to be a model for a show.
    My mother told me I was fat and took me to the chemist and bought me diet tablets.
    I remember being quite shocked when whilst I was being fitted by the wardrobe person she said "my goodness, you are tiny"! Extrememly confusing; as was my father saying I was going to put on weight everytime I consumed a glass of water.

    Did I develop an ED? Yes. Did I have pre existing phychological vulnerabilities that made me suseptable to ED? Yes.
    Do I believe that a lot of those vulnerabilities were inadvertantly caused by the same parenting methods? Yes.

    I will also say that the normalising of my behaviours I now consider only half of my recovery. I was still living a half life and dreaded the return of ED.
    Therapy was what finally made me "safe". Physodynamic and 4years of it.

    I can now see that the Ed was not part of "me". It was not part of my biology. Simple therapy tools healed the phychic wounds I had suffered.

    My parents are not to blame, and neither am I. What is, is.

    I can understand how the support and help of ones parents during recovery would be a v helpful thing. I do however believe that peoples ED's and their disorders causes vary enormously.

  10. If you have a genetic or biological predisposition for mental health issues then even if your parents are the Huxtables you are in trouble. If your parents sucked at parenting, you are in peril in terms of your mental health - even without a predisposition. A predisposition AND dysfunctional/cruel/inept parents? Oy.

    Truly, I think good psychotherapists should be available like a public utility - like electricity and Interstate Highways. Marriage licenses should come with coupons for counseling and birth certificates should have guaranteed family therapy sessions included!


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