F.E.A.S.T. Advisor on Rachael Ray show

Dr. Cynthia Bulik, my friend and a F.E.A.S.T. advisor, was on the Rachael Ray Show today talking about "orthorexia."

I'm of the thinking that orthorexia is a term that describes everything from very unhappy relationships with food all the way to people with undiagnosed anorexia. The difference: anorexia is a brain-based mental illness driving thoughts and behaviors, while unhappy relationships with food are unhealthy thoughts and behaviors that society aids and abets.

Your thoughts?


  1. interesting thoughts. I'll have to chew on this a bit and get back to you on what I think :)

  2. How would you tell if someone should be diagnosed with orthorexia or annorexia? Could you only tell if they were anorexic or orthorexic based on how hard it was for them to recover?

  3. I have a heap of thoughts on this, which I will hopefully explain in a blog post tomorrow. The crux of the issue seems to be where you draw the line between an eating disorder and disordered eating. How are we defining an eating disorder? Are we using the most accurate criteria? Do these factors help distinguish actual eating disorders from disordered eating?

    It's a tough question!

  4. I look forward to the day when we're researching brains BEFORE the onset of ED -whether AN/BN/ORTHO/EDNOS/subclinical AN/BN/etc. I have long wondered if something abnormal happens when the pituitary kicks into production of hormones; if there is something "off" in the hormone production of those who develop ED? Is there something missing in the production of prolactin, adrenaline, testosterone and/or estrogen? And what about the mal-production/absorption of serotonin? Or what about those with gut issues as babies/toddlers; does that lead to ED? Do any or all of those things automatically set someone up for ED? Or is the key to ED found in a brain-chemistry-disorder? It will really be wonderful when we're at the stage of research as we are currently at with Breast Cancer (though of course, that has miles yet to go, too). (Your broken record here: this is why the FREED Act is so important --research!! et al)

    The people I work with who suffer with Orthorexia, even those with 'just' sub-clinical Ortho., have as much a brain disorder as those with anorexia; of course, just like with anorexia (in my opinion) the brain dysfunction/disorder depends on how long they have been dealing with it, how severely manifested their Ortho. is, and how dire their under-nutrition is. As with other ED, I have not witnessed the cognitive brain changes show up in the behaviors and thoughts of those with Ortho until after malnutrition and physiological and psychological addiction have set in. (This is all theoretical and anecdotal since I'm not doing 'brain research'.)

    But I think the above goes in line with what I know of all "eating disorders" thus far --there are varying degrees of ED and at all levels of ED, they carry deadly consequences both psychologically and physiologically. Can we say that all ED other than AN, esp. ED's at the sub-clinical level, that they are not brain disorders and that it's just an unhappy relationship with food and unhealthy thoughts? My thoughts on that are: No, we can't (yet) and we shouldn't (yet) because it does a disservice to the persons suffering. Making that claim now would esp. concern me given the current state we're in with Ins. companies and the suffering and death people endure trying to secure treatment. Brain disordered anorexia or subclinical BN, I would hate to see ins. companies say that it's really 'just' an unhealthy relationship with food, not an eating disorder, because you don't have brain-disordered-AN, therefore treatment is not required.
    Like many who suffer, I was not clinically diagnosed with anorexia --me, because I was 'only' 10 pounds under my natural and healthy weight. But I can tell you that every system in my body, including my brain, was shutting down. Was that a brain disorder or just an unhealthy relationship with food driven by society? I think it was both and I think I needed treatment for both my brain and my body. I think what started out as an unhealthy relationship with food and my body (a relationship that society cheered on) turned into my brain suffering the severe consequences of under-nutrition and was therefore like Swiss cheese, irregardless of my weight/Dx. Only after "re and over nourishing" my brain was I able to sustain changes to my thoughts and my behaviors (and regain my will to leave anorexia and bulimia behind for good). (ie: my brain healed both psychologically and physiologically so that my emotions could be rational and also evolved (so that I would no longer take someone saying I was 'prettier' when I was thinner as "truth" --That is not my 'healed brain disorder' speaking, that's my emotional intellect speaking...which of course, I couldn't have if I wasn't well-nourished, I know :) ~ This all just goes to show that we need to expand and consider varying and new degrees of "eating disorders" so we can treat them most effectively.

  5. I'm tacking this on because it came to me as I was thinking about the amazing abilities of our brain to overcome disorders and diseases. ~ I know that my situation is not every one's situation, and that I was lucky to not have OCD along with my ED, and that I didn't damage my brain beyond repair, but I think maybe this might be helpful to mention in case even one person who is suffering/affected is reading this and it turns on a light in their disordered brain. ~ In my personal experience, there was a different level of my brain controlling me when I was AN. When I was dealing solely with BN, I know I was chemically and physically addicted in a different way than I was with AN, and I couldn't just 'stop'. Healing from bulimia took more than just nutrition (though that was KEY), it took CBT, EMT, and LOTS of practice, and re-recording the tape recorder in my brain. But with AN, I felt like my body and brain were addicted in different ways --the compulsions were different and the physical rush was not there. And in those differences lay an important factor in me fully recovering. When I was anorexic, there was always a time when I had the ability to stop and ask for help to get healthy. I could have chosen to get help. However, the depression and the belief that I lacked the autonomy in my familial and social settings to do it, kept me locked in the belief that AN was the best I could ever do and I chose to hang on so I didn't have to deal with the fears of the unknown that come with recovery. The time to leave AN behind came when my days consisted only of interactions between me, God, and a stray cat. My days were completely alone (no longer had friends/family involved in my daily living) and somewhere in these times, the enigmatic will of being human kicked in and I choose to commit to healing my brain and my body. The lights went on the day I met Mr. and Mrs. Ron George and Kitty (and Anna) Westin. And I decided then: enough is enough, it's time to stop being stubborn, it's time to release this game of testing my own will-power, time to stop caring if this is what society thinks looks good on me, it's time to seek my autonomy from AN, and it's time to heal. I talked back to (and fed) my disordered brain and won. ~~ I'm lucky, though. My body somehow held out during all of the years of torture and undernourishment (not without consequences, though). I have witnessed, not only in my life, but in the lives of others that the brain is so much more powerful than we can even venture to believe when ED is a part of our lives. But just like Jill Bolte Taylor who healed her brain after a stroke --because she set her mind to it-- you HAVE TO set your mind to overcoming ED...and you HAVE TO nourish it to give your emotional will power a chance. Brain disordered ED or subclinical ED --if you are suffering in any way: recognize today that you can heal and that waiting to heal is an option that will only further your suffering and hasten your death. WANT control of your brain (emotionally, physically, etc.) again and do what it takes to get it back. Never underestimate the power of your brain.

  6. I agree: no amount of malnourishment OR mental symptoms should be left untreated. Period. But the treatment would vary, wouldn't it, depending on the cause? If one has a brain disease that locks one into certain thoughts and behaviors that is different than someone who is still functioning normally cognitively and emotionally.

    At this time, we have no empirical test of the difference between people who think or behave in a disordered way because they have learned to and those who do these things because their brains are wired that way.

    What worries me is the ubiquity of treatments for eating disorders that treat the problem as something to get at with logic and reason and emotional appeals. While there is certainly a margin of people and of the brain experience of the illness that can be reached that way, I think it is a disservice to the majority that can not - and will be left to suffer for longer because they CAN NOT change their behaviors and thoughts until they are brain-restored.

  7. I agree, Laura...my first treatment was from people who sought to heal me emotionally. I was 'coddled' (? allowed myself to be ?) into believing that I just needed autonomy from my mother and my ED would disappear. Yea, that was helpful :)
    Today I see that treatment has expanded with research; of course there's more to do and learn about and from on both fronts...and not all treatment is as good as others, that's for sure. ~ And YES! individualized treatment is key...some people can unlock their brain one way and others cannot. Just as now they treat some forms of breast cancer with treatments formerly used only for prostate cancer --the future of ED treatment and research holds bountiful unknowns. Right on about not having the empirical test yet about the "why" of behaving yet...that will be awesome to uncover --I look forward to that!!

    I think that brain restoration via nutrition and cognitive/emotional restoration/expansion is not linear or separate, but concentric. Of course, the beginning of the circle depends on exactly what you were saying: first understanding what the person is most suffering from and treating the most life-threatening part of their disorder first.

  8. (ps: yes, to your first sentence re: the treatment would vary depending on the cause...but unfortunately we're not 'there yet' with insurance companies understanding that ALL varieties of illness deserve treatment)... I realize this is a result of my fears --that if we label 'ED' as a brain disease (which more and more insurers are paying for --not all, but more), other EDs will fall through the cracks of Insurance claims. In the ideal world, your statement is right on :)

  9. I agree with a lot of what "FREED" has to say.

    I would like to add that I beleive my cognitive distortions started at least a year before the first ED symptoms.The nutritional changes exacerbated these problems and esculated the ED behaviours.

    I eventually dealt with the majority of the behaviours and nutritional imbalances and this helped significanly. I was in no way truly "better" though. I was living half a life. It took therapy and a lot of it and now I am finally whole and (almost) 100% free of my past.

    Surely all mental health conditions involve disordered thinking/brain activity. Saying that some are solely caused by brain disorders (genetic) is another thing intirely.

    I beleive there is some reasearch that proves that sub clinical AN and BN persons still show almost all of the abnormalities and cognitive problems as full blown cases. I shall search for it and post if I find it.

    As far I undersatnd these things genes only predispose one. Environmental factors change neurobioligy and can result in abnormal cognitive processes.

    I would always judge how serious something is (and how much one needs help) on how much the condition interferes with their life and their happiness (obviously health as well).

  10. Reading about FREED experience I felt it was my son talking. He tells me the same. It is all in my head and if I want I can do it in a day... He talks all logic. But when it used to come to doing... he would stop at a point. He only improved when we left him on his own... fighting alone ... but of course keeping an eye on him in case he might need medical help for body functions. Reward strategy works well to some extent when the patient is younger but not when they cross teens....... Do this only then u get that....
    He kept trying his own ways of increasing his weight ... until, he was too tired and started to eat vegetables and other stuff... But all without our watching or intervention. We cant bring them to balanced eating until they find some reason to come back... My son has... he wants to dance again...ike he used to.. So I agree that if an AN has strong will to be an anorexic he HAS A STRONG WILL ANYWAY. It is just a matter of the path chosen. He can be cured only when he decides.... or else he is just kept alive. Im not sure about medication part... how much is needed ... is it needed or not ???? No clue even after going thru it for 3-4 years now.. But double thumbs up to Maudsley Approach. they need parents as parents are the only ones who can have so much of selfless love and patience. They need someone who loves them unconditionally... and keeps trustig them even if they fall every time... because eventually they will rise.

    I have started to think that what if I was training my son to win Olympics... he had to compete with teh world and I would need all teh patience and hard work to make it happen.

    I suggest that when dealing with AN always have a strategy in place...and NEVER GIVE UP. It is sure treatable but needs lots of patience and strategy....


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