"Very ingenious, as all Freudian arguments are"

I think the eating disorder world would so benefit from getting outside our box. We need to start looking at the thoughts and behaviors of eating disorders from a fresh perspective - and see the brain as a place that can be damaged and show symptoms with a logic of their own.

Of course, at the same time we'll need to stop using similar logic in our lives when we don't have an eating disorder... like that our weight is so darned important or that food is magic (the words antioxidant and organic, for example) or that avoiding food is a search for 'control.' Why is it possible to believe that you can have a phantom limb because of something in the brain but your conviction that you are too big when you're 89 pounds is clearly about size 0 models and a fear of growing up?

I can only imagine what Ramachandran could do with body dysmorphia and eating disorders.


  1. I think the issue you're raising is quite complicated...

    I very much agree with the notion that EDs 'take on a life of their own', with any original meaning (if there is indeed any underpinning meaning...) being lost once the ED has established itself. Furthermore, I am not a fan of a most Freudian 'psychobabble'. I also think that NEDA have 'lost the plot' in inviting Naomi Wolff to deliver a keynote lecture at their forthcoming conference. [I have read 'The Beauty Myth' and, well, it's typical run-of-the-mill 'women's studies' stuff, that bears no relation, in my opinion, to EDs].

    However, I have always felt that the late Arthur Crisp had a point when he suggested that AN may arise as a consequence of a fear of puberty and adolescence. To my annoyance, my mother bought his book 'Let me be' in the early 1980s when I was in my mid-teens, and anorexic. When I read it I remember feeling 'this doctor understands me'.

    I didn't deliberately try to reverse puberty and my AN was not about deliberately trying to keep a child's body, but I did struggle terribly with the social changes of adolescence (probably due to Asperger characteristics) and I was certainly not upset when I lost weight and my early pubertal development was reversed. I stuck in AN because of the 'safety' associated with adhering to rules, rituals and routines around eating and exercise, but I was still quite scared that if I looked normal that I would be expected to act normally - when I didn't understand the social world of the teenage girl whatsoever.

    Now, of course, some might argue that I had a brain illness triggered by negative energy balance, and that my feelings while anorexic were consequential to my brain illness. However, my AN was preceded by overwhelming anxiety and depression associated with a recognition that I didn't 'fit in' to the world, as well as trauma.

    For some people, EDs can develop as a consequence of a simple diet, or illness-induced weight loss, and there is no deep underpinning psychopathology. However, there are some people who have experienced trauma, or have quite severe identity confusion during adolescence - and they start to restrict food because they feel unable to cope with life. Therapists would do patients a disservice if they ignored that.

    In terms of psychobabble: when you get some time watch the video series on YouTube entitled 'The woman who thinks like a cow'. It's a silly title but a good BBC documentary about Temple Grandin, (high functioning autistic). Her mother describes how she, as the mother to an autistic child, was psychoanalysed. She describes how one psychiatrist suggested that she maybe wished to have a pe*** (male organ). The mother states "there are many things in my life that I would have liked, but I certainly never wanted one of those...."

  2. This makes so much sense to me and explains the similarities and differences between all mental illnesses.

    The faulty wiring attaching to a different part of the brain resulting in everything from mild depression and high anxiety levels to full-blow mental disorders such as aspergers, an or schizophrenia.

    This makes my endless theorising on eating disorders not being a seperate "illness" from, say, aspergers but an interconnected fault in the wiring of a brain, an actual reality.

    I am not sure how I could use mirrors but do think that this makes the neuroplasticity treatment of an (ie time being a major factor in recovery) an absolute cert (IMHO).

    Also, Cathy, I wonder if there are different triggers for the onset of an ed. For some it may be losing weight means the brain doesn't have enough food to set the pathways in place and therefore takes a shortcut, resulting in a malfunction, some may be born with this malfunction underlying and some may have this malfunction caused by stress, hormones or injury.

    I think it is time to rethink so many things.

    Love this man - please can I have him for Christmas.



  3. Shocking, Charlotte! (But I'll wrap him in a bow and send him to you after I tire of him.)

  4. Please get tired really soon!

  5. Uh, oh. Our friend, M, has called first dibs and rightly - she is the one who pointed me to that video!!

  6. What Cathy says makes so much sense to me as the mother of a daughter suffering from bulimia. Since finding the ATDT forum and FEAST, I have learned so, so much about eating disorders but I have also been so confounded and confused by the difference between anorexia and bulimia and how the experiences of families refeeding a child with anorexia could have any applicability to our situation. I truly believe that if I could get my daughter to speak to me about her bulimic behaviors and their origins she would say something very similar to what Cathy said. I can almost hear her saying that her ED "was preceded by overwhelming anxiety and depression associated with a recognition that I didn't 'fit in' to the world." Again, she doesn't speak to me about her ED or about much at all but I know from family meetings with her team that she has had these feelings of not fitting in with her family, with her friends (despite having a very loving and close family and a close and rather large group of long-time friends.)
    When I began to follow the ATDT forum, it seemed to me that there were almost 2 distinct illnesses: one where a child/adolescent goes on an innocent diet or loses substantial weight for some other reason and falls into the rabbit hole of anorexia. With these it seemed that refeeding to a healthy weight eliminated the anxiety, depression, oppositional defiance and other harmful behaviors that happened after the onset of anorexia (not to minimize the agony of refeeding -- I know that it is an incredibly difficult task for most families/sufferers)and the child seemed to go on to be a relatively happy, well-functioning adolescent/young adult. For a few others, including my daughter, it seemed that this model had no applicability. My daughter was never underweight and while her eating was very chaotic I can't imagine that it was much more chaotic than many teens who don't have EDs but simply have chaotic schedules. She was so depressed and so anxious and still suffers from those debilitating disorders despite normalized eating for many, many months now. So, thank you, Cathy, for articulating it so beautifully: "There are some people who have experienced trauma, or have quite severe identity confusion during adolescence - and they start to restrict food [or purge food, in my daughter's case] because they feel unable to cope with life. Therapists would do patients a disservice if they ignored that." Yes, therapists and families do these sufferers a real disservice if they ignore this.
    I'm really interested in how others view this issue Cathy so clearly articulated.

  7. anonymous

    If you would like to email me, I can ask Cathy if she would like to talk to you via email, if that helps.



  8. Hi Anon,

    I also think my daughter had some of these exact same feelings well prior to the onset of her eating disorder, in our case anorexia. Some of this is more obvious to me in hindsight.

    But I now suspect that her pre-existing anxiety, her unusual self-consciousness, and the rest of it were actually symptoms of a slightly off-kilter brain chemistry, and that this same brain chemistry is what made her vulnerable to an eating disorder.

    Like you, we also continued to see severe problems despite normalizing her eating and weight. We sought out specialists who address brain chemistry directly. I was shocked that they were able to describe my daughter's "quirks" as a youngster to a T. And happily, after re-balancing her brain chemistry, some of the things I'd assumed were personality traits eased dramatically and others simply disappeared.

    I agree that pre-existing anxiety and/or depression, the reduced ability to navigate growing up, any possible trauma, or even just the lack of effective coping skills should not be ignored. But I'd really love it if we could get to the point that all clinicians/therapists at least stopped to consider that some of these things might be continuing symptoms--fellow travelers, if you will--rather than causes.

    I'm happy to discuss this further with you, or anyone.


  9. Wow! I have a new intellectual hero. Now I have to memorize his name and the correct spelling so I can find everything he's done.

    thanks Laura.

  10. I believe every individual with an eating disorder is unique. But I think the malnourishment is a factor that makes most patients quite similar while ill and is the one factor we can - if we have the will - remove.

    Removing malnourishment from the picture, at first diagnosis and thereafter and against the patient's will when necessary, is something we can do.

    Then we can look at the person, the individual, again. Some will have "states" caused by the malnourishment and the trauma of refeeding. Others will have "traits" that pre-existed and present the greatest threat for relapse.

    Let's give the one medicine ALL ED patients need to all patients, and personalize the treatment that each one needs after that.

  11. For those who want more from Dr R.

  12. Dr Ramachandran has long been one of my professional heroes. I was struck, when reading his excellent book on phantom limb syndrome (Phantoms in the Brain), how similar the issues are to body dysmorphism. I would recommend this book to anyone.


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