definitions: core illness, or the complications?

So many "buts."

"But our patients are more ill."
"I see older patients."
"So many have been traumatized."
"It's a very complicated illness"

I think it is time to re-frame eating disorders. Let's separate the illness - a temporary brain condition - with the consequences of failed treatment.

I'd like us to look at an eating disorder as a problem that happens to certain people under certain circumstances and is, in itself, quite treatable. This problem we're talking about presents very much the same way in most patients: a drive to treat food in a disordered way, a distorted relationship with one's body and feelings, a distorted relationship with others, and certain fixed beliefs around food and the body.

The problem I'm describing is treatable. If caught early and brain restored and behaviors normalized the symptoms abate and can be addressed in a rational way.

The rest are complications:
  • Pre-existing or co-morbid mood or personality disorders
  • Traumatic events 
  • An environment - social or personal - that complicates efforts toward recovery
  • The medical consequences of restricting, binging, and compensatory behaviors
  • The traumatic effects of treatment
  • The traumatic effects of one's illness on one's family and friends
  • The consequences of the illness on one's development and life 
The first two require intervention even without an eating disorder, period. The rest are dependent on how well others respond to the illness - personally and professionally.

Why separate the illness from the complications? Primarily because this confusion has led to generations of misunderstanding the illness itself, but also because it is the complications that are unique to each patient. The illness doesn't change much person to person, but the effects and RESOURCES do. No two patients have the same resources or complications.

Separating the core illness means truly individualizing treatment.

If we saw each new patient and their family with a clean slate - and with optimism - with a pretty simple if dangerous illness - that's a start. From there we build resources and skills to fight the illness. If, along the way, there are complications revealed, we deal with them. That is a very different stance, I know. But I'm more and more confident that most cases of eating disorders could, if identified early and treated for what they are, be approached in a way that prevents most of the complications that we now tend to think of as the core illness - and offers the person with the illness help for real issues that need addressing in order for that person to live a satisfying life, even without an eating disorder to complicate the picture.


  1. but, but, but....
    surely patients and their families bring their own scribblings to the slate.
    I agree, start off with a clean slate, but make it a big one that can accommodate the baggage that will be dumped upon it from the very beginning, or it will be too narrow and constricted and end up failing the patient and family as surely as a slate with a predefined pattern laid upon it.

  2. This is my stance, as well, Laura. I'd love to see this essay in Huffington Post or a variation of it. I also advocate for second and third opinions as soon as possible once re-feeding does not eliminate behaviors that are harmful to the individual. Thank you for writing this piece!!!!! By the way, I don't view your stance as different. Rather I view it as more holistic.

  3. i think this is so great.
    what a revelatory post, laura.
    need to think more about this but it seems so logical and the possible positive implications, endless.

  4. Anonymous: agreed.

    Jen: thank you and let me work on that. I'm honored you think so - I've been formulating this POV for a while now.

    Rose: I'm so glad. Means a lot.

  5. Valid argument. Here is a question for you: Do you think it makes sense to consider anorexia (1), which is simply a brain disorder and anorexia(2), which is an eating disorder brought on by trauma issues, co-morbid ways of dealing with the world?

  6. Hello Laura,

    Have you written another book yet? Would you consider it - please? I have just reread your book (we're on day 15 of the Magic Plate, and would find a Maudsley guide, Toolkit book, or Question & Answer book incredibly helpful. I've read several other books that were very helpful such as Give Food a Chance, books by Janet Treasure, Help Your Teenager Beat an Eating Disorder, and several others, but . . . a compilation of frequently asked questions would be incredibly helpful. I've been using the F.E.A.S.T. site - what a wealth of information. A book, though, would have the advantage of a Table of Contents and index. For example, months ago I took the time to search each page for interesting posts and found one about the ten things I would tell my daughter but it would be hard, time consuming, for me to find it again. There are so many great tips about hyper-metabolism, recipes, avoiding constipation (okay not the most thrilling topics but necessary), and much, much more! You know, the nitty gritty stuff. Many families do not have the advantage of a FBT therapist. Your first book has touched so many families. I spoke with a local mom, that is amazing as we live in a rural area, who shared her success after reading your book four years ago. Her daughter is recovered and a college freshman. Your name carries weight and the amount of wisdom you could pass on in a book format is substantial. How about it, Laura? Am I convincing enough? Thanks for listening and considering it!!!


  7. Hopefully,
    Good question. I'm leaning on the not separating the two. I still think the core illness is the same and the trauma is a complication and POSSIBLY a reason for the initial restrictive eating (through stress appetite reduction, or for the emotion deadening effect of less eating). My makeup is such that stress doesn't affect my appetite and eating less makes me more upset - different than my daughter. If you're wired to feel better on less food then trauma is certainly going to make that trap door bigger and the hole deeper.

    Laura, you're so kind. I have another manuscript on EDs (and two others not on EDs - agents take note) but no buyers. My co-author and I are shopping it around but no bites yet!

    I'd also like to write a book version of the ATDT wisdom, but it is a matter of time - and I have precious little right now. If I had some volunteers to help....

  8. In all other diseases, if a treatment isn't working, we don't blame the patient, we blame the treatment and look for another type of treatment. Why should an ed be any different? Why should a person with an ed think that it is their fault if they aren't better or their parent's fault. How very uncharitable....


  9. Raye-Anne,

    Like a lot of fads and trends, I believe we've fallen into this because it just SEEMS to make sense. It fits into other ideas we have about self-actualization and self-betterment.

    Plus, we love villains and guilt and blaming. It makes a good story and for easy solutions.


Post a Comment

Popular Posts