The Woman in the Mirror

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Eating Disorders: Fighting Stigma with Science

National Eating Disorders Awareness Week 2013

I have been working in the field of eating disorders since 1982. National Eating Disorders Awareness Week (NEDAW) is a good time to reflect on how far we have come since that time and how far we have to go.

When I started in this field, misinformation abounded about the disorders. The vacuum caused by the absence of data was fertile ground for the emergence of myths. The persistence of those myths has done a huge disservice to patients and their families for decades. As Gloria Steinem so rightly said, “The first problem for all of us, men and women, is not to learn, but to unlearn.”

 In honor of this year’s NEDAW, I propose unlearning three myths and replacing them with three truths.

Truth 1. Eating disorders don’t discriminate. They do not care about your sex, your race, your ethnicity, your age, or your socioeconomic status. Persistent myths have led providers and families to miss cases because of preconceived and erroneous notions of who is afflicted by eating disorders.

Truth 2. Families and partners are our best allies in the treatment of eating disorders. The evidence base supports the use of family-based treatment for youth with anorexia nervosa. Emerging evidence also suggests that engaging partners is a fruitful avenue of intervention for adults with anorexia nervosa. Historical practices of parentectomies and parent blaming alienated our treatment allies. This is not to say that parenting does not require attention during the treatment process. We can all, always become better parents. But providers need to engage and not alienate family members during the treatment process.

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Truth 3. Eating disorders are caused by a combination of genetic and environmental factors. Decades of replicated research has shown that anorexia nervosa, bulimia nervosa, and binge eating disorder are heritable, i.e. that genes play a role. Large-scale international investigations are in place to identify which genes are operative and how they influence risk for these pernicious illnesses. Pure sociocultural theories of illness have not withstood the test of time. Their dominance is in part due to the tyranny of face validity. People see pictures of ultra-thin models, are told that individuals with anorexia nervosa are striving to look like those models, and the belief that they are related persists because the explanation is highly face valid. But alas, it is false. Anorexia nervosa is not a choice, it is a biologically based mental illness. Genes play a role, but environment does matter. Genes load the gun and the environment pulls the trigger. We all vary in how sensitive we are to various triggering events.

There are more truths, but good things come in threes. If each of you goes out and shares one of these truths with another person, you will have used science to fight stigma. Help us use science to bring eating disorders out of the shadows; to help men come forward without shame seeking treatment; to help midlife sufferers not be fearful of a provider not telling them they should have grown out of their illness.

Spread the truths; erase the myths.

For more mythbusting, stay tuned for the release of Midlife Eating Disorders: Your Journey to Recovery. Available for pre-order now www.cynthiabulik.com.

 

Cynthia M. Bulik, Ph.D., author of The Woman in the Mirror, is a Distinguished Professor of Psychiatry and Nutrition at the University of North Carolina.

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