Visiting hours were soon, and if I wanted to see my parents, I had to finish my dinner. I truly didn't have an out. If I didn't eat what was on my tray, I knew my doctor would order a nasogastric tube. If I refused that, he would get a court order to have one placed. So ever reluctantly, I picked up my fork and started eating.
If family dysfunction caused an eating disorder, then recovery could only proceed after the family dysfunction was resolved. But that wasn't the case. Improvement in eating disorder symptoms was what caused family functioning to improve.
A lot of the media coverage of the story has said that Photoshopped images "promote anorexia." I'm not entirely sure I understand what that means. I think I know what they're getting at--that looking at these images make you more likely to develop anorexia--but there's no actual evidence that this is true.
A growing body of research is finding that people with eating disorders have difficulties in figuring out what other people are feeling. It's not that they don't care, or that they can't put themselves into other people's shoes. It's that they just can't figure it out.
Treating anorexia with solely behavioral approaches isn't likely to help what the authors believe is a metabolic disorder. You can't treat diabetes that way, the authors argue, and you can't treat anorexia that way.
Doing something for reasons of health seems to make it above reproach. Coworkers or relatives might call you out if they think you're doing something extreme for vanity reasons. But health? And with doctor's orders? It's like a Get Out of Jail free card!
Our society doesn't understand eating disorders. They're seen as an uber-extreme diet of control freak teen girls, a phase that people will grow out of, a desire to look like models and celebrities, a choice, a teen trying to find freedom from her (and it's always a "she") from her over-controlling family, an expression of vanity.
Although saying an eating disorder is "about control" seems like a massive oversimplification, many people with eating disorders do struggle with finding control. Enter magical thinking. A study published last month showed that people with eating disorders have a decreased tolerance of uncertainty. And this intolerance of uncertainty can directly lead to magical thinking.
Adults with eating disorders also have options--cognitive behavioral therapy, dialectical behavioral therapy, and interpersonal psychotherapy have all been shown to be effective for bulimia nervosa and binge eating disorder. But the high drop out rates have prevented researchers from identifying empirically sound treatments for adults with anorexia.
If weight isn't the sole arbiter of the seriousness of an eating disorder, then it can't also be the benchmark of recovery. Weight restoration (if necessary) and normalization of eating habits are just the first step in eating disorder recovery. Only with nutritional rehabilitation can you begin to address other psychological issues like anxiety, depression, and trauma.
When I was first diagnosed with anorexia over a decade ago, no one told me about biology. No one told me about serotonin and anxiety and how starvation affects brain chemistry. Instead, I was peppered with questions about my intrusive mother, society's beauty ideals, and what I needed to choose recovery.