Eating Disorder or Disordered Eating?
This year I want to write more about Mental Health Awareness. Last blog, I introduced the idea of Mad Studies and following that lead, I’d like to shine more focus on; our culture’s attitudes towards people with mental health conditions, the existing treatment approaches in the mental health field, and the possible prevention of stigma and pathologizing within and around our mental health care systems.
I’ll start by addressing something personal and incredibly important to me; the consistent rise of diagnoses of eating disorders in our culture.
I myself have food and eating-related issues. So do many people that I know. Considering, “globally, approximately 70 million people suffer from an eating disorder in their lifetime”, it’s really not hard to believe that me, you, and anyone we know may have food and eating-related issues.
Personally, I don’t like to use the words suffer or disorder, when I consider the food and eating-related issues that I live with. This type of terminology makes me feel damaged and hopeless.
I don’t like calling my condition a disease, because really, food and eating-related issues may be seen in our body, but modern science is now proving that the nature of these conditions stems from neurological differences in the brain.
“Medical definitions of eating disorders have often focused on external factors, including cultural pressures, parents' attitudes toward weight and diet, and stressful or traumatic events that might trigger disordered eating habits. While the environment certainly plays a part in shaping the behaviors, evidence is mounting that eating disorders begin in the brain.
Staying consistent with the Mad Studies Movement and the Neurodiversity Paradigm, I strongly believe that food and eating-related conditions stem from external pressures AND neurological differences in the brain.
Food and eating-related conditions are far more complex than simply calling them physiological diseases. These types of conditions shouldn’t try to be understood or treated with just a simple diagnosis or label.
In our culture, food and eating-related mental health conditions have been traditionally misunderstood and pathologized.
From 1994, the older Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV) identified eating “disorders” into three simple categories; Anorexia Nervosa, Bulimia Nervosa (and Bulimic-type eating disorders), and/or Eating Disorder Not Otherwise Specified (EDNOS).
In 2013, Binge Eating Disorder was introduced into the DSM-IV because it had been earlier identified only as a sub-category of Bulimia with other conditions such as Compulsive Eating Disorder, Purging Disorder, and Obesity.
And...with even more updated research on the diagnostic symptoms for these not so simple conditions, the criteria was later changed in the current DSM-5 to include Other Specified Feeding and Eating Disorders (OSFED) and Unspecified Eating Disorders (UFED).
In summary, “the number of eating disorder diagnoses in DSM-5 has increased from three to eight. These include six specific diagnoses: (1) Pica, (2) Rumination Disorder (RD), (3) Avoidant/Restrictive Food Intake Disorder (ARFID), (4) Anorexia Nervosa (AN), (5) Bulimia Nervosa (BN), and (6) Binge Eating Disorder (BED). They also include two “umbrella” diagnoses: (7) Other Specified Feeding or Eating Disorder (OSFED) and (8) Unspecified Feeding or Eating Disorder (UFED).”
So? Does the new updated version of the DSM make life easier for people with food and eating-related conditions?
Somewhat. It definitely gives a wider spectrum of criteria for Medical Professionals to use when diagnosing a condition. Diagnosis definitely helps pinpoint certain unhealthy symptoms and behaviors that can help determine a treatment plan in which to eliminate and/or change the symptoms and behaviors. But...
Once the diagnosis is made, the unhealthy symptoms and behaviors are defined, and the treatment plan is outlined, what does the “label” really do to help someone with food and eating-related issues?
It tells them what they "have" and perpetuates more stigma and disease shaming towards that person. It also creates a feeling of hopelessness because now the label of the condition holds power over the person being labeled. At least it does for me.
What if we (our culture, the mental health community, and its survivors) were to place more focus on treatment of the behaviors of these conditions?
So again, once the criteria are defined, the ideal treatment plan would not only teach proper body nutrition and wellness, but also pay close attention to the thoughts, feelings, and behaviors of the person.
Cognitive-behavioral therapy, or CBT, is the leading evidence-based treatment for adults with eating disorders and is also adapted for use with younger patients. It is based on the theory that a person’s thoughts, emotions, and behaviors are interconnected and can be restructured to support new, healthier thoughts and actions.
A label given to us doesn’t have to be constant. It doesn’t have to restrict how we behave or define who we are.
Research is proving that brain-based conditions can be changed and with the right tools and support systems, new behaviors can be formed and the condition can be more manageable to live with.
Walter Kaye, MD, director of the UC San Diego Eating Disorders Center for Treatment and Research and Christina Wierenga, PhD, professor of psychiatry at UC San Diego School of Medicine and co-director of research at the UC San Diego Eating Disorders Center for Treatment and Research, explain: “We are developing strategies to help patients learn skills to manage or compensate for temperament characteristics, such as altered reward processing and sensitivity to hunger and satiety. One way we do this is by involving family members in treatment and building external structures that reduce uncertainty and provide helpful feedback to promote recovery behaviors.
Aside from new brain imaging studies being recognized, existing cognitive behavioral therapies being more readily available, or more effective brain medications being introduced, what does the future of food and eating-related conditions in our culture look like?
Food and eating-related issues are becoming increasingly more common in contemporary children and according to a 2012 article from CNN,
A study conducted by the Agency for Healthcare Research and Quality showed that hospitalizations for eating disorders in children under 12 increased by 119% between 1999 and 2006. More recent numbers are unavailable, but experts say the problem isn't getting any better.
In spite of the unprecedented growth of eating disorders in the past two decades, eating disorders research continues to be under-funded, insurance coverage for treatment is inadequate, and societal pressures to be thin remain rampant.
In understanding and effectively treating the food and eating-related conditions in our culture, more brain imaging research is essential. Mental health awareness and education must also become a priority.
All in all, we need to continue to help nurture each other.