September 19, 2012

well, men deserve equality in mis-reading of eating disorder symptoms, too

When I read an article on eating disorders I'm looking for a clean piece. What I mean by that is "can I offer this article to a parent in crisis with little time, not much grounding, and in the middle of critical decisions?

So, an otherwise interesting article that includes much of what I'd like the parent to see is ruined for my purposes if it has certain poison pills. 

This GQ article is a good example, "Male Anorexia: 20 Percent of Anorexics are Men."

It's movingly and artfully written, and in a widely-read publication. It includes some simple (actually, simplistic) biological information. It brings up the very important issue of lack of treatment resources for men. Many of those quoted are people who do know the science and the history and have devoted themselves not only to eating disorders but to male eating disorder patients. All good.

But can we really afford some of the mistakes in this piece?

"More and more men are starving themselves to death in a pathological pursuit of perfection."

How evokative! But, we don't know whether more men are developing anorexia or not. We know that more are being diagnosed, yes, but the leap to the numbers growing is unsupported. Rates of anorexia in the population seem to be steady over time and across cultures as well. This idea that a disease has to be growing in numbers to be important is maddening. But worse is the implication that the growth has to do with society's pressures on men. So, this begs the question: if it turns out that diagnosis and not prevalence is growing does that mean male eating disorders are less important? Will we be dropping all the speculation about six-pack abs and body as metaphor and pressures on men?

Calling a mental illness a "pursuit" of anything is to misunderstand it terribly. The perfectionism in anorexia is a symptom, yes. But do we say that people with OCD are in a pathological pursuit of symmetry? That depression is a pursuit of unhappiness? This kind of language around eating disorders perpetuates the myth that eating disorders have a reason, a justification, a deep meaning. Those myths are great for social causes and fundraising walks but if they're wrong then they hurt advocacy in the end.

Perhaps the most telling is that these narratives of victimhood and deep pathology don't go together with the other information about brain function and treatment included in the piece. It's a kitchen sink prose poem including opposing ideas without resolving the contrast, not journalism. When the public reads these pieces without that analysis, more misunderstanding ensues.

And oy gevalt, the pictures! This is just the imagery that makes well-meaning eating disorder media into pro-ana porn. Eating disorders are a mental illness, not a weight condition. These pictures don't illustrate anything but a tired, incorrect, harmful reflection of what the public thinks these disorders are and what the not-quite-getting-it author has gathered. It pains me that equality for males with eating disorders has to carry with it the same myths as we've had about female eating disorders. 

"There is no data to support this belief" does appear here, but isn't applied to most of the content. 

7 comments:

  1. Mental condition or mental illness? I seem to have a compulsive urge that today is pointed at food. It can point elsewhere... work...writing (poorly)... studying... dieting... learning about this problem... but it has always been with me, aka, a condition, not illness. It is just where it points that changes.

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  2. Fred, "mental illness" is a term to describe brain problems - including compusive disorders. I don't know what a "mental condition" is. I don't know if you are suffering from mental illness, of course, but if you have a compulsive behavioral problem then I think that is considered a mental illness.

    A treatable one.

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  3. This article is full of errors. Where to start?
    1. It says the illness normally lasts an average of 8 years in males, 1/3 longer than in females. However, among females who receive Maudsley/ Family Based Treatment, the average time to full recovery is less than two years, not six. (Maybe six years with old school approaches to treatment.)
    2. The article makes it sound as if refeeding syndrome is a serious problem. It is not. More anorexics remain ill for lack of food than from eating. Refeeding syndrome is relatively rare and is easily managed.
    3. The article is filled with blanket statements about the supposed cognitive style of people with anorexia. However, each sufferer's experience of the illness, and his thought processes, seems to be unique. The only thing they all have in common is difficulty eating. The article perpetuates stereotypes.
    4. The article leaves the impression that residential treatment, such as at Monte Nido, is the best approach. There is no evidence to support residential treatment. In an article published in the International Journal of Eating Disorders in 2006, researchers noted that there have been no randomized controlled clinical trials showing that residential treatment is more effective than treatment approaches in which the sufferer remains living in her family or general community. People with AN often become socially isolated from mainstream society. Confinement in a residential center merely worsens the isolation, causing the sufferer to lose her employment or fall behind in her education, making it even harder to return to a normal life. Meanwhile, outside of the eating disorders field, the rest of the mental health community has, for many years, been moving away from the idea of placing people with mental illness into residential facilities.
    5. The article does not mention that semi-starvation significantly affects the brain and cognitive processes. Instead the article tends to focus on life experiences.
    6. The article places parents in the background. However, parents are normally the best chance the sufferer has for recovery.
    7. There is no evidence that the approach to treating males should be any different from females. In the FBT trial conducted by Lock and LeGrange, 9% of the study's subjects were male.
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038846/?tool=pmcentrez There was no indication that the males in the study fared any differently than the females. Overall, the FBT approach was far superior to talk therapy. That conclusion would seem to apply to males as well as females.
    CB-US

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  5. CB: The RCT you link to and the stats you cite ("among females who receive Maudsley/ Family Based Treatment, the average time to full recovery is less than two years, not six") apply to ADOLESCENTS. The GQ article featured adults with EDs.

    Also, 9% of n=120 is about ten or eleven people. Not enough to draw any significant conclusions.

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  6. The GQ article claims that AN normally lasts an average of 8 years in males, 1/3 longer than in females. It does not, however, cite any data to support that claim. The best available statistics I've seen indicate that the duration of illness might actually be shorter in males than in females. Gueguen, Severe Anorexia Nervosa in Men: A Comparison with Severe AN in Women, International Journal of Eating Disorders, May 2012; 45(4), p. 540.(average duration 5.91 years in males; 8.38 years in females) However, nobody to my knowledge has ever taken a large, unbiased population-based sample, so it's impossible to say one way or the other. But it's certainly not possible to support the contention that is made in the GQ article. Ultimately, it probably doesn't really matter, since AN is really bad for males and really bad for females. We need to help both groups.

    In my original post, I said that the average time to full recovery for a mixed group (males and females) is less than two years when sufferers receive Maudsley/ Family Based Treatment. That's true, based on the RCT I cited.

    Although only 9% of the participants in the study were male, that percentage roughly represents the percentage of males in the overall population of all those who suffer from AN. The study group, therefore, was representative. There's no reason I can think of why M/FBT would not be just as effective for males as for females. However, if there is data showing a differential effect, I'd be happy to look at it.

    CB-US

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  7. "Calling a mental illness a "pursuit" of anything is to misunderstand it terribly. The perfectionism in anorexia is a symptom, yes. But do we say that people with OCD are in a pathological pursuit of symmetry? That depression is a pursuit of unhappiness? This kind of language around eating disorders perpetuates the myth that eating disorders have a reason, a justification, a deep meaning. Those myths are great for social causes and fundraising walks but if they're wrong then they hurt advocacy in the end."

    This is perfectly (and eloquently) stated. Thank you, Laura.

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