December 12, 2014

"The diet feels good: they feel calmer"

If I could choose the first thing you ever read about eating disorders, this should probably be it.  Many of my friends are talking about it and for good reason.

It's not fair, but some people have a
paradoxical response to hunger.
It is long since time we stopped, as Cynthia Bulik puts it so well: "psychologizing" anorexia nervosa. That goes for all eating disorders, of course. We need to start our thinking about these mental illnesses by seeing the symptoms as neither natural nor willful. What looks like a "desire to control" or a "desire to be thin" is neither. These are biologically driven psychological symptoms with a predictable trigger: energy imbalance.

Imagine a group of sixth grade girls who decide to go on a diet. Or imagine a boys’ wrestling team that decides to engage in some serious crash dieting before weighing in for a meet. Most of the girls and boys find the period of negative energy balance unpleasant and can’t wait to break the diet and go out for pizza and ice cream. For a few, however, they find that they actually feel better under negative energy balance conditions. The diet feels good; they feel calmer. The anxious chatter in their heads diminishes enough to suggest that this might be an escape route from the pervasive discomfort with which they have been living. The positive biological reaction to negative energy balance lures them into continued and escalating dieting in a quest for the paradoxically improved sense of well being that it confers. It is simultaneously seductive and destructive. It is seductive because of the promise of calm and control it holds; it is destructive because it has the power to kill.
from "Negative Energy Balance: A Biological Trap for People Prone to Anorexia Nervosa," by Dr. Cynthia Bulik

We need to start seeing energy imbalance itself as a risky state for certain people, whatever the "reason" it starts.

5 comments:

  1. Yes, yes, yes. This piece really resonated with my daughter as well.

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  2. As someone who, after 10 years of being in recovery has finally reached the point of actually being "recovered," (Finally!) I can relate to this feeling of calm. I do, however, think it's dangerous to dismiss anorexia a psychological issue and focus on the biological basis for it. Over the years, me and my group of friends have been simultaneously jealous and perplexed (and admittedly bitter) as we've watched dozens of people achieve full recovery in a year or two.

    It is only in retrospect, that I see why we have been so ingrained in our eating disorders. After all, we've been very pro-recovery...going out to eat together, preparing meals together and supporting each other. Shopping for new clothes together. We have never shared numbers or tricks with each other. But still after a decade, we are still struggling. I personally, while now ED free, have a ways to go in therapy.

    As I was saying, it is only in retrospect that I see why the friends I was drawn to from support groups and treatment programs are all still in therapy. Why we latched on to each other. Because our families are so dysfunctional we could be on Dateline or 20/20. Because we have PTSD or DID. Because if we didn't have an eating disorder, we'd be drug addicts or prostitutes or a variety of other things. Because we all were hoping to die but were loving each other so much that we couldn't act on it.

    So fine, I get that for most people with eating disorders, they can recover quickly through Maudsley and it's a biological condition. I try not to feel bitter, and I am fighting back tears and I think about what my friends and I have been through at the hands (or other body parts) of our parents. But I guess I'm thinking that there needs to be a balance. That for some people it is more environmental than biological, and that's just how it is.

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  3. Anonymous,

    First, I'm so sorry about your family life. There's simply no explanation or excuse or reason for a human being to grow up in a dysfunctional environment. None. Children deserve safe and nurturing and healthy homes.

    I have no doubt in my mind that having a mental illness and growing up without a nurturing, healthy, resilient family is not only awful but decreases the opportunities for recovery.

    But isn't that true of diabetes, of cancer, of ADD, of any condition that requires a safe and loving family? It's tragic that a treatable condition might be untreated and left without the necessary intervention. Tragic.

    But working backwards from how severe or enduring the illness is to make conjectures on the family is risky business, and potentially dangerous for families trying desperately to save a loved one.

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  4. I suppose that's the difference. No one was trying to save us within our families. We got by through seeing interns and therapists/dietitians that do sliding scale. It takes a village. I suppose the types of parents who do Maudsley would be safe people.

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  5. Healthy, functional parents WANT to be involved and do what needs to be done. Those who don't, well, their kids are in trouble no matter what.

    But the fact is, when parents are told by society and clinicians that they are not necessary, or that they are somehow at fault, they sometimes withdraw thinking that is what is best for their kids.

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