Childhood Eating Disorders Blog

Dear Readers,

My freelance writing has taken me lately into research on orthorexia, a topic that Marcia addressed a little while back in one of her posts. Described as a “fixation on righteous eating,” orthorexia is a condition where obsession with eating healthily becomes so extreme that it leaves no room for other interests or activities and can imperil the sufferer’s health.

Sounds familiar, right? Marcia described it as a modern-day variant on anorexia. Another researcher I spoke to sees orthorexia as an amalgam of an eating disorder and its frequent partner condition, obsessive-compulsive disorder (OCD). The term “orthorexia” is not in the Bible of mental illnesses, the DSM (Diagnostic and Statistical Manual of Mental Disorders), so is not recognized by the psychiatric community as an eating disorder or any other type of mental illness. So we are relying on the definition of the man who first coined the term back in 1997,  Steven Bratman, M.D.,  who described what he saw: people not motivated by a desire to lose weight, but by the desire to become as healthy and “pure” as possible.

But once you starting talking to eating disorders professionals who have seen these so-called “orthorexics” first hand, it appears that as Marcia surmised, things aren’t so clear cut. Marcia told me, “We’re seeing a lof of kids falling into this type of dangerous eating  and parents are missing it because it looks like their child is interested in becoming more healthy. Almost always these kids are vegetarian. There are a number of studies about the higher risk of eating disorders among vegetarians, and declaring one is vegetarian often precedes the diagnosis of an eating disorder.”

 Marcia also noted that often she sees patients like these striving to elevate their vegetarianism into veganism, an even higher level of self-denial.

So can someone who fits the orthorexic profile so clearly also want to lose weight, counter to Dr. Bratman’s definition of the condition? 

“I have not seen a young teenager where there isn’t an eating disorder lurking in all this,” declares Marcia. Among adults, she adds, it can be harder to tease out the eating-disordered component in the orthorexia because the “healthy behaviors” are so ingrained in the person’s life that it has become the norm for them.

Marcia often hears the refrain “I didn’t mean to lose all this weight!” from her patients. When she hears this, she always asks herself, “Is the healthy eating/vegetarianism/veganism/raw foodism/ a cover for an eating disorder?” She explains, “It’s hard to find a woman who doesn’t feel reinforced by the culture because she is thin.”  I suspect the same goes for many men who suddenly find they are thinner as a result of a new and obsessive interest in “healthy eating.”Let us know your thoughts on this topic!

Take care,

Nancy

Dear Readers,

For those of you who have helped or are helping a loved one battle an eating disorder, one of the most puzzling aspects of these diseases can be the absolute conviction of your loved one that she or he is fat, when in fact they are starving to death, or even on the thin healthy side.

There are so many other behaviors associated with eating disorders that are equally inexplicable: Why does your child feel happier and safer the more his bones stick out, the more he courts cardiac or cerebral damage? Why does she crave the ritual of stuffing herself with junk food until she feels sick and passes out? How can she continue starving and purging when she knows eventually her bones will crumble like bread sticks and her teeth will rot and fall out?

Two eating disorder specialists, Johanna Marie McShane, Ph.D., a psychotherapist, and Tony Paulson, Ph.D., a social worker, have written a book designed to explain these mystery, and in general take you inside the eating-disordered person’s head. It’s called “Why She Feels Fat: Understanding your Loved One’s Eating Disorder and How You Can Help,” and it is published by, Gürze Books, the publisher of our book.

This is a great idea. As many of you know from reading our book, family based therapy is now considered the most effective way to treat adolescent eating disorders. Yet as much as parents want to help, often they are held back from being truly effective by their absolute bafflement at how their smart, responsible and loving child has seemingly lost all reason when it comes to food, exercise, shape and size.

McShane and Paulson act as psychological translators, explaining the complex web of emotions that lie beneath exclamations such as “I feel fat,” or “I feel chaotic and out of control.” Eating disorders, they explain can be many, many things: A way to feel secure; a way to make life feel predictable, a means of communicating emotions. They can impart a calming sense of “being in control” for the child who feels his life is entirely out of control. And, as we saw with Dr. David Herzog’s book (see my April 20 post), eating disorders can be a way for the child to prove that she is “good enough,” even as she fears and believes that she isn’t.

Eating disorders, the authors explain, aren’t really about being thin (although the desire to be so, fed by our thin-obsessed culture, can be the launching pad for an eating disorder); they ultimately become a cherished coping mechanism.

After reading this book, I was struck anew by how similar an eating disorder is to a negative and destructive personal relationship. Your child’s world has shrunk to the point where this isolating relationship is all she has in the world. She clings to the relationship, having come to believe that without it, she is nothing.

You may have to fight the fight of your life to extract your child from this destructive relationship, but once you understand the anxieties and fears that lie below all the inexplicable food behaviors, you will have an easier time emphathizing with your child, and a better chance of winning the battle.

Good luck and take care,

Nancy