Dealing with eating disorders

Deanne Jade responds to the October 'New voices' piece.

In Nancy Tucker’s ‘New voices’ article ‘The “ugly stepsister” of the eating disorder family’ (October 2016), I am quoted as saying that online groups of eating disorder communities are groups of people who are ‘mentally sick’ and who display ‘toxic behaviour’. I have since learned the source of this misinformation is the website Buzzfeed, whose reporter spoke to me briefly a long while ago.

Neither I nor any other properly trained eating disorder specialist generalises about the effects of social media and eating problems without detailed qualification, even though we may have private thoughts about the role played by social media in promoting or endorsing harmful behaviour. People active in ED communities or communications online may or may not be ‘mentally sick’, but many of them are not in robust mental health. After all, eating disorders are mental health conditions which are dangerous to physical and emotional health; they have high morbidity and share features with addictions, mood disorders, phobias, OCD and delusional disorders. I have no problem suspecting that many of the eating-disordered people who seek a following via social media platforms may have ongoing issues with mental health and pose therefore a potential danger to other vulnerable people.

The evolution from anorexia nervosa to bulimia nervosa is predictable, a natural consequence of sustained starvation; it does not require a personality rethink. For this reason, Professor Fairburn has suggested that we think of eating disorders trans-diagnostically, putting less emphasis on DSM categorisations with what we infer about the typical patient, and more emphasis on personal formulation. The person who evolves from anorexic to bulimic is simply revealing an aspect of their character that was already present, if suppressed, during the years of starvation. While psychologists and researchers try hard to categorise ‘typical sufferers’, it is often the exceptions that prove the rule, which is why in some cases diagnosis, and the personality attributes we infer from this, is dehumanising.

Whether it is anorexia, bulimia or their atypical forms that elude diagnosis, treatment is the same. Correcting dietary chaos is one priority. The other priority is to deal with the deeper psychological deficits which give rise to the salience of appearance and the intensive, intrusive pre-occupation with
food and weight which reflects it.

Deanne Jade
Principal, National Centre for Eating Disorders

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I have read this article with a lot of interest.
I do think that many of the forums, Pro Ana which I have looked at many times, can be helpful to those who are at their wits end and wish to find a form of help not via a doctor, that said there is another feature in some of the sub topic forums that in essence to be bulimic is to be weak where as to be anorexic is to be *strong*, a pervasive ideology given strength by media in a subliminal way.
Skinny feels as a slogan caused so called outrage a few years ago when Kate Moss uttered such words, but this was a falsehood of outrage given this system places high value on acute slimness.
Another thing to take into consideration is the matter of race and eating disorders,Asian females from China Japan Cambodia etc, are viewed socially and genetically to being of a smaller build, yet there are many who succumb to an eating disorder believing their body shape/weight is not in keeping with their own personal cultural normsa, we then have Black/Mixed race females from an African or West Indian background who have for years been told via various forms of media, in particular Urban music they should have *thick meaty thighs bottoms and hips", yet this message is not the message seeped into a Eurocentric system which seemingly views such forms in a general sense as *too big*. thus unacceptable.
Thereafter girls and women who are very aware of this system and their own figure which seems at odds with it, may develop an eating disorder which many other Black/mixed race people, in particular men refuse to accept.
Of course at this point I must make clear that other factors can and do play a part, personal life experience, etc, but it is important to reference eating disorders from a perspective whereby All are at risk but very often this is not documented.
Gender is another issue, many boys and men suffer eating disorders but to date very little in the way of extensive research, I could be wrong but I have searched.
To conclude, whether those on eating disorder forums are *mentally ill or not* what is highly possible is that they do not feel listened to in their every day life thus turning to an on line forum where by proxy one can create a persona and hide thus developing a sense of security, a security maybe missing in their day to day life.
To conclude, a very interesting read!!