Grey issues in Eating Disorders
Top 10 Eating Disorder Controversies:
(In my opinion, and not in order of importance)
- Full recovery is possible (to the point of being “cured”)
- EDs are symptoms of a deep-seeded childhood trauma or toxic environment
- Treatment should not be forced upon those who don’t feel ready to recover
- Weight gain goals should be 100% of ideal body weight
- Meal plans and/or monitored exchange/calorie counting is necessary
- Without working through the underlying psychological causes of the eating disorder, one cannot completely recover
- Anorexia, Bulimia, and Binge Eating Disorder are all on one disordered eating continuum
- Society is largely to blame for eating disorders
- Spontaneous recovery is possible (without professional treatment)
- The AN diagnosis should not be dependent on weight or menses
One chooses ED behaviors … recovery also is a choice; treatment is best accomplished in a hospital/residential/IOP/PHP setting vs. at home, with family; “expert” care is paramount vs. “experts” don’t agree, take themselves and their research too seriously, and primary-care clinicians can offer suitable and perhaps more helpful support; EDs are organic, neurological brain disease vs. EDs are mental illnesses borne out of emotional and psychological pathology; with full nutrition, the rest will fall into place (or fall by the wayside); successful treatment requires significant time in a clinical setting vs. shorter term symptom stabilization followed by outpatient support; hospitalization nurtures a culture of chronicity and institutionalization; if insurance coverage were better, eating disorder incidence and course duration would decrease (throwing money at the problem will help); patients should know their weight and be involved in their care vs. others should take control of patient care and patients shouldn’t see/know their weight; one eating disorder is more clinically significant/severe/alarming than another vs. all eating disorders carry substantial health implications and deserve equitable clinical attention; medication is ineffective vs. medication is a helpful part of a treatment plan for addressing global psychiatric issues. And so many more … good post to stir conversation!
One chooses ED behaviors … recovery also is a choice
Oh, good one! Can’t believe I left that one out. I probably could have made a top 20 list, with all the unknowns in the field… Thanks for contributing!
You’ve both certainly nailed down the biggies. But at what point will we have concensus on the answers? So frustrating!
This is a great list! I think you could easily make top 10 lists for controversies surrounding diagnostic criteria, 10 for therapeutic models etc. Among some the diagnostic group, some I have read lately (in addition to the one you mentioned about weight and menstruation in AN): number of b/ps per week for BN, should BED be separate category, should purging disorder be separate, should ED-NOS be subdivided…and many, many more. I think, at least with regards to diagnosis, many of the issues go back to where to draw the line between “disordered eating” and “eating disorder” and if there is a way to make some of the criteria less arbitrary. Personally, I still really like the study you wrote about a few months back where they categorized people according to the severity of disorder (so you had AN-3 or AN-4 etc).
Hello. My two cents
1,2,3,4,5 are nonsense. the restraint of number 4 is why i am currently refusing treatment. I think its completely unrealistic in todays social context, and preventing my recovery. 5 is what triggered me back into anorexia from bulimia, and i don’t care if they alledge more therapy at the time would have addressed this, they are full of theories which i have proven wrong. 6 and 7 i am on the fence. I think 6 is true to a certain extent if the trauma is great enough. otherwise mountains are created out of mole hills and the situation becomes worse, resulting ultimately in a decline of the patients mental health, not an improvement. I am walking proof of this, my first shrink treated my past like a rummage sale, and i spent 3 or 4 months picking up the pieces. 7 i sort of agree with, although perhaps not completely. i believe maybe there should be another type of ED, symptoms of this being the sufferer migrates from one type of eating disorder to another, perhaps based on mixed personality traits, or mental illness (mood swings etc). not agreeing with 8. Number 9 i hope to prove. ten i think AN should be based on weight alone. i was reading the blog of a person who should technically be dead because of their BMI, but who was stil menstruating. Hardly EDNOS!!!!
Lola x
I agree with Lola on points 4 and 5 being too restrictive. These points are grounded on restrictions, rules, and demands to ad to your already dogmatic way of “controlling” your eating disorder (been there 17years!). More research needs to be done on 1. helping the ED sufferer recognize that the issues initially triggering the ED had nothing to do with food, 2. no one or thing is necessarily to “blame”, 3. control is an illusion, 4. isolation is dangerous state for the body and mind to be in for any length of time.
I also disagree that ED is a choice. It’s a mental and physical state that manifests from our need to control the world around us in an effort to “survive”. The tools to open us up to alternative methods of dealing with life lies in connecting mind and body. EDs know what to do to stop the madness and label themselves “well”, they just haven’t learned that it’s a safe enough world to do it.
Liz
As far as ED as a choice: IMO there is, within what some call free will, also a distinction between conscious choices and unconscious choices. I believe that any form of pathology, including ED (been there, done that), is a complex mess of energies that encompass each of our unique mental, physical and spiritual beings. There is so much of our experience as humans that our conscious minds just cannot process. However we are still taking in this information, this negative energy, on the unconscious levels. Both the conscious and unconscious selves contribute to each person’s unique experience of ED, which to me helps explain why there is so much to “debate” about the subject.