Denial: Not exclusive to addiction
Dr. Drew made a comment a couple of episodes back (Ep. 306 “Triggers”) that I was pretty surprised to hear:
“Addiction is the only disease that you have to convince people that they have.”
I highly disagree with this statement, and think that denial is a large part of many mental illnesses… and even some physical illnesses. Just to name a few:
- eating disorders
- personality disorders
- depression
- ptsd
- dementia
Sometimes people just don’t want to admit that they’re struggling with a mental illness (maybe they think it means they’re a weak or defective person). Sometimes people feel their issues aren’t severe enough to warrant a diagnosis. “I’m not depressed — I’m just in a negative funk.” Some of this probably has to do with the stigma and stereotypes of people with these diagnoses. You always think of the most severe cases. With anorexia, you think of an adolescent girl who’s emaciated and never eats, ever. With depression, you think people who never leave their house and cry all the time or are suicidal. With PTSD, you think rape or child abuse or something horrific. You end up comparing your symptoms with those on the far end of the disordered spectrum… and then of course you feel like you’re okay! There’s also the misperception that you can’t be sick and be functional in life. You can be both awesome at your job and still very disordered.
Denial and minimization are hallmarks of eating disorders. There are probably a thousand different reasons why, but to name a few:
- not feeling “sick enough”
- still functioning in everyday life — maybe you’re even very successful in other aspects of life
- weight is not extremely low (maybe it’s even normal or above)
- still eating (or keeping food down) sometimes
- you have previously been much sicker & are comparing current symptoms to those during the height of your disorder
- “everyone has somewhat disordered eating”
- “I am healthy enough”
- all-or-nothing thinking — you have one or two good days and feel that you are therefore fine
- fear of having to change
One difference between addiction and eating disorders, is that you are forever a recovering addict (at least that’s the most popular ideology). You can be sober for 40 years, and you’re still a recovering alcoholic. With eating disorders, you can jump all over the diagnostic landscape. There’s switching between disorders, periods of recovery, relapse, and maybe full & sustained recovery. Because of this, you may have to be convinced a dozen times in your life that you have an ED. And, with the line between normal and disordered eating being so fuzzy (diet food… disordered or not?), it can be hard to tell whether or not you have an issue.
Convincing someone that they have an eating disorder can be a long, frustrating, and repetitive process. I’m very biased, but I’d even venture to say that EDs take more convincing than addictions.
You are spot on with this post for so many reasons. I had a similar reaction when I heard this statement on CR3 and I think your arguments are all valid reasons why people with EDs can be reluctant to seek treatment or deny the seriousness of their illness.
As you say, people with EDs can face waxing and waning of their symptoms which only reinforces the idea that things might not be as bad as they really are. I am also biased, but people with addictions often times face legal issues that can serve as objective evidence that loved ones can use to help convince an addict that they have a problem. Clearly, unless an person with an ED is stealing food, they are unlikely to face that sort of objective evidence that there is a serious problem with their behavior.
Furthermore, we live in a society that is weight and appearance focused. It isn’t unusual to be complimented for loosing a few pounds, or having a ‘trim figure’. It seems almost impossible to open a magazine, click on a website, or turn on the television and not be faced with the latest weight loss secret, or diet. Addicts don’t have the same sort of societal acceptance or reinforcement of their problematic behaviors that people with Eating Disorders face on a daily basis. I think it would be pretty hard to convince an alcoholic that the had a problem if they were praised for their hangover, or their ability to get drunk.
I realize its futile to compare one illness to another in an attempt to determine which sufferers are most difficult to convince, but I think that it is important to recognize that denial is a real and important barrier to treatment. EDs certainly are complicated beasts and treatment is complex and (for better, or for worse) a long term endeavor.
There are billions of dollars made on people who have eating addictions. These addictions are easily manipulated through mass marketing from Big Food and Big Pharma industries. Media advertisements for processed “natural” junk foods, quick weight loss programs and a strong focus on prescription drugs lead us to believe that stuff is normal. Over the past three decades our purchasing habits have become compulsive and super sized! As a result most of us need some type of help, therapy or increased education to break the bad spell.
I thought the exact same thing when hearing this quote! I am biased because I have suffered from an eating disorder but never addiction, but I would argue that an eating disorder can be even harder to convince someone of then addiction, particularly when one is addicted to illegal substances. As you mentioned, in today’s society it can be so easy for someone with an eating disorder to minimize or deny the illness because it seems as if everyone is dieting, overexercising, obsessing with food/weight. Even though an eating disorder is very different then the “normal” preoccupation with dieting, I know that as the eating disordered individual it is very easy to ignore that difference, especially when you are doing better then at the height of the disorder.
I can see how the same can be true of alcoholism – it’s easy to say “I don’t have a problem,” especially if you mostly drink socially, but at least with illegal drugs there is the fact that they are ILLEGAL that I think can potentially help with the denial part. While it is clearly wrong to vomit after eating, you wont go to jail for it if caught. It’s hard when caught up in the moment to remember all the reasons why it isn’t good to purge, but very few things as concrete as “you could end up with a criminal record.”
With regards to terminology, I have started thinking about eating disorder recovery the same way substance abuse recovery is used. I put so much pressure on myself to be “recovered” by a certain time frame, that stepping back and saying “recovery is a lifelong process” is actually proving to be helpful, rather then discouraging. In the same way an alcoholic can never have just one drink, I think I will have to be equally aware of eating, at least for awhile. Whereas someone who has never suffered from an eating disorder can skip a meal and then will probably just make up for it later, I worry that if I skip a meal, it will trigger something in me, like “oh look I skipped breakfast today and didn’t feel super awful, so no breakfast tomorrow.” Maybe eventually that wont be my reaction, but for right now at least, I think I will be a “recovering anorexic/bulimic” for awhile.
Maybe dr. Drew includes eating disorders as an addiction. I don’t think he was referring soley to drug addiction. But great post either way
Kate,
Wish I could ask Dr. Drew if he considered EDs to be an addiction! Maybe I should call into Loveline
– grey
I wonder if Dr. Drew meant “addictions” to include all addictions. Let’s face it, there is a very addictive component to an eating disorder. In fact, for many people, part of what an eating disorder gives to them is a “high.” So at least for me, I would have to hear the quote in its context to determine whether or not I agree.
Cesar,
I definitely agree that some of the eating disorder is addictive, and that there are many similarities between eating disorders and addiction. I personally wouldn’t lump EDs under the same umbrella as drugs/alcohol addiction (unless it were a pretty large/generic umbrella), but know that others do. Still, though… would you consider depression or PTSD to be an addiction? I think there can be a lot of denial around those issues, too.
grey
@greythinking re: FamilyInsights.net/Cesar:
Yes.
Depression is an addiction to sadness. PTSD is an addiction to avoidance.
Granted that’s not all there is to either of those two disorders (not by a longshot), but still…
…of course the other side of this potential debate could show that almost every ego-syntonic disorder will involve some degree of denial. At that point, would every ego-syntonic disorder involve some form of addiction?
Honestly you are very much right with the assertion you are holding on EDs.
The element surrounding all Eating Disorders is the inherent presence of a low self esteem.
Looking into the EDs in general, It is irrefutable that all eating disorder, Anorexia Nervosa,
Compulsive Overeating, Binge Eating Disorder. etc. are active. Although not all the EDs has to be matched under a group.
It is also irrefutable that there is a great distinction between the word adiction disorder.
I think, Dr. Drew ,is right holding the assertion.But I mustn’t fail to put in that there is a great distinction between addiction and eating disorder.
Although all EDs. be it, Bulimia Nervosa, Compulsive Overeating,Anorexia Nervosa, e.t.c. there are certain dangers to victims.
The element surrounding all Eating Disorders is the inherent presence of a low self esteem. Concidering some of the eating disorder as an addiction, we need to draw a line between addiction and eating disorder, because not all the eating disorder is an addiction.
There are some other conditions, as well as the ones you listed, such as bipolar disorder and schizophrenia. I think that Dr. Drew was thinking more in terms of medical conditions like asthma, diabetes, a sinus infection, etc. At least that’s what flashed into my mind when I watched it. Thanks for the great post!