Monday, November 4, 2013

Eating Disorders Not Otherwise Specified (EDNOS)

There are a lot of people who have eating disorders, but don’t (or can’t) find treatment and healing because they don’t fit into any of the diagnosable categories.

Even if someone is trying to find help on her own, for example, through reading information on the internet, she might become discouraged because she doesn’t fit all the criteria listed for either Anorexia Nervosa (AN) or Bulimia Nervosa (BN).

This is problematic for anyone suffering from an eating disorder because that window of opportunity, that brief moment when she really did want to get better, was met with the realization that there is no help for her.  In addition, she might even be confronted with feelings of “I guess I’m just crazy” or “I do not deserve to get help”.  Worst case scenario, the lack of treatment might spur a resolve in the victim to “try harder at the eating disorder so that it gets bad enough to merit help”.

The paragraph below is taken from the article, “My wife has an eating disorder”.  The husband, and author, writes about his experience:

Emily, obviously, has an eating disorder. It is neither anorexia nor bulimia because it includes symptoms considered exclusive to both and is instead categorized under the heading “eating disorder—other.” Food stresses her out. We have spent literally 45 minutes in a restaurant batting away increasingly brittle waiters as politely as possible until she can figure out what to order; on more than one occasion, the waiter has snapped at us and we’ve just had to get up and leave because people start to stare, which makes Emily even more nervous than she already is.

The writer would agree that the current check marks for determining whether or not someone has an E.D. are unfortunately inadequate.

Eating disorders are way more complicated than we think.  For example, in dealing with anorexia on paper, there is a check list of symptoms.  One of those items is losing your period for three or more months at a time.  This can occur to a women’s body when she is severely underweight and malnourished.  Yet, this is not a guarantee.  There can be dangerous eating disorder patterns including serious starvation, but depending on the person and her original weight, she may or may not lose her period.  And, stubbornly, doctors continue to use this symptom as an indication of whether or not someone deserves eating disorder treatment.

In his article, the husband continues:

The leaving utterly mortifies her; one of Emily’s darkest nightmares is that she would be a bother to someone, but even worse than that is the feeling, in her words, that “if I get fat again, I’ll die.” I used to think she was being hyperbolic until I finally realized that she really did think she’d die if she gained five pounds — not of anything specific, just of being fat. Again, my wife is freakishly smart. She knows people don’t die from gaining five pounds. But she is certain, though she knows intellectually that this is not the case, that she will be the exception.

These words might sound crazy to those who do not struggle with an E.D.  However, it is very real.  People who suffer from eating disorders live in a twisted world.  As you can see from the above paragraph, even “freakishly smart” people can still have irrational fears concerning food, weight, and appearance.  I would argue that a more accurate determination of an eating disorder would be to examine one’s food and eating anxieties.

This would ring true for the wife in the article:

[S]he can’t order takeout after 8 p.m., because she gets tired and the stress of fatigue pushes her that crucial few inches over the precipice into recursion and terror and paralytic anxiety… She hates to eat with anyone besides me, and even then, although we’ve eaten nearly every meal together for five years and change, she has to know what I’m ordering, and if it’s a salad, she has to get a smaller salad. If it’s a steak, she has to get a smaller steak.

The eating disorder is just a manifestation of deep, unshakable fear: that she’ll never be good enough, that she’ll never live up to the standards set for her, that she’s somehow ugly in a part of herself no one else can see, and that fear, actually, is eating her; consuming her from the inside out.

If you want to read the whole article, you can find it here.

If not, I will leave you with his poignant conclusion to all women (and men) struggling with an eating disorder [emphasis added]:

Many women already deal with eating disorders; others are in the early throes of anorexia or bulimia or some permutation thereof and “just trying to lose weight” or some other excuse.  Here’s the thing: an eating disorder is not a part-time occupation.  The name fits much better than whoever wrote the DSM-IV entry probably intended: it is an eating disorder in the sense that it disrupts your ingestion of food, but it is also a disorder that devours.  It devours you, and it will devour your loved ones if you let it.  If you understand only one thing from reading this, please understand that an eating disorder is not something you do to yourself; it is like suicide in that it constantly tells everyone who loves you that their opinion of you is worthless, and you don’t care what they think.  Unlike suicide, it is reversible.  Antidepressants, anti-anxiety drugs, good old-fashioned therapy, and occasionally tough-love inpatient treatment can work wonders, and ultimately, you will be the person you’re supposed to be. Trust me, you are not supposed to be the person you are becoming when you purge, exercise until you pass out or see spots on an empty stomach, or eat half an apple for dinner.  That person is dead.

Thanks for reading.  Have a nourishing day.

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