If you've had your eyes open in the last month in the twin cities, you have probably noticed this title posed as a question on a billboard or city bus. It's part of the Emily Program's (Eating Disorder Treatment Services) latest campaign offering help, and any one of the estimated 10 million females and 1 million males battling Anorexia Nervosa, Bulimia, or Binge Eating Disorder (Crowther et al., 1992; Fairburn et al., 1993; Gordon, 1990; Hoek, 1995; Shisslak et al., 1995) have an all too painful answer to that question. I have a very personal experience with this issue, and while I could write a book about my experience and healing, I'll use this post to share a couple brief thoughts from my point of view and a few research findings that are new to me and what questions these leave hanging.
1. Brain Chemistry.Once you've been entangled with an eating disorder, it never fully goes away. Even after doing the work of challenging psychological distortions and maintaining 'healthy' eating habits over a long enough period to be considered 'recovered', you will never have an unaffected relationship with food. While I'm able to look back and acknowledge the period of wasted time and unhealthy coping mechanisms as a closed chapter in my life, reading about hunger, eating, and eating disorders brings up emotions and re-analyzing the motivations of control, fear, and self esteem that cycled, evolved, and even transformed disorders up until the point of therapy.
One of the documented affects of both anorexia and bulimia are changes in brain chemistry. Does this reverse after recovery? A 2005 University of Pittsburgh School of Medicine Study reported increased Dopamine and Serotonin in recovered anorexic and bulimic people. Chemicals related to reinforcement, reward, appetite, mood, and impulse control. This study also found increased activity in a specific serotonin receptor in recovered bulimia type anorexia, and receptor overactivity strongly associated with Harm Avoidance Anxiety in restrictive type anorexics. Hormones also differed from those who had never had a eating disorder. Elevated levels of the neuropeptide Y and peptide YY in former anorexics and low levels of hormone of cholecystokinin (which seems to cause satiation) in bulimics.
Beyond brain chemistry, culture's obsession and constant discussion of diets in everyday light conversation will never let you avoid it like alcoholics can avoid the bar.
2. Western Culture to blame? Because most eating disorders take their hold during the ages of adolescence/young adulthood, the popular belief is that magazines, media, and cultural standards are to blame. Are they? I don't know if media alone can be causal of a true eating disorder. I think there are those who deliberately 'diet' themselves underweight, but know they are doing it. Research supports though that the belief that being thin is the answer to all problems is prevalent in Western Culture, and there is a focus on body image as a way of improving lives, getting better jobs, etc. Still, the fact that disordered eating behaviors have been documented throughout most of history calls into question the assertion that eating disorders are a product of current social pressures.
Here's an article with more on culture and eating disorders
3. Prevention. Imagine that included in the routine teen-age doctor visit was a brain scan that identified whether a teen was at risk for an eating disorder?Would this knowledge be empowering? Would a teen given this predisposition guard themself against falling into an eating disorder? Would it make a difference? Can the medical field and/or parents do a more vigilant job of acknowledging the beginnings of disorder?
When I was 16, my concerned Mom made a doctor appointment without my knowing, when she knew my period had stopped. The doctor asked me questions, I lied. I sat there and said I ate whatever wanted (which was true, but I just didn't want to eat anything but 1/4 C. cereal and lettuce/cucumber in a day at the time). The doctor did nothing but tell me I needed to eat more or workout less. She offered me birth control, told me I could go to Dairy Queen, and sent me on my way. This only fueled me. I sometimes think adults, even doctors, can be in denial or exercise judgement toward young females with eating disorders, especially anorexia if it's not yet medically dangerous. Years later I wondered what might have happened differently had someone asked genuine questions of motive rather than focus on food.
If you or someone you know is struggling, I recommend talking to a therapist because there is healing. Recommended reading for understanding what your friend might be experiencing, Unbearable Lightness by Portia de Rossi
Here's the full articles on Biochemical Correlates of Anorexia and Bulimia
Sorry for the long post, if anyone's still reading.