Showing posts with label eating disorder. Show all posts
Showing posts with label eating disorder. Show all posts

Sunday, 19 April 2015

'I Feel Guilty But I Hate My Body': a feminist confesses

Here’s a fact I’m uncomfortable admitting: I could tell you, in order, every single food item that I have ingested in the last 72 hours. I could also, with a fair amount of accuracy, tell you how many calories each of those meals contained, and how I felt while eating them. (The Cheesy Wotsits I had on the way to a party the day before yesterday? Guilt. One hundred calories but, hey, I needed something to line my stomach. The lentil and Quorn sausage stew last night? Fine, but I made sure I didn’t have too many bits of sausage. The Marmite on toast I had at midnight because my stomach wouldn’t stop rumbling? Awful.)
There are things I couldn’t tell you. I couldn’t tell you how many times I looked in the mirror, for instance, or indeed in any reflective surface (the dry cleaner’s window, the door of the bus as it passed me at the traffic lights), in the hope that the body looking back at me would be somehow different from the reality. I couldn’t tell you how many times I pinched the fat on my thighs and thought “crap”. I couldn’t tell you how many times I thought about my weight, or my waist measurement, or just about my body generally, which seems to have ceased to be a vessel that carts me around through life and has become, to borrow a phrase, a battleground. It is too many.
The above, I recognise, sounds strange and obsessive. It is. But I do not believe it is unusual. So many women I know in their 20s – I am 27 –describe similar anxieties, the obsessive dieting, the skipping of meals. But even so, when I blogged about it earlier this year, after I read a celebrity magazine that promised to reveal “What the stars really weigh” (spoiler: much less than I do), I was surprised by the response. I wrote about it in a rage, having been sent into a tailspin of insecurity that led to me, once again, Googling “Lose 10 pounds in seven days”. I set out upon yet another ridiculous diet, this one involving a strange combination of cottage cheese, Ritz crackers, beetroot and frankfurters. The regime is, according to nonsense internet mythology that my rational brain did not believe for a second, one they give to patients who need to lose weight rapidly before surgery.
You may wonder why I allowed a celebrity rag to affect my self-esteem so negatively. But I do not believe it is a question of intelligence. As Millie Benson, a 23-year-old lawyer who “stares at other girls’ thighs constantly”, tells me: “No matter how much feminist literature I read and no matter how much I tell all the other women I know how beautiful they are and how much they shouldn’t worry, the next minute I will stop myself having a slice of cake in case my bum gets any bigger.”
The messages are everywhere, and being told that you’re too clever to fall for this kind of media manipulation does nothing to solve the issue at hand: that many women, of all different walks of life, are going about their lives hungry or hating themselves, or both.
Naturally, after a few days on the diet, I nearly passed out at the doctor’s surgery during a routine checkup. I was embarrassed, and furious, that I couldn’t seem to escape the cycle of self-loathing that I have railed against so often as a writer and editor. I feel embarrassed about writing this now, as a feminist who has co-authored a book about the pressures the media, and women’s magazines specifically, place on young women today. I feel guilty that I hate my body to the extent that, in my mind, it detracts from anything else I might achieve, meaning that I have turned down television appearances for fear of looking fat, and that it has preoccupied me far more than my own career in terms of energy. I am aware of how it limits me, but I hate my body nonetheless.
“You have an eating disorder,” some readers of my blog informed me, and I felt affronted. An unhealthy relationship with food, maybe; perhaps even disordered eating. But an eating disorder? I don’t think so. I am a healthy weight, as are many of the women who contacted me to describe their own struggles, their food obsessions, flaws and feelings of being just “too much”. This is despite these women having made significant real-world achievements: a PhD in astrophysics, two beautiful children, a successful career, a loving partner. This is despite, for many of them, being slim. Slimmer than me.
There are undoubtedly those who will say that, in the midst of an obesity crisis, “skinny bitches” feeling fat is the least of society’s problems. I can sympathise with that viewpoint. It is how I feel when I speak to those who are thinner than me. “What’s your problem?” I think. “I would love to be that thin.”
I know I have been socialised to compete with other women – to size them up, to envy those who are slimmer – but I believe their suffering is as valid as mine, and that body image problems can manifest themselves even when, from the outside, you’re seen to embody the media-approved feminine ideal.
Take Liz, a 27-year-old researcher who at one point became “obsessed with the scales” and still fixates on “bad foods” to the point where occasionally she makes herself sick. “I often catch a glimpse of myself in a window or a mirror and my heart sinks. I try to avoid walking past rows of shops for this reason,” she says. “I find myself making excuses if I know there are going to be cakes at work, because I don’t trust myself. I feel worse when people have made them themselves. The rational part of my brain knows I’m being stupid, too: I’m a size eight, for Christ’s sake.”
Rhiannon Lucy Cosslett in trousers
tter
 ‘The young women I speak to do not desire the label of an eating disorder. They hide their food issues like a dirty secret. They’ll even preach to others about the dangers of restriction.’ Photograph: Desmond Muckian/Guardian
From the girls in the office chatting 5:2 to the teenagers on the bus mimicking Towie’s “no carbs before Marbs” – it’s everywhere. So often eating disorders – most frequently anorexia nervosa – are claimed to be a middle-class, white woman’s problem, a disease born of privilege and perfection. But a study conducted by King’s College London this year, which surveyed 1,698 multi-ethnic individuals (a general population sample) in south-east London, found that the majority of participants who believed themselves to have disordered eating patterns were of an ethnic minority. Low-level food issues (as one woman I spoke to described them) are not simply the preserve of the white middle classes. The culture of slimming and dieting, of bingeing and purging, of “fat chat” with your friends (“I’m so chubby”, “No, babes, I’m the one who’s chubby”), does not discriminate.
But many of the women I spoke to who admit to a preoccupation with food verging on the obsessive balked at the notion that they might have an eating disorder. “There’s a real fear of trivialising eating disorders,” says Sabine, who is 24 and works for a startup. She charts her eating patterns as having developed when a teenage boyfriend told her she had gained too much weight. She regularly skips meals and once, along with her flatmate at university, devised a diet that consisted solely of prawns, cocktail sauce and apples. “Every time you do eat, you think, ‘Oh, if I eat this now, then I don’t have to have dinner.’ It’s a constant balancing, constant worrying about calories and trying to tally them up in your head all the time,” she says.
“It’s a female issue that doesn’t get enough coverage and it ruins people’s lives, it makes everything so much harder,” she adds. “You can’t get away from food… it’s everywhere, and if you love food, which I do, it really impinges on your life because you’re constantly worrying about it.”
She also engages in regular fat chat with her friends. “I have one friend, and about 50% of what we talk about is what we’ve eaten. ‘Oh, I’ve had a baguette for lunch – is that really bad?’ ‘No, it’s not that bad, just have a salad for dinner.’”
How would you begin to describe these kinds of obsessive thought patterns and behaviours? Where does the division between anorexia and what some call “almost anorexia” lie? An infographic created by private American healthcare group CRC that was circulating online described “almost anorexia” as affecting one in 20 women, and as involving frequent restriction, mild binge eating, infrequent purging and negative body image. Some women were uncomfortable with the label, thinking it pathologises a problem that is hugely widespread (and, let’s be honest, it may be in the interests of some groups to do exactly that); others felt it was a new, nuanced approach to a common problem and that the threshold for an anorexia nervosa diagnosis is too high. “This could describe 85% of my friends,” one girl told me.
Others pointed out that there was already a diagnostic term for these kinds of food issues: EDNOS (eating disorder not otherwise specified), for those who do not meet the diagnostic criteria of other eating disorders. In 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association and aims to offer standard criteria for the classification of mental disorders, removed EDNOS, because it was so widely applicable, in favour of OSFED (other specified feeding or eating disorder). This is a clinical diagnosis, and far from being a description of a less serious eating disorder than anorexia or bulimia, it is a recognition of the fact that disordered eating can incorporate symptoms of both disorders, and others.
So, while OSFED incorporates, for instance, a diagnosis of atypical anorexia nervosa as applying to an individual who meets all the criteria for anorexia, with the exception that that person’s weight remains within the normal range, it is still a diagnosis of a serious condition. Earlier this year, Cosmopolitan magazine and the eating disorder charity Beat co-authored a report entitled The Secret Illness, which highlighted how EDNOS sufferers are being denied treatment because their symptoms aren’t serious enough. The campaign urged GPs to be less fixated on diagnostic criteria, because EDNOS sufferers can, on the outside, appear to be a healthy weight. On the inside, however, their lives can be a daily struggle.
The latest edition of the DSM has also changed several of the criteria for anorexia nervosa, including the stipulation that the patient must have stopped menstruating in order to be considered anorexic. Then there are the non-clinical labels, which seem to be cropping up more and more often. In June of this year, food blogger Jordan Younger came under fire from vegans when she wrote of how she was abandoning veganism due to an eating disorder called orthorexia nervosa, a severe obsession with eating healthily. She had become addicted to juice cleanses. “I was living in a bubble of restriction,” she wrote.
Rachel is a recovered anorexic whose eating disorder manifested itself in an obsession with healthy eating. “[I was] over-thinking food choices,” she says, “and trying to get more protein, more energy density, the correct macro-nutrient ratios… after which I got so exhausted I just chose nothing because it was easier than feeling guilty about the ‘wrong’ choice.” She continues: “The current obsession with health, image and fitness is way out of kilter [with] self-care.” It raises the question: in our seemingly flaxseed and clean eating-obsessed Instagram culture, just how many women are hiding an eating disorder behind a healthy lifestyle obsession?
Reading Kelsey Osgood’s memoir How To Disappear Completely: On Modern Anorexia, I came across yet another label, wannarexia, often used by eating disorder sufferers to disparagingly describe someone who actively and flippantly seeks out an eating disorder. An exhibitionist, or fake anorexic, in other words. (It is worth pointing out that many anorexics fail to believe in the authenticity of their own illness, lamenting that there will always be a “better” anorexic out there.) Wannarexics may have been diagnosed with OSFED, or they may not. Perhaps we’re living in a society in which there exists a spectrum of disordered eating, ranging from my low-level food issues to full-blown eating disorders, with orthorexia and wannarexia and God knows how many other potential labels in between. As Osgood points out, regardless of motivation, wannarexics are still trying to starve themselves. She describes wannarexia as “a gateway drug for teenagers”, but points out that its symptoms are not to be taken lightly. Self-starvation is self-starvation.
The young women I speak to – friends, acquaintances, teenage girls, strangers – do not desire the label of an eating disorder. They are the opposite of the so-called wannarexic. They hide their food issues like a dirty secret, are ashamed of them, or simply regard them as a part of the workaday diet chat so common in offices up and down the country. They’ll even preach to others about the dangers of restriction.
Cat, a student who describes herself as an “uber-feminist”, tells me: “I’ll often be found loudly denouncing skipping breakfast or eating nothing, shouting at my friends about how ‘your brain just doesn’t work if you diet! It doesn’t work! Have a goddamn biscuit!’ And yet none of my friends knows that I’ve been bulimic for six years and borderline anorexic for six years, too. Nobody would be able to tell, because while I’m certainly not fat, I’m quite curvy with a big bottom and I really don’t look as if I have an eating disorder. I’ve managed to keep it secret from even my closest friends for years and years because I function extremely well. But I obsess about my weight constantly, and I really hate myself for it, especially for being such a hypocrite. I preach self-love all the time to my friends and can’t seem to find any for myself.”
Rhiannon Lucy Cosslett
tterPinterest
 ‘There are those who say that, in the midst of an obesity crisis, ‘skinny bitches’ feeling fat is the least of society’s problems. I can sympathise. It is how I feel when I speak to those who are thinner than me.’ Photograph: Desmond Muckian for the Guardian/Desmond Muckian
Another young woman, Alexandra, tells me that she began having what she describes as negative thought patterns when a teenage boyfriend told her that she had cellulite. “I wouldn’t actually say I had a problem with food or diet at all, although I don’t think I have ever sat down to a ‘sinful’ dessert without a little voice saying, ‘You’re being naughty!’ which says something in itself,” she says. “I don’t drastically cut calories or go on crash diets, or anything like that. What I do is fitness related. I don’t believe I’m obsessive, but I do exercise every single day, and I scrutinise myself for minuscule changes brought about by my latest challenge (this month it’s the ab challenge).”
What interests me about Alexandra’s case is how she hides her hang-ups from her friends. “Because I am so thin and muscular, I actually don’t talk about these issues much with my friends. [I] am acutely aware that I look how some of them desperately want to look.”
She believes that the rise in fitness culture is linked to this tendency towards extreme dieting and calorie cutting. “The disordered eating and obsessive dieting goes hand in hand with the meteoric rise in fitness programmes. Some women do faddy diets, some women do ridiculous fitness regimes, some do both, and all are risky.” Fitspiration – slogans and images of fit, attractive women that are common online and that aim to inspire you to achieve the perfect body through fitness – “is not that far from the pro-ana thinspiration that is so dangerous and damaging,” she says, referring to websites that post “inspiring” pictures of thin people.
Am I part of a generation of young women hung up on their body image but unsure where to turn? “One thing I have noticed is that it’s not cool, sexy or attractive for a girl to worry about her weight or watch what she eats,” Millie says. In this society saturated with diet tips and fitness blogs, with “bony boasters” showcasing their ribs on Instagram and bikini selfies on newsfeeds, our food neurosis seems explicit, on the table for all to see.
Such neurosis is familiar to me in a way that it isn’t to my mother, though I know an unhealthy obsession with food can be passed down. (Sabine, for instance, mentions a friend’s mother who used to survive on a can of tuna a day.) But Millie says her mother doesn’t recognise the sheer level of self-loathing her daughter suffers.
“As a feminist in the 1970s and 1980s, she fought and campaigned for equal pay and women in the workplace, and for sexual freedom for women, and they saw some big advances and big wins. She then got married and had children, feeling like the world was heading in the right direction and that, to some extent, the world had been righted. But she then said that suddenly, she had two teenage daughters who were worrying about their armpit hair and their teeth not being white enough and their figures not being nice enough, and wondered what the hell had happened.”
I asked Susie Orbach, clinical psychologist and author of Fat Is A Feminist Issue, what had changed. I’m nervous because I haven’t ever really articulated the depths of my food obsession verbally before. “I’m curious as to where one would draw the line between unhealthy eating patterns and an eating disorder,” I tell her, and when I listen back to the tape of me recounting my food anxieties, I sound small and pathetic, like a child.
“Of course it’s an eating disorder,” she says of my eating patterns. “To me it’s more that we have a culture that’s so disordered towards eating and bodies that how could it be otherwise? How could it be when you’ve got plastic surgery games for nine-year-olds? [The apps in question caused uproar in January and were swiftly removed by iTunes.] When you’ve got mums obsessing about their bodies, in front of their kids?”
“But what if…” I say, weakly, “these girls don’t tick all the boxes?”
“I think if you read the DSM they’d tick a hell of a lot of them. But that doesn’t really matter, does it? It doesn’t matter whether it’s diagnosable or not, what matters is that we’ve gone mad in our relationship with our food, and it’s a new form of violence against girls and women.”
We have gone mad, I agree. At times, I feel that I have gone mad. And “absolutely it’s getting worse”, Orbach says. “Everything’s a trigger. There are huge, huge industries riding on this. It’s one of the most successful assaults there is, and because we all want to feel comfortable, we don’t even know that we’re doing bad things to ourselves. We think we’re being good to ourselves when we decide not to eat.”
But what can we do about it?
“I guess the question I’d ask you is: how long are you going to put up with it?”
This question stuns me. I wasn’t aware that not putting up with it was even an option. “Become a refusenik!” she says, and I want to: I really want to. Orbach’s work is an attempt to create a social movement to challenge the body fascism that surrounds us. “The fashion industry is hugely powerful, the beauty industry. They make a lot of money out of making every little surface of our bodies feel uncomfortable,” she says.
Orbach wants to work at every level – from the government report she published in June on how to help new mothers with not passing on their body difficulties to their kids, to advising schools on how to teach young girls body confidence. But what about those of us who are already grown?
One of the things I find most dispiriting, I tell her, is how resigned all the young women I speak to feel about this, how resigned I feel. “It’s so heartbreaking,” she says. “We don’t want women to have a full-time job managing their appetites.”
And that’s the crux of it, really. My full-time, unpaid, job is managing my appetite, and in between that I write for the Guardian. I so want to become a refusenik, as Orbach suggests, and by going into schools and talking about these issues with teenagers, I am attempting to fight back. But I know that when this article is published, I won’t focus on the career high of having a feature published in a national magazine. I’ll focus on the photographs, and how much I hate them. And I’ll think of all the other girls out there hating theirs – on Facebook, on Instagram, everywhere – and ask myself: how long are we going to put up with it?
Costumes by Kirsty McKenzie. Hair and makeup: Laurence Close at Carol Hayes Management and Sophie Higginson at Frank. All footwear: Carlo Pazolini

Source:- http://www.theguardian.com/lifeandstyle/2014/nov/08/feel-guilty-but-hate-my-body-feminist-confesses

Monday, 9 March 2015

A Body To Die For: The ABC's Of Eating Disorders

I had gone to a lot of trouble to land myself in the hospital. At 15, I had embarked on a diet and had shed 50 pounds in six months. My body had started out slightly padded, clad in baggy painter's pants to conceal my thighs. As I shrank, I wore tighter pants to flaunt my success, until those too began to hang on my diminishing frame.

- from Evelyn Strauss's, "Facing the Plate" (Salon 9/13/00), a personal account of the author's experience with an eating disorder.


This is a horrifying but typical picture of a young woman suffering from an eating disorder — something that, according to the National Institute of Mental Health, affects more than five million Americans today.   Aside from cases where depression or other mental illness leads to suicide, it is hard to think of a psychological problem that poses a greater threat to a person's physical health. Those afflicted with eating disorders try to lose weight by dieting, purging or other means until they make themselves sick. Though some get treatment and recover, others literally starve themselves to death. 

As Ms. Strauss's story illustrates, a particularly troublesome aspect of this illness is that while its victims may appear not to understand that they are making themselves sick, most of the time they know exactly what they are doing to their bodies. In cases like these, friends and family members can beg, plead and try all they want to convince victims that they are too thin or that they are ruining their health but they continue to do it anyway. 

What can you do if you or someone you care about is suffering from an eating disorder? The good news is that there are treatments. The first step, however, is to become informed about what eating disorders are, the different kinds and how they affect the body. 

There are two main types of eating disorders. Their technical names are anorexia nervosa and bulimia nervosa. The table below shows the main ways in which they differ.

Eating disorders are a uniquely dangerous form of mental illness. 

Table 1.
Eating Disorders


(Based on the American Psychiatric Association's Diagnostic and Statistic Manual, IV)

Anorexia Nervosa
  1. Refusal to maintain body weight at or above a minimally normal weight for age
  2. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight
  3. In postmenarcheal females, amenorrhea, i.e., for at least three consecutive menstrual cycles.
Restricting Type:
person not regularly engaged in binge-eating or purging behaviors
Binge-Eating/Purging Type:
In addition to symptoms of anorexia nervosa, the person regularly engages in binge-eating or purging behaviors.
Bulimia Nervosa
  1. Recurrent episodes of binge eating characterized by 1) eating in a discrete amount of time a large amount of food and 2) a sense of lack of control over eating during the episode
  2. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, enemas, and other medications; fasting or excessive exercise
  3. The binge-eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for three months
  4. Self-evaluation is unduly influenced by body shape and weight
  5. The disturbance does not occur exclusively during episodes of anorexia nervosa.
Purging Type:
During episodes of bulimia nervosa, the person regularly engages in self-induced vomiting, misuse of laxatives, diuretics, or enemas.

Nonpurging Type:
During the episodes of bulimia nervosa, the person has used other inappropriate compensatory behavior such as fasting or excessive exercise but has not regularly engaged in the purgative methods listed above. 

What Are the Warning Signs?
Some of the common early warning signs of bulimia are extreme weight fluctuations, preoccupation with diet and really bad breath. Typically, a victim's family or doctor might notice that the victim's weight is going up and down over a period of months or years. The victim may begin to abuse diuretic drugs or laxatives, begin to exercise obsessively or make themselves vomit after meals. Repeated self-induced vomiting leads in the short term to bad breath and in the long run to dental and other physical problems. When confronted, however, the typical bulimic will deny everything.

When asked to explain their behavior, both anorexia and bulimia victims will insist, no matter how objectively thin they may be, that they "feel fat."
  These feelings can be so extreme and unreasonable that doctors often conclude that victims are mentally ill and have lost contact with reality.3 Deep down, however, this is not the case. In fact, those with eating disorders understand how they really look and what they are doing to themselves. The problem is not that they are irrational or out of contact with reality, but rather that they cannot control their behavior. 

Another warning sign of an eating disorder is excessive concern with a particular part of the body. Victims may turn to plastic surgery or liposuction to fix a supposed physical flaw or just to "stay thin." 

Certain psychiatric problems often accompany eating disorders. These include depression, anxiety disorders (especially obsessive-compulsive disorder), borderline personality disorder and substance abuse. 

Who Are the Victims?
Traditionally, most victims of eating disorders have been thought to be White, economically well-off girls or young women. This remains largely true, although the picture does seems to be changing. Recent studies have shown that growing numbers of African-Americans and other minorities are becoming afflicted with eating disorders, especially bulimia.

Boys and men are also at increasing risk for eating disorder. Although studies show that nine out of ten victims are female, males who participate in certain sports (e.g., wrestling, gymnastics, running), are homosexual, or who suffer from addiction or personal disorders are at greater risk of developing an eating disorder. Anorexic males can be just as preoccupied with body image as females, but tend to want to have a slender waist and muscular, athletic shoulders and chest. This is sometimes called "reverse anorexia".

Eating disorders are appearing among all socioeconomic groups. They are crossing age barriers, showing up in younger and younger children. More and more preschool and grade schoolers are developing eating problems, showing preoccupation with weight and size, and going on diets.


What Is the Cause?
No one has found an exact cause of eating disorders. There are, however, circumstances and influences that make some people more vulnerable. Among preschool children, studies have found a strong association between eating problems and extreme parental attitudes about food and weight, particularly for children of a mother with an eating disorder.    Ironically, being overweight is also a contributing factor. And childhood obesity is definitely on the rise. 

Today, as many as 50% of grade school children are overweight. This has caused an increase in diseases in children that were once seen almost exclusively in adults, such as Type 2 diabetes. Studies indicate that youngsters who are teased or feel ashamed about their weight are much more likely to develop an eating disorder when they are older. (Parents should be aware that in some cases, children who show symptoms of anorexia may in fact have a pediatric autoimmune neuropsychiatric disorder (known as PANDAS) that is associated with streptococcus infection. This can be cured with antibiotics. 

Some people also seem to carry a gene that makes them more likely to develop anorexia nervosa or bulimia nervosa. 

Finally, a startlingly high percentage — in the range of 30% to 60% — of those with eating disorders are victims of past childhood physical or sexual abuse, or of a more recent adult trauma such as rape. This could explain why post-traumatic stress disorder is more common in those with eating disorders.


Read the rest of this article here:- http://www.thedoctorwillseeyounow.com/content/behavior/art1960.html?getPage=1