Eating Disorders: Spectrum, Stigma and Shared Treatment
The Spectrum of Eating Disorders
Medical and mental health professionals are beginning to realize that eating disorders aren’t finite categories that can be simply and cleanly reduced to anorexia and bulimia. Rather, eating disorders are better explained as existing along a spectrum. Anorexia nervosa and bulimia exist on that spectrum, but so do other food- and body-related conditions, such as binge eating disorder, compulsive exercising, and other compulsive eating patterns such as orthorexia, or an obsession with health foods.
While it may appear easier or more convenient to cleanly classify eating disorder sufferers as having one particular food-related condition, the individual and his or her history of compulsive eating patterns often show overlap in different manifestations of eating disorders. For example, a binge eater may also shift into anorexic behaviors, and an anorexic may, from time to time, engage in binge eating. Understanding that the bigger issue is the mental illness behind the food behaviors, rather than the particular food behavior itself, helps both the eating disorder sufferer and mental health professionals address the deeper, more vital issues and emotions that underlie the disease.
Binge eating disorder and compulsive overeating, long thought to be simply physical conditions, are now in a place to receive proper awareness and mental health attention. This step also shows that eating disorders and body size are not necessarily related. Many binge eaters may not be obese, and many anorexics, having formerly been obese, may not be excessively thin.
Obesity is often stigmatized within mainstream society as a lack of willpower around food, and as a result, there is decreased compassion or sympathy for those who suffer from binge eating disorder. Seeing the disease as merely a physical condition, the general response is that these people need to diet, or exercise more, or just put down the fork. This inclusion in the DSM shows that there is more to being overweight than a simple lack of willpower, an unwillingness to eat in moderation or a proclivity for sweets. There is an undeniable psychological component.
This also helps to bring attention to a community of suffers that is often overlooked and thus fails to receive proper help and/or funding for awareness. The world of eating disorders is bigger than the relatively small portion of the population that battles anorexia or bulimia. In actuality, when all eating disorders are combined, more than 30 million Americans are suffering from some kind of food-related disorder.
Despite differences in physical characteristics and symptoms, those suffering from an eating disorder like anorexia or bulimia and those with obesity have “shared psychological components, commonalities and underpinnings,” said Dr. Scott Kahan, director of the Strategies to Overcome and Prevent (STOP) Obesity Alliance at the George Washington University School of Public Health and Health Services, a nonprofit obesity policy organization.
“Low self-esteem is extremely common in both, as is body dissatisfaction. They are both very much environmentally driven. Both place excessive emphasis on appearance and body size. In the same way, many of the same psychological underpinnings play into both.”
Seeing the connections between anorexia, bulimia and binge eating disorder can help medical and mental health professionals better tailor care to the larger population of eating disorder sufferers. It also poses a possibility for a shared approach to the treatment of eating disorders in general, despite the particular manifestation.
Though some clinics and treatment centers are experimenting with treating multiple eating disorder populations together, the approach is not without controversy. Integrated therapy can benefit both populations because anorexics are able to see that people who are obese are not to be feared, and they are often able to learn compassion for people who suffer from binge eating disorders. Those who are overweight, by being paired with anorexics, often see that thin certainly does not equal happy and that anorexia is no easier to deal with than any other eating-related disorder.
However, others question if this method of treatment is effective. Anorexics, fearing fat, may not be able to connect with those who are obese, and those who are obese may feel that they are being judged by thinner group members, thus inhibiting open and honest communication.