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Courtesy of tumblr.com

Popular "thinspo" websites such as the Tumblr "thinspiration" aggregate photos (such as the one above) as they erroneously posit eating disorders as lifestyle choices.

BY DINA ZINGARO

In print | Published February 23, 2012

In a country with a $40 billion diet industry and an advertised body type that only five percent of American females naturally possess, eating disorders permeate American culture and have the highest mortality rate of any mental disease. Whether binging, purging or avoiding food entirely, 24 million people in the US suffer from eating disorders, 95% of whom are between the ages of 12 and 25, according to the Renfrew Center Foundation.

Though stereotypes of eating disorders may conjure up images of a minority population of emaciated and shallow teenagers with fears of muffin tops and saddlebags, unhealthy relationships with food characterize the lives of disciplined, driven and determined women and men for reasons far more psychological than simply food.

In tandem with NEDA’s National Eating Disorders Awareness week from Feb. 26 to Mar. 3, Wendy Cramer from the Renfrew Center, a residential eating disorder treatment facility in Philadelphia, will address the pervasiveness of eating disorders on college campuses, and the symptoms and strategies to supporting a friend who may be struggling with one.

As part of the presentation, a senior Swarthmore student will be speaking and sharing her own story about her 10-year struggle with anorexia, her relationship with food and the obstacles of an ongoing recovery.

Eating disorder and disordered eating

According to the Renfrew Center, one in five women struggle with an eating disorder or disordered eating, which is a classification used to describe a wide range of irregular eating behaviors that do not warrant a diagnosis of a specific eating disorder such as anorexia nervosa or bulimia nervosa.
Usually the most widely known eating disorders, anorexia is characterized by a refusal to eat, calorie and fat gram counting and starvation, while bulimia is marked by recurring episodes of rapid food consumption, tremendous guilt and then purging either through laxatives, self-induced vomiting, fasting or excessive exercise. However, binge-eating disorder is actually the most common and describes the self-destructive behavior of eating large amounts of food, often by yourself and driven by negative emotions.

Currently, though there are no binge-eating criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), Cramer explains that it exists in a “sort of catch-all” diagnostic code called “Eating Disorder Not Otherwise Specified” or EDNOS. The DSM provides codes of standard criteria for the classification of mental disorders and outlines such definitions for eating disorders. Therefore, individuals may be struggling with disordered eating, body image issues and chaotic or extremely rigid patterns around food, but they cannot be diagnosed if they do not meet all the criteria.
Though the Swarthmore student was a “textbook case” for anorexia, after meeting others in her experience, she believes that the DSM clinical definitions can be restricting and dismissive. “A lot of people with the diagnosis of EDNOS feel almost marginalized by doctors and even other people in treatment because they feel that their issues aren’t as concrete, aren’t as recognizable and therefore aren’t as serious, which is a very dangerous place to be in,” she said.

Cramer noted that “if someone doesn’t fit [all of] the [DSM] criteria for one of the eating disorders, we cannot say that they have an eating disorder, but they have disordered eating. And to be honest, that is probably 99% of women.”

Though 90-95% of those with eating disorders are female, men do experience eating disorders and, among gay men, nearly 15% suffer from bulimia or anorexia. Unfortunately, a stigma exists for men seeking mental health treatment in general and especially for an eating disorder, since as Cramer explains, there is often a flawed perception of eating disorders as a “girl problem.”

Control and perfection

In the midst of a major relapse after eight years as an anorexic, a Swarthmore student felt the enormous burden that accompanies an eating disorder. “[The anorexic habits weren’t] paying off cognitively, emotionally, physically anymore. I couldn’t function; I couldn’t accomplish things I wanted to accomplish,” the student said. “It was all I could think about — eating, not eating, and what to eat — and after a while it just felt really suffocating.”

In her professional experience, Cramer believes the general population tends to misunderstand the severity of the extent to which eating disorders distorts normal living. “This is not just ‘Oh, snap out of it or just eat, stop throwing up and everything will be better,’” Cramer said. “It’s such a lonely life because you don’t have time for anything else. It’s a total obsession with foods, calories, what you are going to eat and what you are not going to eat — it’s exhausting.”

Diagnosed at the age of 12 after meeting all of the DSM criteria for anorexia, the student’s heavily restricted relationship with food, which including using the Internet to check the calorie content of every food she ate, originated from a desire for control rather than a longing for a body image ideal. “If I wanted to look like Jessica Alba when I was 12, I would have stopped [with the unhealthy eating] way earlier than I did because I was way off [in my appearance] because there is no way anyone would have construed [what I looked like] as attractive. That really wasn’t my idea of attractive either, I just felt like it needed to be that way.”

Consistent with the student’s experience, when asked about the patterns in motivations for eating disorders, Director of Student Health Services Beth Kotarski answered with one word: “perfection.” Although unhealthy relationships with food may arise initially to fulfill a perfected body image, someone experiencing an eating disorder, as the student explains, “has something much more serious going on emotionally and psychologically than unhappiness with their thighs.” For her, the need to control each aspect of her included what she put into her mouth. “I was a huge perfectionist when I was a kid and for one reason or many reasons that manifested as an issue with food.”

As Cramer explained, women with eating disorders tend to be overachievers, very smart and creative women with a great deal of discipline, however they use this determination and drive for an unhealthy lifestyle.

In the locker room

In 2005, the NEDA reported that in a study of Division I NCAA athletes, over one-third of female athletes reported attitudes and symptoms that placed them at risk for anorexia nervosa. Social influences, performance anxiety and athlete’s self-appraisal contribute to athletes’ dissatisfaction with their body, especially in individual sports such as gymnastics, running, dancing or figure skating; sports that emphasize appearance or weight requirements such as bodybuilding or wrestling; and endurance sports such as running and swimming.

Head Athletic Trainer Marie Mancini described the role and extent to which athletic trainers may address eating disorders as “recognition and referral.” Working closely with the teams, Mancini tries to develop strong relationships with athletes since she believes eating disorders are symptoms of other things in students’ lives rather than only body image issues.

In some cases, student athletes have been restricted from their sport based on a ruling by Worth Health Center and were unable to return until certain criteria were fulfilled, such as reaching a certain weight. “First and foremost, you want to voice concern for [the athlete] so that they know you are truly looking out for them and care,” Mancini said.

With NEDA week approaching, Whitney Ladd Post — the co-founder for Eating for Life Alliance — addressed the intersection between sports and disordered eating on her blog “Invisible Victories.” In light of recovery, she feels that the intrinsic characteristics of athletics such as sense of team, commitment, step-by-step training toward a goal and positive self-coaching may be applied to actually treat eating disorders.

Making friends with the “frienemy”

“Eating disorders are messed up because they are one of the few disorders that you don’t want to get better from. You see it as integral to your identity and who you are and the longer it is with you, the stronger that perceived need becomes,” the Swarthmore student said, who is currently still in recovery.
Her game of self-betterment — rather than a desire to lose weight — and challenging her self-control by eating fewer calories day-to-day consumed her life. In August of 2010 before her junior year, she began a day treatment program at a local center with the expectation of returning to school with her peers. However, after three weeks, she realized she needed more time and stayed at the center for an additional three months.

Returning to normal life, however, and what she describes as “learning to walk again” proved the biggest challenges. “Being in treatment is the easy part. You feel like a child because everything is done for you … right after treatment, you are left to your own devices and there is all that self-doubt and the guilt of possibly screwing up again,” she said. “You can never stop paying attention because that’s when you get in trouble.”

Unlike those with alcohol and drug addictions, people recovering from eating disorders cannot choose to completely cut food out of their lives. Being sober from food does not exist and thus, patients are encouraged to make peace with food, which often exists simultaneously as an obsession, fear and enemy. Addressing this challenge of recovery, the student said, “has been so hard because food is a drug or was for me, or not eating it was a drug for me. It felt great. I don’t know why, but it did. It calmed me down. I felt like all my problems could go away if I just didn’t bother with food — totally irrational. But now I have to make friends with it.”

Following eights years with her eating disorder as her main extracurricular in middle school and high school, which included four respective weekly appointments with her therapist, dietitian, nutritionist and medical doctor, she feels that recovery poses a challenging catch-22. “[Recovery at the day program] almost reinforced my identity as someone with an eating disorder because when you are in a place like that, you are treated like a patient.” A standard day at the program — breakfast, therapy sessions, lunch, therapy sessions, snack, therapy sessions and dinner — revolved around eating and discussing food with therapists and other patients. “All you focus on is food when you are trying to focus less on food. It’s weird,” the student said. “It’s a sad but necessary model for recovery.”

In light of this challenge, Cramer hopes to instill hope in her upcoming lecture in the possibility for recovery. “Recovery is a lot of hard psychological work, but it’s completely possible. Yes, you will have days when you don’t feel great about yourself or your body, but we all struggle with that,” Cramer said. “Yet, to know that you will not return to those self-destructive behaviors and will have coping skills and a good support system becomes a hopeful and ongoing process.”

What to say

Reflecting on her own experiences, the student suggests “active support in the form of asking” or in other words, just asking what the individual wants when addressing their struggle with an eating disorder. “The fewer assumptions you make, the safer you will be in how you act around the person who is trying to get better or struggling,” she said.

However, approaching someone still in denial or not yet ready to address their situation becomes increasingly difficult since often being insistent can worsen the situation. “When I was stuck in that sick mindset and I didn’t want to get out, anybody mentioning it mostly just irked me and reinforced my belief that ‘I don’t need other people, this is something I have to do this by myself,’” the student said.

In her presentation, Cramer will address the challenges of and ways to express concern and support for loved ones who may be struggling with an eating disorder.

“Thinspo” and seeking community

Though abnormal obsessions with the body and especially the female body have saturated culture for some time, the means for young women to access the newest fad diet and the latest trend has become faster and easier with technology and the Internet. “Thinspo” refers to a series of pro-eating disorder sites that encourage unhealthy relationships with foods and posit eating disorders as lifestyle choice rather than mental disorders.

Amidst the pro-ana sites for anorexia nervosa and pro-mia for bulimia nervosa, the Tumblr called “thinspiration” serves as a more general platform for inspiration, encouragement and support for people with eating disorders. Users such as shrinkmedownforeternity or hhipb0nes post photos of protruding collarbones and hipbones as inspiration and seek companionship in their choices: “still [I’m] pissed that I can’t work out do to throwing up constantly but hey, [I] might lose a few pounds! hahaha.” Another user seeking approval posted her new daily diet: coffee for breakfast, both gum and coffee for lunch and coffee for dinner.

“Eating disorders are very secretive, and isolating and it is very easy for someone who is disconnected and isolating themselves from other people to find this online community that will encourage these very dangerous behaviors and they egg them on with pictures and verbal support,” Cramer said.
For the Swarthmore student, since her anorexia began at a young age and therefore, such images seemed incomparable with an underdeveloped body, her problem was not “comparing, but counting [calories]” and such sites played less of a role in her disorder. However, she does understand the loneliness associated with eating disorders: “When you are eating in a very controlled fashion — specific amounts, specific times, specific ‘everythings’ — you don’t want to do that in front of people because it’s embarrassing. So, when you don’t eat or choose to eat by yourself, your social life disappears.”

Hope in recovery

Both mentally and physically healthy, the student said, “part of getting better is not having the urge to do that anymore, not to compare so actively and constantly, not to self-assess and nitpick and not be mean to yourself.”

Amidst this cultural obsession with the physical and control, rather than living in the moment, Kotarski invites both male and female students to “block out the noise of society” and to engage in “a conversation about power and strength and having something substantial to elevate ourselves above it all.” As part of NEDA week, Cramer’s lecture and this recovering student’s story will facilitate dialogue for students about supporting the prevention of self-destructive behaviors, the possibilities of recovery, ways to create support systems and develop healthier relationships with the self.

Wendy Cramer and the Swarthmore student will present on Feb. 28 in Sci 199 at 4:30 p.m., hosted by Speak2Swatties, Swarthmore’s student-run peer counseling and mental health advocacy organization.

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