As a psychology student, I understand why psychologists feel that labels and standards are important; however, as a woman who knows many people who struggle with disordered eating (including myself) I hate the way the psychology community treats eating disorders.
For instance, one woman in the comments of an article I read* has gone through several diagnoses, from anorexic to exercise bulimic to EDNOS**, depending on which doctor was treating her at the time; because she felt as if the psychiatric community could not help her figure out conclusively what was wrong with her this woman ended up alienated from therapy and, thus, forced to heal largely on her own. This is not good.
Eating Disorder diagnosis and standards are useful tools; they help psychologists to have a universal understanding of what a patient is going through, for one, and they also help people to figure out what they are suffering from and how to begin treatment. However, the strict category model currently used by the DSMIV is also incredibly problematic.
I have friends and relatives who have struggled with disordered eating. For that matter, I’ve struggled with a disordered relationship to food off and on for my whole life. If there’s one thing I know, its this: no two people with an eating disorder look or act the same. Eating disorders, at least in my opinion, are a lot less about behaviors and a lot more about mental processes. What do I mean by that? It’s simple.
Lets take Weight Watchers as an example. A person who has a healthy relationship with their body and food can go on Weight Watchers and lose weight without losing themselves; that’s not necessarily true of someone with an eating disorder. The last time I went on Weight Watchers I did it for a week and three days exactly before I quit and never looked back. I did this because I knew the way I was behaving was not healthy: I was obsessing over food, making graphs and calculating points for hours each of those days, I was pushing myself to eat less and less points each day, and I felt horrible if I ate up to my points limit for the day. Essentially, my thought processes behind the healthy diet became incredibly unhealthy. I wasn’t eating a dangerously high or dangerously low amount of food, nor was I exercising excessively… what I was doing was obsessing, and hurting myself with my own thoughts. I may not have had an eating disorder in the traditional sense, but I certainly needed guidance to help me rectify my disordered thinking about food.
Most people I know have a story like mine; many of them have stories much more intense then mine. I was lucky, my experience ended fairly positively as I found a therapist who could help me feel comfortable with my body and my food choices, and my parents found a way to finance that therapy. Unfortunately, due to strict insurance policies and even stricter diagnosis guidelines many people’s stories do not end like mine.
The DSM IV categorization model is ridiculous. For one, it says that a heavier person who engages in all of the behaviors of anorexia or bulimia, cannot be anorexic or bulimic until their weight is down to a dangerously low level; this means that large numbers of people who meet all of the mental and behavioral requirements for a diagnosis cannot get the diagnosis (and the treatment that goes with it) all because of the way their body looks. Instead they get slapped with an EDNOS diagnosis, one that most insurance companies do not cover the treatment for; unless they can afford to pay out of pocket many of these people are left without help in dealing with their eating disorder.
Beyond insurance issues, this way of diagnosis plays into messed up antiquated thinking that reinforces the misconception of eating disorders as being all about weight and calories when, in reality, they have more to do with disordered thought processes that drive behaviors than anything.
Why do I bring this up? Two reasons. One: I truly believe this is a feminist issue. My brand of feminism includes fighting for adequate care for people with physical and mental health issue; care that meets a decent baseline standard regardless of income level; the way Eating Disorders are currently understood and “treated” does not promote adequate care, especially not for people who don’t have the money to see several different therapists in an attempt to even get a diagnosis.
Second: it doesn’t even make sense! The current model sweeps people with legitimate eating disorders under the rug every day, all because it is resistant to varying human experiences and change. The bottom line? This is dumb, something needs to be done, and we can do it. Here are several actions you can take to support those in your lives and your communities who struggle with an Eating Disorder:
- Look into the National Eating Disorders Association’s STAR Program, which works to make treatment and research more accessible.
- If you’re taking a psychology class, challenge the professor to lead a discussion on Eating Disorders that deviates from simply focusing on the DSMIV criteria for the disorder.
- Do some independent reading and become a resource for those around you who may be struggling with disordered eating, you never know when someone might approach you for help.
- Write to the American Psychological Association (makers of the DSM) and share your personal experience with them, explain why this current model fails many people, and encourage them to continue doing the research needed to fix this broken system. (Obviously this is a long process that involves much talk between qualified psychologists at conferences and so on, but still, outrage from the public has played a huge part in making changes in the past – for instance, public protest helped push the movement to remove ‘homosexuality’ as a mental disorder forward.)
*I’m being vague intentionally, in an effort to avoid sending attention towards someone who may not want it.
** Eating Disorder not Otherwise Specified
This has been crossposted @ Amplify.