Understanding an Eating Disorder

What is an eating disorder?

  1. An eating disorder is a type of anxiety disorder—perhaps most closely related to panic disorders and phobias.
           
  2. Both low vagal tone and high startle response at birth predispose someone to the development of anxiety disorders in later life.1
     
  3. Having a predisposition for anxiousness doesn’t mean you will develop an anxiety disorder in your lifetime.
                    
  4. We will never be able to genetically screen to determine who will and who won’t get an anxiety disorder. The living human system interacts in infinite and unpredictable ways with the environment.
     
  5. The activation of the threat identification system in our brains, when no actual threat to life or limb is present, is the foundation of all anxiety disorders.
     
  6. An eating disorder is an anxiety disorder where the threat identification system is involuntarily activated in the presence of food. However, that’s not how it feels or even how the patient thinks about the condition.
     
  7. When the threat identification system is activated in our brains, we experience a cascade of physical changes in preparation for directing our bodies towards survival.2
     
  8. When this survival system is activated in the absence of any real threat, it still generates the same physical changes in our bodies as when the threat is real.
     
  9. How we interact with a real threat is a two-step process: we respond in the moment and then we assimilate that experience through memory and emotion after the fact.
     
  10. Everyone initially has a post-traumatic stress response immediately after surviving a traumatic experience. The development of post-traumatic stress disorder happens when memory and emotion struggle to assimilate what has occurred.3
     
  11. Eating disorders have much in common with PTSD—the avoidance of food is reinforced by emotion and memory.
     
  12. It makes no sense to your conscious mind to treat food as a threat, and so your conscious mind tries to make meaning of signals that a threat is imminent while in the presence of food. In today’s world, that situation will often be framed as a fear of getting fat and/or getting sick.
     
  13. However, three hundred years ago in Europe, avoiding food was framed as a fear of being disconnected from God. And 30 years ago in Hong Kong it was a fear of abdominal pain that framed the same experience of self-administered starvation.4
     
  14. There is only one eating disorder spectrum. The DSM-5 breaks out the various avoidant behaviors into distinct categories of eating disorders and it also has a distinct category for people who are above average weight and avoid food as well. But the underlying driver for all those categories is the same: the misidentification of food as a threat.
     
  15. There are distinct activators, reinforcements and alleviation that are unique to each individual. However, the resolution of an eating disorder involves retraining the threat response system.

 

Eating disorders
are not caused by:

  • Being a rich and white female teenager.
  • Cold, distant mothers.
  • Seeing thin models in the media.
  • Dieting: anything from fad diets to so-called ‘lifestyle healthy eating’ diets.
  • Bad, abusive, neglectful, uncaring parents.*
  • Fat-shaming and fattism.
  • Seeking attention and/or selfishness.
  • Taking a diet “too far” (whatever that means).
  • Wanting to make someone else pay for the harm they’ve caused you.
  • Going through a temporary developmental phase.

No one knows what causes an eating disorder. We know that you must have some genetic predisposition, but we also know that the as yet unidentified genotype (or possibly genotypes) doesn’t cause an eating disorder either.

An eating disorder has to be activated; it’s not predestined. And beyond the myriad activators that may play a part in someone developing an eating disorder, it also then has to be reinforced and embedded in behaviors before a full blown eating disorder is present.


* Traumatic childhood experiences may activate a preexisting predisposition towards anxiety disorders, but they don’t cause anxiety or eating disorders.


Iben Rodriguez: Flickr.com

How do we treat
an eating disorder?

  1. There is no cure for an eating disorder.
     
  2. An eating disorder can be trained into complete remission. And that remission
    can be permanent.
     
  3. Remission is indistinguishable from how those without an eating disorder function around food and eating.
     
  4. Eating disorders are not in remission when you achieve a target weight assigned by either treatment teams or anyone at all.
     
  5. Pursuing target weight as the focus of a recovery effort generates relapse, not remission.
     
  6. Achieving remission requires eating freely without restraint; resting and refraining from all exercise and discretionary activity; and retraining the avoidant behaviors despite a threat response that is activated by food.
     
  7. Remission is not realized through healthy living, balanced diets, or through swapping out avoidant behaviors (eg. taking up body building, running, macronutrient clean eating in favor of outright food avoidance).

* Keep in mind that we live in a fattist and healthist culture and therefore you have to look beyond how people speak of their eating habits to what their actual eating habits really are.


Who do we treat?

We don’t treat anyone at the Eating Disorder Institute. We provide information for adults who suspect they have an eating disorder so that they might pursue treatment that best suits their goals.

Most of those who have eating disorders in adulthood have not developed the condition in adulthood. For most they were treated for an eating disorder in their youth, but target weights and the cultural acceptance of diet-as-lifestyle and exercise-as-lifestyle meant that the condition was reduced in severity, but not placed in remission.

Those who have no history of restriction of food intake in childhood will still likely have a long history
of anxiety and/or obsessive compulsiveness dating back to childhood that may have shifted in expression towards food avoidance in later adulthood.

We focus the materials and information on this site towards adults with eating disorders. Children
and youth are well-served within the framework of the Maudsley Family Based Treatment protoco
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1. Theodore Beauchaine, “Vagal tone, development, and Gray’s motivational theory: toward an integrated model of autonomic nervous system functioning in psychopathology,” Development and Psychopathology 13, no. 2 (2001): 183-214.

2. McEwen, Bruce S. "Physiology and neurobiology of stress and adaptation: central role of the brain." Physiological reviews 87, no. 3 (2007): 873-904.

3. Halligan, Sarah L., David M. Clark, and Anke Ehlers. "Cognitive processing, memory, and the development of PTSD symptoms: two experimental analogue studies." Journal of behavior therapy and experimental psychiatry 33, no. 2 (2002): 73-89.

4. Lee, S. "Anorexia nervosa in Hong Kong: a Chinese perspective." Psychological medicine 21, no. 3 (1991): 703-711.

5. http://www.feast-ed.org/