Eating disorders come in a bunch of new flavors these days. The DSM V (the newest version of the diagnosis and classification of mental disorders) offers an expanded menu, compared to our earlier choices of anorexia, bulemia, binge eating disorder, or the old DSM IV option, NOS (Not Otherwise Specified). The following diagnoses will surprised some of you but maybe comforting to those who could use a name for their troubling symptoms.
Pica refers to the compulsive eating of nonfood substances. The astonishing list includes dirt, soap, glue, paint, ice, toothpaste, hair, coffee grounds, and even cigarette butts and ashes. Yes, eating those things.
Patients with rumination disorder regurgitate their food, which they then either re-chew, re-swallow, or spit out.
Avoidant/restrictive food intake disorder manifests in one of three ways: apparent lack of interest in eating or food; avoidance based on the appearance, taste, smell, or texture of food; or concern about negative consequences of eating, such as choking or nausea.
NOS in the DSM V is now known as “Other Specified Feeding or Eating Disorders.” There are 5 subtypes in this category:
Atpical anorexia nervosa, in which the patient has the symptoms of the disorder but, even with weight loss, remains within the normal weight range.
Those with bulemia nervosa (of low frequency and/or frequent duration) meet the criteria for bulimia, but those behaviors occur less than once a week or for less than 3 months.
Ditto for binge eating disorder (of low frequency, etc).
Purging disorder refers to purging (vomiting, laxatives, diuretics) without binge eating.
And bringing up the rear is a disorder so many people complain about without realizing they’ve “got something”: night eating syndrome. This syndrome is the name for excessive food consumption after dinner or eating at night after awakening from sleep.
So there’s the facts. Now I ask myself, as a coach experienced in helping clients with eating disorders: what do I know, and how can I help.
I’ve learned that eating disorders are a torment of the mind. Looking at a client’s weight tells you very little about her thoughts. A man or woman whose weight is within normal limits can still be driven to distraction by an internal critical voice. “You’re disgusting. Look how much you ate.” “Why can’t you control yourself, Miss Lardbucket?” “Your thighs/tummy/rear end are fat.” “Look at your midriff bulge!” “Everyone in this room is thinner than you.” “Everyone is fatter than you.”
The voice gives lessons and rules: “First work out on the treadmill and record how many calories you burned. That’s the amount you’re allowed to eat today.” “Because you ate carbs today, tomorrow you’re allowed to eat only salad.” “You had a piece of pizza. You’ll increase your bike riding form 2 hours to 3 to make up for it.” “Don’t eat anything with more than 0 grams of fat.”” Be a vegetarian, don’t eat anything with gluten.” “Sugar? Addictive; once you start, you’ll eat the whole pie.”
The voice also offers comparisons: “You ate more than anyone else today. Tomorrow, only water and plain yogurt.” Or the “good news”: “You’re the only only at the party who ate so little. Only 2 carrots. I’m proud of you.”
And the voice prevents you from hearing the words and feeling the needs of others around you. You have no energy for relationships. Your main “relationship is between you and the voice.
The voices alienates friends, family, and colleagues. “I wish I could join you for a drink after work, but I’m so busy.” Perhaps your friends are fooled when, for the 5th time you’re at a restaurant together, you announce you’re not ordering anything because you’ve just eaten. Maybe they don’t notice that you mash your serving of birthday cake around your plate so they’ll think you’re enjoying your party. The intense mental concentration required to avoid eating the cake–but make it look as if you did– brings you to a different space from others in the group–a lonely, painful space.
How do you recover, how do you shush that voice for good? Begin by recognizing that voice isn’t you. I know it seems like you because it’s in your head. But there’s much bigger, healthier you that knows how to take care of yourself and get well. Read Jenni Schaefer’s Life Without Ed.” Ed is what Jenni named her voice. She offers clear advice on identifying the voice, separating from it, and gaining control. She recommends putting together a healing team of professionals to help in the journey.
If you’re ready to getting started on your healing journey, begin by interviewing the professionals you’re going to work with. Avoid treaters who set rules for you. Since eating disorders have so much to do with control, your inner critic is likely to sabotage people who tell you what to weigh, when to exercise, what to eat, how much, and when. Look for professionals who understand the bigger picture, the mental torment of the inner voice.
Today begins National Eating Disorders Awareness Week. A good week to get started.