This past month, I was diagnosed with an eating disorder.
It’s probably not the one you think, and if you know me, you probably don’t think I “look” like someone with an eating disorder. You probably would also tell me it doesn’t sound like something clinical if you heard what it was.
It took me 37 years to figure out what my eating disorder was, and now that I have the diagnosis, I feel a great sense of relief. The only thing now is to get to work.
Disordered eating as the norm
As a good little feminist, I have known for a long time that disordered eating is the norm in our culture, especially for women. Thanks to the self-imposed and media-encouraged ideology that being healthy means being thin, millions of women (and men, too) across the west have weird issues with food. We make up rules where some foods are “good” (generally, low-calorie foods like lettuce or vegetables) and some foods are “bad” (like high-calorie foods, including carbs, meats, cheeses, fats), and judge ourselves morally on what our intake looks like on a given day. We abstain from “bad” foods during “cleanses” or even for the rest of our lives, even if these foods don’t pose any risk to our health. While there are diseases like celiac or allergies or intolerances, most women who remove foods from their diets do so more to keep their waistlines in check rather than because of any doctor-diagnosed condition.
We have apps for tracking calories, including what we put into our stomachs and what we remove through exercise. We set up groups on social media to encourage each other to be weird with our food or to celebrate better fitting into societal norms about our sizes. We have designed dogmatic rules about what sorts of food to eat every day, saying we need to hit certain “macros”. And we think this is normal. In fact, we call it “wellness”.
At the same time, we are surrounded by cues that food is an emotional cure-all. Ice cream can help you get over a break up. Carbs of any kind can get you through a bad day. You can earn “bad foods” by going through some kind of traumatic situation.
I don’t think I know a single person who doesn’t have some form of disordered eating. I wouldn’t recognize ordered eating if it hit me in the face (preferably in the form of a giant steak).
Meet my diagnosis: Binge Eating Disorder (BED)
Of course, disordered eating and an eating disorder are different things. Certain behaviors can belong to a class of disordered eating without necessarily requiring a clinical diagnosis. Just because we all have weird relationships with food, it doesn’t mean we all have an eating disorder.
When most people think of eating disorders, they probably think of anorexia or bulimia, and also teenage or college-aged women, who are the poster children for these disorders. My specific diagnosis is for Binge Eating Disorder (BED). This is a disorder wherein I eat too much food, often in response to trigger, past the point of comfort or when I’m not even hungry.
“That just sounds like how people are with food,” you are probably saying to yourself. That’s what I thought when I heard about the diagnosis, too.
It’s true, many people do overeat. There’s a lot of biological reasoning for this: our bodies have evolved over centuries to try and store fat up in case a famine or hard time was coming ahead. We’re predisposed to eat so we can be sure we have energy all the time and survive. In times of stress especially, our bodies will urge us to eat more, and to eat more high-fat and sugary foods, to keep us from the certain doom our hormones are telling us lies ahead.
Overeating can be a disordered habit, especially with the amount of stress most of us have in our lives. People turn to food for comfort.
The clinical diagnosis
To be diagnosed with BED, you must meet the following criteria, according to the DSM-V:
- Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
- A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
- The binge eating episodes are associated with three (or more) of the following:
- Eating much more rapidly than normal.
- Eating until feeling uncomfortably full.
- Eating large amounts of food when not feeling physically hungry.
- Eating alone because of feeling embarrassed by how much one is eating.
- Feeling disgusted with oneself, depressed, or very guilty afterward.
- Marked distress regarding binge eating is present.
- The binge eating occurs, on average, at least once a week for 3 months.
- The binge eating is not associated with the recurrent use of inappropriate compensatory behaviors (e.g., purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
So if you overeat on Thanksgiving and Christmas, but not at least once a week, you probably don’t have BED. If you have some ice cream to comfort yourself after a stressful day, you probably don’t have BED. If you overeat once in a while but don’t feel totally mortified by it or like you’re unable to control yourself, you probably don’t have BED.
However, BED is the most common eating disorder in the United States. If you meet the criteria above, there’s a good chance you do have it.
I discovered I had the disorder by hearing a friend talk about her treatment. “That sounds really familiar,” I told her. And when I sought expert advice, those experts agreed: I had BED.
In spite of this, it’s been hard for me to accept that BED is a real diagnosis. It feels like it’s all just in my head; like it’s something I should just be able to control. I’ve had to come to terms with a lot of my own assumptions about eating to accept that it’s something I need help with.
An addiction you can’t just quit cold turkey
One problem that people like me have with BED as a diagnosis is that they believe that binge eating is just an issue of mind over matter. That is to say, a person who cares about their body should just be able to control the amount of food they eat. That seems pretty obvious and reasonable.
In our thin-obsessed society, we often judge overweight or obese people as being out of control, lazy, or just unwilling to take their health into their hands. This is another side of our disordered eating-filled culture: the belief that eating food is a moral issue. I’m not talking about veganism or vegetarianism, wherein the types of food we eat can be deemed to be moral choices. But the choice to eat or not to eat, or how much to eat, is not actually moral issue.
Neither is the shape of a person’s body. Health is also not something you can judge about a person based on their body shape. There are very thin, very unhealthy people, and overweight, extremely healthy people. There are myriad reasons a person could be underweight or overweight, that can’t be pointed to just by the amount of food or types of food people eat.
Eating and especially undereating as a sign of morality has a long and sordid history in our country, with pretty racist undertones. We didn’t really start judging fat people as “bad” until sugar and other treats became more readily available to poorer people. For a fascinating take on this, check out this fascinating chat with Dr. Sabrina Strings on the racist origins of fat phobia.
I know all this. I also know a lot about nutrition and exercise and theories of the mechanisms that cause our bodies to gain or lose weight. I know a ton about psychology and trauma and coping mechanisms.
So why can’t I just stop myself from overeating?
The answer is complicated. As someone who suffers from the disorder, I can tell you: I don’t really know. I can’t even tell I’m binge eating most of the time until the episode is over, and if I do catch myself in the midst of an episode, I still can’t stop, no matter how much my brain says I need to. I’m addicted to food, or the feeling food gives me.
Addiction is a complex illness, and different people require different treatments to overcome addiction. In my case, I’m addicted to food. I can’t just quit it cold turkey like one could with cigarettes, and I can’t ever quit it fully like one can with hard drugs or alcohol. In fact, trying to stop myself from overeating by dieting and restricting calories can actually send me back into a binge path pretty quickly.
And in a similar way to stepping down alcohol or drug usage, binge eating disorder is better treated when monitored by professionals. This is especially true because of the psychological reasons associated with the addiction. Overeating is a coping mechanism I have learned over years of practice. If I remove that coping mechanism without the proper tools in place, I can cause myself far more harm.
The plan to treat my disorder
There are many centers across the U.S. that treat binge eating disorder. In fact, my diagnosis came from one of these centers, and the urgency with which they tried to get me enrolled gave me some pause. I thought it was because they wanted my money. But after speaking with the people who worked there, I realized it was because they consider BED to be a life-threatening problem. They basically wanted me to enroll in rehab immediately, just like an alcoholic or a drug addict who was seeking help for their condition.
Unfortunately, my insurance doesn’t cover the treatments I have looked into, and I can’t afford the money it would take to be in a full-time treatment plan. I’m currently looking for a therapist who treats eating disorders (my therapist does not) and a nutritionist who can work with me as well. I’ve also ordered a ton of books to read on the matter, although I recognize that this is not something I can treat on my own (or I would have done it by now).
The biggest thing I’m doing, though, is relying on my friends for support. I’ve been able to talk about the issue with my family without judgment, which has been wonderful. Some of my friends have been more accepting than others, but I know they love and support me.
I was initially pretty embarrassed about my diagnosis for a number of reasons, especially those listed above about not being “in control”. I only shared the diagnosis with a few close friends and family. But now I want to be open about it, mostly because the reason I was able to get a diagnosis and start working on treatment was because a friend was honest with me about her own struggles and treatment. Hopefully my honesty can help some others who are in need, too.
I’ll probably be writing a lot more about this in the coming months as I try to deal with my diagnosis and figure out what to do next. If you wanna join in the convo, let me know.