Also, if you're comfortable with your diagnosis of atypical anorexia, that's okay! This post addresses the issue of people who are uncomfortable with it and it may not be for you!
I don't think there's a single person who hasn't connected anorexia with thinness. Thinness of all levels may it be slim, svelte, emaciated, boney etc, it's a connection many people with and without eating disorders make. After all the DSM 5 definition of anorexia is
"According to the DSM-5 criteria, to be diagnosed as having Anorexia Nervosa a person must display:
- Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health) .
- Either an intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain (even though significantly low weight).
- Disturbance in the way one's body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight."
However, the general definition is (copy and pasted from a general dictionary):
an·o·rex·i·a
ˌanəˈreksēə/
noun
- a lack or loss of appetite for food (as a medical condition).
- an emotional disorder characterized by an obsessive desire to lose weight by refusing to eat.noun: anorexia nervosa; plural noun: anorexia nervosas
- Both seem to meet the general consensus that anorexia is a pathological desire to lose weight/fear of gaining weight and an intense effect on intake. Naturally one would trust the DSM since it is considered a psychiatric bible, however the DSM 5th edition was established in 2013, which may not seem all that long ago, however in that same edition, atypical anorexia was categorized under EDNOS (Eating Disorder Not Otherwise Specified), showing a significant rise in people diagnosed with that subtype of EDNOS.
- Since we're getting into definitions, let pull up the DSM 5 and a general dictionary definition of atypical anorexia.
DSM5: "According to the diagnostic criteria for anorexia nervosa from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), individuals struggling with this disorder will have a restriction of energy intake relative to their caloric requirement, which leads to a significantly low body weight in the context of several factors, including gender, physical health, age, developmental trajectory, and more. Other criterion includes an intense fear of gaining weight and/or becoming fat as well as disturbance in body perception." (credit to eatingdisorderhope.com)
Here is the general definition: meeting all of the symptoms of Anorexia with weight at or above normal range
Alright, so now we have our English lesson for the day.
Let's time travel back to 4th grade and create a venn diagram of similarities and differences for anorexia nervosa and atypical anorexia.
I apologize if it's difficult to see.
But, let's get into the point I am trying to make.
In recovery from anorexia nervosa, people are told that they need to gain weight and that is the most important step in recovery. To be admitted into treatment, most people either need to meet a certain BMI or are put on a list based off of their "need". Unfortunately, most people seen as most in need are people whose weight is extremely low. Now, of course people with those weights desperately need treatment, but by placing that as importance, it leaves many people who even are underweight but not at the lowest ranking, as well as normal weight or overweight people in a waiting game.
The official diagnosis of atypical anorexia has been described as soul crushing and even triggering.
Think about it. The majority of people with anorexia have weight loss as a primary goal and thinness as the only thing that matters. The pain of accompanying mental illness, extreme isolation, wishing you were dead, are only seem worthwhile by this numerical ideal. By telling someone that they are anorexic but not thin enough to be deemed actually anorexic is heard as "you failed at your pain" or "wow your situation is so atypical- no anorexics are fat". While of course that's not what anyone means to say, eating disorder professionals should know that the way a disordered brain works isn't rational.
Let's take the case of Jacqui Valdez for example. She had lost weight, rotted her teeth, had chronically low blood pressure, and numerous other complications, and she finally sought help after years of despair. She was then told that she was not at a low enough body weight for hospitalization she would otherwise need immediately. This only fueled Valdez's illness as she wanted help and to get it she'd need to lose weight, exactly doing what her illness thrives off of sending her into an even deeper and worse place. Valdez was lucky enough to recover, but so many in her situation continue to lose weight, and since they don't have access to help, they aren't protected from further spiraling, and eventually lose the desire to recover, especially if they've hit their goal weight or finally qualify for the dream of an anorexia diagnosis.
We need to stop the rhetoric that "real" anorexia is the goal for proper treatment. Not only does it idealize an unhealthy body type for people deeply ill, it also perpetuates the message that fat people are less worthy or can't possibly have restricted or been truly ill. It also leaves healthy weighted people in the dust. Their anorexia fortunately isn't necessarily seen as the laughing stock that it is in overweight individuals, but it is seen to be more of a diet or phase compared to their underweight counterparts.
I never would have thought that being diagnosed with anorexia was a privilege. At 12 years old I was on my deathbed and despite my opinion, considered extremely underweight. I had first priority by doctors and treatment teams. It could very well have been to the heart and blood complications paired, but after talking with a few friends, specifically one person who was overweight throughout their entire anorexia, they faced similar medical complications but was told that it must be something else. They had lost their period, had heart palpations, fainting spells, and felt physically close to death, but remained determined to reach a lower weight to qualify for the help they barely even wanted anymore. They wanted to be anorexic and have that as a diagnosis to finally feel worthwhile of treatment. I was no more or less important but because of my bmi I was seen as ill while they were seen as fine, even a binge eater.
By saying that to qualify for anorexia we need to be emaciated and/or thin it continues the stereotype that eating disorders are visible and more of a physical illness. It continues the fear that sufferers have that if they reach a healthy weight their struggle is no longer valid. It continues the fatphobic message that fat people aren't deserving of compassionate healthcare or eating disorder visibility.
Emaciated anorexics exist. Thin anorexics exist. Toned or muscular anorexics exist. Quote unquote "normal" anorexics exist. Curvy anorexics exist. Fat anorexics exist.
And if you still insist that all but two of those should have atypical placed in front, you cannot deny that anorexic still follows.
You are certainly entitled to your opinion of whether it should be called atypical enough, you have to remember that 17% of eating disorder suicides are considered "atypical anorexic" (ncbi).
Maybe calling the term atypical anorexia fatphobic is a stretch, but it certainly doesn't do any good for people with anorexia or atypical anorexia.
Atypical anorexia is still anorexia, and considering the only differences are body weight and DSM definitions, it is a sad reflection of our society's view on eating disorders and the perpetuation that eating disorders are about body image and weight when ironically the goal of treatment is to get out of that.
I don't know about anyone else, but I'm sick of seeing so many people with atypical anorexia push themselves towards death just to feel validated.
No comments:
Post a Comment