Eating Disorder Parity: What people don’t get about Binge Eating Disorder and the “war on obesity”
With the 2013 revision of the DSM right around the corner there will be a need to rethink, both at the professional and public level, how we conceive of the “war on obesity” and the way in which both health care providers and lay people talk about food and weight. As some of you may know the diagnosis of Binge Eating Disorder (BED), which was previously in the appendix of the diagnostic manual for mental health conditions, will now be featured alongside Anorexia Nervosa (AN) and Bulimia Nervosa (BN) as a major eating disorder diagnostic category. This is a wonderful step forward in the diagnosis and treatment of this eating disorder (which incidentally is the most common ED in America), however with it needs to come a shift in the way we think about obesity and food. Not all individuals with Binge Eating Disorder are obese or overweight, conversely not all overweight or obese people have Binge Eating Disorder- however there is a significant portion of individuals whose weight is a reflection of their eating disorder. There is a major difference however in the link between weight and eating disorder with BED in terms of judgment, assumptions, “prescriptions,” and evaluation. As a mental health professional and someone who works with many people with disordered eating, I am acutely aware of the type of damage that can be done to someone with Anorexia if they were be told to “just eat something.” This is a disorder about shame, guilt, control, trauma, depression, anxiety, the list goes on and on. The solution would never be to “just eat something” and minimizing the felt experience of someone with this mental illness is destructive and counter-therapeutic. It is a wonderful thing that most health care providers and most minimally informed laypeople now know that Anorexia and Bulimia are not so much about food as underlying emotional issues, and so the “just eat something” tag line is now a much less frequent wound for these patients. However, I cannot say the same about individuals with Binge Eating Disorder. If you have ever been overweight or obese you will know that your physical appearance, specifically your weight and size, somehow reduces any social inhibitions that others may have against sharing advice or opinions with you. “How much do you weight?” “Should you really eat that?” “I know a diet that is really effective; I have the book if you want it.” “Just eat less and exercise more.” “Just stop eating.” These statements are damaging and traumatizing to anyone who struggles with weight, but for someone who has a mental health condition that is driven by shame, guilt, control, trauma, depression, anxiety that is associated with their weight these sort of statements add an extra layer of horror- that is blame and the illusion that if they just “stopped eating” you would be better. Sadly these statements are not only prevalent in the general public and media, but they come from the doctor’s office too. The scariest thing to me is that I have heard mental health professionals who claim to be “passionate about the treatment of eating disorders” say that they “just don’t get those people who hoard food and binge, they are really messed up!”
It is clear that you would never publicly blame someone who has cancer for their cancer, you would never tell someone to put a band-aid on a broken leg, you would never tell someone with Anorexia to “just eat something,” and you should never tell someone with Binge Eating Disorder to “just eat less and exercise more.” I think we as a society and those of us in the health care field (mental or physical) have a long way to come in order to view Binge Eating Disorder in its context, which is on a continuum of serious mental health conditions that goes from Anorexia Nervosa to Bulimia Nervosa to Binge Eating Disorder. However, we need to consciously make an effort to begin to establish parity in the way that we interact with Binge Eating Disorder and it’s more understood and less publicly judged eating disorder spectrum counterparts.