i'm in ur dsm-iv dissecting ur phrases

It's difficult for me to justify treatment for myself. Even knowing what I do about the brain chemistry and emotional intricacy of eating disorders, I can't bring myself to justify treatment for me when I weigh in the triple digits.

This is against the emotional wishes of my mother, the professional advice of my doctor, and my own common sense on the subject. I certainly know what I'd tell any other person, whether she was my daughter/patient/friend or no one at all to me. If I saw her symptoms, her thoughts, her frustration written down, or if I heard it articulated to me, I'd tell her that price was no object. I'd tell her to find a damn therapist. The end.


The past fifteen-or-so years' literature comes to the general consensus that restricting-type ED patients are sensation-denying and that binge-type patients are sensation-seeking. (That is not to say anorexics and bulimics, respectively. In fact, that entire idea ignores the fact that bulimics restrict and anorexics binge, almost without exception. Technically an anorexic patient can be purging type, and a restrictive bulimic patient can really be ED-NOS, or something else entirely; they're supposedly working on it for the DSM-V.)

I tend to raise an eyebrow at this overly simplified finding (in case you couldn't tell from the parenthetical), but then, the major study you find when you look into it does come from 1993, so there's hope, I guess.

Nevertheless, I can't help but wonder where the conviction (or impulse) to poo-poo talk therapy fits into the theory of a binge-type patient being sensation seeking. Therapy offers such a range of sensations, doesn't it? And not many (indeed not most) of them comfortable. The sensations of substance abuse and promiscuity are, likewise, not, technically, comfortable - emotionally or physically. Binge-type ED patients have, supposedly, an empirical tendency to be drunk floozies (not to put too scholarly a point on it). I don't consider myself a drunk floozie (the floozie part would be hard now that I'm married, but the drunk part would be easy enough to achieve), and I suppose I take issue with the phrase "sensation seeking." It fails to consider the psychosomatic fact that binges block out all sensation, just like restriction. Not just all feeling, but all sensation. That's approximately 60-80% of their point, depending on the day, or the relapse, or the patient. Being drunk (or high) or a floozie (or et cetera) would also, ultimately, block sensation rather than seek or invite it. Yes. That's it; I take exception to "sensation *seeking*."

I also take exception to my hypocritical reticence toward talk therapy at this point in time. But I guess it's not surprising; I'm just not sensation seeking right now.


  1. Hi,
    I read your blog all the time, but I never comment. I just wanted to let you know that the tentative new criteria for the DSM-V are up on the website:
    It's fairly interesting, especially the personality disorder changes. You should check it out.

  2. Thanks, Lauren! I was reading about this in a NY Times article today, but they didn't have the link to the actual DSM-V page. Cool...

  3. what types of therapy are commonly used for ED? because there are a lot of effective newer therapies for addiction that could be very helpful for EDs, i think.

  4. Talk therapy with a heavy emphasis on CBT is popular, though with a lot of patients who have co-morbid diagnoses of personality disorder DBT is a popular option.

    There are also "new age" methods like the Rosen Technique, but by virtue of their newer and less clinically accepted status, I wouldn't say they're "commonly" used.

    I am a big proponent of nutritional counseling as well, and think in some instances of relapse that alone can be enough to turn things around.


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