"It's not like a real disease or something. It's a choice."

Quote from my husband's asshole friend, having no idea whatsoever to whom he was saying that sort of shit...

The next time someone tells me that my eating disorder is not a "real disease," but a choice I made because I wanted to be thinner, they're getting this, verbatim:

"AN (anorexia nervosa) and BN (bulimia nervosa) affect only an estimated 0.3% to 0.7% and 1.5% to 2.5%, respectively, of females in the general population. This disparity between the high prevalence of pressures for thinness and the low prevalence of eating disorders (EDs), combined with clear evidence of AN occurring at least several centuries ago, the stereotypic presentation, substantial heritability, and developmentally specific age-of-onset distribution, underscores the possibility of contributing biological vulnerabilities.

"... Twin studies of AN and BN suggest there is approximately a 50 to 80% genetic contribution to liability accounted for by additive genetic factors. These heritability estimates are similar to those found in schizophrenia and bipolar disorder, suggesting that AN and BN may be as genetically influenced as disorders traditionally viewed as biological in nature."

Those bits of Unmitigated Awesome are from the study "Neurobiology of anorexia and bulimia nervosa," by Walter Kaye. It appeared in Physiology and Behavior this April.

I'm serious. I'm memorizing all of that. Particularly the twin study part.

I have actually met people (mostly older or male) who would be surprised to learn that eating disorders may be as genetically linked as bipolar disorder. Similarly, I've met people (of all ages and sexes) who think that anorexics (and bulimics) are "lazy" in that they "don't want to get on the treadmill to stay thin," so THAT is why they restrict their caloric intake (or engage in purgative behaviors) and keep at it with the eating disorder.

Regardless of why/how they begin (that's a whole different post), there is clear evidence showing that eating disordered behaviors and symptoms continue not due to some superficial choice, but due to changes in brain chemistry and structure. There is less research into bulimia than into anorexia on this subject, but reading this study was the first time I've been able to see actual numbers in the context of for-real, no-shit hard evidence. Not that I totally understand what:

"increased 5-HT1A postsynaptic activity has been reported in ill BN subjects,"

or

"PET imaging data suggest that such behaviors are related to disturbances of 5-HT and DA neurotransmitter function in limbic and executive pathways,"

mean, but I get that there are measurable changes in brain chemicals/synapses/what have you during (and sometimes after) an ED. And I understand that chemical change in the brain is not the same as a strict "choice." At least, anything in a study that talks about brain function alterations, then says, "tend to be present in the ill state and persist after recovery," doesn't sound like much of a choice to me.

Of course it's a literal choice to eat only 500 or 2,000 calories a day. Of course it's a choice to go ahead and finish the macaroni and cheese, and the mashed potatoes, and the biscuits, and the cornbread, and some Oreos because your husband is out for the night and ohmygodfirstopportunitytobingeinmonthsandmonths, or to eat a well-balanced dinner until you are full, and then stop, even if you are home alone and free to indulge your most disordered impulses. Those are choices.

But much like there will always be people who don't. under. stand. why alcoholics can't just NOT have too much to drink*, there will always be people who are convinced that anorexia and bulimia are essentially about being thin, and that they're about a deliberate choice that was made and is being made. Or essentially about being lazy. Or about not liking food. Or liking it too much. And search me why, but I wonder if I will ALWAYS be like a fricking magnet for this type of person (because sometimes it really feels that way). Well, the next time my hidden polarity somehow attracts such an ignoramus, at least I'll have my handy little phrase all tucked away inside my warped, crazy little brain.

*There are studies that indicate alcohol as the MOST brain-changing dependency/addiction, even more so than heroin, so I'm not comparing ED neurological side affects with those of alcoholism. I'm bringing up alcoholism as another disease.

(By the way, my favorite section title in this study: "Clinical symptoms and puzzling behaviors." Yes, they are puzzling, aren't they?)