Interesting Number

Interesting Letter

Federico Andreotti

When you're 5'4"*, ___ lbs. stark naked should not wreck your day. In fact, if you're 5'4", ___ lbs. stark naked ought to tell you that you need to take in just a handful more calories, since minimum healthy weight for 5'4" is 108 lbs. if you're a stickler for impersonal charts, and ___ lbs. is juuuust shy.

However, when you're 5'4" and you have an eating disorder, and you've recently been seeing the lower value of --- lbs., then that higher ___ lbs. might raise a saucy eyebrow at your schedule for the day, cackle, and shoot the whole day to hell.

It's hard to say what feeling that higher number triggers, but the feeling is akin to claustrophobia. The fact-based knowledge that weight fluctuates daily, the embarrassing certainty that the same shift downward would elicit a mixture of pride and shame, and the intellectual acceptance that it's the disease fixating on the numbers are squashed like a rush hour subway commuter by the claustrophobic sensation triggered by that higher number that is so few ounces away from "minimum healthy weight." If I may nix the subway thing and mix my metaphors (it's my blog; I may), the sensation is not unlike the vaguely creepy feeling I've gotten in costume corsets. That corseted feeling is wrong, and no matter how I've tried to explain it to other costumed cast members, I can never communicate the feeling with any justice. It's a not-quite nauseated state of being. It's a not-exactly-anxiety. I'm willing to bet $5 that there's a German word for this feeling, but I can't find it.

That feeling is one of the manifestations of an eating disorder. We carry that feeling around in the back of our heads like a hitchhiker. It bides its time, then it comes out to play. Be aware. It's there. Happy NEDAW week. Yeesh.

* As I recently discovered, I'm not actually 5'3", or at least, I haven't been since sometime after college. Did I grow an inch between age 22 and 28? Possible. Was I slouching when my height was measured in 2003? Even more possible.

It's Very Prestigious

An article following the trend of low body weight and possible eating disorders in ski jumping. An atrocious quote:

"Women's gymnastics, you hear a lot that maybe they have problems," said Alan Johnson, the executive director for Project X, the developmental United States ski jumping team. "I look at all of them and those girls are way fatter than ski jumpers."

Oh, girl. Alan Johnson, you just made my Ignorant Asshole List for 2010. Congratulations. If you come out as Top Ignorant Asshole at the end of the year, I mail you something smelly and sticky. Good luck to you.

all your diagnoses are belong to me

Lauren was awesome enough to leave an actual link to the newly released proposed changes for the DSM-V. Here's the page with Eating Disorder revisions.

One of the proposed (indeed, it's already in the DSM-IV) criterion for a diagnosis of Bulimia Nervosa is: "Self-evaluation is unduly influenced by body shape and weight."

In a diagnosis of Anorexia Nervosa, the criterion related to weight perception is: "Intense fear of gaining weight or becoming fat, even though underweight, or persistent behavior to avoid weight gain, even though underweight. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight."

As someone who's never taken even Psychology 101, and as someone who has variously been diagnosed as BN and as AN-P, what I'd like to know is: what exactly prevents the BN diagnostic criteria from mentioning an intense fear of gaining weight or becoming fat? What about "disturbance in the way in which one's body weight or shape is experienced"? The vast majority of bulimics I know have consistently reported these feelings. I know I do - almost constantly. (Side note: it blows.) The AN diagnosis doesn't apply until you're at 85% of "expected" body weight, which is vague, but which is sometimes rendered as "minimum ideal body weight" in less official writing. If I can self-report all the criteria of an AN-P diagnosis except being at 85% or lower BMI, is there really some sort of switch when I drop from 88%, to 87, to 86, to that magic number, 85%? Anecdotally, I can tell you no, absolutely not. I feel as crappy or as great (depending on the hour or day) at 90% as I do at 85%. Weight, shape, fear, and weight gain avoidance are just as persistent for me. I think I may mask the fear and disturbance better when I'm at a higher weight, but it's there. It's always there.

I'd be interested in hearing the rationale behind the differences.

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.

I Probably Shouldn't Reread "A Modest Proposal"

I'm reading The Hitchhiker's Guide to the Galaxy books by Douglas Adams. I'm on Life, the Universe and Everything, and last night I stumbled across a quotation so apt to this blog that it is now affixed right smack dab in the right-hand column, in place of the Anatole France quotation, which no one probably bothered to translate anyway. (That one said, "It is human nature to think wisely and to act foolishly.")

How I went 28 years without actually reading any Douglas Adams I will never know, particularly since my sphere of acquaintance is liberally littered with Adams fans of all stripes. Anyway, the books are fantastic, they're weird, they're a bit frustrating, and I can't recommend them enough. Also, they contain excellent life lessons such as, "It is a mistake to think you can solve any major problem just with potatoes." That line starts out one of the chapters in Life..., and when I came to it my jaw dropped and I laughed out loud.

What is an eating disorder (or any addictive behavior) other than the attempt to solve major problems just with potatoes? (Or just with lack of potatoes. Or just with alcohol. Or cocaine. Or gambling. Or cutting.) I already knew this, of course, and have paid lots of money over lots of years to learn it over and over and over again so I could try to translate the intellectual knowledge to lasting behavioral changes. That lack of transfer is the single most frustrating hurdle for me, being a reasonably intelligent person. How can you know something for a fact, like, really know it backwards and forwards, and yet you can't bring yourself to know it in the only way that counts? Reading a one-liner in a satirical book isn't really going to change anything (otherwise everyone would have read Jonathan Swift and Ireland and England would have had nary a problem again), but gah. I just love it.

"It is a mistake to think you can solve any major problem just with potatoes."

Yes, yes it is.