"Atypical" Eating Disorder...

Eating disorders are grossly misunderstood by both the general public and non-specializing healthcare providers which, I suppose, is probably true of many mental health disturbances and disruptions. This is especially true of atypical anorexia and binge eating disorder. I also often hear folks say that someone they know has lived through “a bout” of anorexia or bulimia as if an eating disorder works like a flu, ripping through the body until it has run its course.

​The truth is, eating disorders — at least, those that involve hatred of the body — actually behave much more like addictions. We would never say that someone had “a bout” of alcoholism. An addiction — especially one normalized and encouraged by the society in which one lives — is always a potential coping mechanism when life gets hard or when certain related triggers crop up. Always. We can get deeper into and more committed to our sobriety or our abstinence or our recovery but the choice (however unlikely we are to make it) to engage in the behaviors associated with our addictions/ eating disorders is always there.

Furthermore, there are far more folks living with eating disorders than are actually diagnosed with eating disorders because much of what constitutes eating disorder has been fully normalized and even encouraged by diet culture which has fully co-opted mainstream healthcare and fitness culture.

Finally, once again thanks to diet culture, we often only see eating disorder when someone is severely underweight but anorexia nervosa, which is partially characterized by severe underweight, is only one of several different types of eating disorders. Atypical anorexia works similarly to functional alcoholism in this way. One does not have to have hit absolute rock bottom to be disruptively dependent on alcohol just as one does not have to be underweight to be disruptively engaged in restrictive eating disordered behavior. In fact, it is common for folks who are suffering with atypical anorexia to be living at a higher weight that presents as a pathology to medical professionals. This, in turn, causes doctors to prescribe the very behaviors that are destroying their patient’s mental — and physical — health. This is just one of the many ways that the medical (and fitness) community fails when the only marker of health they pay any attention to is weight/ body size.

The frustrating thing about the diagnosis of “atypical” anorexia is that it is actually far more common than anorexia nervosa so its name is a diet culture inspired misnomer. While atypical anorexia does not pose the same urgent need for physical intervention that the danger of being severely underweight requires, all of the same mental health risks for dysregulation and self-harm are present.

Simultaneously, the clear connection between atypical anorexia and binge eating disorder often goes unnoticed by even eating disorder specialists because we are much more hyper focused on the pathology of “over-eating” rather than “under-eating” or starvation. This is because our culture hates fat bodies. Even though “underweight” poses the more urgent health risk, we are more likely to worry about and treat “overweight.” Again, this is because our culture hates fat bodies — more than we love actual health. The research shows us that restriction causes binging. This means that folks who suffer with binge eating disorder are likely living in a mindset of and/or going through periods of restriction.  Folks who are living with binge eating disorder are probably also living with atypical anorexia and living a life in which they swing from one side of the pendulum to the other over and over. This swinging back and forth might happen over periods of years, months, week, days, hours, or even minutes but what we know about the restrict-binge cycle is that it is much more common to swing back and forth between the two than to stay on one side. We also know it is far more likely to get help for binge eating disorder which might entail the encouragement of engaging in the exact behaviors that will trigger swinging back to atypical anorexia.

The bottom line is that these misunderstandings and misinformed treatments arise largely because the vast majority of healthcare and fitness professionals stay stuck in their weight-centric model of care. They hate fat bodies more than they love health. They rely on their attachment to thin supremacy more than they are willing to see or admit the harm they are actively causing. And, sadly, the more gains we make in attempting to mitigate that harm, like all bullies, they just double-down on their hatred and bullying behaviors.

(The following paragraph directly addresses healthcare and fitness professionals who are still working within their traditional weight-centric model of “care”)

It is always difficult to admit one’s mistakes, particularly when those “mistakes” have caused pervasive destruction across an entire population’s health, and particularly when you have told yourself you are dedicated to helping improve your patients’ / clients’ health. But digging your heals in, stomping your feet and demanding that thinness is exactly the same thing as health does not make it so. It never will. No matter how many stomachs you staple and remove or amphetamines you prescribe.  No matter how many 4 year olds you put on a diet, ensuring a lifetime of body hatred and eating disorder. No matter how many “lifestyles” you desperately try to alter over and over and over again. Your simple-minded, myopic, singularly-focused hatred of fat bodies is neither “health” nor “care.” Find your courage and find a better way.