With the 2013 revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) upon us, there is 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 laypeople talk about food and weight.
The diagnosis of binge eating disorder (BED), which was previously in the appendix of the DSM-4, will now be featured alongside Anorexia Nervosa and Bulimia Nervosa 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 eating disorder in America), however it needs to come with a shift in the way we think about obesity and food.
Not all individuals with BED are obese or overweight. Conversely, not all overweight or obese people have BED, but there is a significant portion of individuals whose weight is a reflection of their eating disorder.
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 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 experience of someone with this mental illness is destructive and counter-therapeutic.
It is a wonderful thing that most health care providers and 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” admonition 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 weigh?” “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 and anxiety that is associated with their weight, these sort of statements add an extra layer of horror. The statements contribute to self-blame and the illusion that if they just “stopped eating” they would be better.
Sadly these statements are not only prevalent among 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; so you should never tell someone with anorexia to “just eat something,” or 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 go 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 its more understood and less publicly judged eating disorder counterparts.
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Emma Wood is a Licensed Psychologist at Baylor University Counseling Center. She serves as the coordinator of Eating Concerns Assessments and is the facilitator of the body image and eating disorder prevention and education Body IQ work team. She received her doctorate in Clinical Psychology from Midwestern University in Downers Grove, IL, where she also received her Master of Arts degree.
Dr. Wood takes a feminist approach to her work and feels that empowerment is a catalyst for change in many clients she works with, and that social action can be an essential part of the healing process. Her specific clinical interests are in the areas of eating disorders, identity development, diversity, self esteem and women’s issues.
Dr. Wood has been featured in articles addressing mental health concerns on college campuses as well as issues related to eating disorders and self-esteem. She is a regular contributor for wearetherealdeal.com, voted a top body image and body confidence website and also contributes to FemPop, APA Division 35’s blog addressing feminist perspectives on pop culture. Dr. Wood is on the board for NORMAL non-profit and DiversityFIRST. Dr. Wood presents nationally at conferences and special events on topics of eating disorders, body image, feminist approaches to mental health promotion and diversity.