When Dieting Turns Chronic

Who would have imagined that being disciplined at dieting would actually be a bad thing? I mean, to be able to resist nachos and choose grilled chicken instead—that’s a good thing, right? And what could be wrong with learning how to control ourselves enough to just leave that huge helping of cake on the plate? Isn’t this what we’re all supposed to strive for?

[At the Crossroads]

It was Christmas of 1998. My husband and I were in Michigan visiting my family for the holidays. It was a quick visit, with the ever-present demands of work waiting for us upon our return home. On the last day of our visit, my father took me to breakfast at one of his favorite hole-in-the-wall restaurants in the small town of Brighton where I grew up. I ordered a poached egg, dry toast, and coffee. Everything was going along just fine until he looked me in the eye for a moment. I knew what was coming.

“I’m concerned about you,” he began. “You’re too thin.”

“I don’t agree, Dad,” I replied. “I’ve been to the doctor several times this year for various little things, and every time I go she gives me a clean bill of health.”

“Have you told her how you eat?” he asked.

I considered this carefully. “I guess not,” I admitted. “If it will make you happy, I’ll go again, tell her how I’m eating, and see what she has to say.”

True to my promise, I made an appointment with my doctor, and a few weeks later, I was sitting in her office, resolved to tell her exactly how I had been living.

“I’m here because I think I might not be eating quite right,” I said. I proceeded to tell her that sometimes if I thought I ate too much at lunch, I’d just skip dinner. Or if I ate too much one day, I might not eat the next day, just to make up for it. But then I might eat pizza, or something else normal, so you see, I wasn’t an anorexic, because an anorexic wouldn’t touch a piece of pizza.

She wrote all this down in my file and then asked me, “Do you want to live to be a skinny, brittle old lady?” It didn’t sound all that bad to me. Better to be skinny than fat, right?

She then proceeded to take my blood pressure and do a number of tests, including blood work and even an EKG. I smiled with satisfaction as all of the blood tests came back normal. I was healthy after all, just as I thought. My little weight control plan couldn’t be all that bad.

Which is why a shock went through me when I read the diagnosis the doctor wrote on the bottom of my little pink slip: anorexia.

Anorexia? I thought anorexia meant starving day after day, eating a grape and a lettuce leaf and calling it a meal, missing periods, growing lanugo (body hair), and eventually being hospitalized, dying a death of refusal of food!

I paid my ten-dollar co-pay and wandered down the steps to my car. Confused, dazed, and emotionally stripped, I got into the car and just sat there for a few moments. The voices began to swirl in my head: Anorexia … You have to admit there’s a problem … I guess I have been a little preoccupied with this weight thing … Oh God, this is a moment of decision. And then the tears came. I’m not totally sure what I was crying about, but I know that I was scared. Scared to admit that I had a problem. Scared that everyone else had known it all along and I had somehow been blind to it. Scared that everyone was going to think I was a loser. Scared that I had let myself get to this point.

[Subclinical Eating Disorders and the EDNOS Category]

As I sat in my car on that rainy January day in 1999, I considered my options. I could choose to throw out the diagnosis of anorexia, since, having read through my mother’s medical books, I knew that I didn’t technically fit all the criteria (though I realized that I was highly anorexic in my thinking). Or, even though anorexia wasn’t the most accurate diagnosis, I could accept it as a name for my behavior and place my focus on trying to deal with what was a very real problem in my life: an unhealthy obsession with weight. By God’s providence, this is what I chose.

st-forward to Christmas of 2000. I was in Virginia visiting my mother and told her about the book I wanted to write. I explained my belief that there is a whole group of women and men who might not fit all the criteria for anorexia, bulimia, or binge eating, but who have a unique and very real problem that needs to be addressed. In our conversation I referred to it as an “in-between” disorder.

She copied off for me some pages from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), a reference manual for professionals who work with mental disorders of all types. Sandwiched between several pages of information on anorexia, bulimia, overeating, and binge-eating disorders, I discovered a short little segment termed EDNOS (Eating Disorders Not Otherwise Specified).

Finally! In these paragraphs, I found the exact problem I was struggling with. Those who have EDNOS—also called subclinical or subthreshold disorders—fit part but not all of the profiles of the better-known problems. For example, in my case I had several anorexic behaviors but hadn’t been missing any periods, which I took as a clear sign that I was not clinically anorexic.

Other disordered eaters might be borderline bulimics or binge eaters, but since they don’t fit all the criteria, they feel misunderstood and wrongly labeled. But the EDNOS category provides a home for us. If someone had talked to me about this before, I probably would have been more willing to admit that I had a problem.

To better understand EDNOS, it is helpful to think of eating habits as being on a continuum. At one end of the continuum are the more extreme forms of eating disorders, such as anorexia, bulimia, and binge eating. On the other end is healthy eating. Between these points are unhealthy behaviors that, while not considered extreme, can significantly affect the way we live our lives. In my case, I bounced from one end of the continuum to the other, finally ending up in the EDNOS category. Some people start in this category only to move on to more dangerous behaviors. Others never reach the behavioral extremes but live in a never-ending nightmare of the in-between, obsessed with weight, and preoccupied with looking a certain way.

[Just How Big a Problem Is It?]

See Also

In the absence of hard data, Anorexia Nervosa and Related Eating Disorders Inc. (ANRED) states, “We can only guess at the vast numbers of people who have subclinical or threshold eating disorders.” Christopher Fairburn and G. Terence Wilson, authors of Binge Eating: Nature, Assessment and Treatment, add, “The EDNOSII category tends to get overlooked despite common clinical experience that a sizable proportion of patients belong to it.”

Indeed, as I began interviewing counselors and therapists, it was repeatedly confirmed: Many more women struggle with chronic dieting and non-extreme eating disorders than with full-blown eating disorders.

Sharon Hersh, author of Mom, I Feel Fat! tells me, “In my practice, if one out of four has a diagnosable eating disorder, two out of the other three have a subclinical disorder.”

Leanne Spencer puts it this way: “If we had an effective, true environment in which to get women to respond honestly about body perception, eating habits, diet practices, and obsessions with food, we would see a very high percentage that fit the EDNOS category. If forced to guess, I would say that 85 percent of women have distorted views about weight, and 70 percent of those progress to subclinical behaviors.”

In certain environments, the problem seems especially concentrated. According to research done by Dr. Alan Schwitzer and his colleagues at Old Dominion University in Virginia, college campuses are particularly dense breeding grounds for disordered eating. Between 25 and 40 percent of women on college campuses struggle with unhealthy attitudes toward eating and weight. And yet only 6 percent would be considered clinically anorexic or bulimic, indicating that a large percentage of students might not be getting help for their problem. Because of this, Dr. Schwitzer tells me, “Resources would be much better spent on mid-disorders. Refer out the more extreme cases … Subclinical problems affect more people.”

Within the athletic community where high value is placed upon form and fitness, subclinical disorders are rampant. As one researcher notes, “The prevalence of subclinical eating disorders exceeds that of clinical eating disorders among female athletes.” Since people of all ages participate in sports, children and adolescents, as well as adult men and women, are feeling the pressure to be lean.

Perhaps a final test of the breadth of this problem is to consider how many other people you know who are constantly obsessing about their weight and feel the need to diet continually. According to a study done in 2000, nearly 65 million American women are on a diet on any given day. Of these, 35 percent—more than 22 million women—progress to pathological dieting. And these figures don’t take into account the millions of men who also struggle. When considering these statistics, we can’t overlook the fact that this little-discussed problem has quietly claimed an unhealthy role in the lives of millions of people.

I often wonder what would happen if they all started showing up in therapists’ offices—would we all start to take the problem more seriously?

[From Life Inside the “Thin” Cage. Copyright © 2003 by Constance Rhodes. Used by permission of WaterBrook Press, Colorado Springs, CO. All rights reserved.]

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