Tuesday, November 24, 2009

Legitimizing Binge Eating Disorder

This L.A. Times story about whether to include binge eating disorder in the next edition of the Diagnostic and Statistical Manual of Mental Disorders has been making the Internet rounds, usually with a sufferer refuting the supposed claims in the article.

But the piece suffers from a case of badius journalius: In a piece with the headline "Is binge eating a psychiatric disorder?", there is exactly one source who cautions against adding BED to the DSM--and he's a professor of literature. A literature professor with an emphasis in psychology, yes, and the author of books about the evolution of diagnoses (his book Shyness: How Normal Behavior Became a Sickness is his sole given credential in the Times piece), yes, but a professor of literature nonetheless. Not a clinical psychologist; not a treatment practitioner. Christopher Lane isn't even representing the voice of the trollish Everyman who hangs out on fat-acceptance blogs to harass the participants. His main argument against making BED an official diagnosis is that it would medicalize a complex behavioral disorder, encouraging treatment practitioners to shove pills down a patient's throat instead of look at the underlying issue. In other words: His problem with BED as a diagnosis is a problem with the contemporary direction of psychiatry.

(Side note: What's interesting to me is that patients with eating disorders usually develop their behaviors to mask the underlying issues of anxiety, depression, obsessive-compulsive disorder, etc. In other words: binge eaters are already medicating themselves. I wholly believe that psychiatric medications are overprescribed, but if someone is numbing themselves with food or the absence thereof, I'd rather see the needs unmasked in an appropriate, monitored setting--and if medication rather than binge food is the prescription, so be it.)

I wish that the Times piece had dared to interview people willing to give voice to the true stigma against pathologizing BED. That is, what the Internet trolls pop up to say on fat-acceptance sites: That it's just gluttony, plain and simple. In the heat of the debate over the "obesity epidemic," the rush to judge what those evil, evil fat people who will make everyone's health insurance rates rise, the thought of legitimizing what may appear to be sheer gluttony seems absurd. First you want us to accept fat people, and now you want our insurance to cover their treatment--not for weight loss, but for a "disorder"? Yeah, buddy, I had a "disorder" last night at Cold Stone Creamery, knowwhatimean? Because that, I believe, is the starting point of having an actual dialogue about whatever controversy may surround BED's possible inclusion in the DSM. (That is, assuming there actually is a controversy; since the article didn't interview anyone with any power within the American Psychiatric Association, it's hard to tell. I can only go on the word on the street.) If detractors--or, hell, even the writer of a piece for a major newspaper on something that directly affects 3% of the population--had dared to be honest about the gut feelings against BED's inclusion, the myths could begin to be dispelled. (For starters: BED sufferers aren't eating out of a love of food, or a lack of willpower; they're not all overweight, and not all overweight people have BED; treatment for the disorder, not weight loss, is the goal.)

Anorexia and bulimia are widely recognized as legitimate disorders. I don't know if there were professional skeptics on the matter at the time of inclusion in the DSM, but I imagine that public acceptance of the legitimacy of these disorders was aided by the misperception of glamour surrounding them. As a culture, we have a fascination with thin women--even those who are clearly ill. (One sweep of the newsstand proves that.) There's even sort of a casual, ignorant envy of some patients--I've heard people say they wished for "a hint of anorexia," when clearly what they mean is a hint more thinness, or a desire to eat whatever they wanted without worrying about their weight. But nobody glamorizes someone lying on the couch downing 15,000 calories in a sitting, especially if that person is overweight. I'm beginning to suspect that BED won't be legitimized until our culture's fat hatred is eradicated. And that, my friends, spells a quiet death knell for its acceptance.


  1. I agree that Healy's articles should have featured more perspectives, but I actually think Lane is right that eating disorders are psychological matters rather than psychiatric ones. If only more clinicians treated them in that way, we'd have a better understanding of why people over- and undereat.

  2. I wholly agree--it's impossible to treat an eating disorder with medication alone (unless it's the medication that's prompting it in the first place). But what Healy is critiquing applies to mental illness as a whole, really. He's treating BED as though both practitioners and sufferers will think a pill can cure it all. But practitioners and sufferers of eating disorders that have already been legitimized by the medical community--bulimia and anorexia--use medication AND behavioral therapy AND family therapy AND talk therapy. For Lane to single out BED, to me, stinks of fat prejudice.

    What medicalizing depression and other mood disorders has done has led to a great degree of overprescription. But it's also led to acceptance and awareness of those disorders as legitimate, which has decreased their negative stigma. I think in this day of the "obesity epidemic," to remove the negative stigma of BED (not all sufferers are obese, but many are) feels risky.

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