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Friday, June 8, 2012

Gary Taubes on Anorexia

Hey gang ... I'm working on the Big Fat Lies blogumentary ... just when I think I've found everything I'm remembering to include, I come across more.  But I'm near completion and after some time to do other things in my life (grin) will likely get to publishing it next week.  In the meantime, I came across a quote that really turned me off to Taubes when I heard it.  It really had little to do with his scientific manglings, but more to do with his attitude about fat tissue regulation showing an utter disregard for eating disorders.  I blogged on it once over on the Chronicles blog but couldn't find the quote at the time.  So when I heard it this time, you can imagine it jumped out at me!  

As someone who struggled with ED's, and could just have easily succumbed to anorexia rather than what eventually led to lifelong struggle with overweight and obesity, I found this personally offensive.  It's moreso because I feel that Taubes misuses the works of Hilde Bruch -- probably the single name most associated with studying and treating eating disorders -- to support his so-called Alternate Hypothesis.  Bruch is the author of The Golden Cage and various other books on both anorexia and obesity.  I have a copy of this book and just paged through it to refresh.  Bruch was not, as Taubes would have you believe, fixated on some metabolic even that precipitated this disease or others.  Her focus was on finding out how it starts so perhaps to prevent it from progressing, and how to help (mostly young girls) sufferers unlock their cages.

Sure, you can feed an anorexic carbs (and protein) and pump them full of insulin and put bodyweight back on them.  This will not cure them, however, and may well be one of the more cruel things you could do to a human being capable of literally starving themselves to death because they are so afraid of gaining weight and their reflection in the mirror.

So I put together this "short" since I was playing with a different video production program. 

41 comments:

Sanjeev said...

Gary Taubes on insulin
Gary Taubes on obesity
Gary Taubes on fructose/glucose
Gary Taubes on ASP
Gary Taubes on calories

here's a synopsis of all of the above:
Gary Taubes on acid

Sanjeev said...

> capable of literally starving themselves to death because they are so afraid of gaining weight and their reflection in the mirror


fear's part of it but in interviews I've heard with patients there's also pride in being able to do it

I don't know if that's an ego defense mechanism to try to cover up the fear, but that's the self-reporting.

IcedCoffee said...

Anorexia is not equivalent to Anorexia Nervosa.
Anorexia simply refers to a decrease in appetite.

Lesley Scott said...

from what I've read about anorexia nervosa, it's typically quite "Type A" teens & young women that it affects, with a focus on control and "pride" of accomplishment. I work in the fashion industry where the whole "thin model" debate tends to pop up about once a year, lately focusing sites which use shots some of the really super-skinny, high-profile editorial models to "promote" anorexia. the whole thing makes me so sad; fashion & beauty is supposed to be fun and empowering, not something to die for. I struggle with a lot of weird eating & food obsessions that I wish I could shed & relate to food more like my hubs, who interacts with eating a lot more normally: he's hungry so he eats & when he's full, he stops. Me, I'm forever banning certain trigger foods from the house, trying this supplement or that experiment; it's exhausting, but I can't really help it. I'm not saying my food-related issues are potentially life-threatening like anorexia can be, but I find a lot of guys (sorry, fellas) just don't understand the emo component of food & make retarded generalizations, like our friend GT, that I find beyond infuriating.

Evelyn aka CarbSane said...

I'm aware of that, but let's be serious here. Anyone mentions anorexia is talking about the eating disorder. Indeed since his fantasy is that it be treated as a fat tissue disorder rather than an ED, this point is perfectly clear. Bruch studied ED's.

Evelyn aka CarbSane said...

It's really sad and I don't know what it would be like to grow up in today's world either. The young ladies our friends/relatives have raised are generally confident in themselves and their bodies, although one never really knows what's going on behind the scenes. I notice young women not being modest about belly rolls and even flaunting them these days ... not sure what to make of that ...

Speaking of the guys, this was one of my peeves with all these "grand theories" on the cause of obesity and whatnot. All that some nutrient must be deficient or in excess, or too many O6's or low fat or whatever. Here's where Matt Stone still has my heart, because he does seem to "get it", even though he seems to have strayed into woo woo terroir with the RBTI stuff.

I've met a few men with ED's. I imagine it must be even more difficult for them. It's one thing for men not to "get" women (at least some, most?), it's quite another for them to recognize men with these issues.

IcedCoffee said...

I would avoid putting words in Taubes's mouth. He might very well be referring to Anorexia Nervosa, but that's not what he said.

Evelyn aka CarbSane said...

:-)

Lesley Scott said...

I like Matt Stone, too. he's out there, but he has more of a deft touch. plus, I don't mind woowoo all that much. I may not opt in, but I certainly like to hear about all options and then make up my mind accordingly. My dad was a scientist (he worked in aerospace in the 50s & 60s) and like many of his colleagues, loved Science Fiction because they found it inspiring in a way. It's like, the really creative writers would dream up "out there" scenarios, which the scientist then were inspired to make happen in real life. Anyway, not trying to diss conventional approaches which, as Emily Deans pointed out in that point, isn't wrong; just, more, when it comes to the emo side of things, keep my mind as open as I'm able.

Evelyn aka CarbSane said...

Yeah, I've heard of this as well Sanjeev. I know when I was 105-110 lbs I could "see" one pound on me when the scale registered when I now know that is impossible. I was thin ... too thin for me as I even heard the guys whisper to other girls at one point ... and still thought I was fat. But I still looked pretty healthy, not bones sticking out thin. Still I can imagine had I kept my course, I would not have been able to see that I was truly thin. The one recovering anorexic I knew in real life had a hard time gaining weight and accepting it. I could relate as 120 was probably a good weight for me but I would not have ever been able to deal with being that "fat" back then either. I imagine that rapid forced weight gain could be seriously counterproductive.

Evelyn aka CarbSane said...

He said "instead of an eating disorder" howzzat putting words in his mouth? C'mon!

LeonRover said...

On the clip (above) I hear Taubes referring to Rony (Hugo), and can see that name on the displayed slide.

In her book on Eating Disorders, Hilde Bruch refers to a patient having been treated with insulin by another physician prior to Bruch's involvement. The patient did gain weight, but it it was not a long term cure.

Slainte

ItsTheWooo said...

You indeed can see one pound of weight. Especially at 105-110 pounds.

In a size zero, a few days of eating more will result in noticeable body fat gain; as in, my bones are less prominent, my skin thickness is fuller. Similarly the reverse is true a few days of not eating enough results in bones and thinness. Half a week of a caloric difference is enough, not even a pound is enough.

For every person who says I'm thin, I can't help notice I receive vastly more attention than heavier women. This was even moreso true thinner than I am now. It only became untrue that I was so thin I appeared unhealthy (and was unhealthy). Thinness is a marker for youth, a thinner body suggests youth, and youth is attractive.

FYI, as "cruel" as it is to use insulin injections to treat anoretic patients, we do this EVERY DAY and use zyprexa and other insulinogenic drugs to pile on weight. It works, although, it doesn't fix the underlying problem it can help prevent the more important issue of immediately killing themselves.

Some theories of anorexia describe it as an addiction, a way of disinhibiting dopamine with a cyclical escalating nature. The treatment is years and years of forced feeding, similar to abstinence from an addiction. My subjective experience would agree with this totally. In a way such treatments may be long term effective if the patient is forced to feed, to resolve an addictive hedonistic self starvation.

I remember meeting one girl online who had anorexia nervosa restricting type (FYI there are subtypes of anorexia, only restricting type can benefit from insulin therapy or drugs to gain body fat)... she was given zyprexa by her psychiatrist, ignorant of what it is or does. She must have had an underlying vulnerability to metabolic disorder (which is rare in AN) because she gained 100 pounds and developed PCOS.

I do think taubes is absolutely correct a defect in bodyfat/appetite regulation is part of anorexia. There are many girls out there who hate how fat they are but a tiny teeny percent <1% is capable of starving to death... and usually they dont report being hungry and demonstrate abnormal appetite reactions (such as becoming less hungry while hypoglycemic, demonstrated in studies). There are many AN girls who don't have the "fear of body fat" issue, and instead demonstrate "denial of low weight" which is quite a different thing.

Furthermore anoexia nervosa dramatically precedes a modern preoccupation with thinness; the overrepresentation of females isn't becuase of "pressure" (IMO a sexist implication) ... its more than likely because of sex steroids and brain development, where a dominance of serotonergic activity may predispose to abnormal appetite and self starvation for example.

Female twins (very high estrogen prenatally) are at greater risk for anorexia.
Males are at the lowest risk.

I don't think taubes believes a lack of insulin is the cause of AN, but he is absolutely right that AN is a biological disorder, the evidence is overwhelming, and psychological/"my feelings need food" theories are so totally outdated 80s nonsense. You can pile on weight most anoretics by modulating their endocrine and nervous systems to an appetite, via zyprexa, via insulin. That is significant. It suggests the drive to grow fat is ultimately greater than the drive to be thin in anorexia, which would suggest anorexia may involve a DEFICIENT drive to eat/grow fat... and again, the research absolutely supports this (lack of hunger, lack of hedonism, etc).

P2ZR said...

Sanjeev: 'fear's part of it but in interviews I've heard with patients there's also pride in being able to do it '
Yes, a mad relentless obsession with starving oneself out of seemingly inescapable life problems, and into some bizarre wretched perfection. Perceptions change with weight; as the scale goes down, one is always 'normal weight', and everyone else is correspondingly fatter. In some sense it is also an escape from the suffocating world of fatness, which isn't quite logical (what does it even mean?), but neither is AN.

Woo: 'There are many AN girls who don't have the "fear of body fat" issue, and instead demonstrate "denial of low weight" which is quite a different thing.'
IME these are overlapping issues. As long as there is some visible/pinchable body fat, which is intolerable, the weight is 'clearly' not low enough.

Also, the absence of hunger I think was a learned response. But I know that not all lose their hunger.

I don't know how many anorexics you have been around clinically, but you clearly have not been inside the head of one. I do believe AN has biological underpinnings, but to suggest that fixing the biology alone will cure the disease is both misguided and demeaning.

Unknown said...

So Gary Taubes is making women anorexic?

Sanjeev said...

> I find a lot of guys (sorry, fellas) just don't understand the emo component of food & make retarded generalizations

Men who are subject to the same kind of appearance pressure do many of the same things as women, including stuff like silicone calf implants ...

> I don't know if that's an ego defense mechanism

I didn't mean in a Freudian sense, but empirically documented phenomena

ItsTheWooo said...

Actually the earliest anoretics were pious "starving saints" without any concern for fatness. Fasting for purity was the original confabulation, it is only in the past few decades where female anoretics have been confabulating a fear of body fat.

I've never been anoretic, but I have been underweight, compulsive food restrictive, and I understand how one can desire to be emaciated and fear being normal sized (as it is "fat"), and how there is a perverse pleasure and feeling of power in that... a feeling of power which is an addictive high. This high exists with a paralyzing fear of violating rules, irrational arbitrary ones you have imposed upon yourself. Fear of weight and food seems almost arbitrary to the real issue which is a power in starvation + fear/obsessiveness, merely incidentally focused on body weight and diet as a justification for it.

Biology absolutely allows anorexia to happen. Saying fear of fatness causes anorexia nervosa is like saying fear of contamination / fear of not washing your hands 15 times causes obsessive compulsive disorder (which, btw, is HIGHLY comorbid with anorexia nervosa and not by coincidence).

FYI, as I hovered around ~100 pounds and looked like absolute shit, and people stared at me in public (in a not good way, in a circus freak way), my concern for aesthetics and beauty became non-existant. I could not at all relate to "normal" young women who wanted to be slimmer to flaunt their bodies and show off for sexual attention. My ideal of progress was looking skeletal, being able to more easily see bones which ordinarliy should not be visible. Being able to see every single rib, from below the clavicles to above hips, clear cut indentations between each rib. Being able to palpate and observe every bone in my spine. These sorts of "goals" will permeate your mind when you are a mental nutcase, and the more you veer this way, the less concern you have for conventional / normal aesthetics (and, the more those aesthetics absolutely terrify you, symbolizing failure and fat).

ItsTheWooo said...

On anorexia as a "fear of fatness" and not a primary biological drive / hedonistic addiction / obsessive compulsive like disorder....

When I was in my mid 20s I consulted with a psychiatrist (big surprise right!) due to my history of mood problems. I shared with the psychiatrist my early 20s problem with food restriction/ weight. Immediately she asked: you did this to medicate/help your mood? I was shocked because I was so accustomed to people assuming weight preoccupation / food restriction is a reaction to an inability to know you are thin / pressure to be perfect or similar retarded ideas. However, the psychiatrist got it *right* away I didn't need to say anything it was like she instantly understood...absolutely yes, my food restriction was very much a way to control my mood and raise it.

That leads me to believe she has seen it enough times in her career, she has become quite familiar with the common scenario where a patient will restrict food/engage in energy deficiency to treat depression or mood problem. I needed to say nothing, she already knew and was totally correct.

Lesley Scott said...

"Men who are subject to the same kind of appearance pressure do many of the same things as women, including stuff like silicone calf implants ... "

I know, Sanjeev, it's kind of a sad state of affairs the stock we put in appearance almost to the exclusion of everything else. I sometimes wonder if the fact that no one really reads excellent literature or does much in the way of artistic pursuits as a matter of course and basically want life to be one long entertaining soundbite has left many feeling so spiritually bankrupt (or some such thing) that their physicality is pretty much what's left - from molding it crazily (silicon calf implants) to plastic surgery (think Jocelyn Wildenstein that "cat lady" socialite in NYC that had all those many surgeries on her face) to all the other craziness that tends to dominate the news.

P2ZR said...

'Saying fear of fatness causes anorexia nervosa is like saying fear of contamination / fear of not washing your hands 15 times causes obsessive compulsive disorder (which, btw, is HIGHLY comorbid with anorexia nervosa and not by coincidence).'

Yes, I have heard of this very interesting comorbidity and definitely don't believe it is a coincidence. I was taught to be very clean as a child. Instead of just becoming scrupulous about hygiene, I developed borderline OCD. Still have those tendencies.

I'm not saying that fear of fatness or germs by itself *causes* AN or OCD, respectively (not sufficient), but they are a trigger (necessary) to send biologically susceptible people off the deep end. I would probably never have developed painstaking hand-washing rituals if I had never been taught to fear germy things. I would probably never have developed AN if I had not rapidly gained the weight that made me non-underweight for the first time in my life, which, coupled with other stressful events at the time, rendered me unable to rationally deal with a weight gain that was clearly not the end of the world.

'My ideal of progress was looking skeletal, being able to more easily see bones which ordinarliy should not be visible. Being able to see every single rib, from below the clavicles to above hips, clear cut indentations between each rib. Being able to palpate and observe every bone in my spine. These sorts of "goals" will permeate your mind when you are a mental nutcase'

Agree; well-described. But for my AN, this *was* the ideal aesthetic, the aspiration to which was obsessive. This is the case for many, such as the girls who tape to their bedroom walls pictures of starving models (the ones who are clearly in danger zone, more Isabelle Caro than Kate Moss) as motivation/inspiration.

BenSix said...

Hi ItsTheWoo,

It suggests the drive to grow fat is ultimately greater than the drive to be thin in anorexia, which would suggest anorexia may involve a DEFICIENT drive to eat/grow fat... and again, the research absolutely supports this (lack of hunger, lack of hedonism, etc).

Could I have the references for this? Personal experience had led me to suspect that hunger diminishes as a consequence of one's food restriction growing more severe rather than the other way around.

Cheers.

By the way, this might be of interest to the general commenter.

ItsTheWooo said...

@BenSix The evidence suggests active anorexia does disturb appetite, but these abnormalities persist even after weight restoration/recovery. Here is a study.

http://www.ncbi.nlm.nih.gov/pubmed/11262517


RESULTS:

Hunger ratings increased significantly 45 min after insulin injection in control females. However, ratings paradoxically decreased after insulin injection in AN-R females. They increased slightly after insulin injection in AN-T females, but the difference was not statistically significant. One-factor analysis of variance for the peak values of hunger ratings was significant. These values in control females were significantly higher than those in AN-R and AN-T females.
DISCUSSION:

These results suggest that perception of hunger to insulin-induced hypoglycemia in AN patients is disturbed.

Evelyn aka CarbSane said...

Show me an AN sufferer who didn't get that way by first DELIBERATELY restricting food. Their fat tissue didn't get outta whack the opposite way compared to obese. I think Unknown below is getting at this ... because we all know how anorexic all the VLC'ers are!!

In any case, once in the throes of the disease, weight is a manifestation of reasons behind it. And once emaciated, gaining weight is a manifestation of loss of what has been attained -- be that for escapism, control over some aspect of one's life, reversal of puberty, distorted body image to societal ideals, whatever.

Call it 80's nonsense all you want. In my rather small school class (about 75 girls), two missed at least one semester due to AN treatment, and one did not graduate with us as a result. That's a pretty high rate. If you want to add in ED's the rate would be quite high. There's a reason it afflicts ballerinas, gymnasts, actresses (especially those growing up on film), etc. It all starts with their first diet ...

Evelyn aka CarbSane said...

You were AN?

Evelyn aka CarbSane said...

@P2ZR: "I do believe AN has biological underpinnings, but to suggest that fixing the biology alone will cure the disease is both misguided and demeaning."

Nail. Head. This is what I find offensive about Taubes here. He's so convinced of that insulin is the be all and end all of "normal" bodyfat, he seems to be saying that's all there is to it. Why he hasn't just cured the world by now is beyond me! If carbs drives insulin drives obesity, then VLC should drive anorexia. Well, it creates various binge and other obsessive ED's in many, and may well be a route to AN for some for the same reason other restrictive diets are a gateway, but waves of Atkins popularity have yet to coincide with AN epidemics.

BTW, in his more recent CrossFit appearance, he states categorically that obesity is not some multifactorial problem. They solved it in the 60's!! We just haven't gotten the memo.

bentleyj74 said...

:-) X2

ItsTheWooo said...

@Evelyn

When did I say that anorexia triggering event is separate from food restriction? I would be the first to argue that negative energy balance is a prerequisite to trigger this illness. However, "fear of fat' or "body weight concerns" are about as relevant to developing anorexia as is alcohol to getting into a car accident. Certainly, driving while inebriated and being an alcoholic is one way to crash your car...but some car crashes do not even involve alcohol, and some anoretics NEVER felt fat/feared body weight. This is true, and even the diagnostic criteria for anorexia need not require fear of body fat/feeling fat, a lack of insight into medical frailty is sufficient.

For example, Daniel Johns is the lead singer of Australian rock group Silverchair. Johns developed anorexia nervosa in his early 20s/late teens, and never felt fat or feared body weight...his diagnosis was based on his inability to completely see how sickly he had become.

The modern epidemic of anoretics feeling fat/fearing fat is merely incidental to modern aesthetics, and, for many girls with anorexia, a diet can be the triggering negative energy balance. This is not the logical equivalent of dieting being the triggering IN GENERAL for the population.

There are lots of other ways to develop anorexia. You can have depression/stress and lose your appetite, and end up in negative energy balance (this is what happened to daniel johns). You may be trying to alter your diet to be healthy, and incidentally end up eating insufficiently triggering the illness (e.g. CR or fasting). You may be a young person who is in competitive atheletics, expending a great deal of energy and not sitting down to eat.

What all these conditions have in common is negative energy balance, they do NOT have in common body weight concern/fear of fat, this is merely incidental to the majority of modern anoretics.
INCIDENTAL. As incidental as hand washing is a common fixation of OCD, as modern hygeine rituals promote hand washing, and so people with an out of control brain disease centered around hygiene/order known as OCD frequently develop hand washing rituals. PURELY incidental. Would you argue hand washing causes OCD?

The irony is, the majority of girls out there who care about being fat are totally resistant to anorexia, because their concern of fatness is evidence of a healthy mind with age/developmentally appropriate goals and concerns. Most girls with anorexia nervosa have comorbid illnesses such as OCD (brain processes are similar) and depression, they do not want to lose 15 pounds so they can fit into that trendy new dress and be the envy of their class. The overwhelming majority of normal girls think "skinny" is a size/body type that an anoretic (with body weight fixation/concern) would find terrifyingly large.

You can not make a normal person anoretic by dieting them (most people respond to food restriction via binge eating/compulsive eating, which is these so called "disorders" are endemic to dieting women). You can only become anoretic by dieting if you have an underlying vulnerability to anorexia, which is very rare.

Similarly, you can not make a person manic by depriving them of sleep - the normal response to sleep deprivation is fatigue, irritability, and binge sleeping. However people who have an underlying manic depressive illness may suddenly find after stress induced sleep deprivation a crystal clear meaning in the world, the sky opens up with possibility, and they are now a very important religious figure. This is NOT a normal response to sleep deprivation.

To say weight concern/food deprivation population wide causes anorexia nervosa (an EXCEEDINGlY rare severe mental illness affecting <1% of the population) is as medically ignorant as it is to say overwork/stress sleep loss causes manic depression.

Trigger it, yes. Cause it, never.

ItsTheWooo said...

Regarding your graduating class...if you went to a private girls school (which it sounds like) you are probably overrepresented with anoretic vulnerable people, as the genetics/predisposing factors are believed to cluster in families with high acheivement.

Or you may have had an incidentally high rate (2 out of 75 girls).

Or, the girls may have been misdiagnosed or had a milder subclinical condition.

Either way, the facts speak for themselves, <1% incidence of this illness, in spite of the fact females all over are saturated with "ya better be thin!" messages, and almost all girls diet a few times in their lifetime with BINGE EATING after food restriction followed by giving up the diet being the most common outcome for normal brained people.

ItsTheWooo said...

VLC would be the least likely diet to trigger anorexia nervosa as most forms of VLC diets encourage dieters to eat lots of calories. Negative energy balance/fat atrophy triggers anorexia nervosa.

Calorie restricted diets would be the most likely to trigger, due to the negative energy balance gaurenteed to happen (whereas a thin person/anorexia nervosa patient on VLC is far less likely to spontaneously reduce calories, as they do not have an insulin/blood glucose disorder driving fat growth and hyperinsulinemia like the obese people who spontaneously stop growing fat/over eating on VLC secondary to insulin dynamic normalization).

ItsTheWooo said...

No. But I have a glimpse of insight into what it is about, and believe I had a subclinical form.

http://carbsanity.blogspot.com/2012/06/gary-taubes-on-anorexia.html?showComment=1339199106731#c7385406203074188000 <--- describes here.

Evelyn aka CarbSane said...

OK ... so your own subclinical observations trump all of those of Hilde Bruch during her long career treating AN's and other eating disorders. Oh, and my own experiences and those of which I have significant knowledge of in real life is just 80's hokum. Duly noted. For the record, I went to a public, coed high school.

ItsTheWooo said...

How on earth does that reply even follow my argument? When did I say my personal experiences are the backbone of my logic?

This may be a radical idea, but it is possible you are wrong. Your ideas ARE OUT OF DATE. The modern consensus in medicine (not pop bullshit psychology/women's mags) is that anorexia nervosa is a heavily biological disorder, heavily heritable, and at *best* it is only ever triggered by pressure/expectations to be thin. In religious communities, ritual fasting is just as likely to trigger AN, in spite of the fact there is no pressure to be thin.

You can NEVER make a normal person anorexic by blaring a horn that they are too fat. Normal people respond to caloric restriction as most all women do = by binging and eating lots and staying the same weight, if not gaining weight, when starved in an ad lib cal environment. That is normal healthy brain behavior, bingign while dieting is NORMAL behavior demonstrated by all animals. ALL ANIMALS binge when starved (i.e. "dieted").


For someone who has a mission statement to clarify mistruths, you certainly don't seem interested in any evidence which suggests your ideas may be wrong. You seem to be quite comfortable in your dogmas in spite of ample evidence they are wrong (e.g. clear cut modern research showing anorexia is a BIOLOGICAL illness, such as evidence of influence from prenatal estrogen, abnormal response to reward / hedonism deficits, difficulty with set shifting/excessive focusing/obsessive compulsive mentation, inability to normally respond to pain/pleasure treating both similarly, not to mention the highly genetic / heritable nature of this illness with it clustering gin families)


Blaming thinness expectations for anorexia is as retarded, stupid, ignorant, misguided, as blaming stressful lifestyles / overwork for manic depression. Laughably wrong.

bah said...

I didn't diet and was anorectic in my late teens and early 20s. So there's your person who got that way without dieting. My reasons for eating less and less (at one point probably eating solid food maybe 2x a week and a small cup of fruit juice the rest of the week) were primarily to sever the link between hunger and appetite (i guess i was n=1 even back then). I had some other reasons, but they were pretty secondary. I believed at the time that having appetite be completely unconnected to physical hunger was a good idea.

bentleyj74 said...

I agree with Wooo that AN is likely a biological/neurological condition at it's root which is not to say that I don't think social pressure can be a triggering event. I draw a lot less distinction between the mind and body probably...the line of demarcation is extremely fuzzy in my perception. There certainly are overweight girls who WISH they could find the fortitude to starve and people who seemed "normal" all of their lives until they go to med school and have a psychotic break after a few months of swing shift rotations while trying to defend a thesis. A former friend of mine committed suicide after just such an event. Another didn't but gained quite a lot of weight and would now probably be one of those doctors people make fun of because he's giving you advice on your diet/health.

I come from a large family of extremely high achievers [spent some time in private school too] and Wooo is right about that certain intangible quality that is closely tied to their ability to exist comfortably at such an extreme position on the bell curve. It could and does translate pretty easily into AN or OCD type condition that involve the ability to more or less get high off of your own discomfort as well as fixate almost totally on only one or two aspects of life. This can result in being extremely successful or extremely f*cked depending on how you look at it and whether or not you are happy with how things turned out.

The behaviors outwardly involved in AN will always get social approval which is quite reinforcing as well. If depression looks like laziness and is hard to empathize with [people are often criticized and rejected], AN looks like self control and motivation until you are pretty far down the road or know what's going on in the mind of the individual. Using punishing "beatings will continue until moral improves" methods will usually give short term success with a big boomerang of failure [thank goodness]...unless you are one of those individuals I described above in which case it is extremely effective and will even contribute to feelings of superiority/pride/accomplishment. It reinforces the belief that they really CAN and SHOULD have it all if they can just find the will to stop wasting time doing stupid unnecessary things like sleeping/eating/socializing/recreating aka being alive.

I just don't know how anyone would ever untangle the physical aspect from the mental/emotional as the relationship is so tightly entwined and sophisticated. What you *think* affects what you feel...even physically and vice versa. What you perceive affects what you think etc and so on and your physical mind affects your perception. There is no end to that rabbit hole. Many contributing factors with no clear single causative factor that I can observe. As ripe as my family should be for AN I'm not aware of anyone who actually does have it and all evidence points away from that conclusion. No theory is a slam dunk.

BenSix said...

I agree with ItsTheWoo that it seems to take a particular sort of person to develop AN, and that once it's taken hold their attachment to the sensation of food restriction is far more important to them than their weight, but, at the least, the "triggering" part of the process is a significant factor. I doubt it's a coincidence that it's so prevalent among ballet dancers, for starters. And, while I don't want to play a game of "overstate the importance of the anecdote", my experiences with the bastard were certainly influenced by the feeling that I was a fat slob.

Evelyn aka CarbSane said...

I wish to clarify that ONCE anorectic, the fear of gaining weight is not always over one's weight. Which is why I said

In any case, once in the throes of the disease, weight is a manifestation of reasons behind it. And once emaciated, gaining weight is a manifestation of loss of what has been attained -- be that for escapism, control over some aspect of one's life, reversal of puberty, distorted body image to societal ideals, whatever.

It is prevalent in ballerinas and gymnasts -- sports/endeavors that generally must be started in one's early youth to reach the pinnacle of, and wherein becoming a woman can spoil it all (Nadia Comaneci anyone?). The trigger is not always to lose weight, BUT it is almost never fat cell metabolism spontaneously gone awry. It starts with a deliberate effort to lose weight, starve oneself, delay puberty, etc.

Treating it with insulin may improve the body, but it won't alter the mindset. And whether it's a desire to be thin or not once a person is AN, the fact of the matter is they are too thin/emaciated/unhealthy and many cannot see that in the mirror. (Others do revel in it apparently, never met one of those though I know they exist).

Welcome BenSix!

bentleyj74 said...

"It is prevalent in ballerinas and gymnasts -- sports/endeavors that generally must be started in one's early youth to reach the pinnacle of, and wherein becoming a woman can spoil it all (Nadia Comaneci anyone?). "

Don't forget wrestlers! I'd back up a little further and say it probably starts with a deliberate effort to achieve a performance goal and low weight might be involved there but I think the focus usually always starts with wanting something and being able to control for getting it and being proud of that control. The perceptions of people who have been involved in higher level competitive sports like ballet or gymnastics are for sure skewed by being surrounded by people who are thin and thinner...achievement oriented. They are interested in WINNING the game not questioning the value of the game. It probably seems completely normal and reasonable to expect all other areas of life to be subordinate to the performance goal and more or less irrelevant by comparison to it.

"The trigger is not always to lose weight, BUT it is almost never fat cell metabolism spontaneously gone awry."

Right, that argument took a hard left into territory that left me going..."huh?" pretty fast. There probably is some relationship between metabolism and mood disorder but I doubt it's as simplistic as that. Not every person with OCD has metabolic syndrome, not every person with AN was ever overweight, not every person with met syn has a mood disorder...things just don't ever seem to line up so congruently.

LeonRover said...

From The Telegraph 15th June 2012:

" An anorexic medical student who is close to dying from lack of food should be fed against her will, a judge has ruled, because she may want to live in the future."

http://www.telegraph.co.uk/health/healthnews/9334118/Anorexic-medical-student-should-be-fed-against-her-will-judge-rules.html

Slainte

ItsTheWooo said...

The judge's ruling is a reactionary decision which is common, understandable, but ultimately grossly ignorant of what it means to have severe life long restrictive anorexia nervosa. This patient is 32 years old. She has had anorexia nervosa since 11 years old. It is apparently severe and intractable and innate, as is sometimes true of this illness. While allowing this person to die seems incomprehensible to normal people (and even my reflexive reaction is 'OF COURSE, FEED HER!")... what is the realistic long term outcome for this patient? REALISTIC long term outcome?

Do we believe after the tube feeding ends, she will maintain weight? Do we believe she will not relapse shortly? Do we believe she will ever overcome this painful, horrific illness? At 32 years old, after being in and out of treatments her entire life?

She isn't 15, or even 20, or 25. She's approaching her mid 30s. I think, given her age, and her history, her decision to palliative care should absolutely be respected. What other options are there, realistic long term options? I don't mean acute tube feeding, I mean once she is out of a medical danger zone and has to live with her abusive brain.

...but barges in a judge with no psychiatric understanding, insight, other than generalized moral feelings like "it's wrong to allow someone to die from self starvation" and "eating is so easy, just eat and you'll be fine".

Nigel Kinbrum said...
This comment has been removed by the author.
Nigel Kinbrum said...

ItsTheWooo said...
"...but barges in a judge with no psychiatric understanding, insight, other than generalized moral feelings like "it's wrong to allow someone to die from self starvation" and "eating is so easy, just eat and you'll be fine"."

That has got to be the finest display of made-up sh*t from you yet. You just know that the judge has no psychiatric understanding & insight and feels that "eating is so easy, just eat and you'll be fine".

Suicide by starvation falls under the UK Mental Health Act 2005 (something that I know a little about, given that my mother has been mentally incapable for years and my Enduring Power of Attorney was certified by the Court of Protection under that act). There's a possibility that "E"'s mental illness is treatable by proper nutrition, medication and psychiatric counselling (she may not have had all three previously), which is why the judge came to his decision.

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