Is My (or My Loved One's) Relationship with Food a Problem?
“I wish I had a touch of anorexia.”
I hear this a lot. So does clinical psychologist Jennifer J. Thomas, who is the coauthor of my latest book, Almost Anorexic. While most mental illnesses elicit empathy, anorexia nervosa is often met with envy (“You are so thin!”) and sometimes doubt (“Why don’t you just eat?”). I heard both of these all of the time when I struggled with my own eating disorder.
Why does a serious, life-threatening illness with one of the highest mortality rates of any psychiatric disorder inspire such cachet and even skepticism? A superficial response may lie in the current high rates of obesity. With one-third of adult Americans overweight and yet another third obese, the ability to achieve a low body weight by controlling food intake is exceedingly rare. But you’ve probably never heard people say they wished they had a touch of depression, another mental illness that can also lead individuals to eat less and lose weight. And you surely haven’t heard someone say, “Why don't you just stop having cancer?”
A not-so-obvious—but perhaps more accurate—explanation of both the pseudo-prestige and misunderstanding surrounding anorexia nervosa lies in the definition itself. The criteria listed in DSM-5, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (a book that healthcare professionals use to diagnose psychiatric disorders) are quite strictly defined. The hallmark feature of anorexia nervosa is a significantly low body weight due to self-imposed food restriction. For some, meeting the DSM criteria can feel like earning a badge of honor. Of course, developing a life-threatening eating disorder is nothing of the sort. Important to note, although people with anorexia nervosa have a low body weight, the majority of individuals who struggle with eating disorders—just like people in the general population—are normal weight or overweight.
While only 1 in 200 American adults will develop anorexia nervosa in their lifetime, as least 1 in 20 (1 in 10 teen girls!) will struggle with an equally impairing combinations of symptoms, including restricting, bingeing, and/or purging. In our book, we call this once overlooked category almost anorexic. The medical community does already have a term for this, which you may have heard called Eating Disorders Not Otherwise Specified (EDNOS; in DSM-IV). With the publication of DSM-5 in May 2013, the name officially changed to a new, yet still perplexing acronym, Other Specific Feeding or Eating Disorder (OSFED). Countless people find it confusing to be diagnosed with an acronym. Some have even told us that being diagnosed with EDNOS or OSFED has led them to believe that they have somehow failed at “achieving” anorexia nervosa.
But, unlike what many think, EDNOS is not a “lesser” diagnosis. In a meta-analysis of 125 studies, Dr. Thomas, found that EDNOS was just as severe as anorexia nervosa in the domains of eating pathology, associated mental health distress, and medical complications. Another longitudinal study that followed patients for 8-25 years found that the mortality rate of EDNOS was similar to that of anorexia and bulimia nervosa.
When I was lost in my eating disorder, I waited years in the purgatory of almost anorexia before getting help, which only happened when my symptoms finally reached a full-blown diagnosis of anorexia nervosa.
Importantly, help is available now. In fact, evidence-based strategies make full recovery possible. New research suggests that many of the same techniques that are useful for the treatment of anorexia nervosa and bulimia nervosa (e.g., family-based treatment, cognitive-behavioral therapy, and others) can provide relief for those with OSFED/EDNOS.
If you think that you (or a loved one) might be struggling, visit www.almostanorexic.com for a free and confidential screening. You don’t have to struggle with almost anorexia—not even a touch.
Jenni Schaefer is a singer/songwriter, speaker, and the author of Goodbye Ed, Hello Me and Life Without Ed, which has recently been released in a tenth-anniversary edition as well as audiobook. Learn more at http://www.jennischaefer.com/.