Monday, November 27, 2006


This past weekend's The New York Times Magazine features an article written by a Harriet Brown, the mother of a 14-year-old girl diagnosed with anorexia. Ms. Brown's personal account of healing her daughter describes the Maudsley approach, a family-based approach for treating anorexia, and pays tribute to the genetic factors associated with eating disorders. Brown cautions us against socio-cultural explanations: "If this were true, though, millions of American girls and women would become anorexic instead of the roughly 1 to 3 percent who do. Clearly there are other factors involved." Brown's point is well-taken--a number of factors have been associated with the development of eating disorders; however, when you turn the page after the article's end, it's hard to discount the critical role that cultural images and dialogues play in women's thoughts about their bodies.

(Lest there be any uncertainty, the image illustrates a Times feature subtitled, "An Artful Homage to this Season's All-Important Acessory: The Hat.")


PalmTreeChick said...

Don't know where to start with this one. Two specific paragraphs stuck out in my mind. This one:

A week into refeeding, I'd become an expert in high-calorie cooking. I made macaroni and cheese with butter and whole milk, chicken breasts dredged in egg, rolled in bread crumbs, fried in butter. Carrot cake with cream-cheese icing. Thousand-calorie milkshakes and muffins. When a body is in a state of starvation, it isn't enough to simply eat a normal diet, Dr. Walter H. Kaye, director of the eating-disorders program at the University of California at San Diego, explained to me. The body requires huge numbers of calories to gain weight and maintain it. Every few days we added 300 calories; by Day 9, Kitty was eating 2,100 calories a day. Still, she'd lost another half pound, which panicked me until the pediatrician explained that Kitty's metabolism, slowed by starvation, was now revving high. It's not unusual to lose weight at first, she said; just keep feeding her.

And the other one that talked about how she could not put on weight. These probably weren't the things that should have stuck out to me, but they did. Probably because I wish I could eat 3000 calories in a day and lose weight. Probably because if I eat something i don't usually eat, I gain weight. Probably because I just don't get it and don't think it's fair. Maybe it was because she was so starved but I thought that would make her put on weight faster because her metabolism slowed down so much.

I don't have the schooling/knowledge to understand how that works. I always thought it was the opposite. I don't know.

I'm glad she's doing better and her family was so supportive and helpful in her recovery process.

Anonymous said...

To me, it's neither a shock nor a mystery, but definitely a needed reminder. There are many conditions- physical and mental- to which a person can be genetically PREDISPOSED, and not everyone with the predisposition gets the condition. Clearly environment plays a big role.

I haven't read the article yet, although I do have the magazine at home. But I can tell you that when I make mac and cheese, I use real butter and whole milk. I thought that was "normal".

WifeMomChocoholic said... comment disappeared. I hope it doesn't post twice now.

So much for the theory that dieting wrecks your metabolism.

I don't think cultural images cause anorexia, but I think they definitely contribute to disordered eating like bingeing. Women struggle to achieve the kind of perfection celebrities appear to have and feel guilty when they can't get there.

I've seen it time and time again on weblogs. Women get close to their goal weights and suddenly their goal drops by 10 pounds, they become disgusted by their cellulite, and berate themselves for every cookie eaten.

When I was a size six I decided a four would be better because my stomach still wasn't flat enough, nor my thighs small enough. I became ashamed of my spider veins and stopped wearing shorts. When I couldn't achieve perfection, the bingeing began.

Anonymous said...

This article definitely makes clear to me something I already suspected. That anorexia, like alcoholism, is an addiction. My late sister, a one-time bulimic, descended into alcoholism and spoke to me of the demon that called to her. It spoke to her when she was trying to be good and not drink. It told her that there was nothing wrong with a glass or two of wine. It lured her into the liquor store when she wanted to pass it by. She knew it was a demon, she even used that word to describe it. I wonder if a Maudsly type approach could work for alcoholics...
The genetic predisposition surely exists, but something seperates those who succomb to the beast and become possessed by the disorders and those who somehow come away unscathed from the same environment. Witness my sister and I. I don't have any eating disorders, but knowing that my mother and sister both were alcoholics, I see my demon lurking in the closet. For now, I keep him behind lock and key...but some days I worry that he will convince me to unlock that door.

disordered girl said...

You just can't discount socio-cultural factors. All those girls in "Thin" were taught by adults at an early age that they needed to lose weight. Those adults were responding to cultural expectations of acceptable sizes for girls (and, to be fair, to health concerns as well, although I argue the size concern tends to be the more pressing factor for many).

I'm sure there are genetic factors that make one more susceptible to addictive or compulsive behavioral mindsets, but would the compulsiveness ever be triggered in the first place without the socio-cultural influences? I'm doubtful...

Haley-O said...

I strongly believe that there are both genetic and sociocultural factors at work with anorexia -- just like other mental disorders. Based on my own experience with both eating disorders and anxiety disorder, I strongly believe anorexia is a form of gross anxiety disorder that is biologically predetermined, and triggered by sociocultural factors.

littlem said...

Haley kind of nailed it.

I don't agree with Ms. Brown about the 1 to 3 percent who "do" have the disorder, according to her.

She's talking about the 1 to 3 percent that report their disorder, are believed (unlike some of us who are "recovered" and are therefore "fatter" than society says we're "supposed" to be), and are properly diagnosed.

That's a very different thing, and based on the very factors Haley-O broke down, IMHO the actual numbers are probably a lot higher.

drstaceyny said...

ptc--I'm not sure, either--seems like a good question for a nutritionist or M.D.

anon--me, too!

wmc--I think there's plenty of research supporting the idea that dieting does wreak havoc on your metabolism. This may be an extreme case.

It does seem to be a limitless process, with the "target" moving farther and farther away.

anon--thanks for sharing your story. I, too, think that EDs look like addictions (see several posts back).

dg--I am, too.

haley--I actually have an article on the relationship b/w EDs and OCD--will post abt the idea soon.

lm--true, these numbers may be underestimates.