Monday, April 12, 2010

Your Choice?

Are eating disorders choices? Do you choose to develop an eating disorder, or to continue to engage in your symptoms, or are eating disorders strictly diseases, without any decision involved?

I think most of us would agree that by the time someone is knee deep in her eating disorder, there isn't much choice involved. And yes, there are factors such as genetic influences, familial circumstances, and comorbidity with other psychological disorders (e.g., depression, anxiety, substance abuse), all of which make eating disorders appear to be a fait accompli.

Eating disorders are diseases, right? Why would anyone choose to develop a disease? No one is questioning someone's depression or schizophrenia, and certainly not her Parkinson's or cancer.

But, for many who suffer from eating disorders, there's a moment, early on, when we make a choice--a choice to restrict, to binge, to purge, because in the moment, these behaviors seem to be the best option available to us.

Maybe it's just semantics, as this choice is made without informed consent, without recognition of what will follow. For others, even if there is an understanding of consequences, we might make the same choice, anyway, not really thinking the consequences will apply to us. Does a choice count if you don't even know you're making a choice?

When recovery is on the table, and we continue to engage in symptoms, is this a choice, or are our eating disorders speaking for us? Do you choose to hold on to an eating disorder, or does the disorder hold on to you?


Gayle said...

" because in the moment, these behaviors seem to be the best option available to us" - EXACTLY! And after 3 years, it has me.

SheWunders said...

This is seriously an intersting question. Sometimes I feel like I'm choosing the disorder.

Currently I'm at a healthy weight, but I restrict my diet to maintain it. If I'm not restricting, I'm bingeing. Restricting makes me feel obessive and nuts, but the healthy world tells me to "watch what I eat, eat smaller portions, eat the right foods." I want to know - when obessive healthy eating becomes an eating disorder? said...

I think about this all the time. People say to me, "Don't be hard on yourself; it's not a choice." Somehow, hearing that is not helpful. I think "Well if it's NOT a choice then what the heck am I supposed to do?!" It NOT being a choice makes me feel powerless. So, I like to think of it as a choice. Because it leaves me hopeful and empowered that way. I dont belive it's a choice to have the initial compelling thought to restrict/binge/purge/exercise/whatever.... but I have to believe it's my choice to act on it or not - otherwise there's no point in trying to get rid of the ED, right? I think a/b this topic frequently...

Flushed said...

I think eating disorders are more about the attitude towards food as opposed to the actual behavior. But I think one can grow from the other-behavior can lead to the ED and the ED can lead to the behavior. Like YouTube SuperSkinny Me where 2 woman race to zero but one develops an ED.

Part of weight watchers and many diets out there are restricting but not all of those people have or develop eating disorders from it.

I did. Food took over me and my mind, forbidden fruit if you will, taunting me and nagging at the corners of my mind. I feel like I did this to myself, I built up walls of delusions in my mind, looking at a piece of cake and seeing FAT! Mind tricks. I took dieting to the disordered level by taking it too serious, being too strict and pushing my boundaries too far. There is always a fight in my mind of whether or not to eat this or that like food is crack or something.

It reached another level when I ate a piece of pizza that was tomenting me and I was overwhelmed with guilt and anxiety I HAD TO GET IT OUT OF ME and that was the first time I made myself throw up.

Pandora's Box.

SheWunders said...

@ Flushed - The EXACT same thing has happened to me too. Do you try to fight it? What happens when you do? I'm always anxious about it, but I feel silly going to a counselor when I'm obviously not anorexic or obese and saying “I think I have an obsessive eating disorder.”

azusmom said...

To me, it's like alcoholism. Some people choose to take a drink, then another, then another. Some find themselves unable to get through the day without alcohol. Some folks can have 1/2 a glass of wine every few days. They can take it or leave it.
I made the decision, in college, to start vomiting and taking laxatives. But then I couldn't stop. In grad school, I made the decision to severely restrict my caloric intake and the types of food I would allow myself. Later, I decided I would abuse the WW Points system, exercising to pint of collapse in order to "earn" more food.
Not every dieter will develop an ED, just as not every person who has a drink will become an alcoholic.
And when we try to fit the profile of someone with an ED, we often don't feel as if we are "worthy" of help, because those profiles can be narrow. I didn't think I was bulimic, because I was chubby. Binges followed by vomiting and 40 laxatives a day didn't matter, because if I were "truly" bulimic, I would be skinny, right?
It's a disease that goes deep into the psyche. Food (or lack thereof) may be a drug "of choice," but it is still disordered, diseased behavior, IMHO.

Anonymous said...


Melissa said...

Sure, people choose to diet, but just because a fraction of those diets turn into eating disorders doesn't mean those people chose an eating disorder. In fact, I'd guess that the majority of eating disorders begin with a decision to diet...but that decision's relatively innocuous for people who aren't already predisposed to ED. I like the alcoholism analogy another poster mentioned. A lot of people choose to drink. That doesn't mean that alcoholics chose what happened to them.
Of course, on the other side of the same coin...with an eating disorder, at least once we're past the denial part of it, we choose to continue those behaviors, at least to the extent that, for example, a depressed person chooses to stay in bed all day. Or to the extent that an alcoholic chooses to continue drinking. I don't know if it's even possible to define how much choice is involved when mental illness is involved. You can't completely divorce symptoms of many of these diseases from choice...but you can't completely attribute them to choice either. It's somewhere in between.

Leigh said...

This post is indeed thought-provoking and my gut reaction was to say, no it's not a choice because there's something inside my brain that makes me think this way about myself. Immediately after that I thought, wait a minute, it probably is a choice and if I were a better person - a smarter, more balanced person - I would choose to be healthy instead.

Which suggests to me, Dr. S, that you probably shouldn't take a "yes it's a choice" answer at face value from a person with an ED! We blame ourselves for so many things that to say it's a choice is simply more of the same. Of course we'll tell you it's a choice - the wrong one, we know that, we're bad people, we don't deserve happiness or friendship or love or food. You see where the ED brain goes?

Anonymous said...

We make choices that may turn into eating disorders, but we do not choose to have the disorder. I don't think anyone decided to go on a diet with the intention of developing a full-blown eating disorder in the future. I decided to lose weight back in high school to feel better about myself. Had I known back then what it would turn into, I would have made different choices.

Sometimes it seems like we choose to stay stuck in the disorder; like we are choosing not to recover. Yes, we might make choices that are not conducive to recovery, but we are not doing it because we truly WANT to. They are not rational choices. We are making these choices because of the eating disorder. If I didn't have disordered thoughts running through my mind, counteracting every good decision I try to make, then I would have no problem making those choices.

So to answer your question...No, I don't think eating disorders are a choice.

Anonymous said...

Flushed said: "It reached another level when I ate a piece of pizza that was tomenting me and I was overwhelmed with guilt and anxiety I HAD TO GET IT OUT OF ME and that was the first time I made myself throw up."

I can relate to that. I've been binging and purging for 20 years. Sometimes I think I'll never be able to stop. and when i purge, I tell myself "why do you keep doing this to yourself??" for me, it's not about power, or getting a feeling of control, as it does for some. i just have to get it out of me, and quickly. IE is the only thing so far that helps me keep the monster at bay. I'm so deep into it, i doubt I'll ever be able to stop.

Incredible Eating Anorexics said...

i feel like it is a choice, but i'm not choosing to choose i can eat, i can choose to eat or not eat, but i can't choose to choose eating or not eating. o dear. that doesn't make much sense. I mean, sometimes i can choose to eat. sometimes i can't choose to eat, even if i want to, but im choosing to choose not to eat. (ive made myself dizzy thinking this through!)
please someone understand and word it better than me!

105 pound girl said...

For me, in the beginning, it was a choice. At 13, I did not choose to be slightly overweight, I did not choose to have low self-esteem, and I did not choose to have a mother having a mental break down and an absentee father. But to me, at the time, an eating disorder felt like comfort, like glamour, like it could promise me the world. If only I was thin and pretty everything would be okay. Of course I did not know that 9 years later I would see this as the biggest mistake of my life. But at the time, I looked at my life, and I naively and tentatively choose to have an eating disorder.

Charbelle said...

What an interesting question. I came across your blog through another that I follow. I think perhaps for each of us it's different. We come into it a different way, there are different reasons. In researching and looking back there were indicative behaviors, the chewing and spitting out food, the restricting food intake to a bag of cheerios and diet coke a day, the excuses of I've already eaten.
Then in college the food diary, the restrictive eating, the diet pills and caffeine pills. Finally that summer when I lived on my own and after years of trying I was finally able to make myself throw up. There was a freedom for me in that, I could then eat whatever I wanted and as much as I wanted. I had watched the movies, I had seen the stories that ED's are bad but I just wanted to fit in and be thin.
In looking back I chose to restrict or binge because I wanted to be pretty and I equated pretty with thin. I often times question what is normal. Our views of food and what's a portion size and how much and how often, there are so many conflicting articles. I try to stay within a daily healthy calorie range and excercise. It's hard because for so long I didn't have to worry about it, I wasn't planning on keeping it down.

screaming fatgirl said...

In order for there to be a choice, there have to be options. Most people who have eating disorders have no option. Their thinking patterns travel a one-way street. They may convince themselves that they make a choice, but they really are powerless to say "no" when it comes to avoiding purging or overeating or refusing to eat.

To me, asking if an eating disorder is like asking if a depressed person should just choose to "cheer up" rather than wallow in their own misery. They have no choice. We have no choice.

taosbones said...

When I choose to engage in my emotional eating behaviors I'm rarely experiencing a surge of strength and my choice reflects my desire to be RIGHT rather than HAPPY. It is a foregone conclusion that I will feel just horrid about myself after eating the entire bag of chocolate chips but the personal cost to me to fight the urge (even if I know that it will pass as soon as something distracts me) is too great.

And the giving in perpetuates my feeling of weakness which can beget another emotional eating experience, which makes me feel worse, etc., etc. We have all heard the story.

BUT sometimes I overeat, or eat inappropriately, just to prove I CAN. I'm tall, slender, an aerobics instructor and very few people will BELIEVE me when I talk about my food struggles and/or frustrations. So, I indulge myself secretly, just because the unhealthy part of me sometimes needs to be indulged. But then I feel like a "fitness fraud."

I think that the choice to engage in these behaviors is the simplest, easiest and safest way for many of us (without big, true, life-threatening disorders) can break the rules-it just tends to back fire.

Jackie T said...

I think this is a poorly formed question. The problem with eating disorders is not necessarily the relation with food itself. That's like saying the problem with Alzheimer's is dementia (rather than with the tau protein). Manifestations of illness does not equal the problem.
The problem in eating disorders, which you seem to know as you put it in your header, is the "Disturbance in the way one's body weight or shape are experienced, undue influence of body weight or shape on self evaluation, " as taken from the DSM.
I would argue that it is not a choice, much like other disease processes, some people tend to be set up to have a higher risk for certain things. Add to that the knowledge that eating disorders are only found in developed countries, and that when an un- or underdeveloped country undergoes development, the incidence of eating disorders also develops. So, much like other diseases, I think that it's a mixture of genetic risk and environmental exposure.
I think denying someone's disease as merely up to choice is kind of... terrible. However, I do believe it is a choice to seek help and treatment, much like with other diseases.
I would also argue alcoholism is also a disease.

Castlewood Treatment Center said...

Eating disorders can have many different origins. For some people, there is a fear of growing up and assuming adult responsibilities. Others function well externally, but inside are deeply confused. Some are trapped in the role of perfectionism, being “the good child.” Or has experienced a major loss during childhood. Others experienced tremendous pain in social interactions. Their families suffer from generations of unresolved trauma. Some are enmeshed, without appropriate boundaries. Eating disorders should be treated immediately without delay.

Anonymous said...

Its hard to say if eating disorders are a choice or not.

SO many women diet so why do people develop eating disorders? For me, I just didnt realize what I was doing, I thought I was just dieting. I couldnt see how thin I was getting, I didnt know I was unhealthy. I never 'set out' to get an eating disorder though..I never wanted to develop one and if I new I was I would have stopped. But when I got to that point it was to late..

dana <3

Peace & Love said...

I think it's a choice to decide to binge or not eat but it's not a choice to have an eating disorder. I think your choices you make may lead to something worse such as a disorder. Did you know that the first step to your friend’s recovery from an eating disorder is your support? I actually work with SAMHSA and the What A Difference A Friend Makes program. To find out ways you can help a friend suffering from an eating disorder, please visit

Kat said...

warning: this comment might be triggering to some

I chose my disordered eating. I actively made the decision to severely restrict my caloric intake. I was very careful about my activities. I loved my eating disorder, I loved being thin, I loved feeling hungry and giddy and on top of the world, and I loved feeling superior to everyone else. So I was careful, clever, and secretive about how little I was actually eating. I made certain to never quite be diagnosable as anorexic under DSM-IV standards -- I toed the line with vigilance and maintained my BMI at exactly 18.5 (which is actually very thin for me, given my bone structure, so it was still satisfying).

I had to stop when I started fainting. I loved my eating disorder, but I didn't want to die. So now I eat food like a regular person does, and I'm a healthy weight and all that good shit. But oh, how I miss the giddy high of the three-day fast, I miss being able to see my bones (collarbones so do not count), I miss that feeling of supreme self-control and discipline.

Yeah, I chose that life. And I'd choose it again in a heartbeat. I know I'm more beautiful now than I was then, but I don't care about the beauty; I want the control.