Dealing with eating disorders

In Nancy Tucker's 'New voices' article 'The "ugly stepsister" of the eating disorder family' (October 2016), I am quoted as saying that online groups of eating disorder communities are groups of people who are 'mentally sick' and who display 'toxic behaviour'. I have since learned the source of this misinformation is the website Buzzfeed, whose reporter spoke to me briefly a long while ago.

Neither I nor any other properly trained eating disorder specialist generalises about the effects of social media and eating problems without detailed qualification, even though we may have private thoughts about the role played by social media in promoting or endorsing harmful behaviour. People active in ED communities or communications online may or may not be 'mentally sick', but many of them are not in robust mental health. After all, eating disorders are mental health conditions which are dangerous to physical and emotional health; they have high morbidity and share features with addictions, mood disorders, phobias, OCD and delusional disorders. I have no problem suspecting that many of the eating-disordered people who seek a following via social media platforms may have ongoing issues with mental health and pose therefore a potential danger to other vulnerable people.

The evolution from anorexia nervosa to bulimia nervosa is predictable, a natural consequence of sustained starvation; it does not require a personality rethink. For this reason, Professor Fairburn has suggested that we think of eating disorders trans-diagnostically, putting less emphasis on DSM categorisations with what we infer about the typical patient, and more emphasis on personal formulation. The person who evolves from anorexic to bulimic is simply revealing an aspect of their character that was already present, if suppressed, during the years of starvation. While psychologists and researchers try hard to categorise 'typical sufferers', it is often the exceptions that prove the rule, which is why in some cases diagnosis, and the personality attributes we infer from this, is dehumanising.

Whether it is anorexia, bulimia or their atypical forms that elude diagnosis, treatment is the same. Correcting dietary chaos is one priority. The other priority is to deal with the deeper psychological deficits which give rise to the salience of appearance and the intensive, intrusive pre-occupation with
food and weight which reflects it.

Deanne Jade
Principal, National Centre for Eating Disorders