Regular readers of my blog will have noted frequently my frustration and despair and the utterly ridiculous, BMI-based diagnosis criteria for eating disorders in this country. Anorexics who have lost half their body weight in less than six months have been casually dismissed, whilst bulimics who are a ‘normal’ weight (whatever this might turn out to actually mean) are frequently told that they do not ‘qualify’ as having an eating disorder (as if it’s some sort of severity competition. “Congratulations! You’re nearly dead!”).
We’ve created a situation where only those prepared to defy everything their warped mental state is compelling them to do and give a candid account of their most secret behaviour, or, of course, those who reach the ‘magic’ weight of 5 stone are being treated.
At an Amazonian 5 ft 11, my lowest ever weight as an anorexic during my teens was just under 8 stone (that was around the point when my lips and finger tips were constantly white/blue even indoors and my eyes were closing of their own accord) and as a bulimic it was 10 stone (around the point that my uni friends started taking me to one side and asking me if I had a life threatening illness). At neither of these points was I deemed to have an unhealthy BMI. The most perfunctory visual assessment would have concluded without doubt that there was something very wrong and yet my eating disorder continued to ravage my body unchecked, until several years later, when I finally began to get proactive about helping myself.
Official statistics show that around 30% of people will make a full recovery from an ED. The figure could and should be a great deal higher and it’s merely a question of catching them earlier, before the sufferer is so utterly embroiled in their issue they have literally lost the will to be live. What defines an eating disorder is mindset and behaviour and the apparent symptoms on the physical body are almost incidental. We know, for example, that one does not have to physically faint in the street from exhaustion, rupture one’s esophagus or cease menstruating in order to do considerable damage to one’s long term health and put oneself under significant psychological strain.
People with EDs tend to have fleeting pockets of time during their illness when they decide they want help. It doesn’t take much for this brief flash of inspiration to be altogether eclipsed by the omnipresent voice of their condition, which tells them their friends, their family, their doctors don’t understand and are just jealous anyway, at which point they’ll shrink back into their self-carved prison, in preparation for yet more weeks, months and years of torture. If we can grab people when they make their first foray into recovery and find a way to assess their condition with a little bit of common sense, we can save a lot of heartache, both for the sufferer and for their families.
I therefore breathed an audible sigh of relief when I read a paper published yesterday by CNN entitled “Anorexia and Bulimia definitions hinder treatment”. At last some common sense is being applied. Below are the edited highlights:
"Some insurance companies will only cover treatment for eating disorders if the patient meets all of the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, a guidebook for diagnosing mental illnesses, doctors say. Patients who don't match all the symptoms, which include severe weight loss, are labeled "eating disorder not otherwise specified" (EDNOS) and sometimes don't qualify for the level of care they need……..
A new study, published in the journal Pediatrics, found more than 60 percent of patients with EDNOS met medical criteria for hospitalization and were, on average, sicker than patients diagnosed with full-blown bulimia.
EDNOS originally came about as a way of classifying people with dangerous eating behaviors and thoughts who didn't fully meet criteria for anorexia or bulimia, said Peebles.
But that means this single category can apply to an obese person who binges but doesn't purge, a severely underweight person who almost meets anorexia criteria but continues to menstruate, and a normal-weight individual who purges but doesn't binge, Keel said. For example, a person who regularly vomits after eating small amounts of food would fall under EDNOS, not bulimia.
"Some patients who are normal weight or even overweight are still very medically scary," Peebles said. "They are probably, I would expect, the highest risk to get missed in the community by either their physicians or their parents."
"We're seeing patients younger and younger, patients as young as 5," Peebles said. "Certainly 7 to 12 years of age, that's not uncommon to see anymore."
What kind of society believes it is in any way acceptable for EDs to be prevalent amongst 7 to 12 year olds? For the past twenty years, we have buried our heads in the sand, blaming the individual’s circumstances for what was deemed to be their private mental condition. Meanwhile as many as 1.2 million people in the UK continue to suffer (and that is, of course, 1.2 million diagnosed under the current, woefully inadequate diagnostic criteria, the actual figure is likely to be as high as twice that many) whilst we comfort ourselves with the notion that they must all have suffered significant trauma at the hands of someone who wasn’t us.
Is it a coincidence that the steep incline in EDs has mirrored the meteorological rise in celebrity worship culture, in the increasing availability of plastic surgery, the constant nagging temptation towards X factor style overnight fame and fortune which means that every young man or woman is now judged almost solely on aesthetics? We all condemn ourselves and others to suffer and we all have the responsibility for change. Take the first step today and go to www.bodygossip.org.