Living on the edge.

Disordered eating isn’t a specific characteristic or way of eating, and it doesn’t even often qualify as a medical diagnosis in itself. Despite what media portrays, disordered eating doesn’t look a certain way- even actual eating disorders plague those of every shape, size, gender, and weight. 

What is rarely understood by the general population and those suffering alike is that disordered eating is on a spectrum.  

The continuation looks something like this:

Body dissatisfaction or desire to shape shift -> going on a diet -> constant dieting -> noticeably disordered eating -> eating disorder.

What this flow diagram doesn’t show is that there are all kinds of healthy/normal eating patterns before ever starting on this path.  What works well for one person may look very different from what’s optimal for another.  Cultural and religious influences, food intolerances, family eating patterns, schedules, and preferences are some of the many variables involved in an individuals eating “style” and habits.  And, generally, these are all neutral influences.

But as soon as a connection is formed between a desire to change one’s physical body and manipulation of food intake to achieve such, the possibility of developing an eating disorder becomes a reality.

I’d like to introduce you to the concept of eating disorder adjacency.  

I am not at all implying that everyone who wants to, or needs to, lose weight will develop anorexia or bulimia.  And I’m certainly not implying that anyone who follows a specific dietary method of eating will eventually fall into the dark world of eating disorders.  Not all dieters have the genetic predisposition and personality traits typically present in those whose efforts transition from an “innocent” attempt to shape shift into a full blown earring disorder.  But nor does anyone know their susceptibility.  

The quote “genetics loads the gun but the environment pulls the trigger” exemplifies the complex relationship between eating disorders and the environment. This famous analogy by Dr. Judith Stern conveys the overarching message that all disease phenotypes are a result of interaction between different genes within the host, as well as between genes and the environment.  

The extent to which an individual’s diet develops an unhealthy compulsivity is a combination of their susceptibility and worldly experiences and interactions.  Susceptibility includes genetic factors, but also family of origin inter-dynamics, childhood and prior life experiences and traumas, and modeled emotional regulation.  The worldly experiences (the environment) typically includes both past and present exposure to societal pressures of conformity, behaviors modeled by influential others in one’s life, stress and ongoing traumatic experiences, relationships, and immediate spheres of influence.

So from this respective, one would correctly infer that, statistically, those individuals whose distorted relationship with food develops into a more severe mental and physical state, were likely more genetically predisposed to this form of disease manifesting as it does, and their life experiences and environment further encouraged the development.

But remember that disordered eating is on a spectrum.  So is the extent to which a distorted, manipulated relationship with food and body affects an individual’s ability to function in a healthy, balanced way through life.

The DSM-5 diagnostic criteria for eating disorders are fairly severe.  Unfortunately, the strict criteria for a formal diagnosis does not appreciate the degree of distress that can result from existing anywhere along the spectrum.   But the broadly accepted definition taken from Mayo Clinic is:

“serious conditions related to persistent eating behaviors that negatively impact your health, your emotions and your ability to function in important areas of life.”

The vast majority suffering with food and body image challenges do NOT qualify as having an eating disorder.  But this does not at all mean that their food struggles do not have tremendous negative impacts on the individual’s health, emotions, and ability to function in important areas of life.  And we know that, the longer dieting and body dissatisfaction continues, the more the brain adapts to a new norm of food manipulation and thinking through neuroplasticity.  The “environment” can, thus, be created to an extent from within! I wrote more about this in my post titled “Pain is not the same as harm”.

Jennifer Guadiani, a renowned physician specializing in the treatment of eating disorders wrote “Sick Enough: A Guide to the Medical Complications of Eating Disorders”.   Though oriented towards this more narrow population, the premise of the book is that most individuals struggling with dieting, overeating, over-exercising, or a poor body image frequently feel that they aren’t "sick enough" to merit treatment, despite physical and emotional problems that are both measurable and unmeasurable.

Eating disorders are on the rise at an alarming rate, especially in the US and other western culture nations.  And if the diagnosed number is climbing that fast, with the medical delineation as specific as it is, how many more individuals live their lives as ‘eating disorder adjacent’ people?  How many are teetering on the edge, never quite going far enough for it to seem like a ‘real problem’, yet suffering just as badly through their days?

If you feel like something isn’t “right”, something isn’t right. And that’s enough to deserve and get the support you need to back away from the edge.