3 Reasons Categorizing Eating Disorders As 'Mental Illness' Is Problematic
Saying that eating disorders are purely a mental illness is oversimplified and problematic.
getty What is the connection between eating disorders and mental illness?
Eating disorders are diagnosable mental illnesses. So says the Bible for diagnosing psychiatric illnesses, the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Published by the American Psychiatric Association, the DSM includes hundreds of mental health disorders categorized by symptoms, for both adults and children. Updated every few years, the current version is DSMV.
Eating disorders have their own DSMV category, Feeding and Eating Disorders or "FED" for short. (I’m not sure if the APA intended the pun or not.)
Eating disorders’ inclusion as a mental illness in the DSM has advantages.
First and foremost, recognizing eating disorders as a mental illness adds legitimacy.
As a result, eating disorders are less likely to be viewed as a rite of passage, fad, choice, or attention-seeking maneuver.
Another plus of recognizing eating disorders as a bona fide mental illness is earlier diagnosis and treatment. (And insurance coverage.)
Identifying eating disorders purely as a mental illness is oversimplified — here are 3 reasons why.
1. It can go undiagnosed.
The National Eating Disorders Association reports 20 million women and 10 million men in this country will have an eating disorder in their life. That's a lot of people.
Speaking of a lot of people, imagine randomly asking people questions from a disordered eating screening tool.
Questions like, "How afraid are you of gaining three pounds?" or, "Compared to other things in your life, how important is your weight to you?"
The results of this experiment? You’d most likely find people without a diagnosed eating disorder reporting eating disorder symptoms.
So, if many people suffer from what is considered a disorder (knowingly or not), is the disorder a disorder?
This is where diet culture enters into the equation. Or, as I like to say, "fish not knowing they’re wet."
2. Diet culture is perpetuated.
What is "diet culture," anyway? It’s a set of beliefs that worships thinness and equates it with morality and success.
Diet culture is the lens through which you define attractiveness, worth, health, and your own body. It’s the air you breathe and one of the main factors affecting how you feel about yourself.
What does diet culture have to do with eating disorders? Everything!
Diet culture perpetuates eating disorders and makes recovery much more difficult.
Activist, dance champion, and marathoner Ragan Chastain says that diet culture is "particularly dangerous to those with a predisposition for, currently suffering with, or recovering from eating disorders."
Again, that’s a lot of people!
"Thinner is better, regardless of the mental and physical cost" is a diet culture belief. So is the premise that anyone can be thin if they just "try hard enough." These are the ingredients in a recipe for an eating disorder.
We are surrounded by images and messages that reinforce this premise and keep us hostage.
The message is clear: You have to have a certain size (thin) body and follow a set of rules (e.g., fitness and meal plans) to be successful, attractive, and worthy.
Again, this is fertile ground for eating disorders. (And a dark parody of taking the messages too far.)
3. It goes beyond what the DSM is as a culture-bound syndrome.
A culture-bound syndrome is "a cluster or group of co-occurring, relatively invariant symptoms found in a specific cultural group, community, or context," according to the American Psychiatric Association.
What do culture-bound syndromes and eating disorders have in common?
Research from 1995 on the island of Fiji addresses this very question. The mid-1990s is when American television first began broadcasting in Fiji.
Prior to television, there was no such thing as eating disorders in Fiji. Even though there was a lot of emphasis on food.
But the food emphasis was on the joy of eating and in delighting in the abundance of delicious food. The focus on pleasure is the opposite of diet culture messages.
By 1998, three years after Friends and ER were broadcast, that changed, especially for teenagers.
An astounding 11.3 percent of adolescent girls reported purging for weight loss. They said things like, "I want their (actresses’) body… I want their size."
By 2008, 45 percent of girls had purged in the last month. So, are eating disorders a mental illness? Yes.
But, complex biological, temperament, genetic, and sociocultural factors interact to yield an eating disorder.
Diet culture is a major player in that equation. Factor in diet culture messages and eating disorders can be thought of as a culture-bound syndrome.
Diet culture harms you. Actually, it harms anyone with a body.
That includes people who aren’t on a diet. And even people from a South Pacific island who until recently had a diagnosed eating disorder rate of zero.
So when thinking about eating disorders, please respect that many factors contribute to their development and maintenance. They are a mental illness, but so much more.
Dr. Elayne Daniels is a non-diet, Certified Intuitive Eating specialist and clinical psychologist in MA. If you’re struggling with your body image and/or eating disorder, contact her on her website or send her an email.