A few days ago a paper describing the theory that anorexia may be more of a biological disorder than a psychological condition was disseminated in the media. The general gist as I understood it was that when the majority of people become malnourished the response of their body is to try to make them eat more, whereas when people predisposed to anorexia become malnourished, biological changes occur which serve to keep them acting in a way which perpetuates their malnourishment. In this theory, it’s this “broken” response to starvation which stops a person from recovering, not anything to do with personal choice or motivation. Sounds like my sort of thing, right? I thought it was interesting – I’m not entirely sure that I understood all of the ins and outs, but it seemed to be a variation of the type of research that I think explains eating disorders better than any of the old school psychological theories – and so decided to post it on the twitter feed I run for the ED charity. But however hard I looked, I could NOT for the life of me find an article on the theory which wasn’t full of ignorant/offensive/triggering comments. The comments on the Jezebel article were probably the best of the bunch, but some commenters still seemed determined not to get the point of the article. “So if I diet hard enough I’ll get anorexia?” one person wrote with obvious disbelief. A couple of people (ahem…I might have been one of them) replied saying that no, you need the right biological make up for weight loss/malnutrition to turn into full blown anorexia, but she replied again a few hours later saying “I was just following what the article said to the logical conclusion”. No you weren’t!
This, similar comments and far worse on other articles made me wonder why people are so resistant to scientific explanations for mental health problems. I can think of a few reasons. There’s fear and scepticism about the marketing of mental illness by drug companies, for a start. There’s an attachment to the theories you’ve learned and subscribed to for years too – for example, some people REALLY want to believe that eating disorders are caused entirely by the media’s emphasis on thinness because that’s what they’ve always been told, whereas others are certain that mental illness as a whole is an affliction of the weak and selfish. Even when presented with hard evidence otherwise, people who are truly wedded to a certain belief will find some way to discount everything else. I’m a nerd so I love scientific theories. It would take a lot to convince me that there was NO biological component to eating disorders – but if it could be proved, I like to think I would be open minded enough to change my ideas. It is painful to backtrack on deeply held beliefs, so I am glad that all the evidence points in the other direction at the moment.
From this point of view it makes sense that often the people who are most afraid of this kind of research are those suffering from mental illnesses themselves. Eating disorders are all consuming and the way the illness affects a person can make them deeply attached to the behaviours – becoming terrified of change and/or seeing the behaviours as having benefits which are too important to lose. Being told that this entrenchment in the disorder is a product of biology is kind of like explaining the biological mechanisms behind love to a besotted couple. It can seem reductive and dismissive – if you feel your eating disorder had a justifiable trigger you might feel offended by the growing evidence that the biggest risk factor is genetic. Someone who developed anorexia after dieting due to peer pressure might understandably believe that they had a clear and obvious reason for becoming unwell, as might someone who was abused and sees their restriction as a coping mechanism.
I used to feel that way. I went through a lot during my adolescence, and I felt that biological theories of eating disorders and other mental illnesses somehow suggested that my experience didn’t matter or didn’t harm me at all. Of course this isn’t true – mental illnesses require environmental triggers as well as a biological predisposition, and even if I hadn’t been vulnerable to any type of mental illness I would still have been traumatised by being bullied and raped. I just wouldn’t have developed anorexia regardless of how traumatic my past had been. Also, “environmental” encompasses more than just trauma. For instance, someone with the right biological make-up might develop anorexia after not eating properly for a few weeks due to a physical illness. A teenager who is prone to anxiety and loses their appetite before important exams might first unintentionally under-eat and then begin to starve themselves as the predisposition kicks in, despite the fact that exam stress is a normal part of growing up which many people go through without getting ill. It doesn’t mean that person is weak, it just means their brains react in a certain way to not eating enough. And if you take a hundred people on a diet, ninety nine of them will a) give up after a few weeks, b) lose weight healthily and maintain, or c) go overboard but eventually be forced to eat more by their body (yo-yo dieting anyone? Bodies don’t like being starved). But that final person with the right biology will be the only one to develop full blown anorexia in response to dieting.
That doesn’t mean that the media has a free pass to be as worshipful of emaciation as they like. It doesn’t mean that bullying or abuse doesn’t deeply scar people. It also doesn’t mean that anorexia is the only true eating disorder, and that bulimia, EDNOS and BED are lesser forms of disordered eating. People react in different ways to chaotic or insufficient diets, and there’s no reason why genetic predisposition couldn’t account for why, for any given scenario involving under-eating, some people become anorexic whereas others develop bulimia or a combination of ED symptoms, and the rest of the population escape scot free.
It does complicate things if your eating disorder began while you were going through a lot of stress or trauma. The behaviours seem to take on deeper meanings. Much of that disappears with weight restoration and/or cessation of behaviours – most of my eating disordered beliefs seem downright illogical now, but once I was convinced they were true and no amount of therapy could change my mind. Even so, I think that working out which fears were just part of the illness and which were more than that can be invaluable. For example, in recovery I had a big problem with adjusting to being female-shaped again, because it triggered memories of being raped. That was something I had to work on in therapy after I was weight restored, otherwise it might have caused enough stress to make me stop eating properly again. That doesn’t mean that being raped caused my anorexia, just that it complicated it and that the PTSD had to be resolved to make my recovery more stable.
There are no incompatibilities that I can think of between science and the lived experience of an eating disorder – but I found that difficult to accept once, and it seems that a lot of other people do too. I am always sceptical of research which suggests that a specific drug is a miracle cure for a specific mental illness. But most research is just looking for the best way to explain and treat illnesses. Studies like these might eventually make the difference between a twelve year old with anorexia getting the right treatment first time and recovering within the first year – and the same person living with an eating disorder into their thirties because they received poor, outdated treatment time and again. How can science be a bad thing?