Jon Richardson here, signing on for my first blog post as the Recovery Nerd. My aspiration for this blog is to talk about eating disorder recovery from a point of view that’s a little bit technical and also practically useful. I’m sort of a wonk myself; I like to have as much information as possible about everything that affects my life; and I’m aware that some ED recoverers, family members, and professionals in the field also have wonk-ish leanings and are interested in discussion about the more psychological-science-y side of eating disorders and recovery. I’m hoping we can all nerd out together.
My kick-off topic is, how weird are people with ED’s? This is a hotly debated topic among ED recoverers, treatment professionals, families and researchers, though we usually phrase the question differently, in terms like “Are eating disorders brain disorders?” or “Is that you talking, or the ED?” But what these questions basically boil down to is this: do people with ED’s have minds that basically work like everyone else’s? Could anyone, under the right conditions (or should I say the wrong conditions) develop an ED? Or is there some kind of malfunction going on in the mind of an ED sufferer, something that people without ED’s can’t relate to or understand because their own minds behave totally differently?
Before I give my opinion about that, let me say a little bit about what’s at stake either way. On the one hand, parents and friends of ED sufferers can find it quite reassuring and helpful to think of the ED as a brain malfunction. It makes sense of why the person they love has started behaving in ways that they find incomprehensible and totally out of character, and it does so without blaming either the parents or the person with the ED. Sometimes ED sufferers themselves find this perspective helpful for the same reasons.
On the other hand, there are possible downsides to thinking of ED’s as brain malfunctions. For one thing, it can also be very invalidating for people with ED’s to think of themselves as having malfunctioning brains. It leaves them with little guidance as to when and how far they can trust their own perceptions and thoughts, and when they should write them off as the distorted products of a malfunctioning organ. It also gives ED sufferers and their support people little guidance as to how to get their perceptions, thoughts and behaviors to a better place.
Here’s my opinion, after seven years as an ED therapist, hearing the stories and experiences of hundreds of ED sufferers: people with an ED are not fundamentally different from people without one. That is, ED behaviors and urges make sense in terms of normal human mental processes that everybody has. These normal processes can get into nasty feedback loops, which can certainly take people with ED’s to places that feel really crazy to both the ED sufferer themselves and to everyone around them. But, the steps along the way to those crazy places are actually quite understandable.
ED behaviors make the person doing them feel good, or at least less bad, as an immediate consequence. That makes them want to do the behaviors some more. Psychology wonks call this reinforcement. Reinforcement is a universal process among humans and all other animals with brains bigger than a pea, and it’s a very reliable way to turn an occasional behavior into a rock-solid habit. Reinforcement is why smokers keep smoking, why book lovers keep reading, why people try to win when they play games, and why dog phobics avoid dogs. It’s why your cat jumps up in your lap begging to be pet, and it’s why you fasten your seat belt quickly if you have a car that makes a super-annoying noise until you do.
People with ED’s tell me every day about how their ED behaviors make them feel good, or less bad, in various ways. That seems to me like a sufficient explanation for why they do them. There are dozens of reasons why ED behaviors might make someone feel good, or less bad. Here are a few:
- Our culture tells us that we should feel proud and accomplished when we lose weight, and scared and ashamed when we gain it; so we do.
- The more scared we become of gaining weight, the more that anything we think will prevent that (whether it’s true or not) will feel calming.
- Starvation tends to blunt emotions, which might feel good if we have lots of painful emotions.
- Throwing up releases vasopressins, which make us feel calm for a little while.
- Binging hits our dopamine reward centers, and also often helps people feel kind of spaced out and numb.
- Our culture tells us to feel proud of ourselves when we exercise.
- Exercise blunts anxiety.
- People may feel more attractive at a lower weight.
- People may feel less attractive at a lower weight, which may feel safer if they’ve had bad experiences with others taking a sexual interest in them.
To be clear, I’m not saying that absolutely everything about eating disorders is explained by reinforcement. Some of the extreme fears and distorted perceptions that come about in the course of an ED are not well explained by reinforcement, They do, however, bear a striking resemblance to anxiety disorders like OCD and phobias, and are probably the result of the same mental processes, which, again, are normal parts of our fear processing system that all humans have. (I’ll probably be nerding out about those processes in future posts.) And of course, in ED’s that lead to inadequate eating, the physiology of starvation gets involved as well. This leads to various ED phenomena like taking an intense interest in food even though you’re afraid to eat it, and feeling restless and fatigued at the same time.
The good news is that all of these — reinforcement, anxiety dynamics, and the direct effects of starvation on the brain — are lawful processes. The way that they work is fairly well understood, and the way to counteract them is also fairly well understood. While there’s certainly plenty of room for improvement in our understanding of these things, there are also a lot of wheels that don’t need to be reinvented from scratch. Lots more in future posts on everything that’s understood about these things and how to work with them!
But that’s more than enough for an opening post. Thanks for reading, and tell me what you think!
P.S. I’m an employee of Indiana University Health, but my opinions are my own and do not necessarily reflect the opinions of I.U. Health, nor of anyone but myself. I can be a bit of a bull in a china shop sometimes, so that seems important to mention.