The featured guest is Danielle Miller in discussion about Eating Disorders, specifically Anorexia Nervosa. The follow is a transcription of a live recording which was conducted on 2/22/17. View the DSM-5 criteria within the menu as well as a recipe below.

Hi I’m Danielle. We’re talking about eating disorders today.

**During the explanation of DSM-5 Criteria **

What I think is interesting about that is it says that you have to have a lower body weight, ant that’s how you get eating disorder not otherwise specified. You can hit all the criteria but not lose weight, which didn’t really happen to me, but that’s another topic. I think it’s very interesting that there is very specific criteria that you have to hit in order to be diagnosed. If you have a problem, you have a problem. That’s another issue with the DSM-5.

I know that I have been using the DSM-5 to give explanations of what the disorders are. But it does change. In the 1970s, Homosexuality was finally removed from the DSM. So it’s not always correct, if it does change in the future I will respond to those changes.

For eating disorders, there is a significant rate of mortality, especially with anorexia, due to the low body weight. You know your body can’t function very well if it’s not getting the nutrients that it needs.

Well, if you don’t have any fat on you either there goes all of your heart and brain functions. It’s not fun.

20% of people diagnosed either die from medical complications or suicide, so this is a very serious mental illness.

So when we were talking earlier, you mentioned orthorexia.

Yeah, I don’t think it is an illness included in the DSM. I went to a psychologist later but it was my doctor who mentioned it the first time. And then I went to a psychologist and was told that I definitely have disordered eating, but it sounds more like orthorexia than anorexia. So I don’t know what to do. I don’t know if there are even steps to take for that other than go to therapy, but that was the first time that I had ever heard of it. It’s healthy eating combined with rigid, disordered thinking about food.

I was an athlete, and after I finished with that in high school, I started getting into body building and working out. So that combined with only eating chicken breast with no seasoning, which is gross. You know, only eating this very, very bare minimum amount of food, thinking that I was going to be losing weight and bulk up at the same time, which if you guys are into body building, doesn’t make any sense at all. It was more about coming from a healthy perspective, but I still didn’t have any healthy ideas about food.

DSM-5 Criteria of Anorexia Nervosa

The DSM-5 (Diagnostic and statistical manual of mental disorders) is the standard classification of mental disorders used by mental health professionals in the U.S. Below are the DSM-5 attributes for Anorexia Nervosa.

  • Restriction of energy intake relative to requirements, leading to a significantly low body weight, for over 3 months
  • Intense fear of gaining weight or becoming fat, even though the individual is at a significantly low weight
  • Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of seriousness of current low body weight
  • Restricting
  • Binge-Eating/Purging (smaller binges than Bulimia Nervosa)
  • Biological Components
    • genetic Transmission of disorder
    • history of being overweight
    • parental obesity
    • low serotonin
    • increased dopamine to food cues
  • Dieting History
    • disturbs serotonin levels
    • begins a pattern of rigid control of food intake
  • Psychological Factors
    • stress during adolescence (the age of onset)
    • conditioning
    • difficulty tolerating negative emotion
    • associated family factors
    • enmeshment (poor boundaries)
    • overprotective parents
    • modeling of perfection
    • inter parental conflict
  • Social/ Cultural Factors
    • society’s emphasis on being thin
    • stigma associated with being overweight
    • acceptance of unrealistic body types
  • Treatment
    • no effective drugs
    • usually requires hospitalization (to increase weight)
    • psychological interventions
      • family therapy
      • cognitive behavioral interventions (ex. psychodeducation, hypothesis testing, addressing underlying fears, etc.)
  • means “fixation on righteous eating”
  • individuals have an “unhealthy obsession” with otherwise healthy eating
  • individuals become consumed with what and how much they eat
  • rigid eating style
  • self-esteem becomes wrapped up in the purity of the individuals diet

*Not currently recognized as a clinical diagnosis in the DSM-5, but many people struggle with symptoms associated with this term*

For those who don’t know, orthorexia, like Danni said, is not in the DSM; it’s not currently recognized but it very well could be added to a newer edition. The term was coined in 1996 and means “an unhealthy obsession with eating healthy.”

It all stems from an unhealthy obsession with food and control. So all the different types of eating disorders, I just group them all together because they all have similar causes. And of course they overlap with all these mental illness, which I have experience in. But it’s all about disordered thinking, you don’t think about food as a source of nourishment for your body; you look at it as something that I can control. It can be healthy if it’s done the right way, but it’s incredibly easy to do it the wrong way, especially with western culture and dieting. It’s incredibly easy to fall into an unhealthy mindset. And even the dieting mindset is unhealthy. I can’t go on a diet because I am instantly going to start restricting my food and go back to eating under 1000 calories and working out 4 hours a day. Some people can do that. Some people can go on diets and it’s good for them and they’re losing weight and they can stop but some people can’t do that. That’s when you get into crossing over to anorexia and other eating disorders.

Back to western culture, in my abnormal psychology class I learned that eating disorders are more of a western specific illness. It’s not as prevalent elsewhere.

To say that you have to have a conversation about colonialism and a whole bunch of stuff that we don’t have time to go into. But yeah, we’re focusing on western culture, there’s a whole lot of things that you can talk about with western culture and their obsession with being thin, or you could say societal norms.

A society’s view on bodies can really effect the people living within them.

That’s why, especially for women who feel that pressure and that pressure is if you’re not thin you’re paid less at a job or you are viewed as less attractive or less successful.

There is a lot of stigma towards people who are overweight. It can be genetic , it’s not necessarily their fault but a lot of people believe that.

Yes. But also if you are eating a lot, it is “your fault.” It doesn’t matter. Someone being unhealthy doesn’t really matter. It’s so weird because I took nutrition and public health classes and I was going to be a dietician. That was something that was highly emphasized in dietetic courses. My father is 250 pounds, big guy, but incredibly healthy. He bikes, he wants to go on a biking trip for a week, like bike across America. That’s stuff that I can’t do. So when I realized that, I am in no place to judge anyone. Ever. If you are overweight because of lack of access to healthy foods or lack of access to a walkable environment, that’s one thing. It has a lot to do with infrastructure and money in your community. There are a lot of things that are outside of our control when it comes to that.

That was very insightful. I want to talk about stigma perpetuation and then we can get into your interview.

A lot of people think think that individuals with eating disorders are vain and superficial because they care so much about their thinness. This is an example of a negative stereotype.

Yeah. Stereotypes come from a weird place of truth sometimes. In my opinion, hell yeah I was vain. I definitely cared a lot about what I look like, but that in itself is not a negative thing. You can care a lot about what you look like and still eat healthy and still see food as a positive thing. Since it it in “your control”, in a way, then it is not to be taken seriously.

So a lot of people assume that individuals suffering from eating disorders are to blame, they should just eat, or get over it. But it’s not that easy. Like I said earlier, eating disorders are linked to anxiety and depression.

Yeah, it’s never as easy as just do this and you’ll be okay. It’s never that easy.

I thought the same thing when my psychologist told me that I had a problem and that I needed to go to inpatient therapy. In my mind, I thought no, I’m fine, it’s in control, I can just eat a little more and exercise a little less. It’s fine. Even if I did that, it still doesn’t negate what my mind thinks; it doesn’t change how my mind thinks. What we were talking about earlier at lunch, it’s a physical manifestation of your mind. It should be seen as a kind of depression or an anxiety disorder. It’s all in your mind. There is nothing physical that you can really do to prevent you mind from doing something or telling you that you’re ugly or fat. You can’t just eat a meal and be okay.

You might not even know that there is disordered thinking. You think that’s just the way it is.

Yeah, and even if someone tells you, you will still deny it. I’m fine, I’m thin, I’m looking great now. There’s no way.

This one is important to me. Earlier I mentioned eating disorders are severe mental illnesses and a majority of people trivialize it because they don’t believe that they are  severe because the individual is in control. Or they are choosing to remain ill. I just wanted to make note of that again. It is a severe mental illness and people can die from it.

Tell me a little bit about your family and childhood.

So I’m adopted and I have a twin. I was adopted at around the age of two with my twin. I had some traumatic experiences before then but I have my mom, dad, my twin, and then they also adopted my younger brother. So we’re all adopted.

Do you have any good or bad memories off the top of your head? Tell us something that will give us a snapshot of you as a kid.

So my mom, growing up, was a bit of a butt. Well she was very strict, she’s black, we’re black, so a very strict black mom that grew up poor. She had a hard time with her mother. So when we started growing up, and it was around the time that I hit puberty, we started butting heads. She thought that I was going to grow up and be like her. So there was a lot of tension and a little bit of violence. We’re cool now but it was a little tense being around her.

I’m sorry about that.

Yeah. It’s all good.

Sorry to change the topic completely, but could you explain how your disordered eating began?

Like I mentioned before, I was an athlete in high school. I did cross country and track. I was a varsity captain of both of those. I did dance earlier in high school. So I was very active. Sixteen and seventeen is when I was doing cross country and track and I started eating healthier to improve my times. I was doing 5Ks in cross country. I was doing the 200 and 400 in track and you need to eat a certain way in order to fuel your body.

Did you do carb loads the night before?

That’s what we did. I read, about a week ago, that that’s not good for you. Which broke my heart, I like pasta Fridays. It was pizza and pasta Fridays. We would eat so much and then wake up at 5am the next day and go run. I read that that doesn’t do anything for you.

We just ate whatever my mom had in the house. We were sixteen, we couldn’t buy anything. So we pretty much ate her out of the house. My mom was upset about that because she is cheap.

I love your mom, but she really is.

She grew up poor and that’s how it is. Anyways, I started eating healthier and that was really weird because it quickly, overnight almost, ended up being that I could only eat certain foods. And that was me telling myself “okay, I’m eating healthier, I’m lactose intolerant, I’m not going to eat dairy” and then it felt like overnight that I could only eat chicken, carrots, no seasoning, no oil on anything because I didn’t want to get fat. I don’t even remember a middle period where I was transitioning from one set of thinking to the other, which is really strange to think about.

I think that draws attention to how mental illness seeps in. You don’t notice.

Because it’s part of your brain. How are you going to look back and say wow that was messed up, what am I doing here. Because it is you, it’s part of you. You can’t sit back and think that your thoughts are wrong because you don’t even allow yourself.

That was the end of my senior year. I was running track and ended up having problems during track practice. I would be running and I would get really dizzy and have to sit down. That didn’t even register to me that I should maybe eat more than 800 calories before I go and run for an hour and a half. So I would run for an hour and a half at track practice, go home and do workouts for two more hours. I was working out three and a half to four hours a day. I was fit and I looked great but I was almost passing out every day. I was not eating enough and I was going to track meets and doing really badly because I didn’t have that energy. I didn’t know what was going on.

So I graduated and started going to a psychologist, a person that I had gone to before. We started talking about my eating because I was still eating like that even though I wasn’t working out as much. I still had the mindset that I needed to eat a certain way to be skinny, to remain skinny especially because I wasn’t working out. She tells me that I had a serious problem and that I needed to go to inpatient.

Just to be clear, a psychologist is for counseling and a psychiatrist is who you go to for prescriptions.

Who can diagnose? I thought that it was just psychiatrists.

Both can diagnose, but they do different things. We’ll go back to talking about inpatient.

Oh okay. I had heard horror stories from my birth mother, who has struggled with bipolar disorder for over 30 years now, on top of alcoholism and a bunch of other things. So she had gone to inpatient involuntarily and she had been in a mental ward in a hospital. I don’t like the idea of institutions, although in some situations it is beneficial to remove yourself from a situation, but the way that she has always explained it to me has never been positive.

When my psychologist said that I needed to go to inpatient, here’s a referral, it’s going to be right down the street from your house, I decided that I was never going there. Never. I’ll just eat more. That was my thinking. I never went. I absolutely never went because I don’t think that being institutionalized would be good for my psyche. The idea of being in a place where I can’t leave freaks me out. It might be completely wrong of me to think that because I have never been in that situation but I could never do it. So I did outpatient for awhile.

How was outpatient and how long did you do it?

I did it for about a year and it was pretty good. I bounced around to a few different groups. I tried group therapy, which didn’t work out because I get nervous. I did group therapy for a whole different issue but all of this mental illness and trauma overlaps. Mostly I did outpatient with psychologist. Then I went to a psychiatrist and they gave me some stuff but I didn’t take it.

You don’t get cured. You just deal with it. I had to get to a point where I was okay with food, which is still an issue and I think will always be an issue. If you’ve suffered from eating disorders, it just doesn’t go away.

The same could be said for addictions as well. Even if an individual is sober, they will still get cravings.

Yeah. For eating disorders, you can’t look at certain material. I stay away from social media with celebrities and I try my best to stay away from bodybuilding or anything like that. I can’t do that. I have to limit myself from working out. It helps that I have bad knees so I have to limit myself. I can’t go on diets, I tried to vegan again but I can’t do that.

I bet cutting out a lot of food to become vegan blurs the line.

Yeah you start cutting out and realize that you are restricting. You brain says this is good, do it again. Don’t eat ever. That’ what happened to me a few months ago. I tried to go vegan again and instantly starting working out again. Instantly. I had to come to a conclusion, and thank god my boyfriend was there to give an outside opinion, which is what I needed. I had to come to the conclusion that I can’t do that. Which sucks because veganism is a big part of my beliefs. So that’s been hard.

You mentioned earlier that you have dietary restrictions, how does your lactose-intolerance affect your eating habits?

I do eat dairy because it is too difficult for me. I have to find a cheese that work with my stomach or I drink almond milk. I have to have something that looks like dairy. It sounds insane to me right now, while I’m speaking it, but yeah, I have to eat skim milk cheese. If I don’t then I start thinking that I can never eat it and then it just spirals down. Every time.

Did you disordered eating affect school or your mood?

That’s the thing; it didn’t. It never did. Now it does but I was very successful at keeping my eating habits away from all of my life. I felt like I could separate food from everything that was going on. Food was this thing that I had that I could control. It was just there for me to portion out as I saw fit. Back then I could eat nothing and be fine. So I kept that pretty far away from my personal life, and it never really affected me until it did. As I got older and needed more food and more active with my job, I realized that I need to eat because I can’t think when I don’t eat. At first it didn’t.

I wouldn’t expect that.

Keeping it separate? You kind of have to when you’re rationalizing it. You have to think that it doesn’t affect you, you’re not letting it affect you. It’s separate, it’s just a thing that I do. It doesn’t affect me or anyone else. You can say that about so many things but that’s the reasoning that I used.

People who are good at restricting themselves have a lot of self control.

Yeah. Well it could mean that or an addictive personality. You do it, you can’t stop and you’re really good at it. There’s pros and cons to both of those. My boyfriends friend is really into working out. He had some addiction issues with alcohol but then he stopped that and immediately had to move on to working out all the time. That’s just how he is. Thank god it’s something healthy but that mindset isn’t, which goes back to what we’ve been talking about today.

So you struggle with anxiety, how does that tie together with the eating disorder.

So I’ve honestly never been diagnosed with anxiety. I was diagnosed with depression, lots of similarities between anxiety and depression. Yeah, you hear about depression meals and that, but when I am going through lows, I can’t eat. And I can’t cook either. I have to have something liquid. If I’m going through something or feel it coming on, then I set a liquid meal replacement on the bedside so I can drink it.

Soylent right?

Yeah, I do. It tastes horrible. I have the 2.0 and it tastes like nothing.

To me it tastes like soy milk or oatmeal.

You lucky person. I have to put nutmeg and sugar and a whole bunch of stuff. But yeah that’s what my boyfriend got me for Christmas. It’s something that is easy and if you are depressed you don’t have the thought process going to make food. You don’t even have energy to make food. I can put the powder in water and mix it up and drink it. So that’s good enough.

So you have the powdered kind, not the bottled?

Yes. It tastes like trash.

I’ve only tried the Soylent that is premade in the bottle, which isn’t that bad.

I hear that’s a lot better and a lot smoother. On your stomach, the powdered version is a little harsher. So I have that if I run out of everything else liquid. I don’t want to drink that on the regular. I tried, because the whole idea of Soylent is to drink it as a meal replacement. It’s a great concept but it’s basically meal replacement shakes marketed to engineer bros. It’s weird, it has the consistency of glue.

If you can’t get out of the bed, have it right next to you. So you’ll have low energy because you’re depressed, not because you’re depressed and hungry. Just a little bit better when you’re dying.

You like to cook now. What are some of you favorite recipes?

I’ve gotten really into stir-frys. My boyfriend and I have a lot of stir-frys over rice with a soy sauce and oyster sauce mix. I’ve also gotten into frying food, which is not great for your stomach. Fried meat with soy sauce and rice is the most delicious thing in the world. It’s amazing. We recently got a rice cookers so we eat rice with everything. It even comes with a warmer.

I don’t know what it is but I feel like the carbs in rice are better for you than the carbs in bread. Which I know its not but it feels healthier. Its good for your skin, I don’t know.

Veggie Stir fry

Ingredients:

  • 1 baby bok choy, sliced lengthwise into ½ inch slices (substitute with leeks or a big bok choy if you can’t find it in stores)
  • 1 medium bell pepper, sliced lengthwise into strips
  • 1 zucchini, diced
  • 1 yellow squash, diced
  • 1 tablespoon of garlic, minced
  • ½ red onion, diced
  • 1 small shallot, diced
  • ½ stalk of green onion, chopped
  • 3 medium carrots, stripped with vegetable peeler
  • Meat, cut into thin strips (I like thinly cut beef, and I marinate it with half an onion and soy sauce for up to 6 hours before cooking)
  • Sesame oil and soy sauce to taste

Steps: Once all the veggies are cut up to your liking, heat up a saucepan with oil at medium heat (I like refined grapeseed oil for the high heat). Throw in the onions, shallots, and garlic with some sesame oil and let them cook for a few minutes. Follow with the carrot strips, bell pepper, squash, zucchini, and bok choy bits. Season with pepper and soy sauce while cooking. Once the veggies are browned and soft, throw in the meat and cook until just done. Serve over rice.

References:

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association.
  • https://www.nationaleatingdisorders.org/orthorexia-nervosa