Saturday, October 18, 2014

Almost Anorexic: A Book Review and a Personal Revelation

Almost Anorexic is a book published by the Harvard Medical School’s The Almost Effect series, which discusses the grey area of medical conditions that aren’t necessarily a diagnosable condition but are still definitely not in the “healthy” range. Eating disorders and other medical conditions exist on a spectrum. This book is about falling on the spectrum between healthy and full blown eating disorder, in the grey area with subthreshold conditions that don’t get the attention diagnosable conditions receive. It was a collaboration written by Dr. Jennifer J. Thomas, an assistant professor at Harvard Medical School, and Jenni Schaefer, author of the book “Life Without Ed”, who has recovered from anorexia nervosa, and is chair of the Ambassadors Council of the National Eating Disorders Association. I discovered Almost Anorexic while searching for books that would actually address my personal experiences with disordered eating. This book was the key to helping me to unlock and unearth what was probably my dirtiest not-so-secret secret. I call it this because it is not something that I am proud of and I have a great deal of shame and guilt surrounding the subject and while a few people know, I have never blatantly verbalized or acknowledged it publicly, so perhaps this is a revelation of sorts as well as a review on this helpful book.

People look to the DSM (Diagnostic and Statistical Manual of Mental Disorders) to know if they have a true problem, but while helpful, it also can be one of the biggest impediments to their actual healing if they can’t find themselves in the book. How do you properly treat your illness if you don’t feel you have a legit problem or it isn’t even recognized as one by professionals, family, or friends? This is one of the things that Almost Anorexic addresses. A lot of the reason people think that they don’t have a problem is because of the diagnostic criteria. Sadly, this can keep them from getting the help they really do need. If someone doesn't meet all the criteria for a disorder, they are typically diagnosed as EDNOS (Eating disorders not otherwise specified) or OSFED (Other specified feeding and eating disorders), which aren't even considered officially recognized eating disorders. I would have been in this group dubbed by some clinicians as “diagnostic orphans”. The point is all subclinical eating disorders are worthy of help.

I never became underweight which is required for an anorexia nervosa diagnosis but, like many other diagnostic orphans, I exhibited all of the same behaviors as someone diagnosed with anorexia nervosa. Had I taken the EAT-26 (Eating Attitudes) test back then, I'm sure it would have indicated I had a real problem. I also lost 35% of my body weight which actually WOULD get an anorexia nervosa diagnosis according to earlier versions of the DSM, which called for a weight loss of at least 25%. The DSM has changed since then a couple of times and is now on its 5th edition. In the newest edition I would be diagnosed as OSFED, atypical anorexia nervosa. Even though I gained all of the weight that I lost back after I stopped restricting on top of my intense exercise regime, I still carried many of these behaviors with me into my 30’s; I still struggle with the Binge/Purge pattern even in other areas of my life. Ed is still in my head and still has a big say in my daily life, whether I am fully aware of it or not. Awareness is half the battle. Eating disorders are behavioral disorders, and let’s face it...behaviors don’t just magically go away because you refuse to acknowledge them or time passes. There is still a residue. And while I am not currently dealing with full blown disordered eating anymore, I am still dealing with a lot of behavioral residue from the days when I was. I believe you need to acknowledge and change behaviors or you will unconsciously relive them repeatedly. You can’t change what you don’t acknowledge.

There is a drastic difference between healthy weight loss and an eating disorder. What I did in high school was not healthy and I know now that I most likely lost my gall bladder at the age of 16 because of how fast I lost the majority of the weight. I also know now that intense restriction is not a sustainable way to achieve weight loss...period. Restriction wasn't my only problem, though, as I also developed an obsessive relationship with exercise. Exercise is one of the best things you can do for your body, but not when you force your body to do it as a punishment when you haven't fed it anything for a week. I starved and abused my body, I desecrated my temple. My body didn't trust me anymore after this ordeal, and I am still working on regaining it's trust 20 years after the fact.

I was amazed by how much I found myself in this book, maybe not so much my current Self, but pieces of my Self, and especially that younger aspect of my Self. She was there in all of those pages. The book uses many case studies and personal anecdotes that I definitely found relatable. Almost Anorexic deals with the subclinical end of the eating disorder, while using stories from Jenni’s personal recovery to explain the obsessive relationship people can develop with food and exercise. It not only covers food related problems like binge eating and restricting, but also discusses compensatory behaviors and the highly important subject of body image. Dr. Thomas and Jenni discuss the physiological and psychological changes that occur in “almost eating disorder” syndromes. The second half of the book gives solutions and suggestions for recovery, and also includes helpful activities for you to do on your own, including identifying your social support network, and creating a personalized relapse prevention plan. An interesting exercise from Chapter 6 has you write two letters to your eating disorder, one as if it were a friend, and one as if it were a foe.

In my therapy, I have recently started to dive into this aspect of my story. I thought it would be helpful to "tell someone" as this book instructs. This secret casts a dark shadow on me and I am now working on bringing everything into the light. “For good and for real.” This book is a wonderful read for anyone who has had, has, thought they had, or may have an eating disorder. It is filled with an extensive amount of resources for help. I encourage anyone that thinks that they may have a problem with food and body image to read this book. I also encourage anyone who thinks that their loved one may have a problem with food to think about reading this book. I spent the majority of my life in a state of limbo, somewhere stranded in the middle of the spectrum. Almost recovered isn’t the same as fully recovered and while I’m almost there, I’m not going to settle for almost recovered anymore.

For Good and For Real,
Missie Sue


Almost Anorexic: Is My (or My Loved One’s) Relationship with Food a Problem?
Thomas, Jennifer J. and Jenni Schaefer
Center City, Minnesota:  Harvard University/Hazeldon, 2013. Print.

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