Monthly Archives: December 2015

At one point in my decade long treatment for BED, I was in an Intensive Outpatient Therapy program, which is kind of a step up from standard individual and group therapies but not quite residential (live in) treatment. Five days a week, in the evenings, a group of us reported to the facility for various forms of psychological counseling and group activities. Most of us carried on this way after a full day of work or school. It was demanding, exhausting and, for many, efficacious.

There was, however, an element of the program that didn’t work, or not as intended. Wednesdays we had an hour long group devoted to Body Image, the idea being that we would spend the time discussing our relationships with our bodies, how we felt about how we looked and how it influenced our eating behaviors, how we were impacted by images in the media and how to overcome those triggers.

That never happened.

Oh, we’d try. We’d start out ranting about this commercial or that ad, talk about body acceptance and how unfair social expectations were and how awful people could be. We would be absolutely frothy…for about fifteen minutes. Then it would get very quiet and someone would bring up what their mother said that morning or what their brother or husband had done last night. Someone else would remark how that related to something that had happened when they were a kid and that would lead, in turn, to someone else talking about an older relative who did to them monstrous things no child should ever endure and suddenly we were back where we always ended up in these groups: dealing with the underlying emotional damage that is always the at the root of the compulsion.

Nobody ever said, “I saw an ad in Vogue today and it made me want to binge and purge.” It just never happened. So Wednesday Night Body Image Group turned into just another process group where we talked about the pain that had brought us all there in the first place.

The reason all this came to mind is because I ran across an article about research done at Oregon Research Institute into a particular type of ED prevention program. Nutshelled, the research found that this dissonance-based program changed the way young women’s brains responded to images of extremely thin models and, in doing so, ultimately reduced the risk factors for eating disorders. Using brain scans, the ORI researchers were able to actually “see” the brain responding positively to images of healthy female bodies while the reduction in reward response to thin supermodel bodies was visible, too.

The article set off a couple of firecrackers in my brain. Let me make it clear, I think having young women respond positively to healthy body images is great and I’m all for anything that promotes that. There is a part of me that is uncomfortable with the tail-wagging-the-dog approach of countering media filled with unhealthy images of women by “fixing” the brains of girls so they don’t respond to those images, but the world is what it is right now, so I begrudgingly accept the value.

What bothers me more than that is that it places the emphasis too heavily on body image as a factor in eating disorders. As emotionally satisfying as it may be to demonize the fashion and advertising worlds as the source of all that is evil, they don’t cause eating disorders. To quote the National Institute of Mental Health, “eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological, and social factors.” In the Jenga stack of ED causes, you can remove the Unrealistic Body Image block and leave the tower standing every time. There are millions of people exposed to freakishly unhealthy body types via advertising and entertainment; only a tiny fraction of those will ever develop an eating disorder.

Yet the popular notion that these conditions are caused and driven by the ubiquity of such images persists and that is neither accurate nor healthy. EDs are complex and difficult to understand. Implying, even indirectly, that we can put a dent in the problem by counteracting the images found in the media may be exacerbating the problem by obscuring and dismissing their true nature.

The other thing that set me off about this study and the program it focused on was the complete and utter lack of attention to—or recognition of the existence of—men. Men simply are not. The only acknowledgement that there is a male of the species in the whole thing is a tacit reference in a single sentence from the study that mentions eating disorders being “a key mental health problem that disproportionately affects young women.”

Oh-em-gee! Could you be any more dismissive? I can almost see the contemptuous waving of the hand at the mere mention of men with eating disorders. “Well, you know, actually they disproportionately affect young women, so…pish.”

And so…what? Men don’t count? Apparently, neither the program nor the study could be bothered to examine the impact this methodology might have on the brains of young men. Really now, how hard would it be to modify a program involving positive body imagery for use with men? (hint: not hard.)

It’s so blatantly sexist and discriminatory it’s staggering. Just to be clear, this sort of thing in the world of research is absolutely a two-way street; the marked tendency for heart disease studies to focus exclusively on men is legendary. Still, it’s not okay, it’s never okay. Every article that addresses the subject concludes that eating disorders among men are under-reported. At least part of the reason would certainly have to be the willingness of researchers to dismiss men as insignificant and unworthy of examination…because, you know…disproportionate.

Having conducted my own examination and carefully considered that approach to research and treatment, I’ve reached a somewhat unscientific, but I believe accurate, conclusion: it sucks disproportionately. Perhaps that will get it some attention.