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Step forward, Two steps back

Posted Mar 26 2010 7:11am
Brody at the NY Times is right that Research Is Starting to Shed Light on Body Dysmorphic Disorder . I'm really pleased about this because BDD causes so much suffering and is almost universally misunderstood.

I'm not so pleased that BDD is gaining better understanding at the price of eating disorders: "unlike eating disorders, which mainly affect women seeking supermodel thinness."

One, the proportion of male ED patients is roughly 1/5, not some meaningless minority. It should go without saying that the sex ratio is a matter of incidence but not of the severity for the individual patient. Male eating disorder patients don't suffer less, there are simply fewer sufferers. This is true for MS and other illnesses as well, but we would not think to bring that up except as statistical information. We do it with eating disorders because we mistakenly think it "means" something at a societal level. It is time to stop repeating that endlessly and making male patients and their families feel marginalized.

Two, eating disorder patients are not "seeking supermodel thinness." That is absurd and offensive. Eating disorders occur at and persist into all weight ranges and the patient's perception of body size bears little relation to actual size and the distress is not lessened at "supermodel thinnness." Patients are not "seeking" anything; they are compulsively driven to avoid food and weight gain and report a range of "reasons" for doing so. It is a mental illness not a vanity play.

The saddest thing about the article throwing in that line is that the whole article could usefully have been written ABOUT eating disorders. The mistaken ideas about the illness, the treatment, and the anguish could be written of eating disorders. I happen to think of eating disorders as BDD with compensatory behaviors that maintain the illness, myself, in most cases.

Unhelpfully, the expert in BDDs cited in the article muddies the water in her blog post by describing anorexia as different from BDDs based on the tautology that it isn't because it isn't. If we looked at EDs as a form of BDD, or at BDD as a co-morbid or maintaining factor of an eating disorder, we'd be making progress. By defining an eating disorder as not BDD by describing the additional symptoms of an ED I think we serve neither population well.

One last mini-rant. The body dysmorphia of an eating disorder is often allievated or cured by weight and nutrition restoration. This is such an important fact that it amazes me that it is so rarely discussed. Eating treats the dysmorphia in most eating disorder patients. Patients often feel more normal in body size as they gain weight toward normalization. All the therapy we throw at the body image distress of an eating disorder, but we rarely talk about the functional role of malnourishment in those symptoms.**

**Well, some people do. See Guisinger.
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