A Specialist's letter to someone recently diagnosed with an eating disorder

Few clinical conditions are mis-diagnosed and inappropriately treated more often than eating disorders.

There is really only one eating disorder: the use of food - or an associated behaviour - for emotional reasons, rather than primarily for nutrition or taste.

Obesity comes from compulsive over-eatimg. There is no way of becoming morbidly obese other than by consistently eating too much.

Anorexia comes from consistently eating less than the body requires for metabolism and energy. There is a negative imbalance between calories in and calories out.

Bulimia comes from trying to have your cake and eat it - but not put on weight. Vomiting and purging get rid of the excess food that was consumed.

The substances that cause cravings are refined carbohydrates - sugar and white flour. Once these are eaten, cravings lead to ravenous hunger and an un-stoppable urge to binge until it is impossible to eat any more. The compulsive over-eater will then binge on anything. The anorexic dare not start to eat. The bulimic will get rid of the excess.

An eating disorder is really very little about food or body weight. Eating healthy food changes nothing unless sugar and white flour are excluded from the daily diet. Changing body weight is merely temporary: it can change back or it can swing to the opposite extreme. The eating disorder itself persists.

Alcoholics have to drink in order to stay alive. They drink water or milk or juices. But they cannot afford to drink alcohol, the mood-altering drink, because once they start to drink it in any day they cannot predict when they will stop.

People suffering from eating disorders have to eat to stay alive. But we cannot afford to eat the mood-altering foods, sugar and white flour. Once we start, we don't know when we can stop.

After being stimulated by sugar and white flour, some people binge on dairy products, others on fruit. A binge can be on anything. It is the process of bingeing, not primarily the specific food, that has a mood-altering effect.

Correspondingly, the processes of starving, vomiting and purging are mood-altering in themselves. We can get hooked on them in the same way that we can become addicted to sugar and white flour.

Other addicts also have behavioural components to their compulsive behaviour. Alcoholics tend to take in their first drinks very fast so that these hit the spot of emotional comfort. Drug addicts can get a mild high simply from being in particular places with particular people and sometimes with particular music played loudly.

Addiction is not solely a matter of substances. There are mood-altering behaviours, such as gambling and risk taking, sex and love. For sufferers of eating disorders, the common behavioural addictions are shopping and spending, work and exercise. We tend not to do these activities in the way that other people do them for something they need. We do them excessively, doing them as an Olympic sport, or not at all.

My own body weight used to vary by fifty pounds, up and down. I was always on diets. Nowadays it doesn't change other than by the few pounds that can happen in anyone. I weigh the same as I did as a young adult. I know not only how to get to a healthy weight for my height, but also how to stay there comfortably.

Check the following list of behaviours around food to see if you also have an eating disorder:

  • Being preoccupied by food, always having it on your mind.
  • Being most comfortable eating on your own.
  • Using food, or an associated behaviour, primarily for its mood-altering effect.
  • Using it as a medicine, as a tranquilliser, antidepressant or sleeping tablet.
  • Protecting your supply of food so that you don't run out.
  • Using food, or the associated behaviour, more than you planned.
  • Having a higher capacity than other people for your particular mood-altering behaviour.
  • Continuing this mood-altering behaviour despite being damaged by it.
  • Tending also to use other compulsive behaviours.
  • Being dependent on this behaviour in order to function effectively.
  • Tending somehow to find the time, energy and money for your particular food-related behaviour.
  • Continuing this behaviour despite the repeated serious concern of other people.

Any four of these addictive behaviours indicate that you have an eating disorder.

My aim is for you to have peace of mind in spite of unsolved problems, happy and mutually fulfilling relationships, spontaneity, creativity and enthusiasm.

A group of compounds that are an important energy source, including sugars and starch. Full medical glossary
The chemical reactions necessary to sustain life. Full medical glossary
A tube placed inside a tubular structure in the body, to keep it patent, that is, open. Full medical glossary
Relating to the veins. Full medical glossary
Expusion of the contents of the stomach through the mouth. Full medical glossary