I’m glad you have been able to recognize that appearance/weight concerns were not the motivating factor behind your ED. It is extremely difficult for people to understand that AN is not caused by society’s obsession with thinness. In fact, most of my colleagues, trained therapists and physicians and dieticians who treat EDs, continue to persist in believing that EDs are caused by a desire to be thin. The most important things are that 1.) YOU understand the truth about the etiology of EDs and your triggers, and 2.) YOUR TREATMENT TEAM understands the truth. Clinicians who are ill-informed about the causes of EDs are likely to employ treatment methods that are less effective. It would be wonderful if your close friends and family understood, or at least remained open-minded to what you have to say, rather than perseverating in their own uneducated notions. Presenting them with some evidence-based literature on EDs might help.

Remember, for centuries people (including scholars and scientists) thought that the world was flat. They persisted in this belief even after there was concrete evidence to the contrary, courtesy of 15th-century explorers. The world was round all along. Just because a majority of people, or even a majority of “experts,” believe something, doesn’t mean that it’s true.

Best wishes in your recovery.

Thanks for your comment. I agree that this is not a black-and-white issue. As I mentioned in the blog post, genetics and biological factors clearly play a major role in BN, it’s just that research suggests that culture also plays a major role. In contrast, culture plays a role in the way AN is experienced and interpreted by the patient, and in the way other people interpret the illness. However, the core features of AN seem to transcend time and culture.

Research shows us that there is a tremendous amount of crossover between AN and BN symptoms. In many cases, BN follows after a period of restrictive or binge/purge AN, and there is evidence that BN (at least the bingeing symptom) is, in large part, the body’s adaptive reaction to a period of starvation (thus biologically-based). Even people with BN who have never had AN often report that their illness was triggered by a period of dieting. I think there are two important elements of BN that seem culture-bound: 1.) The bingeing symptom of BN can only occur in cultures where there is immediate access to very large amounts of highly palatable foods (modern, developed nations such as the USA), and 2.) The purging symptom would probably only occur in cultures in which it is desirable to avoid weight gain (modern Western cultures). There are historical accounts of the wealthy ancient Romans eating very large meals, then retiring to the “vomitorium” to purge before embarking on their next course. However, it sounds like these events were reserved for special social occasions and bear little resemblance to the secretive binge/purge cycle of today’s bulimics. Additionally, I highly doubt that these ancient Romans experienced the extreme anxiety, depression, self-loathing, and body image disturbance that characterizes today’s bulimics.

You’re right – research suggests that culture plays a causal role in bulimia nervosa but not in anorexia nervosa. In regards to EDNOS, I’m not aware of any literature on cultural causation, but keep in mind that most people with EDNOS have sub-syndromal AN or sub-syndromal BN (meeting most but not all of the requirements for diagnosis). I would suspect that culture plays less of a role for individuals with sub-syndromal AN and more of a role in sub-syndromal BN. I suspect that culture and environment play a major role in the causation of Binge Eating Disorder (BED). Binge eating is often the result of prolonged dietary restriction, so I would suspect that individuas in cultures that glorify thinness and encourage dieting would produce more people with BED. In addition, in order to binge, one must have ready access to large amounts of highly palatable food, which only occurs in developed, industrialized nations. In response to your question about crossovers (people with AN who later develop BN), I don’t really know the answer to that. I would suspect that culture is not a causal agent for people who have ever met criteria for AN, regardless of whether binge/purge behaviors are present during the AN phase, and regardless of whether the person later develops full-blown BN. In these cases, binge/purge behaviors seem like a biologically-based response to prolinged malnutrition. My view is that in order to starve oneself to the point of emaciation, a person MUST be hard-wired for AN, whether or not bulimic behaviors are present. Many people have tried unsuccessfully to “become anorexic” and ended up with bulimia nervosa instead.