For me personally, the issue of recovery that I continue to struggle with the most, overexercise, certainly feels more like an addiction/OCD issue than anything else.
So although this column in the New York Times focused on alcoholism and drug abuse, I thought that it seemed extremely relevant to ED recovery also. Snippet:
What had perhaps started as fun and harmless use begins to grow troubling, painful and difficult to stop. The alcoholic becomes chained to alcohol in a way different from others who “drink normally.”
In various scenarios of addiction, the addicted person’s fixation on a shadow reality — one that does not conform to the world outside his or her use — is apparent to others. When the personal cost of drinking or drug use becomes noticeable, it can still be written off or excused as merely atypical. Addicts tend to orient their activities around their addictive behavior; they may forego friends and activities where drinking or drug use is not featured. Some may isolate themselves; others may change their circle of friends in order to be with people who drink or use in the same way they do. They engage in faulty yet persuasive alcoholic reasoning, willing to take anything as evidence that they do not have a problem; no amount of reasoning will persuade them otherwise. Each time the addict makes a promise to cut down or stop but does not, the chains get more constricting.
3 comments:
Cammy, you read my mind, I just finished this same article. I think EDs and addictions share a lot in terms of the irrational pursuit of some goal (unattainable thinness, the perfect high) at odds with normal, healthy, social functioning. The most obvious difference from a recovery standpoint is that alcoholic/drug addicts can avoid the triggers for their illnesses, while ED sufferers cannot avoid food, physical activity, the diet culture, hunger, fullness, etc. but instead must learn to live with them.
I guess another difference, in that same vein, is that EDs aren't necessarily addictions at all; I'm not addicted to food, for example, but I am obsessed with it in a lot of ways. That's just my experience, maybe BED has some element of food addiction but I don't know enough about it. Even if someone were addicted to food, full recovery would not remove food from his/her life. Exercise addiction might be a more appropriate basis for comparison to substance addiction, but the big difference there is that exercise is - in the majority of cases, but of course not in extreme cases - healthy. Smoking crack is never healthy.
However I fully believe that genetics can predispose people to EDs and/or substance abuse. I am also inclined to believe that, at in some cases, both are manifestations of other mental health issues (anxiety, stress, depression, PTSD, whatever) that appear in various forms depending on the person's environment, personality, family, social structure etc. Maybe I was doomed to develop some mental health issue, but maybe it would have been alcoholism if my circumstances had been different (e.g. if my father were an alcoholic and left vodka bottles all over the house, if I'd tried drinking in sixth grade, if I actually liked the taste of beer, etc). Who knows?
Good point about what people with AN or BN are actually addicted to. There is a really fascinating book called "Endorphins, Eating Disorders, and Other Addictive Behaviors" that suggests that part of what makes it so hard to recover from an ED is that your brain literally gets addicted to the neurochemicals that result from starving yourself, or to overexercising, or to whatever you're doing to stress your body into releasing endorphins. Same applies to cutting yourself, according to some studies. I'm sure this isn't the situation for all or necessarily even most cases, but it's sort of interesting to think about.
The downside to that book is that it was written at a time when bedside manner for EDs was a lot more brutal, but if you can overlook that for the science it's a fascinating read.
I've also often wondered whether, if my life circumstances had been a bit different, I would have ended up with just a different "issue", especially since the branches of my family tree are dripping with both alcoholics and EDers. You're right, who knows?
I personally suspect that EDs and addictions are related but not identical. Addicts and ED sufferers commonly share a number of predisposing personality traits and co-morbid problems, such as anxiety far pre-dating the onset of the illness. And of course starvation does have measurable changes on the brain, whether those are related to endorphins or not. But I think the genetic profiles will be discovered to be different. It seems that anorexia has been found to be more related to autistic spectrum disorders than addictions at this point. Maybe there are EDs or aspects of EDs which are true addictions, and other EDs or aspects which are something else entirely. Several leading researchers seem to believe that we will eventually find that there are not three or four but dozens of distinct EDs, each with particular biological and behavioural profiles.
It's a controversial topic anyway! I do like a bit of controversy :P
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