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What quasi-recovery feels like

TW: explicit discussion of disordered thoughts

There are many competing narratives when it comes to understanding what it means to ‘recover’ from an eating disorder. There’s a term that gets thrown around in online eating disorder recovery spaces, that is; ‘quasi recovery’. Usually this means something like making an attempt to recover but still participating in some of the behaviours associated with your eating disorder – so basically anyone who isn’t ‘fully recovered’, if we’re honest. The idea is usually that in order to ‘fully recover’ one should be constantly striving to rid oneself of any behaviours and disordered ways of thinking entirely. There are differing views as to what that might look like and, also, whether it’s even possible.

Can you ‘fully’ recover from an eating disorder? It’s a complicated question. I wanted to write this because I’ve observed a lot of different narratives about this and I’m interested in why that is and who is invested in which, what motivates them?

What does it mean to live with a brain that still has all the thoughts but not to act on them? Is that really what recovery is? Sometimes it feels like it hurts more. That isn’t true but you want it to be true. Then you’d have an answer to it all which is, of course, to relapse. To go backwards. To retreat. Go back, deep inside, where it’s safe.

Recovery feels like such a healing word – it makes me think of little wooden huts inside a great, deep pine forest and there are sparkling springs and everything feels fresh and clear and smells amazing. It makes me think of being under blankets, sitting in a window seat with a really nice mug of a hot drink, writing in ink pen something deep and meaningful. It makes me think of a respite, a pause whilst you figure things out. Everyone’s waiting for you but you take as long as you need. Someone makes all your meals for you and they all taste perfect. You don’t have to worry about it, there’s enough vegetables and fruit and protein and everything. And you just do yoga all day and you’re really good at it. You walk around the forest and swim in the water. Nobody asks you to weigh yourself. Nobody asks anything of you.

Maybe that’s what rich people do. I don’t know. It’s definitely nothing like anything I’ve actually done in recovery. I still live in Birmingham, I still need to work or claim benefits or both. I don’t have a window seat with a nice view. I have to cook for myself most of the time or order in or just don’t eat for fucks sake. I’m tired. I feel like I suck at yoga now because I couldn’t do it for a while and I made it into this fucked up competitive exercise thing which is so not what you’re meant to do because I’m an idiot. People are always going to ask things of me because capitalism.

My experience right now is constantly having neuroses about the food I eat, often fucking it up by not eating for a while then eating loads and making myself feel sick and giving myself heartburn all the time. Worrying about getting five fruit and vegetables a day and counting them obsessively. Deleting and then re-downloading my calorie tracking app every other fucking week. Still can’t deal with putting spread on anything and want to scream when other people do it for me.

Wanting to train really hard, making myself exercise plans, feeling better when I tire myself out. Wondering how the fuck I’m meant to fit in three strength workouts as well as swimming, climbing and martial arts. The answer is you’re not. It just feels like all this eating…you’ve got to do something about it.

Being entirely terrified of gaining any more weight.

I want it to be over. So fucking bad.

I think there’s a lot to unpack about the term ‘recovery’ in and of itself. It’s used in a lot of different contexts including recovery from addiction, eating disorders and other types of mental illness. It presents a certain type of narrative – that of being unwell and of actively seeking to address this. It is presented as some sort of ‘journey’ that one has to pursue, something to be actively worked on and committed to. From an outsider perspective it seems fairly straight-forward – you have a mental illness and you try to recover from it in a similar way that one might go about trying to recover from a bout of flu. There are things that help alleviate the symptoms, you have to do a lot of resting, if you’re lucky you can take some time off work and eventually you won’t have the symptoms any more and you can go on with your life.

I think there are several tendencies, schools of thought and approaches to eating disorder recovery. One I’ve noted often in online recovery orientated spaces seems to relate more to the addiction analogy; the same kind of thing that one has to pursue when signing up to Alcoholics Anonymous or a ‘12 step program’. This appears, at times, as an all or nothing approach, usually promoting abstinence only rather than harm reduction. It maps on to eating disorders in some ways, or tries to.

Firstly, the ‘12 step program’ approach is not necessarily scientific; it’s religious. It will often explicitly ask people to put their faith and in a ‘higher power’ of some description in order to be able to believe that, in some way, they are at it’s mercy in their recovery. Or else, the idea is that you should accept passively that you are ‘ill’ but also accept actively that this is all down to you personally – a fundamental contradiction of concept. Does this Higher Power take away agency or award it? Certainly, many of the ‘steps’ involve taking accountability for one’s own actions but, not only this, taking responsibility for getting ill in the first place. For addiction this certainly appears to be self-evident – didn’t you chose to drink or take drugs? If we treat eating disorders as a type of addiction, which seems to be the proposal to some degree, then did you not also chose to not eat?

I find this framing comes from a culturally specific context in the USA. Religion is, in many ways, more powerful as a political force in the US which then impacts on the type of healthcare provision provided, lobbies and what is seen as acceptable in treatment. There’s probably a whole lot more to unpack in this vein but suffice to say that this provides a little context for how narratives of recovery seem to play out in self-help books and online recovery communities at times.

I’ve found a lot of these concepts are parroted or mirrored in ‘recovery content’ on social media – the core tenants being; full recovery is possible, this means no longer enacting any of the behaviours or thoughts associated with your eating disorder, this is the ultimate goal and one that is obtainable. This is, at it’s core, an abstinence approach. This, I think, is where terms like ‘quasi recovery’ make sense – as in, you can acknowledge that someone has put work into recovery but they have not fully abstained and therefore their recovery is only partial. This is usually framed in a fairly compassionate way but many posts are also quite firm: you need to challenge your thoughts, this is the only way to really be recovered and you cannot hope to achieve happiness if you’re not able to do this.

What’s quite attractive about this approach is that it promises an end to your suffering. Like – it really will end, you really will no longer suffer from these thoughts and behaviours, you will be free. Even people like Tabitha Farrar, who is not particularly openly beholden to the addiction recovery style approach, do make claims like this. As in, that you can really be free of the behaviours and thoughts of your eating disorder. I don’t claim to know the answer to this but what I do think is that this promise lays out a particular way of viewing eating disorders and mental illness and recovery from them as some sort of personal development journey. Within this framing there must also be the promise of freedom and also the belief in the fundamental possibility of freedom.

I don’t think everyone who claims that full recovery is possible necessarily is beholden to the abstinence ideology of addiction treatment but I do believe there is overlap. I think the other tendency within the full recovery advocates is one of self-help, CBT (cognitive behavioural therapy) and ‘brain re-wiring’. As in, the idea that it is possible to unlearn behaviours entirely and this is why you’ll no longer have the behaviours or thoughts of your disorder eventually.

This is not without evidence, incidentally, as CBT is very much ‘evidence based’ which is why the NHS love to wheel it out so often. It’s very outcome focussed and has been shown to improve symptoms particularly in patients with OCD and similar behaviour based issues. This is because it essentially attempts to systematically re-train your brain to have a different response to the same stimuli. The thing that was viewed as a threat may stop being viewed as a threat with the right practice and perseverance. If this works then it stands to reason that you could theoretically eventually train yourself out of all eating disorder behaviours and thought patterns.

When you are suffering so acutely, when your life is utterly miserable and filled with these disorders there is nothing you want more desperately than the promise that your suffering will end. Yet there are those who claim that one can never truly recover from an eating disorder, that you will always be in ‘remission’ from it and that it could return at any point in your life. The phrasing of ‘remission’ posits the disorder like a type of cancer that must receive aggressive treatment constantly and be checked up on regularly in order to prevent relapse. And so, this might be seen as more analogous to a ‘harm reduction’ approach if we are to continue with the addiction analogy. The idea being that there will always be thoughts, behaviours but that they can be reduced and the person can be taken out of harms way via treatment and constant vigilance around relapsing into the full disorder (usually correlated with severe weight loss).

This is quite a bleak view, primarily seeming to be taken by professionals who may have more experience with the severe end of the eating disorder treatment spectrum. Certainly it seems to be true that many patients with severe symptoms in need of things like re-feeding seem to revisit hospitals and in-patient treatment visits multiple times. There is also an explicit acknowledgement of relapse; one that almost anticipates it, rather than merely accepts it as a possibility.

So, of the two approaches there seem to be flaws – namely, in an all or nothing approach there is this singular drive to perfectionism in recovery that mimics that of the eating disorder. Yet, in a ‘harm reduction’ approach there is a type of fatalism which almost pre-determines relapse as this even encroaching force in your life. Of course, there is a lot more subtlety than this in reality which it is difficult to portray or even understand when you’re muddling through this yourself.

When I was first trying to recover I felt so confused by the seemingly contradictory advice I was being given. I read Tabitha Farrar’s recovery books, followed a bunch of recovery accounts that were doing this ‘all in’ approach – basically, eat as much as possible, anything you want, all the time and stop exercising completely. The idea being you just constantly challenge your brain, take opposite actions and throw yourself straight in the deep end. Meanwhile, professionals and other books had a more conservative approach which included making meal plans and gradually scaling up the number of calories I was eating until I got to more normal levels, introducing new foods on a weekly basis and only doing simply exercise like yoga. These two approaches more or less map onto the ideas about recovery I described above – full recovery = all in; remission = gradual approach. Both make sense when you follow their internal logics. At this point I don’t think I understood that the reason they were so different was because they had competing views of not only what was possible in recovery but also what recovery actually was.

So, is recovery striving to go ‘all in’, rid yourself of every thought, behaviour and logic of your eating disorder and anything less is merely ‘quasi recovery’ or, at the very least, a partial recovery? Or is it some sort of game you play, staving things off for longer and longer until their inevitable return but maybe, just maybe not quite so bad this time because you’re prepared for it? Certainly both scenarios are far better than having a full blown eating disorder and in both many of the key symptoms of starvation will begin to alleviate, your physical health should improve significantly and you’re overall likely to be doing better mentally.

My experience is that recovery isn’t linear, in any case, and I think that means it’s possible that both of these ideas could be true and it’s just the framing that’s different. Was my little relapse over Christmas because relapse is inevitable and I had just been in remission before? Have I now returned to remission? Or is it because I didn’t commit fully enough, because I wasn’t ‘all in’ enough? Did I just have a slip up but I’m still on my way?

In a way – what does it matter? Perhaps the reality is what works for one person may not work for another. I really hope people who say they are fully recovered are right. I hope people who say they’re in remission feel satisfied with the work they put in. I’m just under five months in to my journey so, the truth is, I don’t know how things will end up for me. All I can do is keep trying.

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Gender, sexuality, weight and desire

It makes sense to write about the intersections I’m currently living within; that of genderqueer (yes, I still use this even though it’s quite passe nowadays), bisexual and disabled.

It makes sense yet I’ve felt I didn’t have much to say on it that wasn’t haltingly embarrassing or actually made any real sense. Trying to describe something that is a set of situations, emotions, tendencies, politics, bodily functions, sexual acts. Being thin or fat is a part of it and everyone knows it. There are those who are explicit about it and those who coat it in sugar or think they don’t care about it.

When I came out to my family via email as non-binary – attempting to short circuit what I felt could’ve been a series of deeply painful conversations – I tried my best to explain all the terms and thought processes I had. One family member in particular took issue with this; called it patronising and patronisingly reassured me that she knew trans people and I, she knew, was not one. She knew this because she had known me as a child and I hadn’t shown ‘the signs’, whatever cis people think those are (I guess acting like the opposite gender in clear and obvious ways). Another thing she said to me is that if I worked on losing some weight, went off that psychiatric medication that had made me pack on the pounds, then perhaps I would be more satisfied with my body and wouldn’t feel the need for all this trans stuff.

Apart from being quite an awful and vindictive thing to say, I do feel there was some truth in it. The idea that women’s bodies are more acceptable and feminine if they are smaller and thinner and therefore if I were to become smaller and thinner I might feel more able to fulfil a feminine role.

For my part, I think my sense of my gender has always felt fairly ambiguous. When I was young and trying to come out I leaned more heavily towards a trans masculine identity because it was the best way of asserting myself as no longer cis. I’m also a firm and controversial believer in some things being true at a certain point and then no longer true later on down the line. I was lesbian when I felt I was. There wasn’t a mistake. I was trans masculine when I felt I was and this was also not a mistake nor was I wrong about it in any way. I am still trans, non-binary, genderqueer; for what it’s worth, which doesn’t feel like an awful lot these days.

Understanding one’s gender and sexuality is part of a process of trying to assert and understand yourself. You have desires that you want to enact, you have ways of moving through the world, you have something in you that is not normative. Sometimes you want to change your body in order to be recognised in the ways that you need to be. This need is deeply painful and, sometimes, it feels unclear how to meet it.

Wanting to be thinner is a fairly normative desire for many reasons – primarily, rampant fatphobia and how this ties into desirability. It is assumed by most that everyone would rather be thinner and it probably isn’t too far from the truth. Before I developed an eating disorder I had a notion that I’d like to be thinner but had many other things to distract me that seemed more important. I thought perhaps people would find me more attractive if I were thinner, though plenty found me attractive already. I thought perhaps my ex would want me again if I were thinner. I thought maybe I’d be more successful somehow, be thought of better, be an object of admiration. These are all what I would term ‘normative’ desires around thinness.

Wanting to be thin is about wanting to fit into the norm. Wanting to change your gender…can be that for some people but it feels less obtainable, somehow. Or it always did to me: being bigger is being more masculine; being smaller is being more feminine. A simple, devastating binary.

Many trans people want to change their bodies but being able to do so has become increasingly challenging over the past few years, with the average wait time on NHS gender identity clinics being a matter of years, rather than months. There is the prospect of going private, of course, if you can afford it but the on-going costs are too much for most. So, what to do?

Changing your body can take many forms but gaining or losing weight feels like the most obvious one – the one that most people seem to have access to. The type of body you should have isn’t just defined in your gender expression but in the ways you wish to express your sexuality. Do you want to get picked up by gay men? A muscular, toned, buff figure will help. Do you want to get picked up by straight men? A slim waistline with subtle curves will help. Know your market and what they desire, change your body to reflect this.

We are sold the idea that changing our body is something that, although not necessarily easy, is possible. This is technically true yet comes with a whole host of lies and propaganda that posit the body as machine with inputs and outputs and some level of consistency. The body is unruly, earthly desires demean it – this religious propaganda seeps into our lives even as religion itself loses it’s grip on society. Attempting to control the body is not a new phenomenon. We have always been trying to do so, under various guises. A focal point of misogyny lies in its fixation on policing a woman’s body and this includes her size. For trans people the body is deeply scrutinised and weaponised – a site of violence and politics, rather than their own.

The body is valued through the lens of desire. Desire is created through various means, it does not come entirely from us and what we desire can be hard to interpret alongside a brutal campaign of racism, sexism, fatphobia, body fascism. We value our own bodies through their desirability to others, we understand our own gender through desirability, too. Being locked away, I felt I could emerge with my body a more normative object of desire.

As a queer person, why did I want this? We are not immune to heteronormativity – it haunts us still, it shapes our desires, our wants. To be a woman is to want to be desired by men, so it goes. This is what we are taught and even when we reject it, a part of it stays with us. The want simultaneously to be wanted and the fear of being wanted. Being wanted is dangerous, it invites violence. Our bodies invite violence, so they say. But they also invite validation, success, inclusion. They invite sex – something we are not allowed to want but should always be primed for.

I was raised under womanhood and most of my life I have been treated as such. Not always a heterosexual woman, a gender conforming woman – I’ve been called dyke, lesbo, not shaved my legs, shaved my head. My experiences align with queer woman and other non-binary and gender non-conforming people. My body has been subjected to violence along these lines but always, it seems, through my relationship to womanhood and performing it correctly or incorrectly. My body has been shamed by men for not performing womanhood. My weight played into this, for better or worse, when I am thinner the violence is more sexualised, when I am fatter the violence is queerphobic. Perhaps I perform femininity better when thin, when there is less of me.

Yet being very thin my body felt androgynous in some ways. There are times when the body escapes sexualisation because it is so clearly lacking in health and vitality, so clearly broken. Gender plays itself out in our fat distribution, our hair, our eyes. Many cis women with anorexia lose their periods, a sort of de-gendering to match their increasingly un-gendered bodies. Maybe for trans people losing their period is also this and even a desirable outcome. A way of opting out of gender, through slowly dying. Of course, it is no real way out.

Regaining weight, I’ve reached a point of desirable thinness again. Isn’t this what I wanted all along? Don’t anorexics do it to please men? (we don’t need to have a sex drive to do that)

When you’re starving yourself, of course, you don’t have much of a sex drive. You don’t have desire and you’re beyond desirability. Again, the opt out. So what now? Now you’re in again? Now you want to fuck again and people want to fuck you? Gender is real again and it’s out to get you. The whole painful, joyful thing. Everything you’ve tried to avoid.

A comrade described the distinction between dysmorphia and dysphoria in the following way: body dysmorphia is understood as wrong thoughts about a right body, while dysphoria is thought of as right thoughts about a wrong body. Though they admit this is a crude distinction, it is, perhaps, illuminating for those who experience both. I’ve written previously about my own body dysmorphia, centering around my size but what of my dysphoria? Some of it seems centered around some similar things – my face, for example, because I think it looks round but also because, to me, that means it looks more feminine. So, am I correct about that in some ways? Either way, it doesn’t seem to be something I can change to my own satisfaction. Even losing a lot of weight didn’t seem to ‘help’ with this.

Queer people always grapple with complex feelings about our bodies, desire, weight. Yet, not only us but heterosexual people, too – I think they are even less able to articulate this because when one is inside the norm it is hard to gain perspective on it, even when it is painful. They hold these things as self-evident – that being thin is good and desirable and being fat bad and repulsive. That being a man is to desire and appeal to women and being a woman is to desire and appeal to men. Very straight-forward, really. Queer communities only alter the narrative slightly at times – men still judge one another in similar objectifying ways to the one’s they were taught in relation to women, just translated. Women still judge one another, police one another.

One could almost argue that women play some of the more significant roles in inter-personal body policing. Whilst systematically fatphobia is enacted primarily by powerful men via the medical profession (male dominated the higher you go) and via government policy (again, the purview of men) in our intimate relationships the role of the Mother and female relatives seems of some importance in our understandings and relationships with our bodies.

For many of us the first person to criticise our body was our Mother and the first person to criticise her body was her Mother. This inter-generational violence permeates through the aunties, grandmas, cousins, Mothers, step-Mothers, sisters and other female relatives. Why do they do this? Sometimes because they believe that if they do not they are leaving you vulnerable, somehow, to the rest of the world’s criticism. They must be the one to make sure that you are keeping the line, that you are performing your femininity correctly and will not be ridiculed. It is a matter of honour, perhaps. A lot of different cultures and communities are very concerned with women’s ‘honour’ because it is a way of policing them and a way of controlling them. Criticism of the body is a key and important way that this is done. I would argue this is fairly universal, if enacted in an array of culturally and context and family specific ways.

So when you are fat, when you are queer or trans or you don’t shave or you don’t have long hair or whatever it is – when you don’t conform perhaps the first person to comment may be your Mother. But she is doing it to protect you. Or else, her criticism exists within a far wider context of patriarchal body fascism which she imagines herself to have a greater understanding of than you do. It is a wisdom to pass on, a pain to continue.

There is so much to say about the pain and violence of gender, sexuality, fatphobia, body policing and how we harm one another with it, as well as experiencing it in a more systematic way. It comes at us from all sides, it permeates our lives, everything we love and need and desire. When laid out like this I feel is there any wonder that people develop eating disorders, that I developed an eating disorder? But I think eating disorders are just one of the myriad of ways that people try to cope with this stuff. An understandable but deadly conclusion to impossible demands. For liberation, we must help one another to fight it. For this, we need to understand that policing one another will always be reactionary in whatever form it takes. That we need to break down this inter-generational violent policing and realise that we are more together than we are apart.

As my new beanie hat proudly proclaims: Riots not diets.

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Perfectionism

Perfectionism, in the most basic terms, is the drive towards ‘perfection’ in all that one does or in the tasks or accomplishments one strives for. It often involves setting a high bar for oneself, measuring one’s self-worth via productivity and setting perhaps unrealistic goals.

A lot of the time people think of perfectionism as a kind of humble brag claim that one would make in a job interview. Saying you just want to do everything ‘perfectly’ can seem like a way of claiming that you have high standards which you can actually measure up to, have a high skill levels and are somewhat meticulous in your work. Of course, it sounds like a good thing – particularly in an intensely productivity focused, hyper-capitalistic context.

In fact, the capitalistic focus on intense productive output seems to lend itself well to a certain degree of perfectionism, or what may look like perfectionism. That’s why a lot of the articles and literature like to distinguish between ‘healthy’ and ‘unhealthy’ perfectionism or, as I like to call it, profitable and unprofitable perfectionism. If these traits end up lending themselves to high productivity in the workplace, for example, they are something to be applauded and unproblematic. When they begin to impact on that performance, then we start to have a problem.

In a way I thought of my anorexia this way – it was very functional, until it wasn’t. That is, until it stopped me from working and stopped me from participating in all of the activities I valued myself for. Anorexia is closely associated with perfectionist traits. I have to admit, I found this emphasis deeply frustrating when I first began to try and understand my illness. I’m critical of anything that emphasises ‘personality’ as a key foundation for mental illness because most of the time it ends up being a way of victim blaming or making a claim that there is something inherent about a person that caused them to be ill. Professionals will often use this as an excuse to withhold treatment or say someone has ‘complex needs’ which they cannot possibly hope to address.

I don’t think that ‘personality’ is a stable thing across one’s lifetime nor is it something that cannot change. The controversial labels of ‘personality disorders’ play into a kind of logic that some people are just inherently ‘insane’ or ‘unstable’ or ‘non-compliant’. To describe something as a ‘personality traits’ seems to betray a kind of determinism that essentially leaves people open to neglect by medical professionals. Even whilst acknowledging that things like BPD/EUPD seem to stem from things like childhood trauma still there is a persistence in the ‘personality’ explanation as well. I fail to see how something that is demonstrably a trauma response is a part of one’s ‘personality’, really and the only people this seems to serve is professionals who want to label patients as ‘difficult’ and ‘resistant to treatment’.

Similarly, I don’t think describing someone as having a trait of ‘perfectionism’ is a viable explanation for their eating disorder. I think some of the traits associated with perfectionism are certainly things that can play into the development of and perpetuation of the eating disorder but I don’t think they arise in a vacuum as some sort of inescapable natural tendency. Why would someone end up being so hard on themselves? Why would they set unobtainable goals? Why would they value productivity so highly? I don’t think one would without some sort of external validation of these traits.

I haven’t published a blog post here in a while. I have three or four drafts of different potential posts that I can’t get round to finishing. Part of this has, admittedly, been because of the high standard I have set for myself in what I ought to publish. I need to do the right research, I need to link to all my sources with good studies otherwise what I say won’t mean anything to anyone. Where does this standard come from? Did I pluck it from thin air or does it actually come from my years spent within academia where this is a necessary part of any writing one does? Did I not internalise this and begin to raise my standards over time as I got positive responses from this type of post? Do I not take every compliment and build it into my new standard that I need to meet every time now?

This is a process that takes place in my own mind, of course, but I also think it is not without it’s external logic and validation. We are taught about productivity from a young age, perhaps our teachers or our parents put pressure on us to perform. Or perhaps nobody puts pressure on us and we feel, therefore, we’ve something to prove. Particularly when one is from an oppressed group there is a far higher standard for our work than for those in the oppressor group. The standards, then, do not come from nowhere. Perhaps we internalise this in different ways but it does not take place in a vacuum.

Wanting to set and achieve goals is, from what we can observe, a natural human tendency. We get hormonal rewards from it – dopamine, oxytocin etc. Perhaps some people’s rewards systems is wired a little differently, their neurotype is a little different. Either way, it seems to be something that we are wired to do. Part of my anorexia was very much based on this tendency – to set myself goals and to reach them. I gained a sense of achievement from it, even when it was short lived. This led to compulsive behaviour, obsession and damaging behaviour.

Another part of anorexia is never feeling you have done ‘enough’ and so the rewards system is always short lived yet intoxicating. The ‘perfectionist’ traits play into this – the unrealistic goals, the higher and higher bar for oneself. To me, this makes sense as one explanation as to why the eating disorder would persist even whilst it clearly did damage and made one miserable. It certainly felt like a motivation to me at times – to set myself goals and suffer enough to meet them. I don’t think it’s the only explanation – as I have explained in previous posts I think there are some biological components to the compulsivity of the behaviour – but it is a tendency that can play into the functionality of the eating disorder.

People often describe their disordered thoughts as having a ‘voice’ that is somewhat separate to them, often a ‘critical voice’ – a term used fairly routinely in therapy. My therapist’s explanation of the voice is that it may be ‘protective’ or have some sort of function that helps you to feel safe. In this case, if you hold the belief that food is a threat then this voice is attempting to protect you from that ‘threat’. Similarly, in order to protect you from the threat and encourage avoidant behaviours there is a degree to which the goal setting can motivate you to stay the course even whilst you are suffering. Thus, perfectionism could be seen as a way of making sure that we are motivated in some way even whilst it ultimately ends up paralysing us for fear of failure.

This is why recovery for things like eating disorders and OCD tend to work on helping your brain to understand that the thing that it sees as a threat is not, in fact, a threat. This is why things like cognitive behavioural therapy, done well, can be particularly useful in these cases. You are rewiring your brain’s fear response.

When you are doing this your brain does all kind of mad shit to get you to NOT. This is where the perfectionism comes in, the ‘critical voice’. When I want to eat I’ll often feel ‘overwhelmed’ by the choices of food I have – what if it doesn’t taste as good as I hope? What if it isn’t an exactly nutritionally balanced as a meal? What if I feel disappointed by the meal in some way? Better just to not have it to avoid these things. There is a kind of perfectionism around the food itself that sets unrealistic standards for it which, in turn, work as a way to prevent the threat. So, the perfectionism functions as way for the brain to avoid threatening situations entirely by catastrophising them.

These feelings leak into other tasks as well – I put a large amount of pressure on myself to do things perfectly to the point where I end up not doing them at all because I know I won’t be able to meet those standards. This has been a pattern in my life – I am very ‘all or nothing’ in my participation because I feel I cannot possibly do anything to a lower standard than I would like. Again, part of therapy is working on this and allowing myself to do things to a lower standard and also allowing other people to help me. Letting other people become involved in your tasks is very challenging when you want a large degree of control in order to maintain the ‘perfection’ that you envisage. A good way to challenge perfectionism is to allow yourself to invite the so-called imperfection of others (of course, you are not really perfect nor is your way of doing things!).

In this vein, I will allow this post to be short and imperfect. I will allow this post to not have too many links to ‘the research’ and I will allow myself to publish it sooner rather than later and not to ruminate so hard. Perhaps I can do this with some other unfinished posts. The process is more important than the outcome. That’s therapy, baby.

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Anorexia co-morbidities: Autism and OCD

CW: some discussion of eating disorder behaviours (no numbers), sexism in medical context

I was diagnosed with Autism Spectrum Disorder (ASD) three years ago in 2018. I was 26 years old, an adult, and had struggled for a long time. I had suspected I might be autistic for some time, though many of my peers were sceptical because I was very good at something called ‘masking’ which is a way of hiding my autistic traits to fit in.

Part of the reason that I hadn’t received a diagnosis earlier than this is due to my assigned gender at birth. Significantly less girls are diagnosed with autism than are boys and this is largely due to extreme gender bias in autism research. Autism was (and still sometimes is) referred to as ‘the extreme male brain’ – the idea that autistic traits are that of someone who is exhibiting the extremes of male behaviour. This is more commonly applied to a certain type of autistic person – the ‘auteur’, as it were, the strange genius. I think of it as a male superiority complex and complete lack of empathy for women and autistic people. And they claim that we lack empathy.

What’s interesting is that anorexia has also been described as ‘the female form of autism’, though nobody seriously posits this any more it is, nonetheless, an insight into the way anorexia is theorised. Women and girls are the overwhelming majority of eating disorder and anorexia patients and it is notoriously under-diagnosed in men. There are certain ideas about which disorders ought to be applied to which gender and a lot of sexist assumptions around an outdated idea that ‘male’ and ‘female’ brains are markedly different.

So, autism is a male disorder and anorexia is a female disorder. What happens when you have both?

There is evidence to suggest that around 20% of those with anorexia are also autistic. Studies have primarily been done on diagnosed anorexic patients, screening them for autism, rather than the other way around. They have also only been done on female participants, again due to the gender bias in both diagnosing and treating eating disorders.

To be clear – I think it is likely true that more women/girls than men/boys have anorexia specifically but I also believe that men and boys are very likely to have eating disorders that are undiagnosed because of the way in which they approach it. For example, body building, weight training and other forms of athleticism where men engage in extreme forms of dieting in order to manipulate their bodies. This is a form of disordered eating which does not present as the stereotypical anorexia but is dangerous nonetheless.

The general consensus seems to be that some autistic traits lend themselves particularly well to eating disorders such as rituals, repetitive behaviour, routine, obsessive interests, rigidity and alexithymia (inability to identify your own emotions). One of the key identifying features of autism is ‘restrictive and/or repetitive behaviours or interests’. This was certainly the case for me; it is very easy for me to become obsessive about a topic if I have a mind to. I researched as much as possible the topic of losing weight effectively and then implemented whatever seemed to be the most evidence based. My calorie tracker became a ritual, a routine, a fixation and my life was ruled by the numbers that it produced. I was rigid in my adherence to it and quickly came up with my own ‘rules’ to follow. The exercise I did was very repetitive, it had its routines and I stuck to it every single day. My approach was very ‘logical’ or felt that way to me – but the logic of the rules soon gave way to dogged determination to stick to them regardless of their detrimental effects and extreme anxiety if they were not followed. My behaviour was very repetitive and I was restricting myself in multiple ways. Autistic people tend to carry out rituals to soothe themselves and to feel safe, as do anorexics.

There is also some suggestion that anorexia can help one to ‘numb’ difficult feelings and emotions that one is having. Autistic people often struggle with very strong emotions due to being over-stimulated often or being exhausted from having to ‘mask’ their traits constantly. The outdated assumption that autistic people lack empathy is now being challenged and there is an idea that many of us are actually hyper-empathic which means we struggle because we feel the emotions of others very strongly. I have struggled with intense emotions all my life; when I was younger I was diagnosed with Emotionally Unstable Personality Disorder (EUPD) more commonly known as BPD (Borderline Personality Disorder). I believe this diagnosis was incorrect and it was my autism that led me to struggle as I did, alongside depression caused by the lack of recognition and accommodations. Anecdotally, I know many women and AFAB (assigned female at birth) people to have had this same misdiagnosis issue.

For those struggling with emotional regulation, in some ways the effects of anorexia, the emotional numbing, can be a coping mechanism. The effects of starvation mean that you are able to focus only on your most basic functions, your obsessions are limited to food and movement, you can only feel irritation really. The sadness is not so intense but neither can you truly feel happy. This certainly bears out for autistic women and AFAB people who may not have been diagnosed until later in life and have struggled intensely because of it. I was told that because I was a ‘high functioning’ autistic that I would receive no follow up treatment or support at all upon my diagnosis.

To expand – the idea of ‘high functioning’ and ‘low functioning’ autism has primarily been a way of allistic (non-autistic) professionals perpetuating eugenicist ideology within the autism community. These functioning labels arose from Nazi scientists attempting to decide whether autistic people were ‘low functioning’ thus useless to society and should be murdered en masse or if they were ‘high functioning’ enough to be of use to the Nazis. Incidentally, one such scientist was Hans Asperger and this is where the term ‘Asperger’s Syndrome’ arose from (for ‘high functioning’ autistics). It is no longer used diagnostically and I would suggest that people do not use it due to this association.

This aside, functioning labels also serve as a way to determine the level of struggle one has in handling one’s autism. If you are ‘low functioning’ then you will never amount to anything, you are ‘stupid’ and need to be ‘looked after’ and belittled. You are sub-human, in a way. If you are ‘high functioning’ you must be extremely talented, super human and need no support at all. Both of these seek to further disable the person in question by denying them agency to explain their own needs and get the right support. Different autistic people need different levels of support, that much is clear, but it ought to be on a case by case basis. My experience of being ‘high functioning’ is that I can function very well…up to a point. Then it all comes crashing down rather dramatically, as it has done repeatedly throughout my life.

Autistic people are highly likely to suffer from mental illness such as depression and anxiety. I don’t believe this is a natural outcome of autism but one that arises from an inhospitable world. Autism is a natural variation in neurotype, a different way of one’s brain functioning, which does not necessarily have to be negative at all. If it were accommodated and not ridiculed I truly believe that autistic people could be perfectly happy and functional. Unlike anorexia, it is not harmful to the person experiencing it – rather suppressing it is harmful, trying to function within neurotypical, capitalist limitations is harmful.

Another interesting aspect of the literature on this topic is the presentation of autistic women in their anorexia. They are often presented as ‘not caring’ about their body image in the same way a typical anorexic presentation would manifest. The diagnostic criteria for anorexia states that one must have a fixation on body image and weight or a fear of gaining weight. There also needs to be an inability to ‘see the seriousness’ of one’s condition and a low body weight. I find the focus on these particular criterion quite strange considering the vast array of other symptoms that present very commonly in anorexia (e.g. compulsive behaviour, food rules). I think it betrays a bias in medicalised pathologising models that see the disorder as primarily a physical issue to be rectified (i.e. increase weight). This makes it difficult for people who may not neatly fit into this presentation to seek treatment. (To be clear, I do think the physical side of recovery is the most important in the initial stages before psychological intervention takes place but in helping people understand they need help I think this focus can be limiting).

That said, I think there is a level of internalised sexism in anorexia communities that causes some people to protest too much about their supposed disinterest in body image. They don’t want to be seen as shallow in some way, they’re ‘not like the other girls’ and their reasons for doing this are much deeper than those other girls. I don’t think anyone with anorexia is only doing it because they ‘want to look like a model’ – simply because I don’t think that could be the only cause of such an intense, obsessive illness. I think clinicians try to minimise and belittle women constantly and because this is something that seems to primarily affect women they believe it is a shallow, vain thing rather than a deep rooted issue. This seems particularly true since the majority of people in anorexia treatment are teenage girls, who’s every thought, idea and action is seen as inherently trivial.

In my experience, a lot of autistic women and girls do end up with some level of internalised sexism because they struggle to perform femininity and are heartily punished for it. Girls can be cruel and the harshest police of performative gender, particularly when young. I don’t mean to say that anyone is lying when they say that their anorexia is not about body image but I do think the way it is presented is problematic insofar that it betrays a form of sexism in its account. It implies that this is not the case for any others or that patients don’t emphasise their body image issues because they’d like to access treatment, for example.

The assessments for eating disorders put a lot of emphasis on your feelings about your body under the presumption that this must be what is driving the disorder. For me, I think I did want to lose weight initially by going on a diet but the weight loss became much more about reaching goals I’d set, sticking to safe routine, feeling unable to stop my behaviours, than necessarily thinking about my body. My body itself didn’t really matter, it felt a million miles away from me, unreal. I didn’t or couldn’t comprehend my body at all sometimes. Once your compulsion begins then it seems to become far less about the body. It actually became far more about my body in recovery than in the midst of the disorder.

Anorexia also often ends up bringing in OCD (obsessive compulsive disorder) tendencies – these are repeated patterns of behaviour stemming from obsessive anxiety about a particular event/ill affect happening if the behaviour is not completed. This can involve things like ‘checking’ (if the door is locked/oven off) or touching something a certain number of times (tap light switch 10 times) and a number of other similarly compulsive behaviours to provide reassurance to the sufferer. If these actions are not completed the sufferer feels panic and even terror of the consequences. This sometimes mirrors the autistic need for repetition and use of repetitive behaviour and routines to feel ‘safe’. The distinction lies in the usually more positive motivations that autistic people have – it provides them reassurance rather than feeling negatively compelled to do it.

I raise this because I think there are similarities in behaviours which might have given rise to some of the similarities in autism and anorexia. It is well established that many anorexia sufferers also struggle with some form of anxiety disorder, of which OCD is common. I was never diagnosed but many of the behaviours within my eating disorder seemed to go from being a more autistic, comfort based routine to one that I felt I could not possibly forgo for fear that something completely terrible would happen. Often this was a fear of gaining weight but it felt more than this. It felt catastrophic, somehow. I’ve described some of these compulsions before – many were around exercise and some around food. I also picked up some seemingly unrelated behaviours that became compulsive as well and I am working on this with my therapist at the moment. There are some links between autism and OCD simply because many autistic people become very anxious due to how difficult navigating the world is for them. To me, OCD is simply one manifestation of anxiety that arises in a certain proportion of people. In a way, it feels like a method of managing that anxiety – though not one you ever consciously thought of or consented to.

The treatment for anorexia and OCD are somewhat similar – ‘exposure therapy’. As in, exposing oneself to the thing that one is afraid of. This is done gradually and with support. You are teaching your brain that the scary thing is not really scary and you teach it this by giving it data to support that notion. I had to do this without any professional support initially. They say that autistic anorexics are difficult to give treatment because they are ‘stuck in their ways’ and routines. This is especially true if they’ve had the eating disorder over a long period of time.

I found it very challenging to change my routines – anyone who knows me well is aware of how I hate to change plans. But I was sick of feeling so powerless and how awful I felt so I forced myself with the help of friends and partners. I don’t think they fully understood how far my fight/flight mode was constantly activated at first. It truly felt like hell. But then it felt less like hell, sometimes. Now it feels like that maybe 50% of the time. Things fluctuate. Some days I have to ask my partner to bring me food and take me out of the decision making process entirely. Some days I eat a full cooked breakfast and pizza. Some days it’s a slog just to stick to my meal plan.

Creating new routines is my next plan, to help me stay on track. I think autism can be a positive thing in recovery because your new interest can be in how to recover, as I feel mine has been. I’ve researched it a lot, I’ve taught myself everything I can. You have to repeat things a lot – create a new eating routine, repeat yourself on challenges. One day I will not be worried about the amount of oil in my food any more! I believe autism can be a strength, although this world beats us down constantly we are also amazing people with lots of knowledge that we can use to help ourselves. Turn that knowledge in on yourself – that is what I am learning to do!

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Eating Disorders and Veganism

Everyone seems to have an opinion on veganism and why they chose to follow it or not. It brings up a number of related issues including diet and lifestyle as well as the obvious animal rights and environmentalism.

As I see it there are two somewhat distinct forms of veganism that have emerged in the current socio-political environments of the West. The traditional vegans come from a more politicised perspective of ethical concerns over the environmental impact of the meat and dairy industries and the exploitation of animals within them. The second type of veganism, broadly speaking, seems to derive from ‘wellness culture’ i.e. dieting, ‘clean eating’ and is largely based around health concerns and the belief that the vegan diet can improve one’s overall health. These are not always totally distinct in practice and it is possible to go from one to the other (e.g. initially doing it for health but then seeing the ethical reasoning as well). The reason I make the distinction is because I think it is important when considering veganism in relation to disordered eating.

There is evidence that there are higher rates of veganism and vegetarianism in women in treatment for eating disorders than for the general or equivalent (i.e. women of the same age) population. A part of this may be down to demographic crossover in those likely to develop an eating disorder and those likely to follow these diets more generally – as in, teenage girls and young women. We know that 63% of those following a vegan diet in the UK are women and the age group most likely to be vegan are 18-24 years old. Those most likely to develop and seek treatment for an eating disorder are women (up to 75%) and the most likely age for onset is 16-17 for anorexia and 18-19 for bulimia.

Given this information, one could intuit a relationship between the two. Certainly, there is a clear causal link between the diet industry’s heavy targetting of women and their likelihood to develop eating disorders. We know that choosing to go on a diet can put you at risk of developing an eating disorder due to its restrictive nature, rule based logic and reinforcement of negative attitudes towards having a larger body. To expand, I don’t think that all eating disorders are necessarily caused by dieting alone but I do think this is a major trigger in going on to develop an eating disorder, particularly binge eating disorder and anorexia. Restricting your food intake can lead to binging on food later on down the line and this seems to be a fairly common response, though to varying degrees of severity.

But is veganism a diet? Or just a lifestyle choice – an ethical choice even? I think the answer is that it can be all three. Many people do decide to go vegan simply because they believe it will help them to lose weight. Some are explicit about this and others hide their intentions beneath the higher moral arguments. I think the rise of veganism within ‘wellness culture’ means that all kind of erroneous health claims come alongside it now which increase instances of orthorexic thinking around it. Orthorexia is a type of disordered eating in which one becomes obsessively rigid around what is considered ‘healthy’ or unprocessed foods and the pursuit of eating only foods deemed to fit into this category. I think it has a lot of links with lifestyle veganism, ‘cleaning eating’ trends and the ideology of wellness. The thought process goes that one can control one’s health by eating a certain type of diet that is normally very restrictive. A more measured concern about processed foods can become cult-like and means the people vulnerable to developing eating disorders can easily fall prey to it.

Many people with eating disorders will use fad diets as a way of justifying their restrictive food habits. It is worryingly socially acceptable to claim to be following a diet as an excuse to restrict your eating. The social acceptability of veganism due to its actual ethical concerns means that it can be an excellent cover for restrictive eating habits in some people. It is less easy to challenge than a more obviously damaging diet because it can genuinely be a healthy lifestyle or ethical choice.

However, I don’t think there is much evidence that becoming vegan or vegetarian will lead to developing an eating disorder in and of itself. In the studies I linked to earlier in this piece, it seems that many of the eating disorder patients chose to become vegan/vegetarian after the onset of their eating disorder, meaning it may well have been chosen as a form of restriction. Many people live as a vegan without any form of disordered eating at all and there are also many vegans who are vegan due to their strongly held beliefs around animal welfare and the environment.

It is true that the current meat and dairy industries impact the environment in deeply detrimental ways and are not sustainable in the long term. The treatment of animals on this scale is obviously causing them enormous amounts of harm and suffering and treating them as mere objects or capital rather than living creatures. My personal belief is that this will need to stop if we are to have any significant progress on slowing climate disaster. The treatment of animals within capitalism deeply concerns me and shows, to me, the strongest possible disregard not only for the animals themselves but for all living things on the planet.

This is why I consider myself a vegan – it aligns with my political beliefs around the environment, animal rights and capitalism. However, I also acknowledge that this action in and of itself is not enough and that market logic cannot be resolved through differing market demands. The logic of capital facilitates all of the ethical violations objected to by vegans and so that is the most pressing thing to be challenged more generally. For this reason it does not concern me if an individual makes a decision not to be vegan for whatever reason. I think it more important that they politically align themselves with veganism than that they always practice it and make certain consumer choices that may or may not be available to them.

I have been vegetarian for over 10 years and I began to eat fully vegan around a year and a half ago, pre-dating my eating disorder by around 6 months. In my recovery I have not always chosen to be strictly vegan because of the ways in which I know I used it as an excuse within my eating disorder. I did not chose to be vegan because I thought it would help me lose weight, as some do, but when I was offered food or wanted to tell myself I could not eat, it was a helpful way to do so. I think it’s useful to be honest about this – perhaps later on down the line I can go back to being more strict but I know at the moment I need to remove any excuse to restrict my eating. However, due to the more long term nature of my vegetarianism, I don’t feel that sticking to this has the same restrictive nature. I have been vegetarian my entire adult life and don’t actually know how to cook for myself any other way!

I think on an individual level only the person with the eating disorder can really have insight into whether they chose veganism because of restriction or because of their moral beliefs. I believe it can also be both, as it was for me. I wouldn’t presume to judge anyone who stopped being vegan entirely in their recovery, if that is what is most helpful and healthy for them. Those in eating disorder treatment should definitely consider whether their veganism is currently suitable for them. There are other ways to contribute outside of food choices and recovery is always the most important thing at the end of the day. It might be possible to reintroduce veganism at a later date or it may be that this type of restriction will always be a trigger for someone. Again, I think this is very individual and should not be judged.

That said, there are a growing number of vegan options available now which can make things a lot easier. There are lots of vegan junk foods out there these days which can be a great challenge for anyone in recovery and one of the ways I’ve been challenging myself and, hey, even enjoying it these days! One of the important parts of recovery is making no foods ‘off limits’ and eating food you are/were afraid of – usually because you thought it would make you gain lots of weight/had too many calories/was too unhealthy. I would say this is possible within veganism for some people but, again, it depends on the thought process and reasoning behind the decision more so than any generalisations.

I’m interested to hear perspectives from vegans with and without eating disorder/eating disorder history and how they feel about this question!

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On Disability

TW: discussion of eating disorder behaviours

I have a lot of clued up friends with a lot to say about disability politics and a lot of what I’ll say here has been drawn out in dialogue, not necessarily something I’ve come to entirely on my own. My own thinking is, of course, around eating disorders and the relationship they have to disability but much of it applies just the same to other disabilities.

Many of you are likely familiar with the social model of disability which posits disability as something that is socially reinforced through lack of accessibility in its many guises (no wheelchair ramp, no flexible working hours, no sign interpreters etc). It is the notion that a world designed without a recognition of differing needs and abilities is the very thing that causes disablement, rather than placing the onus on individuals and their impairments. It is useful here to make some distinction then between what it considered an impairment i.e. the lack of mobility due to chronic pain, the fact of being unable to walk unaided etc and the disabling factors that come alongside it i.e. a lack of walking aids available, lack of access to spaces for wheelchair users or those using mobility aids. One could conceivably have a world of limited disability whilst many impairments would remain. Those impairments could be accommodated for, anticipated, expected and accepted for the natural human variation that they are.

So, within these parameters, could an eating disorder be considered a disability? I’ve found that there are many things about anorexia that are disabling and there is an interesting overlap here of both mental and physical symptoms. Mental health conditions are often not necessarily posited as a disability in the same way that some physical conditions are – or, at least, not by the general population. I think there are many reasons for this but I think it is primarily due to how people imagine disability in relation to themselves. There is an idea that disability or disabled people are Other and belong to a class of people who are either deeply unfortunate child-like creatures or those who have made ‘bad choices’ in their lives and are suffering the consequences. Expanding this to mental illness challenges this notion simply because a wider range of people suffer from it and, God forbid, ‘normal’ people might be included under this.

People also like to think of most mental illness as fairly temporary. You struggle for a while, then you go onto medication, have a few therapy sessions and you’re good as new. That’s certainly how an increasingly privatised and stretched NHS would love to have it and their approach to support reflects this. A limited period of sessions of Cognitive Behavioural Therapy, some SSRI anti-depressant medication and a download of Headspace app and you’re sorted. Seeing mental illness as a disability would mean admitting that some people have enduring conditions that impact their lives significantly but it would also mean admitting that a much larger proportion of the population do have some form of disability. Seeing the shared struggle and similarities between mental illness and other types of disability is politically dangerous – as are most things which provide a material basis for organising.

There are, of course, significant differences between different types of impairments and how they will end up affecting one’s day to day life. Chronic conditions that have little scope for improvement will impact upon someone rather differently to a bout of mild depression. It is important not to flatten out the complexities of impairment and disability and claim that they have the same material impacts and that they impact people in anywhere near an even manner. Many factors beside the actual disability come into play here such as class position, race, gender, immigration status and so on. The impact of the same impairment on someone from a relatively wealthy background compared to someone on the poverty line is vastly different. Wealth can buy access thus wealth can mean less disablement stemming from what is objectively the same condition.

The temporality of disability, particularly in relation to mental illness, also alters the material circumstances of the disabled. To return specifically to eating disorders – many people suffer for many years without getting any support, so much so that they build a kind of identity around their disorder. Yet for others, like myself, they feel that the behaviour is at odds with who they’d like to be and how they see themselves. Many of the behaviours in eating disorders seem to be very intentional – the ‘choice’ not to eat, the ‘choice’ to over-exercise and so on. So, how can it reasonably be called a disability when the person seems to be disabling themselves? Indeed, how could an eating disorder really be accommodated and made less disabling without the intention to prevent the behaviours thus eliminating the problem? When one is recovered does this mean that they are no longer disabled? Does one become disabled temporarily, then?

I would posit that many disabilities are somewhat temporary, particularly things like addiction, mental illness and serious injuries than can eventually be rehabilitated. They may be something that is disabling for a person for a significant amount of time and yet can also be something that they eventually recover from and are no longer disabled by (or, at least, not to the extent they once were). Seeing disability this way is challenging because of the dichotomy society sets up of the disabled Other and the non-disabled, ‘normal’ person. Of course, it is entirely false.

In terms of accommodations which might make an eating disorder less disabling, I think this has to focus on the wider issues of the diet culture, systemic fatphobia, an end to the ‘war on obesity’ narratives as well as an understanding that not all exercise and movement is healthy for all people at all times. A clear example would be the recent move to try to force chain restaurants to display calories on their menus in an ill-thought out attempt to force people to make ‘healthier choices’, as though having this information at restaurants will impact this significantly (spoiler: it really won’t). This is an obvious trigger for many people with restrictive eating disorders – we obsessively count calories and track our food intake and in recovery we are trying to move away from our behaviours. Having the calories displayed will make this far more difficult to avoid and seriously impact positive choices in our recovery which is about gaining freedom NOT to base our every choice on number of calories and, instead, chose what we want to eat based on intuition and what will taste good to us.

In this example we see the way in which policies have been made with an extremely poor understanding of why people even chose to eat out in the first place – usually as a treat, special occasion or an enjoyable social activity. This isn’t the context in which one is usually thinking of making the more ‘healthy’ food choice. Encouraging a balanced diet begins with bringing down prices of fruit and vegetables, allowing people more time to be able to cook for themselves, ideas for a variety of meals they’ll actually enjoy eating. Not using guilt and shame to force people to restrict their food in an ultimately unhelpful way. It is also entirely ignorant of the issues of people with eating disorders which creates the context for them to thrive.

Of course, there are many disabling factors for someone with an eating disorder – mainly, our lack of ability to function well in a variety of contexts. Making choices about food, being able to go to supermarkets and pick up the right things that we feel we need, for example. I struggle personally with supermarkets at all times because of my sensory issues due to autism. But the added factor of my eating disorder, particularly before recovery, meant I could spend hours staring at food in supermarkets unable to come to any decision about what to buy – too many factors to consider. Calories, of course, but also nutritional value, satiety (whether it’d fill me up) and if the cost would be worth it. I would spend hours making complex calculations about calorie content vs nutritional value and try to time my eating exactly so that I would feel full enough to carry out certain activities that I needed to. I would be very rigid about what times I could and could not eat which means I had to structure my day carefully and turn things down if they did not fit properly.

This obsessive rigidity is very disabling and impacts a lot of what one is able to do functionally. A lot of energy is spent, also, on things like exercising which take precedent over all other activities. Being unable to feed yourself, unable to stop your compulsive behaviour and also struggling from fatigue and lack of ability to focus means it becomes more and more difficult to carry out your day to day activities. Physical symptoms can also be disabling – many people with eating disorders understandably have serious gastrointestinal issues which can cause severe bloating and constipation and pain. Some suffer from heart conditions, have poor immune systems and poor circulation which can lead to a whole host of other symptoms which prevent one from being able to function normally.

Despite anorexia having the second highest mortality rate of any mental illness (after addiction) there are a serious lack of resources dedicated to it or, indeed, any other eating disorder or mental health issue. The chronic underfunding and privatisation of the NHS by successive Tory governments means that all mental health provision is lacking to the point of severe neglect. My own experience has been that, after disclosing my eating disorder to my GP, I waited four months before getting any form of assessment from the eating disorder specialist team. In those months I struggled with wanting to be ‘sick enough’ to be taken seriously which impacted my ability to recover. When I was assessed and told I likely have anorexia I was told the wait for one to one therapy was 18 months or I could try group therapy in 6 months time. These wait times are even worse in other areas, so I’m told, and so many people with mental health issues are basically on their own in terms of attempting to recover. There is the option to go private, of course, which is what I’ve had to do with some financial assistance from my partners. Many have no such option.

Without the hope of treatment we are further disabled and the impacts of longer term mental illness take their toll. Early intervention has been proven to be key in successful recovery from eating disorders and yet with these waiting times the hope for this is very faint. Personally, I ended up taking my recovery into my own hands with support from partners and friends and a few private therapy sessions. I read self-help books extensively and researched my conditions and what approaches would be taken were I in treatment. I was able to do this because I come from an academic background and have experience previously with mental health treatments and training from my previous job. I also have a community of people around me who had the time and resources to provide some assistance.

Isolation in this context, then, would be a further disabling factor and one that is increasingly the case for many people. Of course, class plays a significant role in this, too and how able one is to use private therapy as a tool and whether one is able to take long term sick leave from their workplace as I have done. Having friends and partners with access to wealth also plays into this. Thus, though someone may have had to same impairments as me, they would be more disabled by them due to their access to treatment or ability to work on their own recovery with support. There are also those who are able to pay for private treatment in private hospitals with their own eating disorder specialist team whose wealth, in this case, gives them an even greater advantage.

The financial impact of disability should not be underestimated. For most us who work we quickly realise just how precarious our position is should we lose our job. I was relatively fortunate to have a couple months of pay when I first went off sick but many have no sick pay at all or are straight away on Statutory Sick Pay, a paltry amount of money by all accounts. I have had to quit my job due to my eating disorder and the role’s impact on my mental health. I couldn’t have hoped to continue it and still recover. I’ve had to apply for PIP (personal independence payments for those with disabilities) and UC (Universal Credit). Navigating these systems is far from straight-forward and has a huge mental toll on anyone who engages with them.

Disabled people are constantly forced to justify our disabilities. This is particularly apparent in the way that disability payments are set up – notoriously difficult to obtain, very invasive questioning, assessments and inappropriate comments and rejections for those most in need. Disabled people try to support one another through this in various ways – creating guides, coaching one another through the process, attending appointments, assisting with forms. We try to learn how the system works and know that it is never in our favour. It will always be something we have to come together to fight.

Understanding myself as being disabled has come more easily to me because of my other disabilities such as autism, dyscalculia and mood disorders/historic psychosis. However, appreciating just how intensely my eating disorder has disabled me has been difficult to contend with – the realisation that many things in my life I took for granted, such as my work, could come crashing down when I become unwell. This, of course, is a symptom of capitalism and the precarious nature of work. To be disabled within this system is to be constantly oppressed from all directions. If we want a fuller understanding of disability we must first admit that none of us who work for a living, who rely on waged labour, are ‘safe’ from the sharpest end of this oppression. We must admit that those living with chronic disabilities are not Other but our closest of comrades whom we must fight alongside. Capitalist society disables us, solidarity enables.

Viewing eating disorders as a disability has been useful for me in terms of reducing the blame on myself. It is easy to internalise the shame of being ‘unable to cope’, yet recognising external forces as disabling and understanding that there are many factors besides ‘choice’ that got me to where I am feels empowering and interrupts the intense self-criticism which comes alongside anorexia. I suspect this is the case for many other disabled people encountering these ideas. It runs directly counter to neo-liberal individualisation of the self and thus is key in disabled liberation. And, to be clear, disabled liberation is exactly what we all need.

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Body Dysmorphia

TW: detailed discussion of body dysmorphia, ED behaviour mentions, description of being underweight, negative self talk

Despite popular understandings to the contrary, body dysmorphia and anorexia are not the same thing and are often considered separately as psychiatric diagnoses. In terms of the diagnostic criteria, both include disruption or disturbances in self-image or body image, with anorexia being focused upon being unable to perceive one’s own low weight or minimising it’s severity. Body dysmorphia, on the other hand, usually means some undue preoccupation with a certain feature or features of one’s body causing, at times, extreme discomfort and disturbance.

I would argue that most people with eating disorders probably struggle with a level of body dysmorphia, specifically around perceived weight loss or gain. I didn’t think that I did until I started to recover. I thought that I saw myself realistically and that people were making a fuss or it was just that I looked a bit different. I thought nobody noticed. Part of this is that the voice of your disorder tells you lies about it in order to justify carrying on with the weight loss. Without it, if you were able to see yourself clearly, you’d be more able to recover.

You reach a point where people are a little scared. They sigh with relief when you explain because, really, there is no plausible explanation other than some other extreme illness. You know that people are looking but nobody evens bothers to harass you any more because it would be weird to harass someone so clearly sick. I heard some men on the street say to their friend that I looked too sick and he shouldn’t shout anything at me.

Others try to convince themselves you’re just very ‘fit’ or something. You just haven’t been eating enough lately. I don’t know…anything.

Still you want to lose more weight. Not to look good. Maybe you convince yourself sometimes that this looks good but deep down you know…you know you’re angular now, things don’t fit right, your ribs stick out, your knees look too big for your scrawny legs, your face is drawn and gaunt. Still maybe now it’s about proving something; how sick you are, maybe. Or just chasing the sense of achievement you temporarily feel when you see the number on the scale go down, your next goal reached. Or it just feels safe now to keep doing what you’re doing. Safer than seeing reality.

I’ve gained a lot recently through a combination of eating properly and stopping my compulsive intensive exercising. The process of gaining weight during eating disorder recovery is deeply painful because it is everything you’ve been working against for so long. All of your behaviours centre around this all-consuming fear of gaining weight. Everything you do is to avoid this; the restriction, the exercise, the purging. When you stop all this your body is so grateful but there is also a lot of pain and discomfort as it heals itself. It’s hard to feel you’re doing the right thing, even though you are.

Body dysmorphia for me manifests as constant ‘body checking’ – looking at myself in the mirror, specifically my stomach and my face, and feeling disgust at any perceived weight gain or ‘fat’. Taking photos of myself and trying to analyse how fat or thin I look, looking at photos other people have taken of me to see how prominent my stomach looks or if my face looks ‘too round’. I often think clothes won’t fit me because I’m too big but when I try them on they’re fine, maybe a little tighter – nothing like what I’d imagined. This behaviour feels obsessive and hard to move away from.

I often feel that I ‘don’t know what I look like’ – a bizarre concept, since I so obsessively look in the mirror and at photos, yet my brain cannot register what I am seeing. I know, somehow, that what I’m perceiving is not reality but I can’t perceive the reality at all. My partner and friends reassure me, try to give my perspective but it’s difficult to believe anything they say.

‘Body checking’ is common in anorexia when you are fixated upon your weight and any perceived changes to it. In body dysmorphic disorders it is also common to ‘check’ and fixate on the part of your body with the perceived flaw and to become distressed by this. It can interrupt your every day life, make you unable to go out and socialise out of worry, you can spend hours obsessing over it and needing it to be different. In some ways it is similar to how some transgender people feel when experiencing gender dysphoria, though I don’t think conflating the two is useful since gender dysphoria comes out of a genuine incongruence with the gendered body one has.

Yet, as I recover I am able to see that the way I look now really is more healthy, that my body is no longer crying out at me all the time. Making peace with my body feels like it will be a long process. Constantly denying my hunger, pushing my body to exhaustion, ignoring it’s pain and my own feels as though it has caused a rift that I need to heal. It’s hard to do this with a constant inner critic, a genuine fear response to any behaviours I think will cause weight gain. Intellectually, I understand what I need to do but I am waiting for my emotions to catch up.

Some things that have helped – I went to a free form dance class, one that was about connecting with your body and moving in a way that suited it, suited what it felt; rather than a particular form. I’ve gone back to yoga but I’m approaching it in a way that feels more in tune with my body, rather than the way I used to which was to push myself hard to gain strength. It’s hard finding the line at the moment. I’m trying to feed myself regularly with meal plans and not to feel guilty when I am hungry, to try and enjoy food again. Being around other people helps a lot.

I’d hoped to write a post on sexuality and gender, I also wanted to write about bureaucratic violence and work stress and how they contribute to and are a part of eating disorders as an adult. I’ve started but my thoughts need more time to develop. I wanted to post this to explain a little of the experiences and where I’m at. I hope if anyone else is having these experiences this could make them feel they’re not alone and that others understand them. I hope if this isn’t something you’ve experienced you have a greater understanding.

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What causes an eating disorder? Psychology, biology and genetics

What I’ve realised is that a lot of people have their own ideas about what causes an eating disorder, what is and isn’t eating disordered behaviour and if it is so very different from dieting or other weight loss methods in the end. Also, a lot of other people haven’t ever really thought about it or considered it because it’s never something that has entered their lives in a particularly significant way.

When I started to tell people about my concerns around my eating disordered behaviour I was met with kindness but also a lot ignorance. As I’ve mentioned before, a lot of the behaviours that form an eating disorder are very normalised in our culture and thus are able to be minimised or go unnoticed. I feel that it was not until I started to look the part that my behaviours were taken seriously or I was asked if something was wrong more directly.

Some popular responses as to why people get eating disorders are: that they want to feel a sense of control, they want to look like a model, influencer or celebrity, they feel insecure about their body or maybe they have some sort of trauma. I don’t think any of those are totally untrue but they are all quite over-generalising, simplistic and, in some cases, dismissive ways of looking at something complex. In my view even the diagnostic criteria for a lot of eating disorders perpetuate these ideas in unhelpful ways. It assumes a straight-forward relationship between behaviours, aspirations, desires and motivations.

My own experience is that my eating disorder did begin with a desire to lose weight but where that desire comes from is the thing that is often overlooked. The assumption is that young girls are simply vain and obsessed with their looks and so pursue thinness to this end. I’d firstly argue that when the world is constantly rewarding thinness, positing it as strictly positive, desirable and aspirational I wouldn’t be so judgemental about a desire for this type of appearance. Thinness represents something more than simply ‘looking hot’ – it means being successful, able to attract sexual and romantic partners, getting everything you want in life, achieving something, being disciplined, being better. Of course this is an attractive prospect to a teenage girl (the demographic stereotyped as the one’s who have eating disorders) but it is also an attractive prospect to many others for different reasons. When you’re marginalised it seems to give you access to power and desirability you may have been denied. This, at least, is something you seem to be able to change about yourself.

This is how it felt to me – the deep unhappiness I felt with myself and my body seemed to have an obvious solution: change it. When you experience gender dysphoria this can be an attractive prospect. I think also when you experience racism, sexism, disableism – all of these things that are about your body – it makes sense to feel that you should change your body. So, I think this can certainly be a trigger for an eating disorder but I wouldn’t say that’s all.

Theories about why we carry out eating disordered behaviours when they are so deeply counter-intuitive seem to fall into a few schools of thought: genetic, psychological and biological. I do want to point out that from an evolutionary stand point it obviously makes no fucking sense to restrict our food intake and over-exercise, or use purging behaviours. Many other behaviours associated with mental illness don’t make much sense in this regard either so usually we theorise that there has to be something in our brains that is malfunctioning in some way to make us carry out these behaviours.

From a purely psychological perspective the theory seems to go that we are able to carry these behaviours out due to sub-conscious beliefs and traumas which affect our conscious mind and choices. So, it makes sense to look at our past, our beliefs about ourselves, why we might have low self-esteem and a need for control due to feeling ‘out of control’ in our own lives. These are all what I would consider psychological reasons for the behaviours.

What’s interesting about anorexia and restrictive type eating disorders (which it’s arguable all eating disorder are to some extent) is that, once the behaviours like restricting food have begun, there are a plethora of other kinds of behaviour that seem to happen as a result of the body going into ‘starvation mode’. Of course, your body is going to try to protect itself against any perceived scarcity or lack of food and this will have a significant impact not only on your physical body but also on your mental state. Most people recognise their behaviour changes when they are very hungry – you become irritable, tired, light-headed and maybe even aggressive. The average person would combat this by obtaining food as quickly as possible. But what happens when you don’t do this? What happens when you’re in a constant state of hunger? What does your body do?

Every single thing I’ve ever read about eating disorders will reference the Minnesota Starvation Experiment – if you’ve done any reading at all about it you will have read about this. Basically, back in the old days when we didn’t have Ethical Approval Committees some scientists who wanted to learn about the effects of starvation and how to re-feed prisoners of war who’d been starved decided to do a study on some ‘healthy’ fairly young men by keeping them on rations over a period of 6 months and observing the effects. Suffice to say; ‘semi-starvation’ fucks you up. The men reported low mood, irritability, social withdrawal, isolation, reduced cognitive functioning, low sexual interest, food obsession and in some cases even psychosis.

The reason so much literature quotes this study is because it mimics quite effectively how eating disorder restrictive behaviours impact people’s behaviours and also biological processes. That is to say that some of the behaviours associated with restrictive eating disorders are behaviours that are being produced by being in a state of starvation. Some of the men in the experiment also exhibited ‘binging’ behaviours when they were able to escape the conditions of the study and ate as much food as they could in these times. Many people with restrictive eating disorders ‘binge’ on food with varying regularity – their body seems to take over and they find themselves eating and eating without much enjoyment. I’ve seen compelling arguments that this is what Binge Eating Disorder really is – the body trying to get more food after some form of restriction around it. Perhaps not the more extreme restriction we see in anorexia but restriction nonetheless can cause this behaviour and biological response in the body.

My own experience of this fits all the literature – I was shocked to find this, having been convinced that my behaviour and thoughts were utterly deranged and illogical. When I was restricting I expected to be more tired, perhaps, a little hungry. There is sometimes an idea that people with eating disorders simply don’t experience hunger. This is certainly not the case for me. My experience when restricting was that I was almost constantly hungry and using a variety of tactics to deal with this; incidentally a fair few of which I found on diet and weight loss advice sites. I was constantly on edge, far more irritable, short-tempered, withdrawn. I was constantly planning my food and exercise, completely obsessed with food, scrolling through Instagram looking at all the vegan food pages, recipes and tips. I would go into supermarkets and food stores and stare at the food there but never buy it. Just imagine I was.

But why would you carry all this on if you didn’t have to? Is the desire for thinness really strong enough to push through this torture? I think this is why people think being thin is about ‘discipline’ or that people with restrictive eating disorders must be very disciplined people. It seems like being able to override our biological needs is seen as something virtuous. Just, maybe people with eating disorders have taken it all a little bit too far.

I recently took part in a UK wide genetic study on eating disorders through the Eating Disorders Genetic Initiative (EDGI). I filled out a questionnaire and then was sent a kit to provide a genetic sample aka spit in a tube. Genetic testing on a wide scale has been happening more and more in recent years to try and provide us with some data on people with similar conditions and what sort of things might be present in their genetics that could indicate why they were vulnerable to the disease in the first place, what might make effect treatment and whether there are environmental or epigenetic factors at play in certain populations. This has been done for things like breast cancer, for example, and had some promising results.

There has already been a wide scale genetic study on eating disorders in Northern Europe which has identified some possible genetic similarities and factors in people with eating disorders. This research, by Dr Cynthia Bulik and her team, seems to support the argument that there are genetic factors influencing the development of anorexia and they argue that it is a ‘metabo-psychiatric’ disorder. This basically means that people who develop anorexia may have genetic differences in the way that their metabolism functions which are equally important as the psychological components of the disorder. There is also genetic overlap with other mental illnesses like OCD, depression, anxiety and schizophrenia which, I think, is to be expected.

What appeals to me about genetic explanations for eating disorders is the seeming disparity in how things like dieting seem to affect people. Why is it that my first ever attempt to actually diet led me into a full blown eating disorder so dramatically? Is it just that I’m some sort of hyper-perfectionist, ‘Type A’ personality (whatever the fuck that means)?

In Tabitha Farrar’s books and blog she is a strong proponent for the ‘migration theory’ of eating disorders. This is the theory that people who develop eating disorders do so due to an epigenetic adaptation that appears and is activated in certain people when they go into starvation mode. The idea is that in ancient times certain human’s response to a famine would have been to migrate to an area where food was more plentiful. In order to do this effectively they would have needed a large compulsion to move and also not to stop at the first sign of food – they’d need to wait until they got to the mother-load. Thus, their brain would tell them that they did not need to eat much at all but rather needed to keep moving as far as possible. When this response was activated in their brain they’d be able to effectively migrate to where a better food source was. Upon arrival, they’d feast and rejoice and be able to switch back to ‘normal’ after adequate feasting and restoration had occurred.

So, the theory would be that in modern times certain people’s response to perceived starvation would be for their brain to activate this migratory response. This explains why anorexic people feel a compulsion to move a lot (exercise) and eat little (restrict). The problem being that the ‘feast’ moment doesn’t come because there is no obvious time when it should happen. There is not actually a famine happening; the famine is artificial. The brain was, theoretically, only meant to invoke this migratory behaviour for a relatively short period of time; days, weeks, maybe a few months at the most. When no feasting takes places to ‘shut off’ the response it continues and becomes more and more ingrained and thus more difficult to get out of, as we have then created neuro-pathways which incentivise these behaviours and responses to food and movement. It becomes more and more difficult to simply stop these behaviours as time goes on.

Of course, almost all of this theory is pure speculation and there is no way to ‘prove’ that this is, in fact, the case. It is a well-researched bit of theory with evidence pulled from a variety of historical, psychological, genetic and biological studies of eating disorders and seems very compelling as an explanation but we will never really know if it’s the case.

This does fit in somewhat with some of the genetic testing and could explain, for example, what may have led to people having these genetic predispositions. The idea that my diet may have triggered some sort of genetic, biological response in my brain and this is why I went on to develop my eating disorder does feel compelling to me in many ways.

Farrar and others sometimes use this to entirely reject any sort of psychological element in eating disorders and the need for psychological intervention in eating disorder recovery. I think that, although the psychological factors are massively over-emphasised in most treatment programs I’m aware of, they are not without value – particularly in uncovering what led someone to be unhappy enough to begin their restriction or purging behaviours in the first place. Yet I have to agree that what feels like the most important intervention is finding a way to start eating again and getting out of the state of starvation. I think this can include psychological coping mechanisms to deal with the fight-flight response that is invoked at the idea of eating and stopping movement.

The causes of eating disorders and why they may develop is an important topic in the sense that it affects how they are treated but also public perception and personal insight by the sufferer. Learning what I have, questioning myself and explaining what I’ve learnt to others has been really key in my recovery so far. I have a lot of issues with being told what I ought to be doing (maybe it’s my Type A, controlling personality) so figuring it out for myself and trying to implement it has felt empowering to me. It hasn’t been easy but I’m fortunate to have plenty of support from others. I think anyone who recovers or tries to recover is incredibly strong because we are constantly fighting our own very primal responses to things.

Being genetically predisposed to something doesn’t mean it’s a permanent state of things and there are many success stories out there of people who were able to recover. I wouldn’t want any of this to come across as deterministic so to be clear: I very much believe that, with the right support, one can recover from an eating disorder and being genetically predisposed is not that same as being genetically predetermined. The human brain has an amazing amount of plasticity and we are able to survive, change and adapt. It isn’t easy and I’ll be writing more about the barriers and fuckery of the NHS and other bureaucracy one encounters soon but, in my own hodge podge way, I’m making it.

Note: I haven’t done as much research into genetics of bulimia and other types of eating disorders but I am interested if others have anything to point to or say on this, too!

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Fatphobia: An Interrogation

What is fatphobia? I would define it as systematic, societal discrimination and prejudice against fat people, people in larger bodies, people who are regarded as ‘obese’ or ‘overweight’. I use those words in inverted commas because the ways in which those terms of defined are, to me, not particularly linked to anything other than profit.

I’ve been reading some excellent content about weight bias and the Health At Every Size (HAES) movement mostly via Instagram and also in Caroline Dooner’s The Fuck It Diet and Joshua Woolrich’s Food Isn’t Medicine as well as Tabitha Farrar’s recovery books (Love Fat!, Rehabilitate, Rewire, Recover!). I would thoroughly recommend all three as well as the studies they link to, in particular, the HAES study which provides evidence that the long term effects of dieting do not ultimately lead to sustained weight loss and is actively detrimental to our bodies.

But to return to fatphobia – I think this is an under-discussed topic by the left for a number of reasons. Chiefly, most people don’t actually believe it’s a ‘thing’. A lot of people I’ve spoken to think, whilst people are rather mean about fat bodies, there is no systematic discrimination or oppression of fat people. This is incorrect – there are huge health disparities in terms of treatment and health outcomes of fat people due to active discrimination and medical neglect based on weight bias. There is also, in some countries like the US, a wage gap between those in smaller bodies and those in larger. These things can, of course, be linked to other factors such as poverty, race and gender but I don’t think they can be boiled down to this in all instances. It is another aspect of oppression which deserves its own liberatory politic.

Another reason I feel people are reluctant to discuss fatphobia is that is seen as an acceptable form of prejudice. Surely one’s own body size and health is something that can change and that we have some level of control over? Again, I think this is a part of the conservative ideology that one’s health is something that one has complete control over. That individuals are responsible for their own health and that weight is something that’s always within our control. This is categorically not that case. Our weight comes down to a complex mix of genetic, environmental and some lifestyle factors. The way in which we define ‘healthy’ and ‘unhealthy’ weights is not evidence based, rather it has been historically decided by the diet industry lobbies and insurance companies. These are all arguments discussed in the books I mention and worth educating ourselves on.

I went on a diet. I can’t say I’ve been a chronic dieter. My Mum tried to get me to diet with her once – something akin to the Atkins diet to get a ‘bikini body’, I think was how she put it. I immediately snubbed the idea because I was vegetarian and wanted to eat some fucking carbs. Something I find interesting about this framing, though, is the almost implicit recognition that the slimming down would be temporary. Diets are seasonal. They come after periods of feasting or before periods where we are likely to be displaying our bodies – readying them to be more socially acceptable and attractive.

I don’t think I ever understood that dieting doesn’t work – even if I might’ve read that somewhere on some ‘riots not diets’ feminist zine somewhere. Yet, whilst I was in the midst of my most restrictive eating, still somewhat pretending that I was simply ‘dieting’ my thought upon reading that ‘95% of diets don’t work’ was merely that I would just have to diet harder, I would just have to not go back to eating normally or lose enough weight that it ‘wouldn’t matter’ if I gained again.

Are people with eating disorders fatphobic? This is something that I find it difficult to answer. Did my desire to begin the diet that led to my disordered behaviours stem from some sort of desire for thinness that was rooted in fatphobic beliefs? I think there’s some truth to that. Do all anorexics hate fat people? I don’t think so; perhaps some but I certainly hold myself to a complete double standard. I believe others to be attractive when fat but not myself.

But also anorexia is pathological, it is a fear of gaining weight that has gone far beyond any sort of rationality or reason. Many people seem to complete the behaviours out of compulsion rather than an active desire to necessarily be thinner in the end. I think the idea that eating disorders arise out of some sort of failed vanity project is misogynistic nonsense. I think desire for thinness within our culture is entirely understandable, given the amount of pressure we are all under to pursue it. Bombarding women with messages around their need to be be thin and desirable and then treating them as idiots when they care about those things is deeply patriarchal. Even the message that men and non-binary people get about thinness, I think, arise from the same patriarchal, violent, gendered, racialised, fatphobic bullshit.

I feel it fair to point out that many, many people with eating disorders are not underweight, have never been underweight and may also be described as overweight. This is an issue I’ve seen discussed more and more recently and yet another example of extremely harmful discrimination and weight bias by the medical profession. I’ve heard stories of people behaving in far more extremely disordered ways than myself, people who struggled for years and years and never got help because they were considered overweight. (I would recommend the podcast Maintenance Phase for more on this).

It is understandable, then, that there are spaces created for fat people and that a lot of fat activists have some negative feelings about thin people in those spaces. My own feelings around this are complicated at the moment. I was fat. I don’t mean that in the body dysmorphic way I feel fat now – I mean, I was fat and experienced some discrimination because of it. I was told to lose weight by the doctor at my gender identity clinic if I ever hoped to have surgery. This is quite a routine thing, based on ignorance about anaesthetics and their effects on larger people. It’s a risk adverse position and, far as I can tell, not really based on any sound data. A lot of assumptions are made in the medical world out of, what I can only assume is a lack of time and desire to really drill down into what is being advised, whether it really bears out or is simply ‘routine’.

Fear of being fat can often be fear of the discrimination that is levelled at fat people. This is not unfounded. There are many ways in which one is treated better when in a thinner body. There are many ways that one is made to feel more or less desirable based on this. Desire is an interesting one and, I suspect, different for heterosexual and queer people.

The radical queer spaces I’ve existed in often profess to body positivity. I am in circles where there is at least some gesturing towards it. But still I noticed over the years, when I gained weight, that people did react to me differently, treat me differently, look at me differently. And I notice a change now, also, that I am thin. It’s likely not conscious for most people but there are bodies we have been taught are acceptable and it takes a lot to unlearn this.

Due to the fact that weight can change so much I think it can be difficult to categorise people’s lived experiences in a straight forward way – one rarely can, in any case. I would once have belonged in a space that is just for fat people to discuss their experiences. Yet I could hardly impress myself upon it now. It feels strange because I have suffered so much, every part of my thinness feels fake, extremely temporary, almost unreal. It was all so fast, though it felt painfully slow at the time. My brain hasn’t caught up, my sense of self has not caught up. It felt, at certain points, that giving up any compulsions would lead to me immediately becoming fat again, as I was before.

What we associate with being fat is often extremely negative. It comes to represent a lot more than simply fat stored on our bodies. It means something – it means failure, lack of discipline, lack of control, chaos, undesirability, lack of love, lack of care. We think nobody can love us that way. Perhaps because we secretly think these things about fat people ourselves, compare ourselves and think that, at least, we are better when we are thin. The illusion of control, of superiority. But of course, none of it is true. As stated, our body shape and size is not fully determined by our own actions, our own lifestyles and behaviours. There are many, many other ways in which this is determined but we cannot acknowledge this because to acknowledge this would be to accept a lack of control and power over our own bodies, our own circumstances.

Things that seem like choices often aren’t. Working class people, people in poverty have their choices around food and movement restricted every day by their material circumstances. The ‘choice’ of fast food, ready meals, less ‘nutritious’ food is not really that when this is the cheapest and most readily available, the thing that takes the least time, the thing that makes their kids happy, the easiest way to feel good for once. In the West this is why those in poverty tend to be in larger bodies and part of why fatphobia and the framing of an ‘obesity epidemic’ is almost always classist bullshit that doesn’t help anyone.

Why can I write all of this yet still feel I want to crawl out of my own skin when I feel I’ve gained any weight? I have been gaining weight, I have been doing a lot better in recovery than I ever have before. I haven’t relapsed or significantly restricted my food intake for a solid three weeks which is the longest I’ve ever gone. I haven’t done exercise properly for around two weeks even though every fibre of my being wanted to. So, yes, I have been gaining and having a lot of feelings about that. I’m hoping starting therapy soon will help me unpack this more. The NHS have assessed me but don’t seem to be in any rush to help – I’m doing most of this on my own, with help from partners and friends.

Fighting and understanding fatphobia, with regards your own body and the wider issues, is tough but important work. I invite myself and others to continue to interrogate, discuss and advocate on this issue. Stay curious, stay fighting. That’s what I intend to do.

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Exercise and Virtue

I feel scared to write about this. Not everyone with an eating disorder struggles with exercise but it is a major component for me that I’ve found extremely complex to tackle and deal with. It’s very much still a live issue for me and almost harder than the food restriction element in some ways.

Exercise is almost ubiquitously and unanimously supported in our culture. It is the cure all, a force for good, a force for ‘wellness’ and a morally good person simply MUST exercise. This, for me, seems also tied into fatphobia i.e. societal discrimination against fat people. A large number of people take up exercise with some sort of notion that it will help them to lose weight. Most exercise is marketed as a weight loss strategy in some capacity – ‘feel the burn’, ‘a new (thinner) you’ all of that shit.

The amount of moralism around exercise feels suffocating. The number of times I’ve been told of my ‘virtue’ and ‘discipline’ because I exercise a lot. The number of times I’ve been congratulated for my commitment and my fitness. People wishing they could be as ‘good’ as me for going to the gym. There is this underlying assumption that people who exercise really are more disciplined, more healthy, more virtuous and overall that they are BETTER people than those who don’t exercise.

Where does this notion come from? Why is exercise lauded as this decider of virtue? Before we go any further I’m just going to point out that I obviously don’t think all exercise is, therefore, bad and that it can never help anyone with their mental health. That would be absurd. What I am saying is that I was able to get away with a lot of disordered shit because of the culture we have around exercise and the implicit fatphobia that it contains.

You don’t have to do much digging to discover the number of exercise classes, gyms and sporting activities that market themselves as quick and easy weight loss strategies. You don’t have to do much Googling to find the Top 10 Most Effective Exercises for Losing Weight. Trust me, I’ve done it – probably over a hundred times. I have researched it extensively, desperate to find the most efficient way to get that ugly fat off of my body as quickly as humanly possible. We always want it to be quick because we don’t have TIME for anything else. We need to find the most optimal way to burn through those calories whilst holding down a job, maintaining a household, care responsibilities and all the other shit we have to get done.

But, of course, if you CAN’T fit it all in that’s your problem and you’re just not efficient enough. If you cannot find the time to eat well (5 fruit and veg a day, ‘healthy’ grains, whatever the latest protein bar is) you are simply not trying hard enough. If you cannot find the time to exercise you should be waking up at 5am to run for a miserable half hour before work. Or you should buy this expensive gym membership and pop in during your lunch hour. In this environment, of course, you should be finding the maximum calorie burners in the shortest possible time.

Capitalism takes our time away and then taunts and laughs at us for not keeping up with the never ending list of tasks one should be doing in their private and personal time. It’s in the ruling classes interest that we waste our time trying to diet and exercise as much as possible, leaving us with little energy for anything else. The demand for productive activity outside of the workplace has been realised within ‘wellness’ culture – placing the responsibility for health upon the individual whilst failing to recognise the vast array of complex factors that go into it. Health is now entirely our own responsibility and if we do not behave correctly we have only ourselves to blame.

Hence, even amongst friends there was an entirely uncritical support for me exercising a fuck ton. There is enough awareness that those who did want to comment on my weight but realised this might not be very ‘woke’ of them decided, instead, to comment on how ‘buff’ I was getting. This positive attitude to my increased exercise helped me a lot in hiding my eating disorder in the name of ‘getting fit’ and ‘getting hench’. No, of course I wasn’t trying to be SKINNY, I was just trying to get ripped.

Even after I admitted to my eating disorder most people failed to see how obsessive my relationship with exercise had gotten. I failed to see it, or didn’t want to. I still sort of don’t want to.

My behaviour around exercise is compulsive. I do it every day. I never take rest days (up until recently). I feel that without exercise I cannot ‘justify’ eating food because I need to ‘burn’ it all off again. For months I forced myself into calorie deficit. I exercise intensively and I have many OCD style rituals around my exercise. Get to pool, go to the loo, put my swim cap on in front of the mirror, place my water bottle in this spot at the end of the lane, swim 10 lengths alternating front crawl and then breast stroke, pause, go again, do this minimum six times, get out, go to the loo again. If anything from this routine is disrupted I panic. I cry and curl up into a ball. I can’t handle it.

I exercised so many times when I was sick or injured or just plain exhausted. The idea of stopping exercise, which I am currently trying to do, makes me feel completely terrified. It feels like my whole body is seizing up with the fear and panic. I feel as though I’d rather die, honestly. The compulsion is so intense that after eating more food than usual I feel I want to run around the house, up and down the stairs.

I fucking hate exercise.

It feels so odd to type that. I’m completely obsessed with it, I’ve spent so much time planning my exercise for the week, booking in sessions, spending hours working out. I don’t know if I understand what to do with myself without it. It feels awful to stop. But that’s what I am trying to do because I know it is the only way to break the cycle, the obsession, the OCD rituals surrounding it.

I just want to say that if the idea of stopping exercising for a while makes you feel panicked then you may want to re-evaluate your relationship with exercise. If you keep on pushing yourself even though you know, deep down, you should be resting up then you might have a problem. I don’t blame anyone for this because the attitude that one should always ‘push through’ is everywhere. The idea that not resting makes you stronger, when the opposite is true, gets touted all the time. The idea that one can never do too much exercise is all too common.

I realise that my case is more extreme but I do think the cultures around exercise, competitiveness and heavy focus on weight loss and muscle gain as a goal can be very destructive. The attitude one has towards this obviously has an effect but I’ve found that there are many micro-aggressions regarding this mentality. The idea that one ‘deserves’ a big lunch because they’ve been on a big bike ride. The notion that you should ‘walk off’ your dinner.

A reasonable level of activity and movement is something I think is natural in humans. The reason it’s become a chore is related to the way that one is motivated to do it and the lack of opportunity to do it in an actually enjoyable way. It just feels like something you really should be doing. I’ve noticed a lot of people talk to me about exercise now that I am very thin. More often than not they’ll start talking about how they’ve really been meaning to exercise more, they really should get back to the gym it’s just that they’re struggling for time and fitting it all in. It’s almost apologetic, like they are apologising for being in a bigger body than I am or not doing as much. I find this deeply uncomfortable. But I understand – don’t I also constantly compare myself to others, compare my body to theirs, too?

I don’t know how to do exercise enjoyably yet. Forcing myself to rest and not exercise is truly hellish at the moment and I am struggling with it day by day. I am not always succeeding but making this decision to try and stop is a huge deal for me. My goal is to eventually be able to re-engage with exercise in a joyful way, without any compulsion or dread or anxiety. To rest my body and move my body as I see fit. To fuel my body properly when I do exercise and not see it as a way to burn off any and all fuel I have.