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dorianbrightmusic · 1 year ago

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Somewhat Quick Guidelines for How Not to be Triggering to ED-Havers

i'll do a more elaborate version of this some other time, but i have just consumed way too much youtube and i need to get some very mixed feelings out of my system

(tw for some discussion of EDs and the areas these render most sensitive)

Don't equate 'eating disorder' with 'anorexia nervosa'

The most common eating disorders are Binge-Eating Disorder and OSFED – according to Santomauro et al. (2021) and Yasmina and Keski-Rahkonen (2022), OSFED is more common than BED, so yeah. OSFED includes many, many categories in and of itself, including: subthreshold bulimia, subthreshold BED, atypical anorexia, purging disorder, and night eating syndrome. Orthorexia isn't recognised in the DSM-5-TR, but should be. I could not tell you what the most common form of OSFED is – I'd always thought it was atypical anorexia, but some studies I can find on a general population point more to purging disorder, subthreshold BN, subthreshold BED, (see Stice, Marti, & Rohde (2013), while this more recent study in a less reputable journal by Hay et al. (2023) places atypical AN as the most common OSFED. Either way, full-threshold AN is comparatively very, very rare.

Most eating disorders are not becoming emaciated + growing lanugo. If you did become emaciated and grow lanugo, then I'm proud of you for surviving your ED every day, because they are the absolute worst illnesses. However, you are also in a substantial minority. That doesn't make you any less valid—all it means is that EDs aren't necessarily traditional anorexia.

I'll get onto the main difference between atypical and non-atypical AN in a minute, but for now, let's say that even if atypical AN is horrifyingly common, most EDs aren't anorexia of any kind. Most EDs are one of the other kinds. And while good AN rep is great and rare, using 'eating disorder' to mean 'anorexia' is incredibly dismissive of the immense and debilitating of eating disordered behaviour out there. It's limited in the same way as using 'neurodivergent' to just mean 'autism + ADHD' – just as neurodivergence is much, much broader than Au/DHD (and this isn't to detract from the validity of Au/DHD folks), EDs are much, much broader than anorexia, and using 'eating disorder' as a synonym for 'thin and restrictive' is an extremely limited definition.

Moreover, many ED-havers go to immense, immense efforts to downplay their symptoms. The common refrain you'll hear in ED recovery is 'but I'm not sick enough to need help' – and the more narrow the operational definition of ED, the more people are made to feel they aren't sufficiently ill to have a real problem. EDs thrive in secrecy. They are often silent, and they are lethal. By using 'eating disorder' as a euphemism for 'anorexia', we give power to each of these illnesses by letting them remain silent, too macabre and mysterious to acknowledge.

Be specific. Do not talk about someone having 'an eating disorder'. Do not use it as a smokescreen behind which to hide nervousness. Say the exact disorder, or, if unsure, use an adjective: a restrictive eating disorder, an ED with purging, an ED with bingeing, etc.

2. 'Eating disordered' does not mean thin

This goes for all EDs, and especially for anorexia. Argh.

Bulimia is often overweight, and can be any weight. BED can be any weight. ARFID can be any weight. Pica, rumination disorder, night-eating syndrome, and orthorexia can be any weight. Moreover, a thin person with an ED may not have AN—they might have ARFID, BED, BN, or so many more.

And most importantly, most anorexics are not underweight. There exists a diagnostic distinction between AN and so-called atypical AN, wherein the sole difference is that atypical anorexics are not underweight. That's it. That's the one difference.

It's also a completely BS distinction, since ED psychopathology is as bad/worse in atypical AN, and atypical AN recovery rates are marginally worse. The two are the same illness. How thin you are does not necessarily correlate with how restrictive you are, and every use of 'anorexic' as a synonym for 'thin' is indicative of a total misunderstanding of the complexity of this disorder.

Have courage. Give me obese characters with BN and AN, normal-weight characters with BED, characters of all weights with ARFID. Please: I'm outright begging at this point.

3. Sensationalising weight makes us feel, unsurprisingly, fairly awful

Writing eating-disordered characters by focussing on their weight is an excellent way to sensationalise the illness and implant a horrible feeling in audience mouths. If I google search images for anorexia, I will see ribs and spines everywhere. If I google search images for bulimia, I will see extremely thin young women eating pizza or crouched beside toilets. If I google search images for binge-eating disorder, there's no end to the pizza.

There is no definitive size eating-disordered folks are. But the more we see EDs represented in extremes of thinness and fatness—think To the Bone or The Whale—the more we, as a society, convey the message that by not fitting a size mould, people aren't sick enough to have a problem. And that perpetuates the cycle of hiding disordered behaviours and getting thinner.

Making a show of how thin or fat certain characters are is a great way to make people with EDs feel embarrassed either by their similarity to the thin/fat people depicted ('wow, I am disgusting') or by their lack of similarity ('I was never anywhere near that thin. God, I couldn't even succeed at being a failure'). So, please don't emphasise specific emaciated or larger body parts as explicitly indicative of an eating disorder.

4. Please keep the numbers out of this

I don't have the perspective to speak from the POV of those with other disorders, but I can say this much: Anorexia is a very analytical illness—will I be small enough to fit in this space, hold this, do this? —and seeing someone else's minimum weight is an excellent way to make someone feel as if they are a failure for being less thin. This is especially problematic given that 'xxkg lady' is a headline that sells like wildfire in a world where most anorexics aren't thin. I love Hank Green and his work, but the CrashCourse video on eating disorders is an excellent example of how not to handle talking about weight: explicit height/weight numbers are mentioned for the hypothetical sick woman, emphasising the role of emaciation in the illness. It's a bit sensationalist and very triggering.

This is also one of the things Heartstopper (the comic – I haven't watched the show) does right. Though it's not perfect, Charlie's weight is never given a number, and while he's shown to be unhealthily thin, we never get an explicit close-up of any bones or the like. It's other physical symptoms, like fainting and constant coldness, that make it clear that he's seriously, seriously ill. And that took immense, immense tact. Also the fact that later on, after diagnosis, he's explicitly said to have anorexia, rather than the smokescreen of 'an ED', and that he still struggles after he starts recovery... those are all very respectful ways of writing ED-having characters. Alice Oseman, I tip my hat to you.

I'd recommend against mentioning numbers of calories in anything (guess who once scrolled through an ED blog, found out the number of calories in a normal breakfast food, and then was promptly very scared of eating such), or about mentioning explicit amounts of food. Moreover, if you're going to depict a character eating, please do it carefully.

If you want to mention any numbers when writing eating-disordered characters: mention blood pressure, temperature or rate of weight loss/gain (I don't think it's awful to say 'lost/gained this much in this much time), but keep the discourse around rate of any weight change as neutral as possible. If I say I weighed xyz kilograms at my sickest, that doesn't do justice to the illness. If I say my temperature was about 35 degrees and my blood pressure was 59/40, it does, but it's not exactly something that can be made competitive as easily.

5. Don't sensationalise amounts

See above. We don't need to know the explicit number of slices of pizza/bags of xyz/bars of abc that a character consumed during a binge, nor how little a character with a restrictive ED had for breakfast. There is an immense amount of horror that can be engendered through implication. One exception—showing that a character can remember the exact number of whatever food they consumed (so long as this isn't being done in kcal/kj) is an excellent way to show disordered eating behaviour! e.g. I generally count how many water crackers I eat in a snack and have strict (low) limits on how many I'm allowed per day. This is proof AN doesn't go away too quickly.

6. Don't sensationalise weight, generally

This goes out to every time i've seen neuroleptics bashed for having the side-effect of weight gain, but without it being then explained that there are a host of many, many other side effects, most of which are much worse than weight gain.

This goes out to every time I walked out of the ED clinic and saw the Jenny Craig ads across the road.

This goes out to every time I see losing weight promoted as a panacea for every single health condition, including those that cause weight gain.

Showing weight gain in an overly negative light or isolating it when it's one of many, many other things in a category is just tasteless. Please, don't do this.

7. Don't sensationalise kinds of food

Some binge-eaters will never touch pizza or chocolate in a binge. Some anorexics friggin' love chocolate. Don't assume a diagnosis necessarily means one will have or lack a sweet tooth.

8. Setting up ground for comparisons is... worrisome

We probably don't want to know the specifics of someone's diet, clothing size, or any of the like. When handling EDs, please don't focus on the specifics of what someone consumes or how large/small they are.

9. Don't assume EDs are character traits

BN and AN are correlated with perfectionism and harm avoidance, amongst other things, but EDs aren't personality traits. Bingeing is not sloppiness. Restriction is not vanity. Please don't assume these behaviours are indicative of what's in the soul.

10. Please don't focus on white, young, otherwise-neurotypical women

People of all ethnicities, ages, genders, and neurotypes can have eating disorders, natch. There is no single way to look or be eating-disordered.

11. Please don't assume we get better immediately

When you live with an ED, you live with a voice in the back of your head that is constantly vying to hit the self-destruct button. And it isolates you and mimics your own voice, and after a time, it becomes extremely difficult to tell it from your own thoughts. It's being taken over and possessed, semi-conscious, from the inside. It's living in a trance and being made a puppet. It is learned helplessness. It is sewn into the fabric of your thought, your speech, your values. Even before you are acutely sick, you live with it inside you. Learning to survive an ED is learning to live with it beside you—becoming less helpless to the behaviour, but no less aware of the thought for a very long time. Recovery is possible, but it's most certainly not linear, and most certainly a long, long process.

Recovery is not merely the cessation of the behaviour, or weight restoration. It's a disservice to ED-havers to say you can easily get to a point of never having ED thoughts ever again. So know that we are living with our illnesses every day, but that even so, we can move on. Grant us the grace to let us admit we won't always be well, and guide us nevertheless to believing in our own ability to recover.

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