The new psychiatric diagnostic manual, the DSM-5, is about to be released this month. Many of the new diagnostic categories are being questioned. One of particular interest is that of Binge Eating Disorder. Bingeing, or eating a large quantity of food in a shorter period of time than is typical, is a disordered behavior according to theDSM-5. An individual who has eaten excessively at least 12 times in a period of three months meets criteria for Binge Eating Disorder. That means if you “blow out” once a week, you have an eating disorder. Really??
For many, this may be true, but I’m really curious these days about how women (i’m starting there, at the risk of momentarily losing my male audience) REALLY eat.
I know the usually prescribed base for people struggling to maintain healthy eating is three meals a day, two snacks. But once people slide into the reality of everyday life, is that how we really eat? When I give talks to teens, they tell me they frequently skip breakfast, eat “junk” through the day, “pig out” after school if they have raced through the day without eating much. Are they eating disordered? Harried moms pick at their kids meals before they go out and then worry that they “overdid it” when they finally sat down to dinner, relaxed, eating until they are more than full. Is that a binge? (They will assuredly tell me it was a vast amount of food in a short amount of time—and afterwards they have their laments). Colleagues tell me that when a paper is due, they sit down, make a mess of their notes, their thoughts and their eating as they get their thoughts on paper. Later, they clean up their words, their thoughts, their eating. Is that disordered?
In this culture where most everything is now diagnosed and pathologized, I am wondering what “normal” eating really is. A study of 2000 British women revealed that participants confess to eating two snacks a day—but usually when no one is watching because they are embarrassed about eating the snacks. If women can’t even eat a snack in public, what else are they doing that they are embarrassed about or can’t even report in an anonymous study? My guess is it’s much more than two snacks a day.
Remember how sexuality was spoken about a few decades ago? (Well, maybe you don’t remember—but this is how it was)—Pre-60’s, women all knew what they were supposed to do in bed (missionary position) and no one talked about anything more. Everyone likely assumed there was more to the picture… but no one really knew what people did behind closed doors. This of course all changed with research and literature (think The Joy of Sex). With open discussion about what men and women REALLY did, knowledge, shame and a sense of choice about sexual possibilities radically changed.
In the arena of food, however, we are back where we were in the arena of sex generations ago. We are still in the dark ages, with mystery surrounding what women really eat and shame coloring our ability to even talk about it.
We all know that disordered eating has to do with one’s world being out of balance—food and weight are used to cope with feelings, to withdraw, to protect one’s self. We all have moments of that—sometimes even once a week—Does that mean we are all eating disordered?
A patient of mine once asked me if women REALLY do eat candy if they are not bingeing. Yes, i answered—all the time. But that question prompted my wondering how we can better know what women really do—and what is healthy—and what is not. The new DSM-5 presents many answers. But how can we use the new manual to allow for new questions as well. What do women REALLY eat? When is eating healthy? When is it not?
As fellow EDRC psychologist Lauren Waine notes:
“The cost of not knowing how women really eat may be the continued marginalization of people with normal human behavior, with the net effect being a veil of shame, self-reproach, and the felt need for secrecy and hiding among all people”
I couldn’t say it better.