When does a strict diet tip over into being an eating disorder?

Hey folks

There really seems to be a fine line between the two. A close friend has expressed concern that I’m in the grip of an eating disorder having lost a lot of weight this year and knowing that I had what would now be called ‘atypical anorexia’ in 2011-12. You can read about this (here). So, am I just super focused…or is something else going on?

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In the UK, the acronym SCOFF is used by medical practitioners to screen for the presence of possible eating disorders. Answering ‘yes’ to at least two of these questions would suggest possible anorexia or bulimia so here’s me being honest in answering each one:

1. Do you make yourself Sick because you feel uncomfortably full? No.

2. Do you worry you have lost Control over how much you eat? No.

3. Have you recently lost more than One stone in a three month period? One stone is the equivalent of 14lbs so yes…but my starting weight was very high? At the same time, I’ve lost more than the recommended 1-2 lbs a week and I’m jumping on the scales probably far more than is recommended.

4. Do you believe yourself to be Fat when others say you are too thin? No…as I’m still in the obese range. I feel far bigger than my clothes size would suggest but can’t that be the case for many people going through a transformation? Does the mind need time to catch up with what’s going on with the body?

5. Would you say that Food dominates your life? Yes! All day, every day. I wake up thinking about food, I think about how to avoid situations where others, like my husband, will expect me to eat more that I want to, I take ages to go to sleep because I’m thinking about calories and, well, my Google history is full of food-related searches. So, this is a resounding yes.

So, okay, I can say ‘yes’ to two of these.

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When I was ill in 2011-12, the mental health team said that I had all the features of anorexia as I’d gone from a BMI of 43 to 27 very quickly….but I was still actually overweight. They could see that day-to-day life was consumed with all things food-related and almost this obsession about losing that next pound on the scales. They could also see how my heart QT’s interval was becoming prolonged with regular heart tracings. The term ‘atypical anorexia’, which was added when the DSM-5 was published in 2013, basically means that the criteria for anorexia is met except that the person can be ‘normal’ weight or even overweight. So, I think it’s safe to say that this would have been my diagnosis at the time if it existed.

As some of you know, I do have a lot of pressure at home as I’m carer to one of my adult children and so, whilst I’m always the one with a huge, beaming smile, I know there’s a lot of sadness going on right now. So, am I struggling to sometimes eat enough because I’m tired and perhaps struggling as a carer or have I turned to being rather strict because eating and losing weight is something that I can control in life? I’ve decided to pursue some therapy to explore this so I’m hoping that will start in the next few weeks. But returning to my original question ‘When does a strict diet tip over into being an eating disorder?’, I guess this can happen when thoughts about food and losing weight permeate into almost every aspect of life. I’m having days when I feel almost scared of eating so I know I need to challenge my thinking around food to stay well. So, in answering this question, I’m going to have to get back to you. I’ve always been (and I’ll continue to be) open with you.

I hope you have a super weekend. I’m seeing my parents this weekend which is the first time for about 7 months due to Covid so I can’t wait. And I’ll be back on Monday with my next weigh-in

Love Erika xx