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May 27
The Beheld
I write The Beheld (, a blog examining our concepts of beauty, using interviews with women whose professions and passions lend them a keen insight into personal appearance; analysis of news, business, economics, and culture; beauty experiments; and personal essays.


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FEBRUARY 27, 2012 5:55AM

Barefaced and Beside the Point: Appearance Anxiety in Eating Disorders

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In preparation for National Eating Disorders Awareness Week—which starts today—the Renfrew Center sent out an interesting press release, one you’d think would be right up my alley. “Barefaced and Beautiful,” a campaign from the Renfrew Center, one of the best-known eating disorder treatment facilities in the United States, is encouraging women to post photos of themselves on various social media without any makeup. The point is to...well, they sort of lost me on that. I think the idea is to display pride in one’s natural, unadorned self, the idea being don't need to...adorn yourself....with an eating disorder?

Yes, I’m being intentionally dense here. Obviously the idea was to touch on the role of appearance dissatisfaction in eating disorders, using something plenty of people wear—makeup—as an entryway to talk about the larger issue. (Certainly it’s more on point than cryptically posting the color of your bra on Facebook for breast cancer awareness.) And for something like a week designed to raise awareness about eating disorders, you need a campaign that's simple, accessible, and attention-grabbing. But not only does it willfully ignore the myriad reasons women wear makeup in favor of a one-dimensional shame-based explanation, it treats bodily dissatisfaction as the cause, not a symptom, of eating disorders. And if we keep the focus of eating disorder conversations on women’s bodies, we’re doing exactly what women with eating disorders do to themselves.

Obviously I think body image is pretty important. Hell, my contribution to National Eating Disorders Awareness week, other than this post, is with a project called Body Image Warrior Week project, which will show up here later this week. But I’m wary of conflating body image and eating disorders, and I don’t think that they’re nearly as connected as they’re made out to be. It’s not like she who has the worst body image develops the worst eating disorder, or that people whose body image is average are immune from eating disorders. (I have yet to meet a woman with an active eating disorder who has a good body image, but then again, I don’t know tons of women with a good body image to begin with.) I’m baffled that Renfrew chose the makeup hook for their NEDA campaign, unless the idea really was just to raise awareness of the existence of eating disorders. (“Anorexic” has been a coverline of enough celebrity magazines that I don’t think we need any more awareness of that elementary sort, but I digress.) Makeup is deeply tied to our ideas of self-presentation, yes. It’s also a way of controlling the way the way you’re seen, and eating disorders are rooted in control. But none of that shows up in the Renfrew campaign; instead, it’s all about appearance dissatisfaction, as though that alone can prompt a disease that ravages one’s life.

Eating disorders are complex beasts, with not-great recovery rates and the highest mortality rate of any mental illness. We don’t entirely know what causes eating disorders, but last year when I interviewed Sunny Sea Gold, author of Food, the Good Girl’s Drug and a recovered binge eater herself, she broke it down nicely:

Therapists pretty much agree that there are three main causes of eating disorders, and most of us who get them have a combination of the three. One is your genetics. Second is your physiology, like the biology of your actual brain—your personality.... The third thing is environment. Environment is broken into two parts: the environment of your home, what your mom and dad said to you, the behaviors they modeled. The other part of environment is culture. So about one-sixth of eating disorders can be blamed on cultural environment, like the pictures we’re shown.... If we magically were able to suddenly change the images we see in order to be diverse in all ways, gradually that part of the pressure would relieve itself. But it wouldn’t relieve that need of a girl to control her food intake because she can’t control her life.
It’s that last part that continues to get short shrift in popular media treatment of eating disorders. And I get why the media might latch onto images and the thin imperative as the root cause of eating disorders: Media outlets love nothing more than to generically critique themselves (what women’s magazine hasn’t covered the problem of unrealistic body ideals formed by...the media?). Less cynically, poor body image is something most of us have experienced at some point; using this as a hook for readers to empathize with eating disorder patients works beautifully. Plenty of people have dieted to lose weight for aesthetic reasons, and the disordered thought loop that makes a satisfying eating disorder story—I was obsessed with food!—is mimicked in the dieting mind-set. So the average reader may think she’s identifying with the subject, not realizing that what she’s identifying with are the symptoms of an eating disorder: the restriction of food, or the overconsumption of it, the vigilant attention paid. But the eating disorder doesn’t lie within its symptoms. It lies within its causes.

Listen, I’m not saying that there’s no connection between appearance and eating disorders. Of course there is. And body image is an essential topic to so many women’s lives today—including women who have never exhibited a single eating disorder symptom in their life. Do I even need to point out the ways in which having poor body image is a drain of resources? Of enormous intellectual and psychic energy? Of time, of money, of already precious resources? Of emotion? Do I need to ask how many times women have asked “Do I look fat in this?” because we lack the words to ask for support and tenderness? As long as we have poor body image, we walk through this world ashamed. Shame isn’t what I want for any person on this planet; it’s not what whoever/whatever created us probably had in mind; it’s not what any of us want for the people we love. Yes, we need body image work, and we’ve needed it for a long time. And a week devoted to eating disorder education is a good time to reinvigorate that conversation.

But eating disorders do not run parallel alongside a track of bodily dissatisfaction, and the more we conflate the two, the less we’re tackling the true complexity of eating disorders, and the less we're looking at the other threads that unite patients more deeply than hating their thighs. We’re not looking at perfectionism, or the twin sisters of compliance and rebellion, and how all of these play out in the lifetime of an eating disorder. We’re not looking at biology, or heredity, or giving proper diligence to plain old depression and anxiety. Hell, we’re not looking at stress. We’re not looking at choice, autonomy, or modernity. We’re not looking at the role of trauma, or sex, or comorbidity with addiction. And it is impossible to treat eating disorders without treating all of these as seriously—no, more seriously than—body image.

It’s one thing for the media to treat body image with greater weight than, say, family dynamics in eating disorders. It’s quite another for a treatment clinic to do the same. The Renfrew Center certainly doesn’t take this approach in treating its patients. When I was treated at Renfrew for my own eating disorder a few years ago, I was repeatedly struck by how little body image came up as a topic, both from the counselors and my fellow patients. That’s not to say it wasn’t important; it was more that we’d all thought about our bodies so fucking much by the time we landed in treatment that we were chomping at the bit to give voice to the things that we truly needed to be able to speak of. I could deconstruct body standards before treatment as fluently as I can now. But before entering Renfrew I had no words to tell you about the factors that took me 25 years deep into an eating disorder before I committed to getting help.

I still don’t have all those words, or at least I don’t have them in the ways I’d need to in order to share them here. That’s part of why I don’t usually write here about my eating disorder. The other parts are that while I’m doing really well, recovery is a long process and I’m not at the end of it, and I can’t get all meta on my recovery by writing about it. (I have a story coming out next month in Marie Claire about my experiences, and while I’m glad I wrote it and my editor was great, it was also emotionally taxing.) I’m sharing it here because it would be disingenuous to write an 1,900-word essay on eating disorders spurred by an action of the place I was treated without disclosing my personal stake in untangling the essence of what eating disorders are all about.

But the larger reason is that while I’m an advocate for looking at media images critically, and for improving body image in general, I don’t want to do anything to further the problem I’m writing about here. This is a blog about beauty, and while eating disorders have a role in that discussion, that connection is already so firm in the public mind that I feel my role here is to give a little whisper of Wait. I want us to wait before we draw connecting lines too heavily, and instead ask that we look at the connection between eating disorders and appearance as thematic and dynamic, not as an arrow from point A to point B. The connection isn’t that one causes the other; it’s that they’re both partly rooted in expectations of properly gendered behavior. (It’s worth noting here that while plenty of straight men develop eating disorders, gay men are at higher risk.) To untangle the social angle of eating disorders, we need to look beyond the mere existence of the thin imperative and look at what it says about the role of women: that we are to be perfect, controlled, managed, and compliant—themes that come up repeatedly with eating disorder patients, themes that get to the crux of the matter more directly, without taking the meandering detour through our bodies.

Makeup, too, can say a lot about those issues. It’s not the worst motif Renfrew could have chosen for their campaign. Nor is it the best. I’m no PR expert; I have no idea how the clinic could have better channeled their extraordinary work into a simple campaign for the public to engage with. I just know that by the time I was discharged from Renfrew, I’d finally begun to learn that my dissatisfaction with my body wasn’t causing my eating disorder; it was merely a symptom of it, like restricting my food intake or binge eating. I’d begun to take the focus off my body and put it into understanding the roots of my perfectionism, my people-pleasing, my family history, my silent shrieks of rebellion. 

I’d begun to understand that loving my body wasn’t the point. The point wasn’t even to like it. The point was to learn how to eat.

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This was extraordinarily interesting, Autumn. Body image drives so many aspects of womanly life. It is a major issue for a cancer survivor too. I could write my own lengthy post on that–but some other time.

I've worked with multiple young artists who are dealing with eating disorders. Two aspects they shared were an intense need to control whatever details they felt they could, and a much darker need to disappear, to be as small a container as possible. One young woman even lived in a tiny rented room, to have as small a living space as possible, one she could control. Your argument that going without make-up will not adjust a self view this nihilistic seems correct. Yet for some, it might strip away something from the secrecy of eating disorders.
Autumn, this piece was superb -- such a thorough dissection of the many factors that go into eating disorders. My own 4-year-battle with my binge/over-exercise disorder in college was in large part a way of managing my moods than anything else...though certainly perfectionism and family history played into it as well. I was adopted and my biological half-sister was severely anorexic for years. Her father was an alcoholic...I could go on, but I'd just be preaching to the choir. Great piece.
Really great post. Thanks.
Wonderful, as always! Thanks so much for highlighting this issue.
I'm an out-of-control bulimic and, as I was reading your otherwise excellent piece, I upchucked all over the computer screen. Now there are chunks of egg salad and a sesame seed bagel sort of obscuring what I can still read on here. Not your was just that time of the day for me....wink
You are so right. Anorexia is sort of like a game you play with yourself. How far can you go? How much self control do you have? People gave Kate Moss a lot of crap for saying, "Nothing tastes as good as skinny feels"-- but I think she had a point. The pleasure of "conquering yourself" (that's how I saw it when I was anorexic) is really unique. It's definitely more about control than body image, at least for me.

By the way, you're a fantastic writer.
Excellent post.
For me anorexia is kind of like a blankie or thumb sucking- it's what I regress to when I'm really, really upset and feel like my life is out of my control. I don't think that for everyone afflicted it's a coping mechanism, but my version is.
poem from 11.24.10 about my version of anorexia:
I feel skeletal
strangely articulated
my soul a too thin backbone to support even this meager weight

the loss of me was a shock
zombie-like I've been shedding more and more
the flesh cannibalized from within

I wonder when it will stop
if it will stop?
or if I will just dissolve one molecule at a time
I think rather than having women put their faces out their naked (again a focus on what we bring visually to the table) why not have them put their ideas out there about what anorexia is?
Okay . . . I will be the bogeyman here . . . and let me first say that I know about "eating disorders" first hand from two nieces who have it. First off, while you touched on it slightly, men, fathers of girls, are really often to blame . . . these girls grow up with admonishments from their fathers not to eat this or that or they will get "fat."

But more than that . . . I'm sorry, but I don't "play" into the "pity me I have an eating disorder" syndrome. And I certainly don't buy "the body-type" explanation.

Many girls "choose" this path. Yes, choose. OMG . . . punish me for saying that. And they love the path . . . they eat just enough to keep going . . . and make up all kinds of weird claims and excuses . . . .

Most eating disorders are aligned with POWER and CONTROL . . . NOT I repeat NOT body image . . . And you kind of touch on that by the end of your blog . . . But it should be the beginning . . . "The point was to learn how to eat." WTF? What does that mean?

And, of course, the editor of OS, Emily herself, has an eating disorder . . . .la-dee-dah . . . A main feature of OS has been "Foodie Tuesday" which Emily, as editor, has killed. Enough said. Figure it out . . .
P.S. Many girls from high schools love articles like this . . . it gives them permission to have eating disorders. In some schools it's an epidemic, but they won't admit it . . . Yes... eating disorders are contagious . . .
This post is fantastic. Thank you so much for writing this...eating disorders are so much more about control over something than body image. Great post.
Our nation is filled with an obsession on body image. Hollywood's glamorization of dysfunctional plastic beauties also has a powerful influence over the mindsets of young people.

Health and beauty aid advertisers also target young children with what it determines is beautiful and this repeated exposure does nothing to address the dynamics of eating disorders: low self-esteem/ego issues.
I agree with a great deal of what you have to say here, but unfortunately you also perpetuate another myth about eating disorders. This is NOT a feminine condition. Men suffer from eating disorders as well. And sadly, they are far more likely to get real help than their female counterparts.

In that regard, and others, would say that the Renfrew campaign is terribly off target. And if a center specialized in eating disorders misses that important point, it's hard to see how others will get it.
Thank you to everyone who read this and took the time to comment.

Greenheron, that's a great point about the secrecy of eating disorders. I think for some patients, not wearing makeup could indeed be beneficial; I just worry that painting makeup and EDs as being inherently connected displaces attention.

From the Midwest, you're not really addressing what I'm saying here, and frankly I don't like the idea that merely by writing about eating disorders I'm asking for pity. I was purposefully dispassionate about my experience here because it's upsetting to think that people will see my sharing as asking for pity, but alas, sometimes just writing about our experiences gets shaming from people. Also, there's definitely a social component to eating disorders and I wasn't implying otherwise. I think where you and I may differ is that I think the contagion of EDs is that knowing of their existence can sort of provide a bucket for all the amorphous, dissociative feelings that people who may have feelings about EDs have. I probably wouldn't have just organically developed some of my symptoms if I didn't know about EDs--but that doesn't mean I read about them and thought, "Oh, AWESOME, I totally want to do this!" Suicide is "contagious" too because it provides a solution to floating pain. That is the contagion. It's not contagious like a fad, though, which is what I think you're implying by painting yourself as some sort of renegade for "daring" to say something terrifically revolutionary.

Wordsmith, did you read my whole piece? I specifically pointed out that men DO get eating disorders, because I wholly agree that overlooking male patients benefits nobody. I write primarily about women on this blog so I focused on women in the piece.
I did indeed read your whole piece, and made my comment because I did feel it put a very strong emphasis on the female component of the condition. I think that it would be considerably more helpful to strip gender out of the discussion rather than using phrases such as "And if we keep the focus of eating disorder conversations on women’s bodies, we’re doing exactly what women with eating disorders do to themselves."
"It’s not like she who has the worst body image develops the worst eating disorder, or that people whose body image is average are immune from eating disorders."
"To untangle the social angle of eating disorders, we need to look beyond the mere existence of the thin imperative and look at what it says about the role of women: ..."
"Do I need to ask how many times women have asked “Do I look fat in this?” because we lack the words to ask for support and tenderness? As long as we have poor body image, we walk through this world ashamed."
" But it wouldn’t relieve that need of a girl to control her food intake because she can’t control her life."
(The quotes above were easy to pull out because you yourself chose to highlight them.)

One parenthetical statement ("It’s worth noting here that while plenty of straight men develop eating disorders, gay men are at higher risk.") does not constitute a lack of gender bias.
Wordsmith, you're right. I have a gender bias here, and though this blog is specifically about women and I don't intend to make it anything besides that, when talking about eating disorders and their misconceptions I should have taken more care in acknowledging that men get them to--not just explicitly saying that but using male and female pronouns. In my defense, part of the point of this piece was about trying to tease out body image from EDs, and body image is usually thought of in terms of women. But I'm perpetuating what I'm fighting against if I don't take care. Thank you for illuminating this for me.
Been meaning to duck in here. My daughter, who has made two attempts on her life, recently had to deal with an eating disorder, and as you mention in your blog, it came down to deciding to eat right. I am a single parent and we are close, as only two trips to the acute psych ward can make two people, but no one, including close friends, had any idea she suffered from the disorder. No one was aware of any appearance anxiety. But she was purging and using exercise as a proxy.

Her regular therapist had lots of experience in dealing with disorders; and the nutritionist she worked with both were an immense help.

She's now prospering as a freshman in college - got through her breakup with her first real love interest with flying colors, always a good sign.
I've worked with a lot of eating disorder patients and they are really different from one another, despite many common symptoms, as you so aptly point out. Make-up, jewelry, nice clothes and other superficial and fun accessories and acoutrements can be very therapeutic along the way to recovery. Especially, long hair, earrings, and rings sometimes give a bulimic pause to consider not throwing up. I haven't been happy with the treatment of some patients who have been through the Renfrew program because the gamed the system too well and stayed sick, while talking healthy. You are right-on in realizing that with behavioral change, like eating right, exercising normally, and not purging, comes decent, normal body image and other forms of self-respect.
Also, there's no more honor in feeling good about being overweight or underweight than there is in feeling like an inferior person connected with body type. Our whole country should get in shape but not obsessionally, just by learning better perspective and balance.
I'd appreciate if you'd check out my blog, too, by the way--Dr. Jackie's Mental Health Moment.