I'm sad to note that neither side of this debate knows much about the topic.

Eating disorders are a (treatable) mental illness. They are not a choice, and they are not about being skinny. Anorexia and bulimia are brain disorders that can be triggered in those with a genetic disposition when they diet.

Equating a desire to be thin with an eating disorder is like saying that soap commercials cause obsessive compulsive disorder.

Eating disorders are treatable, but you have to know what they are and what the treatments are--and public information that makes it about personal responsibility vs. the media just perpetuates damaging myths.

I rarely see girls who are anorexic. I think most women tend be on the chubby side in New York.

What? I am the parent of an 11-year-old son with anorexia. We know firsthand the devastation of anorexia. I can tell you that anorexia is not a choice; it is a disease.

Current research (see http://feast-ed.org/researchblog.html or http://www.kartiniclinic.com/AV or http://www.maudsleyparents.org/whatismaudsley.html) is showing biological and neurological origins of the disease. I can tell you that this disease is not about being thin and that my son did not choose to be sick--nor can he just choose to get better. It's unfortunate that the media continues to perpetuate incorrect information and stereotypes about this disease.

If eating disorders are simply inherited diseases, why is their occurrence so great in actresses and other women in the public eye --Terri Hatcher, Calista Flockhart, Princess Diana? And why was there no anorexia or bulimia problem in the 1940s and 1950s, when being beautiful wasn't all about being thin? And why does anorexia suddenly become a problem when people in the developing world get their first access to U.S. television shows? Oh, right, they must have experienced a collective genetic mutation that prompted them to get eating disorders in unison.

First of all, eating disorders absolutely existed in the 1940s and 1950s. It's just that people didn't talk about them the way we do now. Rates of anorexia and bulimia have held steady over the last 100 years (we don't have data going back further than that).

Second, genetics loads the gun; environment pulls the trigger. There are a lot more environmental triggers in our current culture: abnormal notions of thinness, constant bombardment of images of unnatural thinness in the media, an abundance of food, and an age of rising anxiety. There is a huge overlap between eating disorders and anxiety disorders. No one can answer this question for sure, but the best and most informed folks in the field today believe that for people with a genetic predisposition toward eating disorders, there are just a whole lot more triggers out there now than there were, say 50 years ago.

Your disdain reveals your ignorance, RR, and, I'd guess, your own issues around food and eating and weight. And that's very sad to me. People with anorexia and bulimia are severely ill; their brains don't work correctly. Do you think schizophrenic people are to blame for their illness? How about the parents of schizophrenics?

Eating disorders are no different.

RR--
It's simple statistics. If around 1 in 20 people will have an eating disorder in their life (1% for anorexia, 4% for bulimia), then there are bound to be a number of celebrities with eating disorders. As well, their strict diets to maintain "Hollywood thin" could set off the chain of events in their brain chemistry to develop an eating disorder.

There were eating disorders in the 1940s and 1950s. Eating disorders existed in the Middle Ages, long before Hollywood and supermodels.

RR, what you're getting wrong is that a biological cause implicates sheer biological determinism. It doesn't. Any disease needs both genes and environment, nature and nurture. The more people are encouraged to diet, the more chance they have of altering their brain chemistry and developing an eating disorder.
--Carrie
www.edbites.com

Ugh. This debate saddens and angers me. It is a fine example of how little the media understands eating disorders. Time after time I read articles that wrongly depict eating disorders as a choice or a way to "look good in a bikini." It is such an insult to blame the sufferer. They do notnot

I'm slim, and till a few months back I've always been comfortable about my figure. Then I took to watching a season of America's Next Top Model, and now I no longer feel satisfied with my appearance. I've started exercising, although my friends tell me there is no need for me to do so, so the problem is definitely in my head. I have no clue as to how I should go about fixing my warped self-image. Tyra Banks is definitely responsible for my muscle cramps, so I'm siding with "pro."

Is this Business Week or The National Enquirer? My non-ED daughter is preparing to study journalism in college and is always on the lookout for examples of poor and irresponsible journalism such as this. Start with some facts, please.
http://feast-ed.org/understandingeds/causeofeds.html
http://video.google.com/videoplay?docid=-7054088385304360926&hl=en

The first medical text description of anorexia nervosa was in 1689 by Richard Morton, and it--like other human illnesses--existed before it was officially described.

Rather than worry about the effects of the media's absurd and constant portrayal of thin body size on the 1% of women (and perhaps about 0.1% men) who have anorexia nervosa. Let's worry about the effects of it on everyone else, especially children and adolescents who are just now forming their own self-image.

The current obsession with "thin" has done nothing to reduce obesity, but it has made scores of people feel bad about their own inability to attain these unrealistic (and often completely unhealthy) weights.

Why are we so concerned about what everyone looks like and so unconcerned about what everyone acts like?

Julie O'Toole M.D., MPH
Medical Director, Kartini Clinic
www.kartiniclinic.com

Also, when looking at actors, athletes, and models (of both genders), let's not conflate people who develop disordered eating and exercise habits because of their profession's standards, with people who have an eating disorder. For joemama, RR, et al, you can't tell if someone has anorexia nervosa--or any eating disorder--by looking at them. My kid looks fine now, but still has anorexia--as she did when she was 40 pounds underweight and in a cardiac intensive care unit. It's not how you look that makes the diagnosis. And, Oriana--people are not "responsible" for their genetic makeup. It's sort of part of the game. If you want to end the blame game, don't you think that applies to the sufferers as well, or most of all?

Blaming the media is the adult's version of "my dog ate my homework." True, sometimes a playful puppy does tear up your homework, but more often than not, it won't touch your papers. Likewise with the media and what it portrays.

Judging by the ever-expanding waistlines of the American public, it's hard to believe that the media's images of thin women is somehow powerful enough to render perfectly ordinary humans into eating disorders. When we want to slim down, we eat less, eat healthier, and exercise or at least, walk and use the bicycle more. Very few of us will just refuse food to the point of starvation and atrophy or run to the nearest bathroom to give back a meal just eaten. Making those decisions to control weight typically involves a broken thought process or a mental illness that seeks more control over one's personal life.

In fact, many anorexics come from overprotective if not overbearing households who've told them what to do and how to do it for most of their lives. By choosing not to eat, they're in fact rebelling against this control and making their own choices about food and when to ingest it. Bulimia can also be an act of defiance or a physical manifestation of shame and depression.

And if you believe that you must model what you see on TV and in magazines, I would read up on something known as "memes" and their role in our decision making. Taking a meme too far is not a good idea, and part of our personal responsibility to protect our health and well being is to audit our memes and make sure we don't engage in harmful ones.

Everything I'd say has already been said, so I don't have anything original to add. Simply:

Oriana and Matthew, you are both very young and still in school or newly out of school. This should be a good learning example for you that you had better know the facts when you write. It seems neither of you do enough to be writing. I'm sad that this was published, as it does nothing but disseminate more incorrect assumptions about eating disorders.

RR and joemama, you both need to educate yourselves much, much better before commenting on this subject. Joemama, I live in New York as well. Not only would I disagree with your statement, I'd back up IrishUp in pointing out that not everyone who's anorexic "looks" like it. In fact, most don't, just like some people who are very thin are absolutely healthy.

I have suffered from and gone through treatment for anorexia. I have never picked up, let alone read, Vogue, Seventeen, or Allure magazines. I have never watched America's Next Top Model and couldn't ever name a famous model--either back when I was a teenager or now. While in treatment, I can't remember ever sitting with my therapist or in group therapy discussing all the "trauma" I have suffered due to the media showing pictures of skinny models and actresses.

If you really want to understand what underlies an eating disorder, maybe you should pick up a book written by a recovered sufferer. You might find that eating disorders are a bit more complicated than you thought.

Call me old school, but I am not convinced either side has merit. I do not believe that anorexia or bulimia is a mental illness (please). Or that it is inherited. The media are in no small way responsible for both "disorders." Whoever heard of either one until recently? Suddenly, it's an epidemic. Peer pressure, TV, and unrealistic expectations put so much pressure on kids these days that I'm almost glad I am old.

Random,
To put it bluntly, you don't know what you're talking about. You're simply repeating the "conventional wisdom" about eating disorders--which, as it turns out, is based on no real science or facts.

The fact is, families do not cause eating disorders any more than the media does. Biology and genetics play a huge role in eating disorders, just as they do in diabetes and other illnesses.

Random,
So you think that many anorexics come from "overprotective if not overbearing households"? Are schizophrenia and autism the result of poor parenting as well, as was once thought?

The conventional wisdom on all three disorders has shifted, though myths regarding anorexia persist. Current research clearly points to genetic origins for both anorexia and bulimia.

How about asking those who have suffered from anorexia? I was anorexic for 8 years some 30 years ago. My weight dropped to 57 pounds. And no, it had nothing to do with beauty magazines or top model competitions. It had to do with self esteem or my perception of it. It's a terrible mental illness and one that nearly killed me. So I hate it when media critics try to draw false parallels to what's on TV. If you're going to connect anorexia that way, why not alcoholism or drug use?

Anorexia? What do they call it in countries where obesity isn't a problem--normal?

The media did not make me anorexic; my genetic predisposition did. I admit, the media plays a role in many a person's body image issues. There is no questioning that. But proclaiming that skinny women on TV drive the rest of us into eating disordered peril is ludicrous. It's like saying video games turn little boys into violent killing machines. It's not true. Certainly, these things will exacerbate an already unstable person. But if you are not wired to have an eating disorder, you will never have one. I had a friend in high school who tried to make herself anorexic. She couldn't. After a month, she went back to eating normal meals and focused on keeping healthy.

No one can will himself or herself to have a mental illness. It's beyond conscious decision. As someone who has suffered anorexia for seven years, I will tell you this--I did not choose to be sickly and weak. I do not embrace the fear-stricken and neurotic, myopic kind of life this illness has forced me into. I am doing everything in my power to get well again. It is the hardest thing I may ever have to go through in life. After being on my deathbed for five years due to being chronically emaciated, I think its safe to say this is an illness. Not a choice or a dream, or anything purported by the media. It's so much more serious than that.

MBA,
Anorexia is found in all countries and all cultures. And malnutrition is not and will never be normal. Period.

Dinosaur,
Do me a favor and go to an eating disorders inpatient unit before you say such woefully ignorant things as eating disorders aren't real disorders. It's not a choice. I am in recovery from anorexia, and I got to the point where I was afraid to eat or drink. It had nothing to do with the media and everything to do with anxiety and fear.
--Carrie

"The fact is, families do not cause eating disorders any more than the media does. Biology and genetics play a huge role in eating disorders, just as they do in diabetes and other illnesses."

http://www.medicinenet.com/anorexia_nervosa/article.htm
http://www.medicinenet.com/bulimia/page2.htm

As you can see, that's not a correct statement to make. Causes for anorexia most certainly include family behaviors as well as physiological issues the brain may develop. There's evidence and a few studies that genetics may be involved in eating disorders, but this research is not definitive and to make an authoritative statement that there are no family components and that these illnesses are as biologically triggered as anything else is simply ignoring the current medical consensus.

"So you think that many anorexics come from 'overprotective if not overbearing households'? Are schizophrenia and autism the result of poor parenting as well, as was once thought?"

The comparison here is that of apples to oranges. First and foremost, the term schizophrenia is essentially a catch-all for all mental illnesses that are not readily identifiable. They're united by an excess of dopamine being produced in the brain and triggering paranoia, hallucinations and delusions. Nothing to do with parenting, it's a malfunction of the brain to put it in blunt terms.

Autism is also a physical ailment that has nothing to do with parenting or with a psychological condition. It's a physical problem, essentially a cluster of diseases that stop the development of certain neural functions.

Eating disorders, on the other hand, are often triggered and sustained by a psychological component, and this very same psychological component is what keeps it going (see links provided above). A person with an eating disorder can choose to stop being anorexic or bulimic. It's much in the same way an alcoholic may decide to become sober, and there are relapses and a wide host of physical and psychological problems to contend with, but an eating disorder sufferer can in essence decide to stop having an eating disorder.

On the other hand, a schizophrenic can't choose not to have delusions or hallucinations or paranoid feelings. An autistic child can't decide not to be autistic anymore and over time develop all the social and imaginative skills that have never been there as a result of the diseases.

"The conventional wisdom on all three disorders has shifted, though myths regarding anorexia persist. Current research clearly points to genetic origins for both anorexia and bulimia."

http://eatingdisorders.about.com/od/riskfactors/f/edsgenetic.htm

It points to possible predispositions. Not origins. The evidence is not conclusive and only points to a genetic component. Not a genetic cause. All such a possible component means is that you may develop an eating disorder easier than someone without these genes when presented with the right trigger--but not that you're somehow doomed to develop it because you have those genes in your DNA. That's simply not how genes work.

Anorexia and bulimia are opposite extremes. In bulimia, a patient overeats, and in anorexia a patient develops a strong dislike for food. Both these disorders can be psycho-somatic, of genetic origin, due to inflammation of liver or other GIT disorders or purely functional psychological disorders like schizophrenia, neuroses or severe depression. People who willingly abstain from food for slimming or overeat for weight-gain do no fall within the category of illness. Anorexia in AIDS is incurable for it is etiologically associated with viral infection. All other functional and organic anorexia as well as bulimia caused by psychological drive of weight-gain are curable. If the anorexia is caused by inflammation of the liver, aloe vera can be of immense value, because it is a great hepato-protective medicine and contains liver-corrective properties. If anorexia and bulimia are caused by depression, antidepressants can be helpful in controlling it. If anorexia is caused by neurosis, tranquilizers can be of some help.

Dr. Nandlal Kanjibhai Pancholi
Vadodara,Gujarat, India

Random,
Just finding a Web site that says that families are to blame for eating disorders doesn't make it true. I'm sure you know that you can find a Web site to support just about any position you'd care to take on any issue. Not all sources are accurate ones. Generic Web sites about eating disorders are about as accurate as an unedited, unsubstantiated Wikipedia page--not very.

Since you are so deeply interested in the subject, I suggest you read up on some of the research that's been done in the last 10 years or so. Look for the work of Walter Kaye, Cynthia Bulik, James Lock, and Daniel le Grange. That ought to get you started.

Many of the folks who adhere to the psychology-based model of causation are giving their opinions. There is no factual basis whatsoever for assuming a psychological or family-based model of causation. Certainly there are people who believe that families cause eating disorders, but I challenge you to find a scrap of actual scientific proof that supports that. You won't, because there isn't any. Whereas there is, in fact, more and more factual evidence about the biology, genetics, and neuroanatomy of eating disorders.

Oh, and if you believe that someone with anorexia or bulimia can "simply choose" to stop having it, I invite you to read this article: www-news.uchicago.edu/citations/06/061126.legrange-nyt.html. Then see what you think.

Do unrealistic beauty standards lead to an upsurge in negative body image? Yes, almost certainly. Does this actually lead people to become anorexic? No, not really.

I've talked to a lot of young women who are extremely unhappy about their bodies. Many of them have at some point tried extreme weight-loss methods that would suggest anorexia if they sustained them. But they don't. They try these methods for brief periods of time and then stop, because their bodies and minds are screaming at them to knock it off and get some nutrients.

They continue on a cycle of trying one diet after another, which is a health problem in itself, but it's not the same as real anorexia.

So we all know that the standard of beauty has changed over the past 50 years. We all know that our eating habits have changed as well. People are lazy. Everyone wants to have their cake and eat it too. You want a nice thin body that is toned. Work out and eat healthy. Stop going out to eat and save the average $60 to $200 a month on eating out and join a gym. I can't feel sorry for someone who doesn't want to help themselves. There is something in everyone's mind that triggers that breaking point. I had terrible self-esteem in high school, my step mom and the kids at my school always called me fat, and I was 5'6" 150 pounds, and I was just "thick." I am the one who chose to throw up my food and drop 30 pounds in two months. I was too lazy to get off the couch and work out. I was in a rebelling stage, because that is all my family ever wanted me to do and I just wanted to be me. On top of that, I realized that I was bigger because I wasn't on drugs like the rest of my high school.

Now I have a 19-month-old, and I am 5'7" and 145 pounds, and I work out, and I eat healthy, and I am not the skinniest person in the world, but I am happy and thin and constantly get praise for my body. We all need to stop blaming the media. You want to watch America's Next Top Model? Okay, then do the workouts that you just read in your Glamour magazine.

Anorexia nervosa certainly occurred in the absence of modern media. This article offers a historical view with an emphasis on genetic/neurological predisposition. http://www.wpic.pitt.edu/research/angenetics/press/cover_story.pdf

Re "overbearing families": I recently heard an eating expert discussing the topic. He said, "It makes a lot of sense that if a child is starving herself to death that the parents get very worried, preoccupied, and watchful, creating the impression of being 'enmeshed.' But the reality is that the maligned parents have been shown again and again to be the best agents to help the child."

"Just finding a Web site that says that families are to blame for eating disorders doesn’t make it true."

True. But if you paid attention, the site I used was a peer-reviewed medical Web site, a competitor to Web MD. If you paid even more attention, you would also note that families are listed as an occasional culprit, not a consistent one. The article is written after interviews with doctors who specialize in a particular area and is then reviewed by the interviewed doctors before being posted. If you disagree or think the doctors who helped write this article are incorrect and you know better, I would suggest contacting them. It's pretty certain they would want to know if they have their facts wrong.

Of course, you would need to present some sort of research proving that your perception of roles that families play in developing eating disorders (none at all) is somehow been proven as correct. But then you'd have to say that families in which a child is always teased about his or her weight in a mean-spirited way or codependent families with a long history of eating disorders somehow don't contribute to the problem.

"I’m sure you know that you can find a Web site to support just about any position you’d care to take on any issue."

Certainly. But it's usually not a peer-reviewed medical site. It also brings into doubt any references you summon to argue with the data used to back up my argument. If you can find a site to support any opinion and that somehow makes it invalid, why should I consider it more authoritative than a well-known medical site?

You can also find books and studies that say what you want them to say. So what happens with this line of counter-argument (generally known in layman's terms as "pooh-poohing") is that we end up with a perfectly circular debate where no source will do and no facts--other than those matching your personal perceptions--are allowed. And that, Harriet, isn't science. It's politics, religion, or personal ideology.

"I suggest you read up on some of the research that’s been done in the last 10 years or so. Look for the work of Walter Kaye, Cynthia Bulik, James Lock, and Daniel le Grange."

Well, if I were to take your method of counter-argument, I would say that you can find a researcher who believes in anything you want to believe. But that's not quite the case here. Their work is varied and diverse, and all of it focuses on the idea that eating disorders are mental illnesses that have many physiological and maybe some genetic components. However, their work does not rule out what I've said, as it maintains that anxiety disorders and negative environments around the victims may push them toward developing eating disorders. So in fact, it's very likely that they contributed to the MedicineNet articles in the first place.

"There is no factual basis whatsoever for assuming a psychological or family-based model of causation."

Really? Because you just provided the evidence for assuming psychological models of causation. Walter Kaye's faculty Web site says that anorexia is a psychological illness often triggered by anxiety disorders. Cynthia Bulik is a clinical psychologist who does indeed perform studies on the biology of eating disorders, but her treatments are indeed based on psychiatric methods. James Lock is a clinical psychiatrist as well as Daniel le Grange.

So you tell me that there's no credible scientific basis to assume a psychological causation of eating disorders after listing psychiatrists as the sources to which I should refer? This would be like my trying to convince you that there was never such thing as the Big Bang but referring you to a number of cosmologists who study string theory and the brane hypothesis. (Both revolve around what happened an instant before the Big Bang and what happened an instant after.) Then, I would insist that there's no basis for a Big Bang in the discipline of astrophysics.

"Certainly there are people who believe that families cause eating disorders, but I challenge you to find a scrap of actual scientific proof that supports that."

It was already provided. However, you chose to discard the evidence as just another site. I do wonder, though. I know you run a blog on eating disorders with a lot of emotional essays, defending those who have developed eating disorders and their families from even a sideward glance, and you link to clinical psychiatrists and groups of psychologists who study the mental aspects of eating disorders while fervently denying that they have any mental aspects. So you're linking to peer-reviewed material that says one thing, and you tell your readers the opposite. Have you ever thought of looking into that?

At any rate, this is a storm in a teacup over a technicality. All I've said is that a notable number of anorexics have developed anxieties and mental complexes from living in overly protective or overbearing families and that an unhealthy family dynamic contributes to the developments of eating disorders. Medical, peer-reviewed sites back me up on that.

I did not say that this is always the case, or nearly always or even often. I just said it happens to many.

"Oh, and if you believe that someone with anorexia or bulimia can “simply choose” to stop having it, I invite you to read this article..."

The link is broken. Since you gave it out on your blog about eating disorders and many message boards again and again as a resource, I would suggest you link directly to the article you are trying to quote rather than a citation archive. Just a friendly tip in making permalinks.

Now, I didn't say it was easy to stop having an eating disorder, and compared it to recovery from a bout with alcoholism. Yes, a patient with an eating disorder can make the decision to stop having it and work toward that goal with the intent of regaining control over his or her eating habits. I never said that an anorexic on the verge of death from malnutrition can just jump up, go get a hamburger, and forget about all her worries as you seem to imply. What you're doing is called a strawman fallacy.

I appreciate your zeal, but really, this is too much. You're going after me with long serrated knives for every word choice, regardless of what I actually say, the context or the quality of evidence I provide, and despite your sources' agreement with the references I've posted. You clearly have an axe to grind, but if you really want to help people with your blog and your advice, you should acknowledge that you can't ignore research you use as guides and references contradicting your personal stance on what an eating disorder is. The problem isn't who to blame. It's how these illnesses develop and how to treat their victims that's important. For that, you need an objective, clinical mind set. Worrying about who's going to say what or have an "impure" thought here and there is not what cures diseases.

Why all the defensiveness among parents on this message board? The pro essay blamed the media, not Mom and Dad.

I'm just going to throw my (bulimic) hat in the ring here and put another option out--addiction.

I don't believe that eating disorders are a mental disease. You can't recover from a disease with just therapy, no matter how intense. However I in no way think that people can just stop. It's an addiction.

I don't think that it's genetic and have never found a study with that convinced me of that. I believe a combination of society, pressures, and personality lead to eating disorders.

Anyone want to fight on this?

RR,
I believe responses from parents are in reference to Random's posts, not the pro essay.

Dinosaur and Roundedge4113,
You may disagree, but the American Psychiatric Association thinks that anorexia nervosa and bulimia nervosa are mental illnesses. In fact, anorexia nervosa has the highest death rate of any psychiatric disorder.

Roundedge4113,
I have no interest in "fighting" on this, or anything else, but this article "Addicted to Starvation" might be of interest.
http://www.sciam.com/article.cfm?id=addicted-to-starvation

I have no interest in fighting either. Random and others, no one knows the causes of anorexia and other eating disorders. Anyone who says they do is blowing hot air. The reason I am an advocate for family-based treatment (besides the fact that it's the only evidence-based treatment that actually works for more than 90% of sufferers) is that it doesn't get bogged down in opinionated rants about causation. It sidesteps the issue, which is pretty much pointless. Who cares what causes it? What we need are treatments that work.

That link worked just fine for me, by the way. The problem must be on your computer. You can look up the story on the New York Times archive online, too; search for my name and "anorexia."

I guess, Random, you are a perfect example of how people feel absolutely free to say and do things online they would never do in real life. Though maybe you are that vicious there, too.

Link worked fine for me, too.

Fashion magazines do not show average women with average bodies because they are of average physical beauty. This is the same reason that average swimmers are not invited to compete in the Olympics instead of Michael Phelps. Average physicists do not win the Nobel prize in physics, and Forbes has no list of 400 average earners.

There is nothing "artificial" about this. Exceptional performance, regardless of the field or category, requires plenty of hard work and deserves to be celebrated. However, by its very definition, exceptional is not something that most people can be. If most people reach levels of performance previously considered exceptional, they would become the norm, after all.

I was never concerned about my appearance, mostly because I was always rather fit. At a certain point I gained weight through a hormonal imbalance, which lead me to develop an eating disorder.

Because I was in my early twenties when I showed first signs of an eating disorder, I was quick to recognize them and start my mental battle. From what I can say is-it is all in my head.

I do not believe it is a genetic disease, I made myself sick, and now I am still making myself get better. There is a definite pressure on both sexes (but particularly on women) to have a certain appearance. It is a shame that even the educated and well-rounded individuals fall into that trap.

I think that some people are simply more prone to such illnesses due to their emotional strength of character, but blaming everything on genetics is an easy way out.

All other forms of anorexia nervosa can be cured except those linked with AIDS and schizophrenia, because the former is linked with an invincible virus--and in latter because of severe disorientation, the patient loses contact with reality and lives in the world of fantasy, and food for him becomes an intrusion on the stream of his bizarre consciousness.

"Who cares what causes it? What we need are treatments that work."

How does one develop effective and safe treatments without knowing what causes the disease by anything other than pure accident? Knowing what the disease is, why it occurs, how it develops and all of its components is half the battle in developing a cure. You're essentially asking people not to care about the root cause of eating disorders, just to poke around blindly to find cure.

I also never took issue with family-based therapies for eating disorders, and I know that they help. What I did take issue with is your insistence for a lack of psychological components in causes of eating disorders while all the sources on which you rely consist of psychiatrists and psychologists who investigate the mental and physical components of these diseases. It's self-contradictory.

"I guess, Random, you are a perfect example of how people feel absolutely free to say and do things online they would never do in real life. Though maybe you are that vicious there, too."

If I'm vicious for quoting medical journals and clinical speech in your opinion, this begs the question of how you can stand to be in the same room with a doctor.

Not wanting to have an emotional moment with you doesn't mean that I'm a villain. But I suppose you need one for your general purposes, and my somewhat detached manner here lends me credibility for the role. If you need me, you can find me in my evil lab, stitching together corpses with Igor and preparing for the first phase of my world domination plan.

(Insert sinister/insane/disturbing laughter here.)

There is an excellent basic description of our present-day understanding of eating disorders in Janet Treasure (from the Maudsley Institute in London), Grainne Smith, and Anna Crane's new book: Skills-based Learning for Caring for a Loved One with an Eating Disorder: The New Maudsley Method. I highly recommend this book.

If anyone reading has an interest in looking further into the genetic and neurobiological aspects, here are a few links.

On genetics and eating disorders (see Published Papers link):
http://www.wpic.pitt.edu/research/pfanbn/index.html

On the neurobiology and eating disorders:
http://eatingdisorders.ucsd.edu/NeurobiologyPage.html
http://www.wpic.pitt.edu/research/anbnbrainimaging/default.htm

On treatment effectiveness:
(The first may be of interest to Random, regarding various therapies for AN vs supportive clinical management.)
http://ajp.psychiatryonline.org/cgi/content/full/162/4/741
http://www.ahrq.gov/downloads/pub/evidence/pdf/eatingdisorders/eatdis.pdf

Readers will judge the reliability of resources for themselves, but I wouldn't put resources like "about.com" in the same category as the information cited above (which Brown is quite familiar with and has written about), whether or not the writer (or peer-reviewer) has a degree. It's especially concerning to see discussion of eating disorder treatment (or contributing factors) that don't break the discussion into AN, BN, and BED, which differ substantially. Unfortunately, we still see them quite often talked about on general interest health sites as if they were all of one piece.

Unfortunately, people suffer from eating disorders right now and, in spite of the fact that they aren't fully understood, those people need help and treatment now. It makes perfect sense to me that research proceed on a number of fronts simultaneously, including possible contributing factors and treatment effectiveness both. Findings from both types of research are likely to help drive the other forward. It's not a "pick one" situation.

Random, dude, you're not coming across as detached as you seem to think.

With regard to developing effective treatments without knowing the cause, Random, that's already been done. Family-based treatment is very effective, and yet--shockingly!--no one knows the cause for eating disorders.

By the way, saying that an illness has a "mental" component is perfectly compatible with saying it's biologically or physiologically based. Last I heard, the brain was housed in the body. You cannot truly separate psychology from physiology.

Believe me, you are the last person in the world I'm interested in having an emotional moment with.

I'm honored by your aspersions on my blog and my writing. I guess my hyper-emotionality is why my work appears so often in the New York Times science section, that bastion of sentimentality.

"With regard to developing effective treatments without knowing the cause, Random, that's already been done."

That's great, but you seem to suggest that it's okay to stop there and not care what causes eating disorders. "Who cares?" you said. Well, maybe if we find out what really causes them, we can develop more effective treatments and help more people faster?

"By the way, saying that an illness has a "mental" component is perfectly compatible with saying it's biologically or physiologically based... You cannot truly separate psychology from physiology."

So by this argument, you're now voiding your previous assertion that there's no scientific basis for any psychological basis in eating disorders. So if you cannot separate physiology and psychology, how can you then separate them and say there's no basis to suspect one of being a component or one of the culprits of a disease?

"I'm honored by your aspersions on my blog and my writing. I guess my hyper-emotionality is why my work appears so often in the New York Times science section, that bastion of sentimentality."

Any writer in a non-fiction capacity must be careful of their facts. And while I'm sure that you have a great publishing history, any and all writing is up for criticism. Criticism is not slander.

Overall, this debate has degenerated from questions about scientific technicalities to emotional objections to assumptions of what someone may have said and personal attacks. And wielding personal accomplishments over others' heads like a battering ram.

I don't see a voiding of any argument, Random. Many prefer to think about psychiatry in terms beyond Cartesian duality of mind and body. I think that's the point you're missing. It's less a question of separating them out than as dismissing the whole paradigm altogether (for me anyway, I'm not speaking for anyone else.)

Quite honestly, I see the over-emotionality as coming from your side. Who said anything about slander? And battering ram? (Don't feel bad--lots of people haven't been published in the Times. I haven't and I'm still okay.) As for criticizing writing, didn't you say you weren't able to access the article mentioned? Typically, reading precedes criticism of writing. As someone who has read the work, I will point out that your suggestion that Brown is anti-research is not correct.

"Many prefer to think about psychiatry in terms beyond Cartesian duality of mind and body. I think that's the point you're missing."

Psychology and internal medicine are treated as distinct sciences. Obviously both work with the brain as the source of cognition, but psychology also addresses the way that cognition is achieved and how its processed by the individual. If they were completely one and the same to medical professionals, then I would see the issue.

A neurologist will focus on the mechanical functions of the brain, where they come from, how they can be altered and why they occur while a psychologist will focus on what it does to a person's perception of self and the surrounding environment. Same organ, different focus.

"Who said anything about slander?"

Harriet said she was honored by my aspersions. Aspersions means slander or defamation. See http://www.answers.com/aspersions&r=67

"And battering ram? (Don't feel bad--lots of people haven't been published in the Times. I haven't and I'm still okay.)"

Using a publishing history to stick it to a random stranger on the Internet is just well... unseemly. It's like the good old Internet argument where one finds two millionaire doctor astronauts with 60,000 square foot mansions in Beverly Hills bashing each other after they left the original topic far behind.

"As for criticizing writing, didn't you say you weren't able to access the article mentioned? Typically, reading precedes criticism of writing."

I've read her blog.

"As someone who has read the work, I will point out that your suggestion that Brown is anti-research is not correct."

I've made no such suggestion. It's just that when told "who cares about what causes it?" a reader will have some questions.

This is what I took to be the anti-research suggestion:

"You seem to suggest that it's okay to stop there and not care what causes eating disorders."

But, whatever. Basing an assessment based on blog reading probably won't yield the most accurate understanding of this, or almost any other, topic.

Answers.com isn't my favorite source for defining words, but if you like it and choose to focus on the secondary definition of aspersions, I guess that's up to you. I don't know much about "old Internet arguments."

Psychology and internal medicine certainly are different disciplines. Modern psychiatry--at least those who are making the most progress in understanding anorexia nervosa--seems to be taking a more integrated focus and have begun to look at how temperament traits relate to brain function and how this might drive the eating disorder behaviors that cause so much suffering. This groundbreaking work includes MRIs on people recovered from anorexia nervosa. I look forward to the day we don't see eating disorders stigmatized, romanticized, or trivialized (I've seen a little of each in the original posts and subsequent comments) but rather compassionately and successfully treated.

In my opinion, anorexia is a media-driven disease. I don't think it affects all countries. In Mongolia, for example, I have never heard of an anorexia case--only in the U.S.

Anorexia should not be stigmatized. Nor should it be treated as only a psychological ailment, because it may be caused by purely physiological causes like inflammation of the liver. Since the hypothalamus regulates appetite and it is sensitive to blood sugar levels, the relation of anorexia to neurological factors cannot be altogether ruled out.

I believe the media and the people are both responsible--not some disease.

Stop sitting here and getting fumed up about this when in fact you are doing nothing to help the situation. Enjoy your food now.

I apologize ahead of time for for the informal writing.

A little off topic, but I was just wondering though many people, both men and women, say things like "I need to lose a few pounds," "I want or need to look like this or that," or "I want to be tan and toned." Wouldn't that still prove that the media is the standard of beauty ever since there was a media and it is pretty much imprinted to our brains? So, wouldn't the cause of anorexia eventually conclude to the media?

It is in my opinion that although Anorexia is a known disease, and it is also about awareness one has on the issue. It is very easy to point fingers at the media for the cause of anorexia, but is it really? Look at those who are not surrounded by the media. Anorexia is among us but not because of the media. A person chooses to watch the ads and shows that are out there and a person chooses whether to fall victim to it. Anorexia is about the fight for discipline and control over one's body. We all want to be healthy and fit, but it starts with discipline and control. The media may impact many suffering from low self-esteem and lack of control, but it is by no means the answer to the many problems out there like anorexia. Though the media should rethink many of their tactics, they are only giving people what they want.

That'’s really shrewd. Good to see the logic set out so well.

Alright, so, Im just a regular everyday girl, from a regular b.s little town right? I got curious, I was looking at pictures of pretty girls who are models; I was looking at pictures of the girls that I wished I could be. I'm pretty seriously overweight in my mind. No one seems to see this right? Anorexia doesn't need a cause really. It's something that can just creep up and bite you one day and start sinking in, so saying just enjoy your food is bull shit. It just doesn't work. I think people from the inside need to post on this more than people on the outside, mostly because people on the outside of the "disease" or whatever they decide to brand it, don't really understand. Media, internal conflict, external conflict, anything can cause it. People need to look into things better.

Besides, you guys seem to have the misconception that all anorexic girls are thin and incurable emaciated girls. They aren't.