I’d like to welcome the newest Shrink4Men contributor who I’m sure many of you already know, kiwihelen (KH). KH has been a much loved and respected member of the S4M community for close to 2 years now and is also a moderator on the S4M Forum. In her offline life, KH is a registered dietitian with 15 years of clinical experience in three countries. So, in the words of another S4M moderator (Mellaril), it’s time to “Release the Kiwi!” – Dr T
Recently on the Shrink4Men forum, there has been considerable discussion about the dietary habits of many of the high-conflict individuals who trouble the lives of those who post there. I took both a personal interest (having had a whole load of trouble with a HCP spouse who blamed me for his overweight), and a professional interest thinking about some of the more alarming characters I come across in my clinical work.
A quick glance at the literature on eating disorders (ED) and the co-morbid mental health issues associated with this group makes it very clear there is a high incidence of diagnosable personality disorders (PD) in the ED population. Authors disagree on the actual incidence, but the argument behind this appears to be which tools are used to identify PD, rather than the existence of PD. The estimates of diagnosable personality disorders in the eating disordered population appears between 9% and 40%. However, this is the diagnosed rate, and we need to think about two things:
- Not all people with ED are diagnosed, and
- Just because they are not at the diagnostic threshold for a PD, doesn’t mean they aren’t crazy!
So what kind of red flags would be worth noticing (and running from) in the dating world, when it comes to working out if your love interest is exhibiting ED behaviour?
She is thin, but would like to be thinner
Big red flag, one of the diagnostic criteria for Anorexia Nervosa is “irrational fear of weight gain,” and this the outward expression of the fear of gain, or at the very least a distorted body image. Women with distorted body images are pretty damn miserable partners, no one is better in bed than a woman who likes her body.
Irregular or no menstrual cycle while thin
Unless you know she has an implant under her skin, or can feel the threads of a progesterone releasing IUD, then beware the woman under 50-years old who has few or no periods. We need a certain percentage of body fat to menstruate, and low body fat leads to cessation of periods. This is bad for bone health, bad for future fertility and a bloody great big red flag you have someone who has an ED on your hands.
She cooks elaborate meals for you and/or family but will only eat a small amount herself. She seems obsessed with planning meals and food related occasions. This obsession was observed in the Keys studies on starvation in the 1940s, and seems to be a feature of starvation. If she gets upset because you don’t want to participate, it is a sign to GTFO.
If she has to do 500 crunches before she gets to bed or she won’t change her exercise routine for any circumstance including a holiday (this will provoke her to find out exactly where the nearest gym facility will be), then be wary. Exercise induced anorexia is common in elite athletes of all sorts.
She has funny food rules for seemingly no real reason. Some religions and philosophies have dietary rules, some medical conditions require a special diet, but unless she can talk about the reasons for doing what she is doing in a competent and adult manner, then be very suspicious of any faddy eating. If for example the reason for being vegetarian is “because I feel bad about eating cute wee lambs,” dig a bit further and find out what she understands to be a healthy vegetarian lifestyle. If you ever see anything that even has a sniff of ritual in an eating pattern, e.g., certain foods can only be eaten at certain times of the day, then run and don’t look back.
An alternate test for orthexia is asking if she would eat something on her forbidden list if she could not get anything else to eat. Choosing to starve is an abnormal behaviour.
Going AWOL after meals
That can suggest purging after eating. It is not a 100% rule, because about 1 in 10 people will need to have a bowel motion within 30 minutes of eating a meal. If she comes back to the table smelling of mouthwash and/or perfume you should be wondering what she has been up to. Pay for the meal and say “good-night,” run and don’t look back.
Chaotic eating patterns
OK, all of us are busy and miss meals sometimes or have them at odd times. A total lack of planning, loads of missed meals, not having some food in the house are all red flags which have to raise alarms, particularly if the person you are talking to is overweight.
Food going “missing”
If you buy food together, go to sleep and next morning some of the food is not there, but she denies it, then be suspicious she is a binge eater. Binge eaters, whether they purge or not, eat foods that are easy to consume rapidly and without much thinking. Commonly consumed items include ice-cream, crisps and biscuits. Finding recent till receipts with this kind of food on it, when the food isn’t around is a big marker.
Weight loss surgery which appears to have failed
Some people need weight loss surgery because they gain weight for genetic or genuine medical reasons, and once it is done it is a life transforming event. Good surgical teams screen for psychological disorders, but there are loads of people who can lie their way through the tests and/or less than ethical surgeons. I’ve met more crazy folk who have had bariatric surgery than I have done in any other field, up to and including hearing from a forensic psychiatric unit they had “found” a surgical patient who was anorexic and had Korsakov’s syndrome from nutrient deficiencies.
As a non-personality disordered woman, I have had to work through my own body insecurities and I am selective of my media use because I find the way women are portrayed unrealistic and disturbing. Like all women over 40 I have to make efforts to avoid weight gain, but I can put things in proportion, knowing I am comfortable in a UK size 10-12 (US 6-8), and no amount of dieting and exercise is going to change my body shape.
I am comfortable with my body and can make jokes about my “baby knees,” while still wearing shorts to exercise. I do exercise, but it is not a big catastrophe if I miss a session (though I can get grumpy if I miss a whole week of workouts!) Although I have food likes and dislikes and a strong preference to eat a healthy balanced diet, I have been known to eat McDonald’s or KFC when there are no other options rather than going hungry. I understand the importance of planning meals, and have just stocked up on my favorite lunch option for the next week because it was on special at the supermarket.
My house-mate and I have a very fair rule, “if you buy treats, you buy two and we share,” so we had a chocolate croissant for breakfast as he spotted them in the reduced to clear section while getting milk and coffee last night. I love cooking for friends and family, but it is not a 3-ring circus event. Food is something I enjoy but does not dominate my life. Any woman whose waking thoughts seem to be 90% on food should be treated as a PD bomb just ready to go off . . . particularly if she works in a food related area like me.
Thanks again, KH, for adding your wisdom and voice to Shrink4Men. – Dr T
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