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Judith Brisman, Ph.D. is one of the pioneers in the field of eating disorders. She opened the first center in the United States dedicated to the treatment of bulimia. Initially called[…]

Big Think and the Mental Health Channel are proud to launch Big Thinkers on Mental Health, a new series dedicated to open discussion of anxiety, depression, and the many other psychological disorders that affect millions worldwide.

There aren’t many people on this planet who know more about eating disorders than psychologist Dr. Judith Brisman, founder of the Eating Disorder Resource Center. In this video, she offers a crash course in understanding the difference between someone who eats disorderly and someone with an eating disorder. We also learn that, deep down, people with anorexia use eating (or not eating) as a coping mechanism.

Finally, Brisman runs through some typical traits of those with anorexia: perfectionism, genetic disposition, and susceptibility to the pressures of society. Most of all, anorexia offers the illusion of control. When you’re unable to control other parts of your life, losing weight by not eating seems like a major accomplishment because it was a (dangerous) decision made of your own volition.

Judith Brisman: The difference between disordered eating and an eating disorder is really an interesting question in our culture because pretty much in our culture most people have disordered eating. It is the rare person who eats when they’re hungry, eats what they’re hungry for. If they are partying and having a good time and enjoying the food and they eat too much. A healthy way of eating would be okay; the next day you don’t feel hungry so you eat a little bit less. But healthy eating would be following your bodily cues. Disordered eating would be when you start to put the "shoulds" in there, you know. I should cut down. I shouldn’t have snacks. I should lose weight. Pretty much all of us know what disordered eating is. You eat a lot and the next day you panic. Oh my god, I’ve gained a couple weights. I can’t have breakfast. I mean, you know, or I better not have any carbs today. That’s sort of disordered eating.

An eating disorder, though, is when the "shoulds" become a psychological way of coping. If I don’t eat carbs, I’m a good person. If I lose 10 pounds, my life will be okay. And what happens is that goal starts to define people. So they feel that if they do indeed stick to these usually unrealistic goals, that they have an idea that their identity would be formed. Everybody knows what it’s like to be upset, to be mad, to just not want to deal with something. And what happens is when someone starts to eat and they realize that they don’t feel anything. Everybody who I work with tells me there’s nothing that feels better. What’s hard about it is it really works. For that moment all they’re focused on is eating and they don’t feel anything. So it’s like a quick Band-Aid to deal with feelings.

And anorexia is the same way. What happens with anorexia is people start focusing so much on their weight or what they’re eating that they disconnect from the outside world. And in a weird way it’s very calming. My patients will tell me that if they’ve hit 95, 94, 93 each day the weight goes down, they know they’ll have a good day. It doesn’t matter what will happen that day. They are in control of their life and it’s a way of coping with their life. It’s a way of coping with interpersonal relationships. You have a fight with your boyfriend; you go home and eat. It doesn’t solve the fight, but it makes someone feel better. So the point to an eating disorder is when repetitively the eating or weight loss or lack of eating is used to cope with life problems.

The way we see eating disorders is sort of a three-point series. We think physiologically, people carry genes that will have certain proclivities. Certain people are just going to be hungrier. Certain people — anorexics we’ve done studies that they’re more perfectionistic. Watch them at five and they get upset if they draw outside the lines of a picture. They line of their shoes. The door has to be open a certain way. We know that anorexics have a very basic physiological drive towards perfectionism, being exacting. So we know there’s a physiological component. We know there’s a psychological component so that if someone is more stressed, if they come from a family where there’s a lot of stress or alcoholism or other eating disorders or feelings that can’t be dealt with or feelings are too out of control, kids are going to need a way to cope. And they’re not going to know how to deal with feelings and the anxieties that they’re brought up with. The third part of it is the culture will tell them what the symptom is. So the culture says well in order to be okay you have to be five foot five and 110 pounds if you’re a girl. And so the physiology that may make someone perfectionistic and the tension that someone’s up against will then be look towards the culture to say okay, well in order to solve this, our culture says be thin. So the way we sort of think about it is people individually have the bullets. The culture shoots the gun.