Please Stop Asking If Eating Disorders Are a ‘Choice’


There’s been media attention on whether eating disorders are a lifestyle choice, and the ever-present media sensationalism about dieting and the obesity epidemic only fuels the fire.

Advocates say arguing that eating disorders are a lifestyle choice blames victims and prevents treatment, whereas opponents would talk up personal responsibility and argue that, if people with eating disorders are victims, they are victims only of their own choices.

Frankly, I couldn’t care less whether a person living with an eating disorder chose it or not. Instead, I believe this debate is completely irrelevant. The person who chose the eating disorder would be just as deserving of help as the person who did not choose it. In fact, anyone who experiences psychological or physical distress is worthy of timely and effective treatment. The same is true of the homeless or those living with drug, alcohol or gambling addiction.

We might be tempted to think by arguing for eating disorders as a lifestyle choice, we’re giving people with eating disorders the presumption they have control over their own actions — just like we would any other person. Any consequences of that choice, therefore, is that person’s to deal with and theirs alone. This view is largely due to ignorance.

Eating disorders are a grab-bag of distorted beliefs about weight and shape; lack of self-esteem and over-emphasis of the importance of shape and weight to self-worth… And these are just the obvious indicators. People with eating disorders are known to show abnormalities in attention, impulse control and cognitive flexibility. They show biases in which pieces of information they attend to in their environment, and symptoms often resemble those seen in individuals with obsessive-compulsive disorder. Evidence is beginning to accrue to suggest that eating disorders have a genetic basis.

How do I know this? Well, I’m a PhD student so am capable of surveying the relevant peer-reviewed literature. I’m also a person who has recovered from an eating disorder. I was hospitalized with anorexia at 18 years old. I heard voices that encouraged me to believe it was better to die than to eat food. Now 24, happy and healthy, I’ve thought long and hard about the causes of my eating disorder and have come to the not-so-profound conclusion: It just happened.

But, let’s say I did choose the eating disorder, that I chose to feel so fatigued I was forced to quit my job, chose to spend hours exercising when I was at risk of going into cardiac arrest, chose to constantly ruminate on how unloved I would always be. The choice is irrelevant because, eventually, I no longer had control. I couldn’t choose to eat food — the voice in my head wouldn’t let me. It told me I needed to stick to my strict schedule or else. As a result, I couldn’t control my weight. I couldn’t control my physical health and I certainly couldn’t control my mental health. I could only stand back and watch them deteriorate.

It started, like many others, innocently enough with a desire to be healthier. A stressful event then took place, and it turned into an eating disorder. Not once did I look at pro-anorexia websites or want to be “anorexic.” My eating disorder was a sane response to coping with extraordinary circumstances happening in my life as a young woman. I’m grateful that my family and (some) health professionals took the time to see me as more than a young woman obsessed with vanity and, instead, see me as a young woman who was very, very ill.

The bottom line is this: Asking whether mental illness is a choice is no more relevant to the mentally ill than asking whether Tuesdays are better than Wednesdays to the non-mentally ill. Above all, asking whether mental illness is a choice does harm. It sees individuals as victims of their own (apparently) senseless choices rather than a product of extraordinary circumstances largely outside one’s own control. Most of all, it stigmatizes rather than humanizes the individual, and so hinders early intervention and the implementation of timely and effective treatment.

When you next ask, “Is it a choice?” when talking about eating disorders, ask instead, “What happened?” That is, try to understand what happened to make the person feel and act the way they do. Talk to a person experiencing mental illness, if you can. Talk to me. Whatever you do, don’t deny someone the opportunity for help because you brazenly believe they’re at fault.

This post originally appeared on Bronwyn’s website

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