Anxiety: Four
Intellorexia
Hyper-Anxiety Enslaved by Intellect
So no, “intellorexia” does not exist but given that we have the media slapping eating disorder suffixes on everything from alcohol abuse (drunkorexia), to diabetic mismanagement (diabulimia), muscle building (bigorexia), male anorexia (manorexia), the denial of fatness (fatorexia)…I figure I don’t want to be left behind.
Underneath all my flippancy, is actually a contemplative post on human attributes. Specifically, it is a post on how anxiety and hyper-intellectualism are often closely intertwined and that these attributes can stymie starting a recovery process or getting to remission from an eating disorder.
Hyper intellectualism is a fairly self-explanatory term. Someone who is hyper intellectual is exceedingly drawn to complex forms of knowledge, philosophical matters and efforts of intense conscious thought and rumination.
While not all hyper intellectual individuals are anxious people, those who are quickly develop neural patterns that interweave the environment-scan behaviours of the anxiety response, with the conscious mind’s predilection for intellectual minutiae.
This so-called intellorexia may be responsible for a patient failing to embark on recovery. But it might also be responsible for a patient failing to enter remission.
Intellorexia convinces you that there is always one more critical piece of information out there somewhere. Either it is something that will make recovery so compelling it cannot be resisted, or it is something that efficiently unlocks the one thing that is not going right in your recovery.
Unshakeable Belief that More Knowledge Equals Better Decisions
Hyper intellectual people likely have a reward system in the brain that lights up like a Christmas tree when they learn something new. All human beings feel some reward when they learn something new, or master a new skill, but some likely have very strong reward responses and others not so much.
I have no idea if those with a predisposition to develop eating disorders are prone to hyper intellectualism or not, and I can safely say I don’t really care enough one way or the other to go on a research hunt right now. I am sure other more intellectual readers here can take up the task if they would like to do so!
Those with this type of strong reward system associated with seeking knowledge may not identify when the rewards of finding new information no longer provide anything more tangible than a fleeting (natural) high.
I have just finished reading a book that is a bit of a broad sweep of information, but nonetheless a very interesting read: Wait! The Art and Science of Delay by Frank Partnoy.
In one chapter Partnoy speaks of making a decision as an expert when compared to doing so as a novice. Experts perform much better under time pressures than novices. Novices can find themselves flooded with information and it immobilizes their decision-making abilities. But there’s a catch— an expert may not be able to identify when the situation is sufficiently novel that they are actually a novice and not an expert.
If a patient becomes an expert in eating disorders, are they not still a novice when it comes to remission? I believe the answer is “Yes”.
I don’t think there is any question that becoming an expert in a condition that you experience is most certainly a necessary part of being a patient.
But at some point, knowing more about the condition itself will not allow you to make better decisions when it comes to either leaping into a recovery process or for living in remission.
Living In Remission vs. NED-W
“Forgive me my nonsense, as I also forgive the nonsense of those who think they talk sense.”
Remission from an eating disorder is not identical to living entirely entrenched in the non-eating disordered world (NED-W). The rest of the world gets sucked into dabbling in all manner of confusing and damaging dieting behaviours. They do so because evidence that restrictive diets are sometimes suitable for those with existing disease states are subsequently (without any evidence) applied as though those diets might actually prevent disease states in the first place. Someone in remission does not have the luxury of being that naïve or trusting of mainstream dogma.
By way of a quick example of this concept, a vegan diet has very modest clinical data to support its use in the treatment of existing cardiovascular disease in men, but also has clinical data to support its equally life expectancy-reducing impacts in otherwise healthy individuals. The point being, if you don’t have the disease state, then the diet won’t prevent its onset and it may also lower your life expectancy.
“B12 isn’t the only nutrient missing from veggies. Creatine, carnitine, taurine, cholesterol, DHA, EPA, menaquinone and retinol are sparse to nonexistent in plants. They are “inessential” because our bodies make them from other substances, but our bodies’ conversion abilities vary and deficiencies may go undetected.”
In a world filled with fearful eaters, you will end up having to stand alone, unafraid, with a rather large bite of an ‘evil’ MacDonald’s burger or Twinkie® filling your mouth while assuring your wide-eyed and terrified NED-W friends that you not only fully expect to survive your eating ordeal, but also have every expectation you will enjoy it as well.
Normative understandings and behaviours in society are not automatically in place because they are inherently right, proven and true. It takes practice to stop asking people to defend non-normative positions and instead ask those defending normative positions to actually step up with some real data.
As you know I often reference the red pill/blue pill decision that Neo faced in the movie The Matrix. Once you “go down the rabbit hole” by taking the red pill then you are no longer able to live in the mirage that is life in the Matrix. As an analogy, once you understand that dieting and restriction are dangerous, you cannot live pretending that normative understandings in our world are acceptable.
But I have yet to mention another Matrix character: Cypher. Cypher chose to take the red pill, but he regrets that choice. He seeks to re-enter the mirage of living in the Matrix. In the movie, Cypher is killed. Moral of the story: you cannot travel back up the rabbit hole.
As an analogy, there are plenty of “Cyphers” when it comes to recovery from eating disorders. They are the ones who regret what recovery has done to their bodies and lives. They are the ones who seek to re-enter a world that really never existed for them in the first place: NED-W. I believe that hyper intellectualism twinned with untreated anxiety makes a patient with an eating disorder prone to chasing those mirages.
Weight Tapering Post-Recovery Effort
By way of explanation, “tapering” is what anyone who has overshot his or her optimal weight set point through the process of recovery from an eating disorder, is desperate to realize.
And while plenty of folk enter remission from an eating disorder with their bodies returning to their hereditary optimal weight set points with no temporary overshoot, these individuals are not hanging out here on this site, or on any of the other numerous forums out there dedicated to helping those in recovery. They have gone on to live their lives.
It is something that doctors will tell patients repeatedly: “Beware those online forums.” However, a vague and ominous warning of “There be monsters! Yar!” is not terribly helpful.
The issue is not monsters but rather something that is referred to in the literature as survivorship bias. Survivorship bias is something that can occur in experimentation, analysis and assessments of all manner of situations and conditions, and it inadvertently leads to serious error in the conclusion.
For example, if you are studying what makes companies successful, you can make survivorship bias errors because you are actually unable to thoroughly study companies that have failed, as they are no longer in existence.
Survivorship bias might be better called a visibility bias. A good example of this visibility bias is how individuals involve themselves in online forums. 90% of all forum participants are lurkers only, meaning they read but do not post or respond to threads. 9% are commenting on occasion and only 1% is contributing. [2] Paul Schneider revisited this 90-9-1 internet rule in 2011 and with a random sampling identified an average of 70% lurking, 20% commenting and 10% contributing.
No matter which data are correct, the upshot is that anywhere from 70-90% of forum participants are invisible. And the 1-10% who are contributing (asking questions, posting on threads) feel sufficiently engaged with the topics to involve themselves in these ways.
When it comes to eating disorder recovery forums and social media spaces, we know that the small minority producing most of the content are highly engaged because they are frustrated or disheartened with the recovery process; highly anxious about embarking on a recovery effort and disbelieving of the information found in the literature; and/or experiencing reinforcement of their own efforts to continue in recovery by helping others.
Let’s face it, commenting and contributing takes time and energy— not to mention there are those irritating timeouts where your carefully constructed response disappears completely! You have to feel reasonably engaged in the topic to get in there at all. That is not to say that the huge silent lurking majority is not empathetic or engaged in reading.
However, if you were in recovery and everything was progressing just as the Phases of Recovery had ‘predicted’ and you were working with a helpful therapist and physician, would you be doing much more than glancing at the odd post and scanning socials/forums from time to time? Probably not.
What is visible on social media and support forums is not fully representative of the entire spectrum of recovery experiences.
Now let’s get into how weight tapering, visibility bias and hyper intellectualism are all connected.
Science, Practitioners and Patients
In so many ways, those with eating disorders are actually great patients. Working with patients with eating disorders is such a fabulous opportunity to get in touch with your inner nerd.
Yes I am generalizing of course. But expert practitioners, such as Charles Fishman (psychiatrist who developed Intensive Structural Therapy), note that even young adolescent ED patients are extremely receptive to logic and are more responsive to therapy and treatment when they are given clinical information and data. [3]
But what does all the science actually mean when it comes to the realities of living with an eating disorder and/or attempting to get that condition into some kind of a solid and complete remission?
A Year or More In: Recognize You Are a Novice
We watched the movie Oblivion the other night. I am not a Tom Cruise fan but we were not being picky— call it an attack of lowered expectations (apologies to Tom Cruise fans of course). However we now have a new catch phrase from watching the movie. It is a question and answer sequence between Melissa Leo’s character and Andrea Riseborough’s character:
“Are you an effective team?” With the correct response being “We are an effective team”.
I imagine that this is the kind pinging that occurs when anxiety has managed to enslave the frontal lobes to do its bidding. Anxiety says something is not right and must be investigated. The Frontal Lobes are sent out to find data to place before Anxiety’s feet. But by then Anxiety is onto other concerns and sends the Frontal Lobes out again for more stuff. Anxiety is not known for long attention spans.
So there you are, maybe 12, 14, or 20 months into your recovery efforts. You are absolutely certain that you have massively overshot your optimal weight set point. You are still struggling with pain and exhaustion, and perhaps hormonal and/or gastrointestinal issues persist as well. Life is in a total holding pattern for you.
It’s still wrong. Something must be missing. Check again.
But why are you waiting for your life to begin? Could it be that your expert playbook was written to presume that a clear set of resolutions would arrive on time and “as advertised” and at that point you would be able to embrace your new life beyond an active eating disorder?
Provisional Living
The life you are living right at this moment is your life. When you treat recovery from a chronic condition as equivalent to the short journey through something like successful knee surgery, you get mired in provisional living.
Successful knee surgery involves significant disability and pain prior to surgery; a convalescence of a known duration that is equally uncomfortable but progresses towards increasing mobility and easing pain; and completes with a sense of “Why didn’t I get that surgery sooner?”— life is “as advertised”.
Chronic conditions have a key word attached: chronicity. These conditions travel through time along with you. They do not have a cure. Periods of complete remission can occur and perhaps even last the length of your remaining natural life. But there are not any “as advertised” promises when it comes to chronic conditions, let alone a nice linear progression from flare to remission.
Provisional living is the belief that life will become what it’s supposed to be once X happens. Provisional living is easy to fall into because while X is not in place, it can explain all manner of bad things in our lives being present.
“Most of us are aware on one level or another that the choices we prefer to make do not reflect the values and beliefs we claim to hold, and are not going to bring us the lives we think we ought to have. Confront that reality head on, and the message that the statue of Apollo said to Rainier Maria Rilke—”you must change your life”—becomes hard to ignore. The avoidance of that reality is therefore the cornerstone on which most dysfunctional lives are built.”
Provisional living is even more likely when the despondency and frustration with chronic conditions that will not let you do what you want to do, mounts up. We all have to find some way to realize that life is happening at each moment and we cannot spend too much time pining for a past perceived normalcy or yearning for a future renewed normalcy when all we ever do is exist in the present in any case.
Will one more screening test, one more article on “obesity”, one more peer-reviewed paper on gastroparesis be that “X”? Will it release you from your holding pattern and plop that post-recovery life into your lap?
Is there an X that must be uncovered or are you simply unaware that you are a novice at living life in remission?
I know that’s a whole battery of questions to mull over.
Shift your attention from being an expert patient to being an expert at your own life.
You Are Your Only Patient
In Kristin Neff’s book, Self-Compassion: stop beating yourself up and leave insecurity behind* she relays the following anecdote:
“A mother brought her feverish child to the doctor to be told by the doctor that the child was fine. The mother disagreed and she said: “I understand you have the benefit of experience and education, but I have to tell you that my daughter is my only patient. I know her in a way you cannot and I am telling you that she is not ok.”
You are your only patient. You know yourself in a way that no one else can.
It is difficult to identify sometimes whether the drive to find answers for the weight, pain, swelling, or other lingering symptoms, is coming from your instinct or from anxiety. But usually, patients can identify readily which is which as long as they remember to ask themselves the question: Am I anxious about the symptoms or am I sensing that something is sufficiently off here that it requires further investigation?
I am not suggesting anyone ignore troublesome or concerning symptoms. Ever. However, I am suggesting that as you progress in your recovery efforts you do need to shift your attention from being an expert patient to being an expert at your own life.
If you do not know a single soul who is accepting of their shape and size, then go out and meet them. Look out what Ragen Chastain has to say about falling into the trap that health is something that must be part of your innate value as a human being: What’s the Deal with Healthy Lifestyle?
Start researching what it is like to refuse to watch or read anything weight/diet/health related at all. Yes, it’s not exactly an easy task in our world today but there really are some people out there who are engaged in other hobbies and pursuits. Really.
And if you are hyper intellectual by design, then disentangle it from its enslavement to anxiety. There is too much to know and life it too short, so do you really want your expertise to remain entirely rooted in eating disorders alone?
If your weight never tapers, if you have lingering pain and symptoms indefinitely, don’t make the mistake of thinking that life has not turned out “as advertised”. Don’t just swap out one facet of your eating disorder for another— and although intellorexia is completely fictitious as an ED facet, it likely has a kernel of truth for many who read this I’m sure.
“When you stop chasing the wrong things, you give the right things a chance to catch you”
Your real life, not your provisional life, may simply be waiting to catch up now.
*Please note that while there is much value to be gleaned from Kristin Neff's book, she does veer into unsubstantiated platitudes when she turns her attention to dieting, as it is not her area of expertise.
http://www.nytimes.com/roomfordebate/2012/04/17/is-veganism-good-for-everyone/the-jury-is-still-out
Hargittai, Eszter, and Gina Walejko. "The Participation Divide: Content creation and sharing in the digital age 1." Information, Community and Society 11, no. 2 (2008): 239-256.
Fishman, H. Charles. Enduring change in eating disorders: Interventions with long-term results. Routledge, 2005.
Greer, John Michael, The Archdruid Report, 2013
