What Does A "Drive for Thinness" Mean With an Eating Disorder?

Have you noticed that it is just assumed in our society that everyone wants to be thin? Thin is never defined, and seems to mean "smaller than anyone else in the room." Everyone seems to agree that being thinner is a constant quest, and that the only difference between people with an eating disorder and everyone else is how strong that "drive for thinness" is. I don't buy it, and I'll tell you why.

Using Common Terms: My Drive For Thinness Isn't The Same As Your Drive For Thinness

First of all, not all eating disorder patients have a "drive for thinness." A significant number of patients experience their symptoms with no connection with weight or weight loss. Some patients, with all the same other psychological symptoms of an eating disorder, describe an ascetic or moral desire to avoid nourishment. Some don't consider food or eating anything more than an expression of their emotional problems. Children, in particular, often describe their physical discomfort in terms of physical pain. Just as patients with obsessive compulsive disorders focus on ideas and aversions closely tied to values around them - like cleanliness and order - the thoughts of eating disorder patients vary greatly in meaning and why they are driven to their behaviors.

Even the term "drive for thinness" needs to be used carefully. It is actually a technical term for a scale measured by the Eating Disorder Inventory (EDI), a 91 question self-report test used by psychologists. Technical terms are great for research and comparing treatments and populations, but lousy for conversational use - or the media. It sounds like something we all understand and use the same way, but it isn't and we don't.

When someone who is mentally healthy talks about wanting to be thin or having too much "junk in the trunk," we can't usefully compare that with someone with anorexia or bulimia talking about "why" they can't eat and "the reasons" they purge.

Fixing the Disconnect Between Objective Weight and Actual Weight

Then, there is the question of "objective" weight. It is easy to look at an 80 pound adult woman living on lettuce and ask "Why does she still want to lose weight? She's so thin." But that woman felt the same way at 140 pounds and it was the same "drive for thinness" that got her there. Obviously, the drive wasn't really to be thin, even if it felt that way. Anorexics do not, generally, feel better about their weight when they lose it - the drive continues. Many anorexics describe the compulsion to lose weight as a fear of gaining any weight, from any weight. Like a python cinching in, the drive isn't based on actual weight but on another more basic drive more difficult to articulate. Patients with bulimia experience the same drives and are usually of average weight. Many binge eating disorder patients share the same drives and thoughts.

To understand eating disorders one must also be familiar with the phenomenon of body dysmorphia. People of any body size can experience this, and malnourishment often brings it on or makes it worse. The sense that one's body is larger or differently shaped than it is is a brain condition that is not just an overvaluing of thinness but an actual physical and visual hallucinatory experience. This distressing perception can result in a futile and self-perpetuating drive to "fix" the disconnect.

None of this is helped by the way most people these days talk about their weight. Our sad societal focus on weight loss regardless of health makes it more difficult to identify and respond to a truly pathological "drive for thinness." I sometimes wonder what is more difficult to change: our weight loss culture or the life-threatening delusions of eating disorder patients. At least people with a mental illness can be successfully treated. The rest of us? I'm not sure.