Five on Friday is coming to you late because I have been fully consumed for the past few days with the Eating Disorders Research Society annual meeting. The inaugural launch of this Society was in Minneapolis a quarter of a century ago. I remember well the buzz in the university auditorium as a fledgling community of researchers discussed what we were learning about eating disorders.
At EDRS 2019 with Ruth Weissman and Marsha Marcus
Fast forward twenty-five years. This conference now brings together hundreds of leading researchers from around the globe. One of the things I look most forward to is the chance to catch up with colleagues who have become friends over the years. Hence the photo above. It is also exciting to welcome emerging researchers who bring new eyes and ideas to enduring questions. Some observations on where we’ve been and where we are going:
1. More eating disorders. In the late 1800’s British physician Sir William Gull and French neuropsychiatrist Ernest Charles Lasègue provided the first modern accounts of Anorexia Nervosa, which has been the archetypal eating disorder ever since. As our field has evolved, however, it is clear that other forms of eating disturbance are actually more common. And it is also these other eating disorders that are still increasing in many parts of the world. Most notably, Bulimia Nervosa entered the official psychiatric nomenclature in the 1980’s, and the most recent release of the World Health Organization International Classification of Diseases (WHO ICD-11) added Binge Eating Disorder and Avoidant Restrictive Food Intake Disorder. Our expanded lexicon reflects greater understanding of these disorders but is still an imperfect map of the full landscape of eating disorders.
2. More female researchers; more males with eating disorders. When EDRS was first founded, the leaders and senior researchers in the field were predominantly men from North America and Europe. Over the course of the past twenty-five years, more women from around the globe have claimed their place as leading scientists. Interestingly, with more women at the helm, more studies are including males and documenting that certain kinds of eating disorders are actually highly prevalent among men. In fact, research suggests that eating disturbances among men often go undetected because we assume men don’t have eating disorders and we fail to recognize the variant expressions of eating disturbance among men.
3. More individuals with lived experience. It seems so alien to me now, but when I was starting out in this field, no one with a history of an eating disorder dared speak about it lest they be shunned. Their role could be as patient but not professional. In some perverse form of paternalism, the experts thought that it would put individuals with a history of an eating disorder at undue risk to be working in the field. Just goes to show how wrongheaded we can be. Today, individuals with lived experience of an eating disorder can choose to be full-fledged members of the research community and they no longer need to stay silent about this particular aspect of expertise.
4. More sophistication around biology and environment. In the first half of the twentieth century, the world of mental health was dominated by psychoanalytic formulations of mental illness. Those were the days of the schizophrenogenic mother who caused mental illness by her cold parenting style. The latter half of the twentieth century was spent batting back the exclusive focus on environmental factors. With new brain imaging technologies and the mapping of the human genome, psychiatric research became consumed with making the case that mental disorders are biological disturbances. Fortunately, we have matured to the point of recognizing that environmental and biological factors are intimately and inextricably linked when it comes to understanding risk for mental disorders, including eating disorders. I hope we have finally put to rest the overly simplistic and mechanistic debate of nature vs. nurture as if it could ever be totally one or the other.
5. More strategic bridges. Research has led to discoveries that improve our understanding of why and how eating disorders develop and what works for prevention and treatment. But the impact of that research could be greatly amplified if it were more strategically linked with policy and practice. And opportunities for new research paradigms will depend on more strategic engagement with individuals whose expertise is in another field. We are at a point where this kind of interdisciplinary work is indispensable to addressing the complex problems that continue to stymie the field. Bridge building is of the essence.
Over the years, it has been a privilege to be a member of this global community of scientists committed to translating intellectual curiosity into research that informs eating disorders prevention, practice, advocacy and policy. We have come a long way; we have a long way to go. It is exciting to imagine what another 25 years will bring.