Over the past several weeks there has been a burning controversy on the Academy for Eating Disorders’ email listserv that started when I used the term “brain disorder” to describe anorexia nervosa — a term all of my readers would be quite familiar with.

It was interesting to watch the conversation develop as it went from “how do you know it’s a brain disorder?”  – and when the answer was to refer to the avalanche of research in neuro-imaging, genetics, etc. (as well as the two year old statement by the head of the NIMH) – to “well, ok, but if you are going to call other illnesses such as schizophrenia and autism ‘brain disorders’ then it loses all meaning.” Huh?

The emails flew back and forth, until it was suggested that “all of us probably accept the concept of anorexia nervosa being a brain disorder” (I highly doubt this is true) and the sensible suggestion that we find consensus on this issue, that in turn resulted in many good statements (none of which carried the term ‘brain disorder,’ however!).

So why do I think the old paradigms of blaming the family and media are still all too prevalent? Well, below I excerpt a paragraph from an article published two months ago in the International Journal of Eating Disorders (based in the US: editor-in-chief Michael Strober, UCLA). The authors are from Germany (to spread the blame a bit). The article is titled “Interpersonal Problems in Eating Disorders”.

The quote speaks for itself; the fact that it was passed for acceptance by this prominent journal speaks to me about how it is unlikely that “we all accept that anorexia nervosa is a brain disorder”. But you be the judge:

“In a comprehensive review of the literature on interpersonal functioning in patients with anorexia nervosa (AN), McIntosh et al. concluded that families of such individuals are often overly enmeshed and rigid, with contradictory communication resulting in submissive behavior by the AN patient.”

Sigh.