Margo Maine

Eating disorders: A 25-year perspective

ABSTRACT I founded Eating Disorders: The Journal of Treatment & Prevention 25 years ago, and its character, reputation, and success are highly attributable to Arnold Andersen, John Foreyt, and Margo Maine, the three original senior editors, whose perspectives follow in this article. Having made the decision to retire from the journal, I asked the senior editors to transition to the emeritus board along with me, which I explain further in my own Last Word, “Goodbye, Eating Disorders,” in this volume (Cohn, 2017). Over our 25 years of collaboration, the senior editors have acquired unique insights into the evolution of the eating disorders field; so, I asked them to contribute retrospective essays in which they also look forward within their primary areas of expertise—presented here in alphabetical order. – Leigh Cohn, Editor-in-Chief

Almost Anorexic: Is My (or My Loved One's) Relationship With Food a Problem?, by Jennifer J. Thomas and Jenni Schaefer

Almost Anorexic: Is My (or My Loved One’s) Relationship With Food a Problem? is part of a groundbreaking series of books by Harvard Medical School faculty, in partnership with Hazelden and other experts, intent on defining the broad continuum between a normal behavioral pattern and clinical pathology. As with other mental health diagnoses and addictions, eating disorders generally develop slowly, with mild symptoms intensifying over time. By identifying the “almost” phenomenon, it is possible to avoid a full syndrome and all the attending pain, loss, and medical and economic consequences of these disorders. The “almost effect” could make a significant difference in the lives of so many who are headed toward, or on the cusp of, a serious diagnosis—and not a moment too soon as more and more struggle with mental health issues and addictions, and eating disorders become globalized. Almost Anorexic is a unique contribution to the eating disorders selfhelp literature, and one of the few resources to address the whole spectrum, from subclinical variations, to full syndrome diagnoses of anorexia nervosa, bulimia nervosa, binge eating disorder and everything in between. That “in-between” zone subsumes emerging subclinical presentations as well as the DSM-5 category called “Other Specified Feeding and Eating Disorders,” previously categorized within “Eating Disorder Not Otherwise Specified.” This includes atypical anorexia, subthreshold bulimia, subthreshold binge eating disorder, purging disorder in the absence of binging, night eating syndrome, and other variants. The authors rightfully point out that subclinical and atypical eating disorders result in medical issues and outcomes as serious as those related to full syndrome eating disorders, and can be associated with other psychological diagnoses such as depression and substance abuse. These “diagnostic orphans” have received inadequate attention in both the professional and the self-help literature, manifesting in seriously ill patients who feel isolated, and misunderstood, and who never receive proper identification or treatment. At least one third of the cases presenting for treatment at specialized eating disorder programs fall in to this category. It is about time that they get the full serious attention that Almost Anorexic provides.

How I Practice

Abstract In my practice I do not “treat patients.” Instead, I minister to prisoners of war. The prisoners are locked in the prison camps known in the health care system as 307.10, 307.51, and 307.50, the DSM-IV diagnoses of Anorexia Nervosa, Bulimia Nervosa, and Eating Disorder Not Otherwise Specified. Many of the prisoners, who conservatively constitute between 5% and 10% of adolescent and young adult women, will suffer for the rest of their lives. Some will die. Like all starving prisoners of wars, they are voiceless and powerless. They have no political energy or strength. They come to me for therapy, for comfort, but I must do much more than listen, encourage, and nurture them. I must speak for them. I must actively resist the social structures that promote this war. I must fight their battle and be a voice for this generation of women who are disenfranchised, disrespected, and dismissed.