Two kinds of bias we need to fight

By Irene Grimaldi

“There are two levels of prejudice that affect individuals with eating disorders. A first level is horizontal, transversal to the various types of these disorders: it concerns the prejudices held by those who are unfamiliar with the topic. When they hear about anorexia, bulimia, binge eating, or other forms of eating disorders, their immediate reaction is a mix of compassion and pietism, often stemming from the self-conviction of being far removed from even the shadow of the pathology. Thus, anyone who is unaware of the topic of eating disorders, upon accidentally coming into contact with it, for example through the media, almost always has a charitable response towards people who are ill: they hasten to recognize them as being different from themselves, a way of emphasizing their own estrangement from a world that is still heavily stigmatized – eating disorders are psychiatric conditions, and mental health is not considered on the same level as physical health in society. 

However, if at first glance the level of prejudice that we call “horizontal” emerges, which affects all individuals with eating disorders indiscriminately – at least if we stay at the conceptual level -, a more in-depth analysis reveals another level of prejudice, which we can define as “vertical”. This consists of the prejudices that are poured upon individuals with forms of eating disorders that have to do with non-thin bodies, i.e., overweight or obese bodies, often belonging to people with bulimia or binge eating. We define this level of prejudice as “vertical” because it generally does not come only from people who are unfamiliar with the topic of eating disorders, but also from those who are “inside” the same topic, either as patients or professionals. 

Indeed, individuals with anorexia or other forms of eating disorders characterized by restriction – pathological forms associated with thin bodies – attribute an extremely negative judgment to 

individuals with bulimia, binge eating, or other forms of eating disorders characterized by recurrent bingeing – pathological forms 

associated with non-thin bodies, i.e., overweight or obese -, as if the bulimic or bingeing symptom derived from a whim, from gluttony. It happens that those who are affected by bulimia, binge eating, etc. are considered “less ill” or not ill at all, compared to those who are affected by anorexia, etc., and end up convincing themselves that it is legitimate that their symptom is perpetually downgraded to a minority, as if it were a pathological form of lesser importance and severity: after all, they, who have fat bodies, bodies to be shunned and denied, brought it upon themselves, ergo it is their fault if they are in such a condition. 

Unfortunately, sometimes the hierarchization of eating disorders does not only concern individuals who suffer from these pathologies, but also treatment centers, where a dangerous process of institutionalization of the secondary nature of bulimia and binge eating compared to 

anorexia is triggered. In general, the phenomenon of discrimination against fat people is also a consequence of the deeply fatphobic society we live in, and fat people with bulimia or binge eating are not exempt from these dynamics. 

It is therefore essential that professionals involved in the treatment of eating disorders defuse this mechanism, primarily in treatment centers, so that individuals affected by these pathologies, regardless of the type of their symptom, acquire awareness of the legitimacy of their suffering, regardless of its nature, and begin to dismantle the prejudices of the vertical level. Only then will it be possible to start disseminating a different narrative in society, which will allow us to demolish the prejudices of both the horizontal and vertical levels.” 

Irene Grimaldi is a Professional Health Educator 

and collaborates with FADA – Association for Families struggling with Eating Disorders, www.fadaonlus.it 

NOTE:  World Eating Disorders Action ™ is a global independent collective founded in 2014 by activists and people with lived experience across the globe to share correct information about eating disorders, promote evidence based treatment and offer a platform for like minded organizations to promote policy, research and program advances, ultimately to help those affected and their families.  We bring together over 300 organizations from over 60 countries globally each year.  Blog posts by individuals and agencies are the opinions and perspectives of those contributing and not necessarily the views of World Eating Disorders Action.