Koski
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Disease Extension, Part 1: Building a Mental Phenomenon
The second mechanism that enables participants’ identity transformation is disease
extension. Previously unexplored, disease extension is the process by which participants expand
the very definition of disease itself. By extending the boundaries of what constitutes an eating
disorder, participants may continue to identify as eating disordered, and thus enjoy its
legitimating power, even after ceasing behaviors and maintaining a healthy weight. Likewise,
those who never met the psychological diagnostic criteria may also enjoy its legitimating
benefits. Disease extension occurs in two ways: through the construction of the eating disorder
as a mental phenomena as well as the construction of a disordered recovery process.
Much of groups’ discussions work to produce an understanding of an eating disorder as
extending beyond the physical in order to encompass the mental. One woman denounced the
media’s presentation of eating disorders as superficial. In her words, “There’s nothing about the
mental healing.” She further explained that newspapers’ and tabloids’ reports of celebrities’
eating disorders typically include nothing but before and after photos and a brief blurb describing
the star’s weight loss or gain. Consider further Kathleen’s remarks. One participant commented
that she found it increasingly difficult to be gentle and forgiving of herself as she progressed.
Each “slip-up” was that much more frustrating. In response, Kathleen replied, “And you notice
it a lot more too. Why am I thinking like this?” For Kathleen, a “slip-up” was a negative or
disordered thought process, not an actual behavior. Through group participation, sufferers
construct eating disorders as constituted as much by mental thoughts and states as physical acts,
whether they be bingeing, purging, or restricting. In fact, it is possible for one to identify as
eating disordered in the absence of such physical acts. Mental processes alone may constitute
the disorder.
Those rare participants, who insist that their eating disorder is in fact an issue of weight,
and weight alone, are met with resistance from the group. For example, one woman, recognizing
that she met the diagnostic criteria for anorexia on the basis of her weight, attended the group
explaining that she hoped it would enable her to gain weight. Therapy proved useless in this
regard. She repeatedly stressed that she did not fear gaining weight, but simply found it
impossible to put on the pounds. The facilitator, who herself had experienced an eating disorder,
refused to accept the woman’s denial of any body image issues, offering the advice, “Well, just
Convention