Instead of looking at whether AN and BN are actually different, Burns looks at how AN and BN are

understood to be different, and what impact this might have. She ties this into a broader discussion of
the construct of femininity, particularly as it is articulated in Western societies.

This distinction is really important for interpreting Burns’ findings, and speaks to her theoretical
leanings. As she notes in the article, using a feminist post-structuralist perspective allows us to locate
meaning in discourse by looking at language used.

Rather than looking for some kind of truth about “what” or “who” individuals who binge and purge or
individuals who restrict are, we are instead looking at how different ideas around these behaviours (and
the individuals who practice them) come to impact their being-in-the-world.

For this study, Burns interviewed 15 women engage in bingeing and purging behaviours and 11 health
professionals, including physicians, psychologists, psychiatrists, and a dietician, among others. She also
looked for representations and coverage of BN in popular culture (e.g., TV, Internet, magazines), as well
as in the psychological literature (e.g., scholarly articles).

MAIN FINDINGS

Control/Lack of Control

Burns discusses how BN has historically been constructed as a lack of control (e.g., Bruch, 1973) while
AN has tended to be described as “over-control” (e.g., Jarman et al., 1997). From the outset, this seems
to position individuals with BN as embodying a number of characteristics socially coded as negative. For
example, seeing individuals with BN as lacking in control, they are positioned as “at the mercy of their
compulsions” in contrast to a “disciplined” individual with AN

Success/Failure

Participants (both those with lived experience of BN and practitioners) also placed value on the ability to
abstain from eating, sometimes describing individuals with anorexia as “overachievers” or “driven.”
Burns argues that this reflects a broader value placed on control and success in individualistic culture;
one practitioner even described BN as “failed anorexia” (which seems offensive, honestly, but there you
go).

Dualism and Severity

Maybe there is nothing inherently wrong with the oppositional categorization of AN and BN. But what
does this say about our understanding of the severity of the two? Further, what implications does this
have for individuals suffering from either AN or BN (or for those who experience diagnostic crossover)?

Burns suggests that this dualistic construction informs understandings of the severity of AN vs. BN such
that AN is understood as deviant by way of the appearance resulting from practices and the associated
potential outcomes of these practices (e.g., ultimately, death). On the other hand, it is the practices
themselves that are seen as deviant in BN.

While either AN and BN could result in death, AN may more obviously represent, to the gazer,
“closeness to death.” The interpretation of the bodies of individuals with eating disorders explicitly
informs others’ understandings of the severity of their practices.

So, “bulimic practices” are seen as deviant while “bulimic bodies” may fit the norm; on the other hand,
“anorexic practices” seem to fit the norm (until a certain point) and may even be
reinforced/praised/rewarded, while “anorexic bodies” hold a “shock value” and are read as deviant.

Femininity

Burns also suggests that “the bulimic body” is more readily tied into dominant historical and cultural
notions of femininity. To succinctly and perhaps inexpertly summarize Burns’ insights into this dynamic:

AN reflects a commitment to a “mind in control of body” that one would expect of accounts of the
(rational, controlled) masculine body

BN is more explicitly linked to the physical, suggesting that the bodily appetite is in the driving seat

This “body ruling over the mind” is more in line with historical conceptualizations of female (irrational,
uncontrolled, dangerous) bodies

There are nuances to this analysis that would make this post excessively lengthy if I were to really delve
into them, but I also think it is important to note Burns’ acknowledgement of the paradox of
understandings of anorexia: while AN in some ways reflects a “traditional” (passive) femininity, the
mind-over-body control is more clearly linked to a historical understanding of masculinity.

With this, Burns also explores how the idea that AN and BN have culturally and historically occupied
binarized positions, this does not mean there is one way of understanding AN and BN; AN in particular
occupies an ambiguous place between positive and negative, normative and deviant. BN, on the other
hand, has tended to more consistently occupied an abnormalized (but more invisible) place in the
cultural imaginary.

MPLICATIONS

Ultimately, Burns suggests that this dualistic construction of AN and BN can prevent women from being
able to express different elements of their subjectivity. Perhaps especially for those who have
experienced diagnostic crossover and have thus experienced both “anorexia-like” and “bulimia-like”
symptoms, the hierarchization and dichotomization of BN and AN may lead to confusion about “what
kind” of person one is, and who is the “real self.” This reflects the very real consequences of being
labelled “anorexic” or “bulimic”; as one participant in this study reported:

I don’t know how the atmosphere had been created but I know that it felt right away that there was
some kind of hierarchy between those labelled with anorexia and those labelled with bulimia and that
anorexia represented this more kind of achievement of perfection and it was a cleaner disorder because
you weren’t throwing up and there were just all of these things that um made – made that category. I
mean that’s the ultimate achievement of anorexia is to kind of have it perfectly / MB: mmm / um . . .
and I was labelled with bulimia and right away um the problem grew really really strong and difficult for
me and decided that it needed to be called anorexia and um I went rapidly down hill in all ways and I I
was in this supposedly very supportive environment but things took such a turn for the worse that I was
um you know an inpatient in a matter of months in a couple of months / MB: right / and that was not
being addressed at all in the program I felt like I couldn’t speak about it at that time but it was there was
some kind of competition happening there that was really unhealthy.

Burns also suggests that a different understanding of AN and BN could facilitate a less pathologizing
understanding of behaviours, bodies, and subjectivities. For example, a more fluid construction might
place eating disordered behaviours on a continuum and sometimes engaged in simultaneously, rather
than fixed at either end of a spectrum.

In the years since the article was written, I believe there has been a move toward a more “continuum-
based” understanding of eating disorders. However, a polarized understanding of eating disorders does
still circulate, particularly when you look at popular culture representations of eating disorders.

Something I see a lot is a lack of recognition of diagnostic crossover and the subtypes of AN; for
example, it is far more common to see someone described as having anorexia and bulimia than to see
them described as having “anorexia, binge-purge subtype,” in popular culture. I wonder about the
impact of this kind of framing on general understanding of eating disorders.

Importantly, this article reveals the potential negative impacts that creating a hierarchy around eating
disorder diagnoses can have. Further, I would suggest that it highlights the importance of not judging
individuals’ eating/health status based on their appearance. I’m likely preaching to the converted, here,
but it is an important point to reiterate.