For decades, we’ve been fed a specific storyline about eating disorders and it goes something like this. They’re diseases centered around weight and body insecurity, triggered by a society with unrealistic beauty standards, mainly effecting young, white females. And for those who have no real experience with them, it’s very easy to think that is what it’s all about.
This is what I thought growing up. I even thought this when I was diagnosed with anorexia at the age of 17. It was what I learned from middle school health classes and TV segments, none of which explained that these diseases were largely influenced by genetics, one’s psychological health and environment. The magazine articles I read on the subject usually featured a blurb about a celebrity who had admitted to having a problem but after treatment was cured. The focus in each medium was always on weight obsession, a term that I heard so much that when the subject came up I eventually became desensitized to it. I never considered what it meant to be so consumed with something that it was impossible to have room for anything else.
The risk of death was something that I had also become desensitized too, as well as the fear of losing my hair or destroying my teeth. These were always the consequences of eating disorders that were listed and like a kid who had heard the “smoking kills” slogan too many times, I was numb to it. I told myself if any of these things occurred, I’d make myself stop because it clearly meant I had lost too much weight and I really was thin enough. I was completely unaware of the diseases effects on the mind (short and long-term) or of the other physical repercussions one could suffer, even when they were far into recovery. Of course, I would find out the hard way. Unfortunately, it took me becoming sick to realize how devastating the disease is and much of this had to do with the way the topic is treated publicly.
We’re still talking about the diseases outside of the correct context. By directing our attention to the more superficial aspects of weight and appearance, we’re implying that’s all there is to them and that isn’t the case. Eating disorders are complex diseases, very hard to treat, and life-altering, even when has begun the process of recovery.
According to the National Eating Disorder Association (NEDA), there are 30 million Americans with the disease and with stats like that, there’s a good chance that you know or will meet someone who has one. If you want to be an ally and create an environment that promotes healing, here are the top four things you should know.
It's Not Just an Adolescent Phase
I’ve sat at too many dinner tables with girlfriends who didn’t know my medical history and heard the phrase, “I was bulimic for a month” or “I tried to be anorexic.” To hear some talk about it, you’d think that the disorders were some perverse rite of passage that people go through growing up. One doesn’t just step in and out of an eating disorder, because many elements that form the disease are out of a person’s control. Most sufferers are already predisposed to it, due to heredity and personality type. Often, there is a co-occurring mental health issue, like anxiety or depression, that can make the behaviors surrounding the illness not only emotionally, but physiologically comforting and addictive. While one’s environment can play a role, it is not necessary to set the disease in motion. It’s not often represented within media or even scholarly literature, but the disease is not discriminatory when it comes to age and professionals are finding more cases of women in their thirties and forties with symptoms. A study published in 2017 in BMC Medicine indicated that a lack of service provisions for that age group served as a barrier for treatment (mainly due to preconceived notions that eating disorders solely effect the young), keeping sufferers from accessing proper care.
According to medical experts, the earlier one seeks treatment (within the first three years of the illness) the higher the chance for recovery. On average, the recovery rate for an anorexic can take between three to seven years. Some advocates and professionals believe that recovery from the disorders are similar to recovery from alcoholism. One may stay sober from the behaviors surrounding the disease but it’s a lifelong process. Relapses can happen along the way, even after years of showing no symptoms. This happened to me, shortly after I turned 25. It took two years before I was in a healthy mindset again and in better physical health.
It's Not the Same as Disordered Eating
Believe it or not, disordered eating is an entirely other thing than an eating disorder. They share commonalities, which is the primary reason people get them confused. An eating disorder is classified as a mental illness while disordered eating is a phrase to describe restrictive eating patterns that take place for a short period of time (for example, fasting whenever you have a new date). Yo-yo dieting is sometimes considered disordered eating, along with taking diet pills or having bouts of extreme exercise. Like an eating disorder, there can be guilt when it comes to food consumption. However, the behaviors are not nearly as disruptive, severe or as long lived as someone with an eating disorder engages in them.
With an estimated 50 percent of the population participating in the behavior at some point in time, it’s far more common than anorexia, bulimia, or binge eating disorder. Although it isn’t a mental illness, it can have adverse health effects, such as nutritional deficiencies.
You Can be of Average Weight and Still Have One
Eating disorders are mental disorders, so it’s somewhat ironic that one’s weight has played such a big role in the criteria for being diagnosed with one, specifically anorexia. The trouble with relying solely on weight and BMI is that it allows sufferers who have all the other symptom of the disorder to go undetected longer.
There was an interesting case study in Pediatrics that illustrated why it was problematic to look to weight as the primary indicator of whether one was ill or not. In the study, the story of two teens with anorexia were described who had to go more than a year without proper diagnoses or treatment, because they weren’t underweight. Both were experiencing deteriorating health, restricting their food and over exercising, but because they had previously been obese and now were in a normal weight range for their age in height, doctors wouldn’t consider that they were sick.
I had a similar experience a year or so after I relapsed. My anxiety had become so bad that I was having a hard time sleeping, so I decided to go back to therapy. I had never seen this therapist before and during our first session (as all sessions go) was asked about prior health issues or if I had ever been to therapy.
“I had an eating disorder I went to therapy for,” I said.
“What was your specific diagnosis?” she asked, not doing a great job in hiding the fact she was eyeing me over.
“Anorexia nervosa,” I mumbled. There has always been a part of me that’s been embarrassed about it and in that moment, I understood why more acutely. It wasn’t the illness I was ashamed of but the fact that even at my thinnest, I never looked like Lily Collins in To the Bone. Maybe naked I was unappealing but clothed, I was just another slim girl and I felt as if that made my sickness less valid.
The therapist was awkwardly quiet. Finally, she said, “Well, you look fine to me.” Because I was already in a stronger mental place, I was able to dismiss her dismissiveness, but I couldn’t help wonder how my younger and newly-diagnosed self would have reacted if placed in the same situation.
Only now are health care professionals acknowledging weight bias which may explain why in the fifth edition of the DSM (Diagnostic and Statistical Manual of Mental Disorders) the weight criteria for anorexia has been removed. While it and other eating disorders do have physical tells, one can’t be certain that a disorder is present by appearance alone.
Any Race or Gender Can Have One
Eating disorders are often depicted as a young white women’s issue but the truth is that men and women from all different ethnic backgrounds can be effected. Out of the 30 million people who have been diagnosed, 10 million are male. People of color, such as myself, are also affected but their symptoms are less likely to be recognized by doctors, even when they’re displaying symptoms. Similar to weight prejudice, studies have shown that medical professionals are less likely to diagnose minorities because of bias, as illustrated by a 2013 study in the medical journal Psychiatric Danubina. While more cases are being reported in comparison to 20 years ago, because of that bias, exact data on the demographic remains scarce.
Regardless of your gender, age or race, if you’re suffering, you deserve support. If you or someone you know is in need of help for an eating disorder, visit the National Eating Disorder Association (Neda) website. They have helplines available, along with a directory of support groups and treatment centers.