What Are Eating Disorders & Why Are They So Misunderstood?
Photo by Jade Soek via Unsplash
Content Warning: This blog contains information about eating disorders, body image, and weight.
The name may seem pretty straightforward, but eating disorders are one of the most misunderstood conditions. Popular culture shows us images of thin, white, teenage girls striving to achieve beauty ideals, but the truth is that eating disorders impact a broad spectrum of the population, for many different reasons, and in many different ways – and recovery can be just as complex as the root causes.
As we mark this year’s National Eating Disorder Awareness Week, consider this staggering stat: 1 in 11 Americans – nearly 30 million people – will develop an eating disorder in their lifetime.
What Are Eating Disorders?
Eating disorders are a range of mental health conditions that cause abnormal eating habits which affect a person’s physical and mental health. Issues with body image are often a focus for people suffering with certain eating disorders but they are not always present and there can be many other factors that are top of mind for the person.
Contrary to the popular misconception, anyone can suffer from an eating disorder, no matter their gender, ethnicity, age, or upbringing. Different kinds of eating disorders are more common in certain demographics than others, but statistics can be misleading due to underdiagnosis and underreporting.
Why Eating Disorders are Hard for People to Understand
Although everyone can relate to the pressure to look a certain way, the impact of emotion on eating habits, and the inclination to fixate on ‘healthy’ eating, this does not necessarily mean they understand eating disorders. Since eating disorders lead to pathological behaviors, the symptoms may seem out of sync with the supposed causes.
For example, a person suffering from anorexia nervosa might fixate on losing weight even though they are already severely underweight. Someone with orthorexia, with a fixation on healthy eating, may make food choices which are extremely unhealthy.
Furthermore, in many cases, a person’s focus with certain eating habits may not be related to what others expect. For example, under-eating or fasting may not relate to body image but rather to control issues.
What Causes Eating Disorders?
Eating disorders develop due to genetic, behavioral, psychological and social factors. These differ from one eating disorder to another, as well as from person to person.
These are some of the most common causes of eating disorders:
Genetic and biological factors
Genetics: People with a family history of eating disorders are at a higher risk of developing an eating disorder.
Brain chemistry: An imbalance in neurotransmitters such as serotonin and dopamine can contribute to the development of an eating disorder.
Hormones: Hormonal changes impact a person’s mood and behavior, especially in adolescence, leading to a higher likelihood of an eating disorder.
Psychological factors
Personality traits: Perfectionism, impulsivity, and rejection sensitivity can trigger maladaptive eating behaviors.
Mental illness: Food and food avoidance are often used as coping mechanisms by people with mental illnesses, leading to a higher risk of developing an eating disorder.
Self-esteem and body image issues: Eating disorders can develop in response to a desire to ‘perfect’ the flaws a person perceives in themselves.
Environmental and social factors
Cultural pressures: In societies that idealize certain body types and promote unrealistic body standards, the risk of developing an eating disorder is heightened.
Marketing: Companies selling weight-loss products or courses use marketing designed to trigger body image issues with no regard to the potential public health damage. Social media has decreased the distance between marketers and potential customers, paying influencers with millions of followers to promote these products.
Family and friends: Parents with body image issues or maladaptive eating behaviors may project their issues onto their children, causing food-related insecurities and low self-esteem.
Trauma: Vulnerability to eating disorders can increase when a person has experienced traumas including physical and sexual abuse, emotional neglect, and domestic violence.
The above factors can trigger or increase the risk of developing an eating disorder. However, there is no single cause of eating disorders, and prevention requires both public health interventions and identifying those who are particularly at risk.
This gives some insight into why eating disorders are a complex subject. They can be unique from other mental health conditions for the following reasons.
Eating disorders are biopsychosocial.
A major challenge with eating disorders is that they’re biopsychosocial disorders, which means they are deeply woven into your body, your mind, and society. From genetics, historical trauma, family history, upbringing, co-occurring mental health challenges, and personality types, disordered eating can arise for many reasons. They can have devastating effects on both your physical and mental health, and it’s difficult to separate one from the other.
Eating disorders can take many forms.
Most people have heard of anorexia and bulimia, but did you know that the most common eating disorder in the U.S. is Binge Eating Disorder (BED), which is more than three times more common than anorexia and bulimia combined and more common than breast cancer, HIV, and schizophrenia? Another prevalent disorder is orthorexia, an obsession with “healthy eating” that’s increasingly easier to hide with today’s trending talk about keto, paleo, and intermittent fasting.
Eating disorders don’t fit stereotypes.
Women are more likely to suffer from an eating disorder, but BED, purging, laxative abuse, and fasting for weight loss are nearly as common among males – and men are actually more at risk of dying than women because they’re often diagnosed later since many people assume males don’t have eating disorders. Transgender and nonbinary people are disproportionately affected by eating disorders because of the complicated relationship between body image and gender identity. Transmasculine individuals, for example, may want to prevent puberty and resort to restricting their eating in order to do so; others may intentionally try to gain weight in order to achieve a curvier figure.
There are constant, conflicting messages across society.
From the moment we wake up and turn on the news to our weekly grocery run to a stress-relieving moment on TikTok, we receive both subliminal and explicit messages about our bodies, food, health, and wellness. These messages often conflate the ideas of body image and health – and they dismiss problematic eating behaviors as normal tendencies. Whether it’s fasting for better focus or obsessing over macronutrients, these kinds of messages have become part of daily conversations so people may not believe they have an issue that requires treatment.
What are Signs of an Eating Disorder?
Taking notice of specific behaviors can be an indication that there is a larger issue at hand. Here are a few common signs of an eating disorder:
Eating alone
Eating bite-sized pieces of food or picking at food
Skipping meals
Preoccupation with meals or mealtimes
Inability to practice flexibility around eating or working out
Consistently visiting the restroom after meals
Constant dieting
Negative self-talk about one’s body shape or size
Preoccupation with calories or ingredients in meals
Constant comparison to others
If you suspect someone has an eating disorder or know someone has suffered from one, there are certain triggers you should be aware of:
Calorie counts on takeout menus
New diets or fad supplements
Comments about someone’s body shape or size
The fit of clothing
Pictures from the past
A powerful way to support someone is active listening. That involves not just hearing the words someone is saying but rather making an effort to understand what they are trying to communicate. Those living with an eating disorder have a complicated journey ahead. An inadequate healthcare system, constant reminders of food and dieting, and stigma, all create barriers and challenges to full recovery. The more we know, the better allies we can be.
Different Eating Disorders & What They Mean
One of the causes of misconceptions about eating disorders is that focus is often concentrated on two or three conditions. However, there are a range of eating disorders, each with its own characteristics.
Anorexia Nervosa
When most people hear the term ‘eating disorder’, their first thought is of anorexia nervosa. Anorexia nervosa is a mental illness characterized by an extreme restriction of food, a fixation on losing weight, and a distorted body image. A person with anorexia nervosa might see themselves as overweight even when they are dangerously thin.
The most prominent symptom of anorexia nervosa is the avoidance of food, especially foods perceived as being high in fat, while obsessively counting calories. People with the illness might also exercise excessively in the hopes of further losing weight.
A common misconception about anorexia is that it is an illness reserved for female teenagers. Traditionally, young women have been diagnosed with anorexia at higher rates than other demographic groups. However, statistics now indicate that the disorder has been underdiagnosed in other groups. The stereotype that males should not care about body image led to a stigma surrounding eating disorders in men. Then, when women were diagnosed at much higher rates, men became even less likely to seek a diagnosis and clinicians were less likely to provide one when they did.
Bulimia Nervosa
Bulimia is another common eating disorder which is often centered around a fixation on weight gain. However, people with bulimia binge eat before trying to compensate by fasting, purging through vomiting or laxative use, or excessive exercise.
While binge eating, the person feels a lack of control over the behavior, despite feelings of shame and guilt. The compensatory behaviors do not generally lead the person to become underweight and loved ones are therefore less likely to recognize the disorder. Over time, these behaviors lead to electrolyte imbalances, gastrointestinal damage, tooth and gum disease, nutritional issues, and other dangerous physical health concerns.
Binge Eating Disorder (BED)
Binge eating disorder (BED) is the most common eating disorder in the United States. A person with BED engaged in regular binge eating sessions, without the compensatory behaviors of bulimia. They feel a lack of control while overeating and continue even when they feel distressed.
BED affects all genders and can occur at any age. People with BED sometimes start eating alone due to feelings of shame surrounding the behavior. BED leads to obesity and other physical health issues.
Orthorexia
Orthorexia, a lesser-known eating disorder, is characterized by an obsession with healthy eating. A person with orthorexia is more concerned with the quality of the food than the quantity, leading to pathological behaviors that are neither physically nor mentally healthy. With the rise of wellness culture, leading to an increase in fad diets, orthorexia often goes under the radar.
Orthorexia is not currently recognized as a disorder in the DSM. However, it can cause significant issues, including nutritional deficiencies and isolation due to the avoidance of social gatherings involving food.
How to Support Someone with an Eating Disorder
A powerful way to support someone is active listening. That involves not just hearing the words someone is saying but rather making an effort to understand what they are trying to communicate. Those living with an eating disorder have a complicated journey ahead. An inadequate healthcare system, constant reminders of food and dieting, and stigma, all create barriers and challenges to full recovery. The more we know, the better allies we can be.
Resources
If you or someone you know is struggling with or has struggled with an eating disorder, there’s help out there. In addition to therapists at Octave who can support eating disorder recovery, here are some great resources:
NEDA - Find Treatment
The National Eating Disorders Association (NEDA) is the largest nonprofit organization dedicated to supporting individuals and families affected by eating disorders. NEDA supports individuals and families affected by eating disorders and serves as a catalyst for prevention, cures, and access to quality care.
Crisis Textline - Helpline
Crisis Text Line provides free, 24/7, high-quality text-based mental health support and crisis intervention by empowering a community of trained volunteers to support people in their moments of need.
Project HEAL - Treatment Access
Project HEAL’s goal is to break down barriers to treatment to give every person a shot at recovery. Their programs help people with eating disorders get the care they need and have been repeatedly denied.