Making Peace With Food

10 Things Mental Health Professionals Wish You Knew About Eating Disorders

We live in a culture where "thin is in," and for some of the pressure to transform is tragic. Just in time for national eating disorders awareness week (February 21-27), the following facts will help you navigate the extreme behaviors and emotions surrounding food that make eating disorders the deadliest mental illness in the world.

1. They’re more common than you think.

The National Eating Disorder Association estimates that 30 million Americans – 20 million women, 10 million men – will struggle with a clinically significant eating disorder at some point in their lives. Since these illnesses impact the whole family, this number increases to more than 90 million when multiplied by the average U.S. family size. If you do the math, that means eating disorders impact roughly 28% of the population.

2. One size does not fit all.

You can have a dangerous relationship with food without meeting all the criteria of anorexia, bulimia, or binge eating disorder – which is why professionals have more recently begun to broaden their categories. The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes the subclinical category OSFED (Other Specified Feeding or Eating Disorder) to recognize other eating disorders of clinical severity.

The OSFED category proves that you don’t have to have all the criteria of anorexia or bulimia to need help. OSFED affects at least 1 in 20 people, including 1 in 10 teen girls. Sadly, many OSFED sufferers don’t think their issues qualify as a “real” eating disorder, so they often refrain from seeking help.

3. You can’t tell by looking.

Not all people with an eating disorder are emaciated or undergo rapid fluctuations in weight. Weight loss – or gain –  is only one symptom of disordered eating. “People with eating disorders come in all shapes and sizes, particularly in the case of bulimia when people tend to be at an average or even above average weight,” says Dr. Peggy Wilkins, a pediatric psychologist with Children’s Hospital at Erlanger.

And just because someone with an eating disorder has managed to return to a normal number on the scale doesn’t mean they have conquered the psychiatric and emotional issues that led to the issue in the first place. The mental struggle will likely continue long after the body has healed.

“It’s common for people to think, ‘I’m not thin enough to have an eating disorder,’ when they are very malnourished,” says registered dietician and licensed nutritionist Pamela Kelle, owner of Your Own Food Coach. “But you don’t have to see an eating disorder for it to be real, because it’s not about size. It’s about what’s happening inside the body.”

4. They aren’t about vanity

If you think eating disorders are solely about a desire to be thin, think again. These conditions often coexist with anxiety, depression, substance abuse, or negative thought patterns. Many people with eating disorders have an underlying problem or trigger they are trying to manage through their relationship with food, or they find relief in the structure and control they have over what goes into their bodies when other parts of life feel chaotic or unpredictable. “Distortions in body image, negative self-image, depression, and anxiety are all potential problems that can be expressed through food,” explains Dr. Wilkins.

5. They aren’t a “choice.”

Eating disorders are illnesses, not chosen lifestyles, say experts at the National Institute of Mental Health. Biological, social, psychological, and interpersonal factors can all contribute to a person getting stuck in the pattern of disordered eating.“It might start as a choice to begin restrictive eating to obtain control in their life, but then it just takes on a life of its own,” says Kelle.

“People choose to go on a diet, and for vulnerable individuals this can lead to an eating disorder,” says Dr. Gail Gnade, a clinical psychologist with Focus Treatment Centers.

6. It’s a slippery slope.

The urge to rigorously control diet and exercise can be triggered by a wide range of situations. It may be the pressure to reach a certain fitness goal, changes in hormone levels during adolescence or menopause, or a traumatic life event such as divorce, abuse, or a death.

For young adults heading to college, the uncertainty of newfound independence, stress to excel in academics, or pressure to fit in can also put them at risk for abnormal eating behaviors that slowly snowball into a serious problem. Once a pattern of anorexia, bulimia, or binge eating begins, it alters brain chemistry, making it difficult to regain control.

“Anorexia or bulimia may start as trying to eat healthier, get in shape for a sport, or lose just a few pounds. These behaviors gradually become more extreme over time,” says Dr. Wilkins.

7. They thrive in secret.

It’s not unusual for people with an eating disorder to withdraw from social life out of guilt and shame. They can become experts at appearing to eat normally in front of others, while secretly over-exercising, purging, binge eating, or restricting calories. If asked, they may deny they have a problem.

The longer an eating disorder remains concealed, the more likely it is to reach a dangerously advanced stage.

“To anyone hiding, I would encourage you to understand there is no reason to feel ashamed. You may feel as if you have done something wrong, but any eating disorder is an illness,” says Kelle.

8. They are on the rise.

While 95% of eating disorders begin during teen years or early adulthood, more and more children are showing signs of being fixated on their weight. Half of teen girls and nearly a third of teen boys at some point try to control their weight using unhealthy measures like skipping meals or taking laxatives. From 1999 to 2006, the number of children hospitalized for eating disorders increased by 119%. In a culture that is diet-obsessed, the message that size matters is not lost on youth.

9. What you say matters.

It’s common to greet a friend or family member with an enthusiastic “You look so good!” But complimenting someone on his or her body, rather than a positive character trait, can reinforce the idea that size is what matters most. Parents or peers who model anxiousness about food, give someone a seemingly innocent nickname related to a body trait, or habitually make comments about appearance can unintentionally teach young people that outward appearance is what makes a person valuable.

“I think it behooves us as a culture to be aware of the language we use that objectifies and reduces human beings to what they look like,” says Dr. Gnade. “People in early recovery from an eating disorder are sensitive to comments about how they look and what they eat. In this context, it’s far better to inquire about how a person feels and their hopes and aspirations.”

10. It’s very hard to get better on your own.

Because of its powerful pull, an eating disorder can be nearly impossible to manage or overcome by yourself. The truth is, only 1 in 10 women and men struggling with disordered eating seek out professional help. Saying yes to recovery is not easy, but it is a step toward a healthier future.

If you fear someone you know has developed a problem, talk to them in private and gently voice your concern. Instead of focusing your comments on body or food, explain you have noticed they seem tired, isolated, or unhappy, and encourage them to explore these things with a counselor or mental health professional.

“Often a person with an eating disorder is cognitively compromised, and this makes it difficult for them to get help. Loved ones are a tremendous asset and can help them connect to these resources,” says Dr. Gnade. “They can show them that they are not alone, and that it’s OK to get help.”

As you seek to help your loved one or yourself, understand that overcoming an eating disorder is not simply a matter of willpower or “deciding to get better.” Treatment takes time, and it generally requires a team approach including professional guidance.

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