What images come to mind when you think of all eating disorders? How about when you think about what they have in common?
Perhaps you think of a skinny white teenager? Or a young, rich woman purging? And/or a middle aged woman in a large body eating from ice cream cartons and potato chip bags?
Oversimplified and misrepresentative images of people with an eating disorder are typical in the media.
One teeny kernel of truth is that all eating disorders aren’t the same. Yet, they share some overlap and in ways that may be surprising.
The most well-known eating disorders are Anorexia, Bulimia, and Binge Eating Disorder. There are others, but let’s focus on the main three for now.
Anorexia is when a person has an intense fear of weight gain and a distorted view of their own body weight and size. In addition, people with this condition go to extreme efforts, such as semi-starvation, to lose weight. The disorder can easily take over a person’s life and have severe medical complications.
Bulimia is diagnosed when someone regularly binges and purges. More specifically, binges are defined as a large amount of food, eaten secretively, and usually quickly. A core feature of a binge is feeling out of control. Loss of control can also occur when eating small amounts of food.
What makes a binge a binge is not necessarily the amount of food but more so the loss-of-control feelings of the person who is bingeing.
After the binge, unbearable guilt and disgust flood in. The sufferer then gets rid of the food by purging, which may include over-exercising, restriction, or laxative use.
Binge Eating Disorder is the most common of the three disorders. The primary symptom is recurrent binge eating without any method to compensate for what is eaten. Feeling out of control and a lot of shame are part of the suffering from BED.
These three eating disorders are the most commonly known. Though they each have distinct symptoms, the disorders have overlapping causes and treatment implications.
What all eating disorders have in common:
1. There is no ONE cause.
Years ago, kids’ problems were blamed on the mother. Schizophrenia? Mother’s fault. Depression? Mother’s fault. The same was true with eating disorders. Yep, Mother’s fault. The blame then shifted to genes, and then onto societal pressure for thinness.
It is not that simple.
Fortunately, science has advanced!
Researchers and treatment providers know that all eating disorders occur due to a complex interplay of five fundamental factors – biological, emotional, interpersonal, social, and psychological.
Take home message: The particular interaction of the contributing factors differs, but all five factors are implicated in all eating disorders.
2. Appearances can be deceiving.
You can’t tell by appearance if someone has an eating disorder. That is right — there is no way to know if someone suffers from an eating disorder just by looking!
The size of a person’s body is NOT an indicator, nor is gender, sexual orientation, or race, of an eating disorder.
A perfect example: Anorexia used to be thought of as a rich white girl’s disease. We now know that Anorexia affects people of all economic means.
Boys and men, LGBTQs, and BIPOCs are not eating-disorder-immune, either. In fact, rates of eating disorders are higher among the transgender community than in the nontransgender community.
One of my pet peeves is the stereotyping by size of all eating disorders. You can’t tell if someone has an eating disorder by judging their body.
Please do not assume a person in a large body has Binge Eating Disorder, or any disorder for that matter. Someone with Binge Eating Disorder may be in an average size body. A thin body doesn’t equal Anorexia.
You can not tell by looking at a body what is going on inside the person’s head — or their body.
3. Reaction to diet culture
We live in diet culture, a belief system that equates weight and food with morality and virtue. Thinness is the end all be all.
Furthermore, You and I and everyone are influenced by it, even if not on a diet. Sneaky ways diet culture disguises itself are as “clean eating,” “healthy lifestyle,” or “wellness.” (If it walks like a duck and quacks like a duck….)
“Fish don’t know they are wet” applies here. Not to fish but to you and me. We are so surrounded by diet culture that we may not even realize it. Despite the fact that it is a $70 billion/year industry.
More often than not, all eating disorders innocently begin with a diet.
Intentional weight loss efforts conflict with the body’s natural set point range of weight. The diet then gets out of control and spirals into an eating disorder.
If there were no diet culture, eating disorders would be very rare.
4. Interoceptive awareness derailed
Interoceptive awareness is your ability to perceive sensations from your body, in the present moment.
So if you notice you have a full bladder and have to use the bathroom, interoceptive awareness is to thank. When you notice hunger and fullness cues, you’re having a felt sense in the moment of your direct experience of hunger or fullness. Thank you, interoceptive awareness.
Another aspect of interoceptive awareness is emotions. How cool is it that every emotion has its own unique physical sensation or ‘autograph’ in the body? Anger, for example, may show up in your body as tension. Happiness as levity. Sadness, for instance, as a heaviness.
The wiring of the mind and body is designed so they can communicate with each other.
To reiterate, noticing bodily sensations provides key info to assist with meeting biological and psychological needs. There is a definite evolutionary advantage to this default mechanism.
Diet culture, unfortunately, messes with the innate, attuned interoceptive awareness mechanisms we are born with.
In other words, diets are all about rules, not about attunement with your body’s exquisite signaling system.
When on a diet, making decisions about what and when to eat are based on external methods (e.g. counting calories, following rules) rather than on trusting and valuing body sensations.
So, what happens is a disconnect from your body’s perfect system of communicating hunger/fullness to you.
Keep in mind that diets emphasize the external — weight, appearance, and rules, often determined and designed by someone you don’t even know. And created by someone who doesn’t know you or what you need nutritionally for optimal well being.
Unfortunately, external persuasion occurs at the expense of interoceptive awareness.
Your body’s capacity to communicate with you is a glorious built-in system. Dieting trashes it.
Fortunately, interoceptive awareness can return online and is an important ingredient of treatment and recovery.
5. Walking heads – “I would rather not have a body”
With all eating disorders, there is a disturbance in how you experience your own body.
More specifically, you have lots of negative thoughts, feelings, and sensations about your body and yourself.
The eating disorder solution is to sever ties with your body, and to end the mind/body relationship. In other words, to function as if your body weren’t there.
The idea is that it would be better not to have a body than to live in a body that feels like a nuisance, hindrance, or source of all things negative.
When your body feels like a receptacle of yuckiness, it’s no wonder being body-less seems like a better alternative.
Another factor in the walking head phenomenon is low interoceptive awareness. All eating disorders are associated with a huge disconnect from the body as if the body were nonexistent. Further, semistarvation, bingeing/purging, and other eating disorder behaviors can cause dissociative states, whereby you might not even feel like you are in a body.
6. All or none thinking, aka stinkin’ thinking
Also known as black/white thinking, good/bad, or dichotomous thinking. This is the tendency to think in extremes as if there are no shades of gray.
Words that may indicate all/none thinking include: always/never; good/bad; all/none.
For all eating disorders, good/bad thinking is the hallmark. Here are examples :
- I ruined my diet today by eating 5 m&ms, so I may as well eat the whole bag and start my diet tomorrow. Or purge after I’ve eaten the rest of the m&m’s. Or not eat until tomorrow night.
- Bread is bad. Fruit is good. I can’t eat carbs.
- I will never find a romantic partner until I am thin. Being thin is my #1 goal.
- Being thinnest among my friends is all that matters.
- If I eat a sandwich, I will get fat.
Cognitive behavior therapy teaches you how to identify distortions by evaluating their validity and offering reframes. You also learn about your underlying belief systems.
Reframing distortions and addressing underlying belief systems is key to healing.
We tend to believe what we think, even if what we think is not true.
Thoughts are super powerful; they determine feelings and behaviors. Often, thoughts are so automatic we may not even know we are having them. Therapy provides a method for identifying distortions and restructuring them to be accurate.
In the examples above, the thoughts are deemed fact by the person thinking them. Consider the impact on the person’s feelings and behaviors. Distortions are fuel for and characteristic of all eating disorders.
7. It is all about food
Eating disorders are called eating disorders because of a disturbance in eating behavior. The eating disturbances differ, depending on the disorder. Food may be withheld, restricted, eaten in large quantities, or purged.
Interoceptive awareness goes offline, and people’s well being overall suffers.
An anti-diet Registered Dietician can offer humongous help with nutrition restoration.
The anti-diet training and philosophy are key; otherwise, nutrition support is likely to make matters worse.
8. It is not about food
Recovering requires more than nutrition restoration because all eating disorders have a mental health aspect.
Addressing and resolving mental health problems is essential to full recovery.
Granted, as a psychologist I am biased. But I can tell you I’ve never heard of anyone fully recovering without psychological guidance and support.
Common treatment issues in all eating disorders include: body image, shame, self-esteem, anxiety, perfectionism, relationships, and value systems. None of the key psychological causes are about food.
9. Social Forces
We live in a culture of rampant weight bias, patriarchy, racism, classism, homophobia, and other social problems. The inequities are vast. All eating disorders occur in a socio-political context.
White privilege translates to the fact that Caucasians typically have greater access to resources than do people whose skin is not white.
Another form of privilege is thin privilege. Just because of their (highly desirable and socially sanctioned) thin body size, some people have greater access to resources and less discrimination than people deemed to be in a body that isn’t thin or that doesn’t meet the cultural ideal.
All eating disorders are affected by culture and the associated stereotypes, biases, and discrimination.
10. Myth city
Common ones are that all eating disorders are:
just a phase
a way to get attention
a lifestyle choice
forever; once you have one, you have one for life
One thing I’ve learned from 25 years of working in the field of eating disorders is that recovery is ABSOLUTELY possible and a worthy investment of time, energy, and other resources.
I know in my heart that full recovery is possible.
I also know that not everyone recovers.
(Access to and participation in effective treatment is more challenging depending on location. Telehealth has helped to level the playing field a bit.)
One of the things I remind people of is that recovery is one of THE hardest things. Blood, sweat, and tears don’t even come close to describing the physical and emotional pain of recovery.
Recovery is also one of THE most rewarding things in life.
I have yet to hear anyone say they wish they still had an eating disorder.
I do hear the opposite. Something like “I had no idea how much happier life could be without an eating disorder.”
Suffering from an eating disorder is like living in prison. There is no freedom, but a lot of darkness. It sucks.
You are worthy of nourishment — physically, emotionally, relationally, and beyond. Reclaim eating as a source of pleasure and your body as the wonderland it is.
Dr Elayne Daniels is a Yale-trained clinical psychologist in private practice. She specializes in the treatment of people with eating disorders using innovative and empirically based methods. Humor and connection are central to her treatment approach. You can contact her here.