What’s the REAL Relationship Between Anxiety and Eating Disorders?

A photo of a woman seated at a table alone, eating soup, reading a book that she is holding in one hand and that is blocking her face.

Anxiety and Eating Disorders often co-occur. Anxiety can begin before an Eating Disorder, around the same time, or after the onset of an Eating Disorder. This chronology has led many to wonder about the real relationship between anxiety and Eating Disorders.

So, let’s unpack this. First, anxiety.

Think of anxiety as on a continuum.

On one end is minimal anxiety. On the other end is severe anxiety. As anxiety approaches the ‘severe’ end of the continuum, it becomes an Anxiety Disorder. To be a disorder means symptoms interfere with daily life and impair functioning.

There are many different kinds of Anxiety Disorders.

They include: Obsessive Compulsive Disorder, Generalized Anxiety Disorder, Simple Phobia, Panic Disorder, Social Anxiety Disorder, and Post-traumatic Stress Disorder.

To have an official disorder of any type means you meet specific criteria outlined by the Diagnostic and Statistical Manual (DSM). This is true for Anxiety Disorders and Eating Disorders. The DSM is THE official handbook that outlines and describes all psychiatric conditions.

In the DSM category of Eating Disorders, three main types include Anorexia nervosa, Bulimia nervosa, and Binge Eating Disorder.

Eating Disorder symptoms are challenging to treat. Plus, people with an Eating Disorder often have other psychological conditions too.

Guess which DSM diagnosis occurs most frequently among people with a DSM diagnosed Eating Disorder?

You guessed it: Anxiety!

Anxiety is the most common condition people with an eating disorder have.

In fact, 48-51% of people with anorexia nervosa, 54-81% of people with bulimia nervosa, and 55-65% of people with binge eating disorder are also diagnosed with an Anxiety Disorder.

Far more people with an Eating Disorder have anxiety, but to a lesser degree than someone with a DSM Anxiety Disorder.

By the way, there is little research on the prevalence of Eating Disorders among people with an Anxiety Disorder.

One of the most common forms of anxiety that co-occurs with Eating Disorders is Obsessive Compulsive Disorder (OCD). In fact, OCD usually occurs first and is considered by some a risk factor for developing an Eating Disorder.

Anorexia nervosa is the Eating Disorder than most often overlaps with OCD.

The other two Anxiety Disorders most often associated with Anorexia are Social Anxiety Disorder and Generalized Anxiety Disorder. (Social anxiety disorder is also more common in people with bulimia than in people without an Eating Disorder.)

Actually, Social Anxiety Disorder is the anxiety disorder that occurs most often among people with any type of Eating Disorder (not only Anorexia.).

Think about the implications of co-occurring Social Anxiety Disorder and Eating Disorders.

When someone has Social Anxiety Disorder, they may be that much more reluctant to seek treatment. Having Social Anxiety makes getting help for an Eating Disorder (and the for Anxiety Disorder for that matter) that much harder. And less likely.

Delaying or avoiding treatment worsens the prognosis for someone with an Eating Disorder. Or with an Anxiety Disorder. Or with both.

Let’s put the pieces together: Anxiety Disorders seem to occur more often in people with an Eating Disorder than in the general population. We also have evidence that Anxiety Disorders likely emerge before an Eating Disorder.

What does this mean?

The sequence suggests that early onset anxiety may increase the risk of developing an Eating Disorder. This is especially true of Social Anxiety Disorder.

The research on the relationship between Eating Disorders and anxiety is difficult to interpret. One reason is because of all the combinations of different Eating Disorder and Anxiety Disorder diagnoses. (As outlined in the beginning of this article.) There are methodological problems in some of the research that also makes it tough to evaluate.

So the inconsistencies complicate the understanding of co-occurring anxiety and Eating Disorders.

Regardless, though, treatment for one often benefits the other.

For example, Cognitive Behavior Therapy (CBT) is one of the treatments of choice for Eating Disorders and Anxiety Disorders.

CBT is based on the idea that psychological problems are the result of distorted ways of thinking and unhelpful behavior. Through the use of specific techniques, CBT helps people learn to cope better with everyday kinds of things. Improved coping decreases their need to use Eating Disorder behaviors. The same sort of techniques are useful in treating Social Anxiety Disorder.

Another plus to mention is that certain medications called Selective Serotonin Reuptake Inhibitors (SSRIs) can be helpful. They are often part of an effective treatment plan for Anxiety and Eating Disorders. SSRI’s were originally developed to treat depression. (They help treat depression too!)

So what is the REAL relationship between Anxiety and Eating Disorders? It depends on which research findings you read.

My professional experience is that anxiety is practically always present before an Eating Disorder develops.

Anxiety can be one of the reasons why an Eating Disorder develops in the first place.

How so? Well, in an attempt not to feel anxious, a person turns to Eating Disorder symptoms. Usually this is not conscious.

Anxiety may then decrease, but only artificially. It is still there. An Eating Disorder masks it. But, the person no longer feels as anxious. The more she relies on Eating Disorder symptoms, the less anxiety she feels. An entrenched cycle has begun.

Anxiety also occurs during an Eating Disorder. Maybe because of sneaky behaviors that are involved. Or due to malnourishment.

Anxiety also occurs after an Eating Disorder and as part of recovery. Why? Well, change can be scary. Feelings are no longer numbed by an Eating Disorder. Instead, CBT and medication provide more skillful ways to be in the world. But learning and changing take time. There is no quick fix.

Both Anxiety and Eating Disorders are treatable. To be you, without symptoms of Anxiety or of an Eating Disorder is possible. Whichever type of Anxiety Disorder or Eating Disorder you have, seek treatment that addresses both. Doing so will be one of the best investments you will ever make.

Dr Elayne Daniels is a private practice psychologist in Massachusetts, specializing in the treatment of people with Eating Disorders and co-occurring conditions of all types.

3 Reasons Poor Body Image And Eating Disorders Go Hand-In-Hand

A whimsical painting of a woman's face, surrounding by koi fish, as if underwater and swimming with them

Not everyone with an eating disorder has poor body image, and not everyone with poor body image has an eating disorder. However, poor body image and eating disorders often do go hand in hand.

Let’s start by defining body image.

Body image is the relationship you have with your own body. As with most relationships, body image is complex.

Body image is important because of how it impacts your physical and mental health, relationships, and self-esteem.

It includes how you see/perceive your body, what you think about your body, and how you feel about it. Body image also includes beliefs and behaviors, and is strongly influenced by Diet Culture.

Diet Culture influences everyone’s relationship with their body, even if they aren’t dieting. Sometimes it’s disguised as ‘healthy lifestyle’, ‘clean eating’, or other such euphemisms. It glorifies thinness and intertwines weight with worth.

In addition to making you feel bad about your body and self, Diet Culture demands you be vigilant about eating and weight.

It says that to be worthy, you must be thin. And if you’re not in a thin body, you are to blame.

Diet Culture shows up as all-or-nothing, perfectionistic thinking regarding food, body and health. Rules to eat “x” but not “y”. To “start Monday” if you ‘blew it”. If not thin, then you’re fat.

It promises that if you follow external rules, rather than trust your body’s wisdom, you will succeed.

This kind of messaging makes having a good relationship with your body almost impossible.

Poor body image often begins in childhood. Thanks to Diet Culture, growing up with a neutral or even positive body image is more the exception than the rule.

Parents are not immune either. They don’t live in a vacuum. Diet Culture is so insidious that even recognizing it is a challenge. Sort of like fish not knowing they are wet. They often unknowingly perpetuate Diet Culture messages, for they have also internalized them.

There’s no shame here- Diet Culture impacts US ALL.

The main points include:

1.Poor body image is due to the internalization of Diet Culture.

2.If there were no poor body image, there would be no dieting.

3.If there were no dieting, there would be no eating disorders.

(Except Anorexia nervosa, which recent research suggests has a prominent genetic component irrespective of cultural ideals.)

How does negative body image present in eating disorders? There are many forms: body dissatisfaction, overconcern with weight and shape, body-related checking, avoidance behavior, misperception of size, and body-related cognitive bias.

There are three basic ways body image and eating disorders go hand in hand.

First, research finds time and time again that poor body image is one of the most common precursors to eating disorders. Second, it is the main symptom of many eating disorders, including Anorexia nervosa and Bulimia nervosa. Lastly, recovery requires improved body image. Without it, recovery is incomplete and/or short-lived.

Let’s look at each of the three ways poor body image and eating disorders go hand in hand.

1. As mentioned, poor body image is a risk factor for eating disorders.

Eating disorder prevention programs often target body image for this very reason. Poor body image is a risk factor for other problems, too, including depression, anxiety, and low self-esteem.

Why is poor body image so strong a precursor to eating disorders?

One reason is poor body image can and does easily lead to dieting, disordered eating, and then to an eating disorder.

Negative body image is a logical risk factor in eating disorders because people who develop eating disorders tend to highly value body shape and weight. Especially to define their self-worth.

2. Poor body image is a criteria in the diagnoses of two well known eating disorders, Anorexia nervosa and Bulimia nervosa.

In the case of either disorder, poor body image presents as body shape and weight hugely influencing self-worth. People with Anorexia nervosa also have a disturbance in how they experience their weight or shape. Sometimes they’re unable to recognize the seriousness of their current (often low) body weight.

The most common eating disorder is Binge Eating Disorder. Body image related concerns are not part of the diagnosis. However, about 60 percent of BED patients endorse overconcern with weight and shape. And avoidance behaviors and body checking too.

3. Why does recovery from an eating disorder require improved body image?

People with an eating disorder sometimes fear they’ll never feel at peace in their body. Especially if they give up their eating disorder behaviors. They inaccurately believe that their only hope to eradicate negative body image is to lose weight and maintain a body size closer to Diet Culture’s ideal.

Surrendering eating disorder behaviors, including dieting/restriction, is especially difficult in the Diet Culture World we live in. An important facet of treatment is to help people learn self advocacy, social action, and how to be the change they want to see in the world.

The good news is that full recovery from eating disorders is possible. Which means that improving body image is also possible.

There’s no shame here- diet culture impacts US ALL.

To move toward healing and freedom from food and body concerns, we have to dismantle and question the ‘truths’ that Diet Culture has enforced from Day 1. And, to consider how buying into these beliefs and messages (most often over and over again) has been destructive to attuning to your body, your needs, your hungers and your trust in yourself.  

As you begin to do this important self-inquiry, externalize some blame you’ve put on yourself.

Join me as we take down Diet Culture, together. Only then will body image collectively improve and eating disorder rates plummet.

I am a non-diet, Certified Intuitive Eating specialist and clinical psychologist in MA. If you’re struggling with your body image and/or eating disorder, please contact me here.

Are Eating Disorders A Mental Illness?

A drawing of a young woman with a globe she is leaning on has an expression of concern.

Eating Disorders are a diagnosable mental illness. So says the Bible for diagnosing psychiatric illnesses, the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Published by the American Psychiatric Association, the DSM includes hundreds of mental health disorders categorized by symptoms, for both adults and children. Updated every few years, the current version is DSMV.

Eating Disorders have their own DSMV category, Feeding and Eating Disorders, or “FED” for short.

I’m not sure if the APA intended the pun or not.

Eating Disorders’ inclusion as a mental illness in the DSM has advantages.

First and foremost, recognizing eating disorders as a mental illness adds legitimacy. As a result, eating disorders are less likely viewed as a rite of passage, fad, choice, or attention seeking maneuver.

Another plus of recognizing eating disorders as a bona fide mental illness is earlier diagnosis and treatment. (And insurance coverage.)

However, identifying eating disorders purely as a mental illness is oversimplified.

Here are three reasons why.

First, let’s look at the numbers. The National Eating Disorders Association reports 20 million women and 10 million men in this country will have an eating disorder in their life. That is a lot of people.

Speaking of a lot of people…

Imagine randomly asking people questions from a disordered eating screening tool. Questions like, “How afraid are you of gaining three pounds?” “Compared to other things in your life, how important is your weight to you?”

The results of this experiment? You’d most likely find people without a diagnosed eating disorder reporting eating disorder symptoms.

So if many people suffer from what is considered a disorder (knowingly or not), is the disorder a disorder?

This is where Diet Culture enters into the equation. Or, as I like to say, fish not knowing they’re wet.

And Diet Culture is the second reason there is more to eating disorders than what the DSM has to say.

What is Diet Culture anyway?

It’s a set of beliefs that worships thinness and equates it with morality and success. Diet Culture is the lens through which we define attractiveness, worth, health, and our own bodies. It’s the air we breathe and one of the main factors affecting how we feel about ourselves.

What does Diet Culture have to do with eating disorders?

Everything!

Diet Culture perpetuates eating disorders and makes recovery much more difficult. As activist, Dance Champion, and Marathoner Ragan Chastain says, Diet Culture is “particularly dangerous to those with a predisposition for, currently suffering with, or recovering from eating disorders.” (Again, that’s a lot of people!)

So, how are Diet Culture and eating disorders linked?

“Thinner is better, regardless of the mental and physical cost” is a Diet Culture belief. So is the premise that anyone can be thin if they just try hard enough. These are the ingredients in a recipe for an eating disorder.

We’re surrounded by images and messages that reinforce this premise and keep us hostage.

The message is clear. You have to have a certain size (thin) body, and follow a set of rules (e.g. fitness and/or meal plans) to be successful, attractive, and worthy.

Again, this is fertile ground for eating disorders. (And a dark parody of taking the messages too far.)

The third way to think about eating disorders beyond the DSM is as a Culture bound syndrome.

A culture bound syndrome is “a cluster or group of co-occurring, relatively invariant symptoms found in a specific cultural group, community, or context” (American Psychiatric Association).

What do culture bound syndromes and eating disorders have in common?

Research from 1995 on the island of Fiji addresses this very question. The mid 1990’s is when American television first began broadcasting in Fiji.

Prior to television, there was no such thing as eating disorders in Fiji. Even though there was a lot of emphasis on food.

But the food emphasis was on the joy of eating. And in delighting in the abundance of delicious food. The focus on pleasure is the opposite of Diet Culture messages.

By 1998, 3 years after “Friends” and “ER” were broadcast, that changed, especially for teenagers.

An astounding 11.3 percent of adolescent girls reported purging for weight loss. They said things like, “I want their (actresses’) body…I want their size.”

By 2008, 45 percent of girls had purged in the last month.

So, are eating disorders a mental illness? Yes.

But…

Complex biological, temperament, genetic, and sociocultural factors interact to yield an eating disorder. Diet Culture is a major player in that equation. Factor in Diet Culture messages, and eating disorders can be thought of as a Culture Bound syndrome.

Diet Culture harms you. Actually, it harms anyone with a body. That includes people who aren’t on a diet. And even people from a South Pacific island who until recently had a diagnosed eating disorder rate of zero.

So when thinking about eating disorders, please respect that many factors contribute to their development and maintenance. They are a mental illness, but so much more.

I am a MA licensed psychologist with a passion to help people of all sizes and shapes improve their relationship with food and their body. If you are struggling with an eating disorder and want help, please contact me here.

What Is Disordered Eating?

Four rows of food, witha woman's arm with fork in hand, demonstrating disordered eating.

Disordered eating is so common that it’s hard to identify and define. It’s just accepted as “normal”.

Kind of like fish not knowing they’re wet. It’s just how they live.

We’re born with all of the knowledge we need in order to eat well. But over time, the knowledge goes offline. Especially with our cultural obsession with thinness as our backdrop. And the tendency to categorize food as “good” or “bad”. As if food has a moral quality.

What is normal eating anyway? To define DISordered eating, we first need to know what ordered (“normal”) eating is.

Ellyn Satter, a registered dietician and family therapist, has an often cited definition. (She has lots of street cred as an internationally recognized expert on eating.)

She says normal eating is….

  • “… eating until you are satisfied.
  • Being able to choose food you enjoy and eat it and truly get enough of it – not just stop eating because you think you should.
  • Giving some thought to your food selection so you get nutritious food, but not being so wary and restrictive that you miss out on enjoyable food.
  • Giving yourself permission to eat sometimes because you are happy, sad or bored, or just because it feels good.
  • Mostly three meals a day, or four or five, or it can occasionally be choosing to munch along the way.
  • Leaving some cookies on the plate because you know you can have some again tomorrow, or it is eating more now because they taste so wonderful.
  • Overeating at times, feeling stuffed and uncomfortable. And it can be undereating at times and wishing you had more.
  • Trusting your body to make up for your mistakes in eating. Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life.

In short, normal eating is flexible. It varies in response to your hunger, your schedule, your proximity to food and your feelings.”

Is it even possible to have a “normal” relationship with food these days?

My thoughts: “YES, but…”

“Normal eating” remains quite the oxymoron in our culture. As if the two words don’t belong together, side by side. And that an understanding of how the two words could possibly be a real thing is hard to believe. A common response is something like, “nondieting and normal eating may work for other people, but not for me. I could never do that.”

Indeed, nondieting (“ordered” rather than disordered eating) may seem like a radical act. To actually tune back into your own body’s natural signals. Not an easy thing to do – the signals have been derailed. Diet Culture’s rules of should’s and shouldn’ts have overridden your body’s inherent wisdom. BUT, you CAN reclaim that wisdom. Actually, to do so is your birthright.

Defining disordered eating is also difficult because there’s no specific criteria. In order to address a problem, defining it is helpful in order to know what it even is. And to understand why it is a problem in the first place.

The main reason disordered eating is hard to identify and define is because it is more the norm than not in our weight obsessed, diet oriented culture.

Consider the fact that disordered eating, Eating Disorders, and dieting are more common than normal eating. That’s disturbing.

So what are the signs and symptoms of disordered eating, and how do you distinguish it from Eating Disorders or dieting?

Signs of Disordered Eating:

Disordered eating takes a variety of forms. Examples include limiting intake to a certain number of calories or macros; eating only certain foods and avoiding others for weight related reasons; bingeing, purging, restricting, and/or fasting.

The mindset and behaviors that drive disordered eating can be hard to distinguish from cultural definitions of normal eating. And to distinguish from an Eating Disorder All of these behaviors are concerning. In time they can easily morph into a full blown Eating Disorder.

Disordered eating often has additional features, including:

  • Self-worth based on body weight and size
  • Body dissatisfaction
  • Exercise to compensate for eating
  • Preoccupation with food, weight
  • Compulsive use of scale to check body weight
  • Fad dieting
  • A rigid approach to eating, such as only eating certain foods, inflexible meal times, refusal to eat in restaurants or outside of one’s own home

There are also lots of side effects of disordered eating.

For example:

  • Decreased ability to focus because thoughts about food, body, and exercise get in the way.
  • Social activities are affected, especially if they involve eating in a restaurant. Or eating foods that aren’t part of the plan.
  • Using disordered eating rules to cope with stress.
  • Anxiety due to food, weight, exercise.

Treating Disordered Eating

Disordered eating impacts physical and psychological health and puts people at risk for a host of problems. And it takes away from quality of life. Big time.

The relationship we have with our bodies is complex. So is how we nourish ourselves.

Fortunately, it is never to late to improve your relationship with food or your body. And there is no better time than right now.

As a psychologist, I’m biased in favor of psychotherapy. At least to support you as you start on the path of improving your relationship with food and your body. Finding like minded people also helps. There are communities to join online for example that may empower you.

Psychotherapy is helpful because it provides an opportunity to understand complex relationships with food and body. Also, therapy helps people move toward body acceptance. In addition, a nutritionist who specializes in eating disorders and adopts a non-diet approach to food and exercise can also be a good resource. Particularly with respect to increasing attention to the body’s natural hunger/fullness cues.

Reclaim your natural default of Intuitive Eating. Eat unconditionally. In whatever way pleases your body. Food is meant to be a source of pleasure. Denying yourself of it does not make you virtuous. Fueling and nourishing yourself well provides a sense of freedom, energy, and limitlessness.

Consider being your own unique fish, and surround yourself with others who share your vision.

I am a psychologist with a passion! IF you would like to learn more about freedom to derive pleasure from food and to be comfortable in your own skin, please contact me here.

How To Heal From 3 Heartbreaking Side Effects Of Eating Disorders

A woman sitting on a chair eating a banana and reading demonstrates it is possible to heal from the side effects of eating disorders

Eating Disorders are serious illnesses that squeeze joy and ease out of your life. They take a huge toll on your body and mind and can shorten life span. Despite how damaging the effects can be, you can heal from (most of) the heartbreaking side effects of eating disorders.

Consequences of eating disorders vary, depending on which eating disorder you have, the duration and severity of the disorder, and a few other factors.

If you have an eating disorder, reading about the side effects is not likely to motivate you to recover. Education alone is not enough.

Upon learning about side effects, you might think “oh, that (side effect) won’t happen to me”. Or “if that happens, I will deal with it then.” Or even “I hope that (side effect) happens because I deserve to suffer.”

Separating the psychological and physical side effects is not completely fair, because the mind and body are connected to one another. One affects the other.

The psychological side effects of eating disorders are what I am going to focus on here.

You can read about the physical side effects here.

How do eating disorders cause psychological side effects?

Well, atypical eating behaviors, such as fasting or chronic dieting, impact your thoughts and emotions. (And, of course, your body.)

Dangerous patterns of compensation, such as self-induced purging or laxative abuse, do too. (And they affect your body as well.)

Even though your body and mind are resilient, the force of eating disorders is fierce and destructive. Withholding nourishment from and inflicting punishment onto yourself cause wounds. And some wounds leave scars.

The psychological impact of eating disorders can be complex. And less obvious than the physical side effects.

The psychological impact is less visible but no less serious.

For example, shame, loss of control, hyper-control, and body image problems are common. So are guilt and anxiety.

Other mental health side effects of eating disorders include:

  • major mood swings
  • depressive thoughts or actions
  • obsessive-compulsive behaviors
  • general anxiety
  • Isolation
  • impulsive behaviors, such as self-harm
  • low self-esteem

(Please note: Research has yet to determine exactly which psychological variables are linked to the cause and which are due to the effects of eating disorders.)

Three lesser known heartbreaking psychological side effects of eating disorders include:

  • Poor interoception
  • Self objectification
  • Psychological inflexibility

Let me explain what these fancy sounding concepts mean, why they’re important, and what you can do to heal them.

Interoception tells you what your body feels on the inside. Interoceptive awareness occurs when you recognize you have to empty your bladder (i.e. you have to pee), or that your heart is racing.

Interoception is also knowing when you’re feeling hungry and when you’re feeling full.

By definition, having an eating disorder means not eating when hungry (restriction/fasting), and/or eating beyond fullness (bingeing). Over time, your body’s hunger and fullness signals get dysregulated because they’ve been ignored. They get used to you overriding them.

Recovery involves improving interoceptive awareness by re-regulating your hunger and fullness signals.

Meeting with a registered dietician who specializes in the treatment of eating disorders can help you do this. The basic recommendation is to eat in a structured, consistent, patterned way each day: Meal, snack, meal, snack, meal, snack. And not to go 4 or more waking hours without eating.

As a bonus interesting fact: I have noticed that a lot of people in treatment for an eating disorder also tend to ignore other body signals, including the need to pee.

2. Self-objectification is a body image concept that has to do with seeing yourself as an object first, and a human being second.

Your experience of being female is defined by a culture that sexually objectifies women’s bodies.

So as a girl/woman, you naturally internalize an observer’s view of your body. This leads to ongoing monitoring of your body’s appearance. And of weight especially. It also increases shame, anxiety, and disgust toward yourself. Self objectification leads to eating disorders and remains a side effect.

Eating disorder recovery involves redefining your relationship with your body and seeing it through your own lens. Learning other ways to experience (see, feel, connect with) your body. And honoring your body as part of your human experience.

3. Cognitive inflexibility increases risk for eating disorders and is a side effect that’s hard to change. Especially for people who have Anorexia nervosa.

Cognitive flexibility refers to the ability to shift your thinking and/or your plan or strategy.

A lack of cognitive flexibility occurs during eating disorders and continues into recovery.

Cognitive Behavioral Therapy is a useful treatment approach. The focus is on helping you learn how to identify underlying thinking patterns that may be keeping you stuck. Meditation can also help.

Eating disorders are serious yet highly treatable. Yes, you can fully heal from an eating disorder – with treatment with a therapist trained in providing therapy to people with eating disorders.

The sooner you seek specialized help, the sooner you will heal from the symptoms and side effects of eating disorders.

And what a gift to yourself that is!

I am a clinical psychologist specializing in helping people recover from eating disorders. What that looks like is working alongside each person, as they discover true joy and passion in life, live fully embodied, and heal more and more each day.

20 Subtle Warning Signs of Eating Disorders

Graffiti of a black woman represents subtle risk factors for eating disorders

Someone you love has been diagnosed with an eating disorder. You Monday morning quarterback and rack your brain. Would your loved one even have an eating disorder if you had known about subtle warning signs of eating disorders? Maybe. Maybe not. In any event, please do not take on the eating disorder as your fault. Because it is not your — or any one person’s — fault.

One of the hard things when it comes to eating disorders is how to differentiate — in people of any sex, sexual orientation, age, or demographic — what’s normal and what’s considered clinical. You may wonder “is this part of being a fill-in-the-blank (teenager/woman/athlete)? Or, is it a sign of a problem?” The “this” could be just about anything – negative body image, certain eating behaviors, or various exercise patterns.

Diet Culture makes differentiating warning signs of eating disorder behaviors hard to evaluate. Especially when disguised as ‘clean eating’, ‘healthy lifestyle’, or ‘wellness.’ They all mean the same thing.

Remember, eating disorders are caused by a combination of biological, psychological, and socio-cultural risk factors — including genetics. In people who are genetically predisposed, subtle warning signs add up quickly and create the perfect storm.

Here are 10 subtle warning signs of eating disorders:

1. Bathroom use Discretely going to the bathroom after eating something is a common warning sign of eating disorders. Often the reason is to induce purging. Notice if you hear the water faucet running for an unusually long period of time. The running water sound is to drown out any evidence you might otherwise be able to hear.

2. Food rules This could be an entire book! There are so many. Here are some examples:

  • not eating after a certain time of day
  • waiting until a certain time of day before eating anything
  • eating only a certain number of calories or grams of a nutrient like fat
  • insisting that food can’t touch on the plate
  • at restaurants only ordering salad, with dressing on the side
  • declining any invitations that involve food, even with friends

3. Inflexible routines The eating disorder becomes the center, around which everything else revolves. This focus influences anything and everything else a person does or thinks during the day.

4. Unusual interest in what other people eat. Vicarious eating is common. In other words, eating ‘through’ watching or talking about what other people are eating.

5. Sudden interest in nutrition, food labels, additives/preservatives. And spending time scouring the nutrition information on products. Looking up nutrition information online before eating is another example.

6. Preoccupation with ‘clean’ eating, Aka dieting, ‘just being healthy’, or some other word that is a stand in for restriction.

7. Viewing Cooking shows, food related videos, or recipes on the internet becomes a regular part of the day.

8. Irritability, whether from the effects of restriction or due to having binged, she has mood fluctuations that are somewhat new.

10. Sneaking exercise, to compensate for what she’s eaten.

And 10 more….

11. Lying about food, exercise, and eating disorder behaviors. Denial of having a problem is common too.

12. Sudden decision to become a vegetarian/vegan, and the decision does not come from a place of animal rights.

13. Frequent use of scale to weigh self, or starting to use a food scale to measure the amount of food before eating it.

14. Excuses to avoid meals with family/friends, such as “Oh I already ate at Megan’s house”,

15. Wearing oversized/baggy clothing to camouflage body.

16. Monitors and compares own intake with others; “the rule” is to consume less than other people at the table.

17. Zoned out expression, due to hunger/malnutrition or preoccupation with eating disorder symptoms.

18. Strange combinations of food, including certain condiments.

19. Insistence on preparing all food herself in order to have complete control over ingredients and quantity.

20. Unusual forms of eating behavior, such as pulling food apart with fingers.

There are many other early warning signs, and the presence of any of the above does not mean the the person is necessarily destined to have an eating disorder.

Plus, the early warning signs for eating disorders vary depending on the type of eating disorder. Early signs of anorexia nervosa, for example, may be different from those of Binge Eating Disorder.

Regardless of the specific thoughts and behaviors, all disordered eating and eating disorders begin with some form of a diet. Or a decision ‘to eat healthy’. Or ‘to lose weight and get in better shape.” The diet could be recommended by a physician, family member, or friend. Even by a Health Education teacher. Or a coach.

Eating disorders are serious conditions, even at times deadly. The symptoms don’t go away on their own. Early recognition of subtle waring signs of eating disorders will shorten the duration of the disorder. And, early treatment is key in full recovery.

And with treatment, full recovery is absolutely possible.

I have specialized in treating people with eating disorders for over twenty years and know personally and professionally that recognizing warning signs can make a huge difference in whether a full blown eating disorder develops. Please contact me if you would like to know more.

10 Risk Factors For Eating Disorders That Every Parent Needs To Know

Three young girls at a table eating and are at risk for eating disorders.

Parents often blame themselves when their child has an eating disorder. Or they blame the child. The cause of eating disorders is way more complicated than faulting parents or the child. When parents know about risk factors for eating disorders, they recognize just how complex these disorders are.

Risk factors for eating disorders come from both Nature (genetics, biology) and Nurture (environment, culture).

The factors combine in a particular way that then leads to eating disorders.

So, the cause of an eating disorder is never just one thing. It is way more complicated than that.

That means there is no single gene that CAUSES eating disorders, nor are cultural pressures for thinness THE cause of eating disorders.

The three categories of risk factors for eating disorders that every parent needs to know come from:

1. Biology/Genetics (Nature)

2. Psychology (Nurture) and

3. Culture (Nurture)

Factors from all three categories combine and result in an eating disorder.

Triggering events distinguish why some people with risk factors from the three categories develop eating disorders and some don’t.

What’s a triggering event? Well, it could be something like a loss, such as the death of family member, friend, or pet. Or a parents’ divorce. Maybe a geographic move of a best friend. Or some other transition, such as to a new school. Even a medical problem, be it a chronic disease diagnosis, surgery, or an injury, can be a trigger.

BIOLOGICAL/GENETIC risk factors for eating disorders:

Biological risks predispose people to eating disorders. Genetics account for 40-60% of liability for eating disorders.

  1. Genetic relative: Having a first degree relative (e.g. parents, sibling) with an eating disorder is a risk factor.

2. Relative with a mental health condition: Having a relative with depression, anxiety, substance abuse, or other psychiatric illness increases risk.

3. Early menarche: Girls whose first period is earlier than their peers’ are at higher risk.

PSYCHOLOGICAL risk factors for eating disorders include:


1 Personality characteristics: Certain personality traits increase risk. The biggest one is perfectionism. Others include high sensitivity, low distress tolerance, and behavioral inflexibility.

2. Body Image: Negative body image is common. But not everyone with body dissatisfaction develops an eating disorder.

People who develop an eating disorder have even worse body image than the norm. They also tend to internalize societal ideals of weight and appearance more.

3. Anxiety Disorder: Anxiety symptoms often occur well before an eating disorder develops. More than 2/3 of people with anorexia have anxiety disorder symptoms first.

SOCIAL/CULTURAL risk factors for eating disorders include:

  1. Diet Culture: The number one risk factor in this category is the societal pressure to be thin. Diet Culture is the toxic system of beliefs that idealizes thinness and connects weight and morality.

    Weight discrimination is the norm in Diet Culture. So is categorizing food as good or bad.

    Living in Diet Culture negatively affects your relationship to your own body and your children’s relationship with their body.

    Dieting is ineffective for sustained weight loss in almost 100 percent of people. When dieting no longer works, eating disorder behaviors such as fasting, restricting, and purging can easily develop.

    2. Teasing: Approximately 60% of people report a history of being teased.

    3. Appearance ideal internalization. Striving to have the socially-defined “ideal body” is harmful. Dieting becomes normalized as a ticket to success.

Eating disorders develop for lots of reasons. Biological, psychological, and cultural factors, along with a triggering event, create a perfect storm.

There are little, everyday things you can do to decrease the risk of an eating disorder for your child. For example, don’t comment on your own or other people’s weight. Focus instead on non-appearance related qualities. Don’t label food as good or bad. Food is just food. Food doesn’t have morals attached to it. Eat a full range and variety of food, and enjoy it! Encourage your child to do so too.

If you yourself have an eating disorder, please get treatment. You deserve that, and so does your child.

While eating disorders may not be 100% preventable, you can absolutely decrease the risk for your child. And for yourself.

For more information, please contact me.

10 Things All Parents Must Know About The Prevention Of Eating Disorders (& Overcoming Them)

Two parents, their son and daughter on standing on a beach overlooking the ocean, representing the importance of recognizing early warning signs of eating disorders

Dieting triggers Eating Disorders. You and your family live in diet culture. Ut oh. How then as parents can you prevent eating disorders? What are some of the things for parents to know about the prevention of eating disorders?

Education for parents about the prevention of eating disorders makes a difference in the life of every family member. There is lots of hope!

Here are ten things for you as parents to know about the prevention of eating disorders.

1. The most common way Eating Disorders start is as an “innocent” diet. (Which is an oxymoron.)

More than 40 BILLION dollars is spent each year on dieting. From an early age, children receive the message that being in a socially acceptable size body (e.g. thin) is essential for happiness. The diet industry, fitness industry, and even the medical field promote unhealthy weight practices (aka dieting), often disguised as ‘healthy lifestyle’ or ‘clean eating’.

Why is this relevant?

The most fundamental way to prevent Eating Disorders is through teaching and modelling nondieting. Dieting is not innocent; it is a significant risk factor for Eating Disorders. And, it promotes mistrust of the body, as well as weight cycling and preoccupation. Dieting interferes with quality of life and is not sustainable. Research since 1959 has demonstrated the futility of dieting over and over and over again. And the dangers associated with it.

I discourage dieting, and so should you. It can lead to an Eating Disorder, especially for susceptible children.

So what can you do instead?

Teach your children how to trust their body, appetite, and needs. Be aware of what you are modelling for them, through your words and actions.

A child delighting in sitting at a table about to eat a delicious looking donut.

For example, eliminate (ideally) or limit your purchase of diet/low calorie foods. Do not speak disparagingly about your or someone else’s body size or weight. Educate your children that no food is “good” or “bad”. Food is food and does not have a moral quality.

Emphasize Intuitive Eating, movement for pleasure, and your child’s many awesome qualities beyond appearance.

Encourage your children to be in tune with the physical sensations in their body. Teach them the skills of Interoceptive Awareness. This education will also help them to regulate their feelings.

One of the best resource for parents of infants all the way through adolescents is Ellyn Satter’s website. It is a rich source of gold standard information for families on eating competence, feeding dynamics and division of responsibility.

2. Learn the basics about eating disorders.

There are tons of free resources online. Prevention is easier if you know the facts. Recognize too that Eating Disorders include more than the two most commonly known (Anorexia nervosa and Bulimia nervosa), and sub threshold forms of Eating Disorders are serious too.

Here are more of the basics:

a. Genetics increase risk. If a biological relative has/had Anorexia, for example, risk increases eleven times. However, an eating disorder is not inevitable. Genes predispose but are not a slam dunk.

b. Eating Disorders rarely get better on their own. With proper treatment, though, they are completely treatable.

c. Eating Disorders occur among boys/men, people who are transgender, and girls/women. People of color, of any socioeconomic status or religion, and of all ages develop Eating Disorders.

Two tween girls are on a hammock enjoying nature.

3. Teach media literacy. Especially with social media. Doing so will buffer against appearance based comparing.

Research studies confirm what you likely already know: Social media usage can promote body dissatisfaction, depending on the images you are looking at. The number of likes you get on your posts also factors into how you feel after spending time on Instagram. More often than not, you feel worse about yourself after spending just ten minutes scrolling on Instagram.

4. Be a role model in as many ways as possible. Both on the inside and outside.

Live your life in a way that is aligned with your own values. When day to day choices are based on your own set of values, you are also instilling the values into your children’s life. Healthy values can be key in the prevention of eating disorders.

5. Teach and model self-compassion to your children.

Being self compassionate is similar to showing other people compassion. Self compassion means you accept imperfection. Life can be hard, filled with frustration, loss, mistakes, and limits. This is what it means to be human. Ups and downs in life are to be expected, and are what connect us as human beings. In this way self compassion strengthens resilience.

6. Eating Disorders are not caused by just one thing.

There are many genetic, biological, behavioral, psychological, and social factors that combine and create the perfect storm. Eating disorders do tend to run in families. Exciting research in the last decade or so using brain imaging will probably provide additional guidelines for the treatment and prevention of eating disorders. Good news!

7. You can not tell if someone has an Eating Disorder by looking at them.

Someone with an Eating Disorder may appear “healthy” but be ill. In general, do not comment on people’s weight or food choices. And, never tell someone with an Eating Disorder they look “healthy.” To that person, “healthy” is code for “you look fat” or “you have gained weight.”

8. People with Eating Disorders are at higher risk for suicide, medical complications, and psychological disorders, such as depression or anxiety. Sometimes they also have substance use problems. Including diet pill abuse.

Eating Disorders can be fatal.

9. Eating Disorders are not a phase, choice, or resolved by a mandate to ‘just eat’.

They are legitimate, serious conditions that require specialized treatment. The typical approach is to have a medical doctor, registered dietician, and a psychologist working as part of a team with you and your child. Sometimes a family therapist is also involved.

10. Parents are not to blame when a child develops an Eating Disorder.

The reasons for why the Disorder developed vary for each person. Further, there is no one set of guidelines for parents to absolutely guarantee the prevention of an eating disorder in their child.

The great news is that there are things every family member can do to create a recovery-promoting environment.

Including parents in the prevention of eating disorders and in the treatment process is especially important.

Eating disorder prevention is critical. As parents, you may not be able to prevent your children from developing an eating disorder. However, please recognize that there are many action steps you can take to protect your kids. And to stack the deck more favorably.

Educate yourself and be mindful of what you are teaching your children.

Your children soak in your comments and behaviors, everyday. You have agency over the messages your children absorb. Use that to your and their advantage.

I have specialized in the prevention and treatment of Eating Disorders for over 20 years and have seen the Disorder’s toll on a family. Full recovery is available to anyone suffering from an Eating Disorder, and for their family too.

How to Overcome an Eating Disorder When You Are Not Even Sure You Have One

Woman sitting outside wrapped in blanket feeling gratitude for overcoming an eating disorder.

Acknowledging you have an eating disorder is hard. Even if you know the facts.  So then how do you overcome an eating disorder when you are not even sure you have one?

Complicating this process is that a person with an eating disorder rarely recognizes the dangerousness of the symptoms.

Head’s up: Denial is common. Expected even.

Even or especially when you know the facts.

An example of denial is “that (fill-in-serious -medical-consequence, such as a heart attack) won’t happen to me. Maybe to other people, but not to me.”

Recovery is difficult, uncomfortable, and at times painful.

However, recovery is 100% possible. ONE HUNDRED PERCENT. And, I have never heard of anyone who regrets recovery.

For sure, how to overcome an eating disorder when you are not even sure you have one is no easy task. 

There is no script, set of instructions, or do-it-yourself manual. Self-help is rarely enough for overcoming an eating disorder. 

Part of you at times may not want to say goodbye to the disorder. That is normal. After all, the eating disorder has played a role in helping you to cope with feelings, relationships, and events in your life. 

If eating disorder behavior were not helpful, you would not have an eating disorder. 

On a basic biological level, you know you need food to survive.  And that your eating disordered relationship with food is neither natural nor friendly.

Even though it might make you feel virtuous, special, or safe. 

Food is not for nourishment for a person with an eating disorder. Instead, it’s something to restrict, binge. or binge/purge.  The relationship with food is used as a way to communicate feelings.

Food becomes the enemy. You versus Food. Sometimes it is also a best friend.

To overcome an eating disorder, your relationship with so many things has to change, not just your relationship with food. 

For example, a common tendency in the relationship with food is to categorize food as ‘good’ or ‘bad’. Doing so is problematic and adds momentum to an already adversarial relationship with food. Another reason it’s problematic is the implication that if you eat “bad” food, you are “bad”, and if you eat “good” (or no) food, you are “good”.

 (Unfortunately, our culture regards food in an all-or-none kind of way based on nutrition content. And, in Diet Culture, worth as a human being is based on food choices and body size/weight. Someone with an eating disorder has taken what is considered normal in Diet Culture to an extreme.) 

The truth is that food has no moral quality. Actually, the only ‘bad’ food is food that has spoiled!

All food is just food. 

Diet Culture infuses morality with food, as if an apple is ‘good’ and brownies are ‘bad’. Are rotten apples with a worm “good”? Are fudgey, warm brownies ‘bad’? Nope. 

“Rotten”, “wormy”, “fudgey”, and “warm” are descriptions, not value judgements. “Good” and “bad” are value judgments. As if you are a  “good” or “bad” human being depending on your food choices. Hardly!

Social media and other sources promote the belief that food, weight, and morality are linked. They are not. 

Diet Culture is sneaky and wants you to be at its mercy so it can sell you stuff. 

Overcoming an eating disorder is hard enough, especially because you don’t live in a vacuum. Triggering messages are everywhere. Some  are obvious, and some are more subtle.  

Any discussion of overcoming an eating disorder must at least reference Diet Culture. Why? Because it is the air you and most other people you know (and those you don’t) breathe. I like to say fish don’t know they’re wet.

Overcoming an eating disorder with Diet Culture as backdrop everywhere is extra challenging. 

(Beware of Diet Culture in disguise, co-opted as “Healthy Lifestyle”, “Clean Eating”, or otherwise packaged as health.)

There are concrete ways to overcome an eating disorder, though, even if you are not sure you have one. 

Or even if you are not totally sure that you want to overcome the disorder. 

The specifics of treatment vary, depending on the nature of your symptoms and which eating disorder diagnosis you have. 

Here are 11 general tips:

  1. Create a treatment team.

    An example of a treatment team is: An eating disorder specialized psychologist, anti diet registered dietician, and eating disorder informed primary care physician. Maybe a family therapist too.

    You are the center of the treatment team. The other experts are there to support, guide, and make recommendations.

    They are on your side. The goal for everyone on the team is to help you take steps toward well-being.
  1. Be patient with yourself.

    Overcoming an eating disorder does not occur overnight. Progress takes time. And the trajectory is not linear. It is more of a squiggle.
  1. You are not a problem that needs to be solved.

    Eating disorders do not occur in a vacuum. There are socio-cultural, biological, metabolic, historical, and political forces at play.  For true change to occur, Diet Culture has to be eradicated.

    But You and only You are the only one who can ‘do’ your recovery. You have support (remember the first tip?)  but YOU do the work.

    Recovery is unlikely if other people work harder than you in your recovery.
  1. Discover new ways to cope.

    Find other methods of managing feelings so there is less need (or no need at all) to rely on the eating disorder.

    One of the ways an eating disorder serves as a coping method is by numbing your feelings.

    Learn strategies to tolerate and express feelings. There are therapies designed for exactly that purpose. Dialectical Behavior Therapy is an example. Two of the four areas of focus are emotion regulation and distress tolerance. 

    A mnemonic that can be helpful in this pursuit is “NCFA”, or Name your feeling, Claim your feeling, Frame your feeling, and Aim your feeling.

    In other words, learn the name of your emotions, validate your feeling, understand why you are feeling the emotion, and then do something with the feeling to express it in a way that is more aligned with well being.

5. Find your tribe

Connect with people who are further along in overcoming an eating disorder than you are. Be sure your relationship is not based on exchanging eating disorder tips! Follow Instagram accounts of inspiration for recovery. (Instagram can also be problematic, so curate carefully! See Tip #6!)

Another idea is to connect with an online recovery group, some of which are low cost or no cost. 

6. Curate social media.

Eliminate triggering images. They are all over the place. Lots of research confirms what you may already know, first hand: Social media, and Instagram and Snapchat in particular, set up unrealistic expectations and lower self esteem and worsen body image.

If you feel worse about yourself, your body, or your life after you are on social media, consider deleting those accounts – or at least be super selective with whose accounts you follow. 

7. Learn and practice self-compassion.

Be on your own side, and try to support yourself as you would a dear friend or other loved one.  Or your puppy!

Self-compassion is not laziness, self indulgence, pity party time, or woe is me. 

It is the opposite. In fact, hundreds of peer reviewed research has been conducted demonstrating the benefits of self compassion.  

Here are a bunch of self-compassion practices to try. Check them out! A formal self compassion practice  is a great investment of time – it can take just 5 minutes. 

Practicing self-compassion strengthens resilience. 

8. Explore ways to express yourself.

So many other ways than through eating disorder symptoms are available for expression. Get creative and honor who you are. 

Learn to play an instrument! Find a hobby! Learn a foreign language!

Random ideas include playing the ukulele, creating inspirational quotes for tee shirts, or learning Japanese.

9. Learn about Health At EverySize (HAES) and Intuitive Eating (IE) approaches.  

They’re empowering alternatives to living in Diet Culture. (Ever notice ‘Diet Culture’ contains the words “die” and “cult”?) 

HAES is based on celebrating diversity in body size and shape and honoring all human attributes. HAES is a social, cultural, political movement.

IE is another great resource in overcoming an eating disorder. Intuitive Eating’s 10 principles provide a philosophy for nourishing a healthy, happy relationship with food and your body. With exercise too!

10. Practice new ways of thinking.

Notice when you hear yourself say/think mean things to and about yourself. If you would not speak that way to a friend, do not speak that way to or about yourself.

A form of therapy called Cognitive Behavior Therapy emphasizes identifying dysfunctional ways of thinking and teaches you how to reframe negative thoughts into accurate, neutral thinking. 

11. Keep your values in mind.

Mind-body-spirit well-being is most likely to occur when what we think, believe, say, and do are aligned. Eating disorder behaviors such as lying, avoiding, and hurting yourself are probably not congruent with your values. How do you reconcile this disconnect? One way is to identify your values, and work toward aligning them with the way you live your life. (The link is to a national survey. If you complete it,  a copy of your results will be sent to you.)

The line between eating disorder behavior and what is culturally normal eating behavior is becoming harder to pinpoint. 

This in and of itself is a problem and makes it harder to figure out how to overcome an eating disorder, especially when you are not even sure you have one. 

Even for people who do not have an eating disorder, dieting is not a natural, helpful for weight, or attuned way to eat.

The only way the blurred line will become clear is by recognizing Diet Culture for what it is and intentionally turning your attention inward to your body’s signals. HAES and IE will support your efforts. 

Sometimes you might wonder if treatment and recovery are better than life with the eating disorder.  At times you might even miss the eating disorder. 

This is all normal, rather than a sign that you’re not meant to recover.

If you get only one thing from this article, let it be this message, loud and clear:

Overcoming an eating disorder is absolutely possible. 

In the words of Sarah Silverman, ”Mother Teresa didn’t walk around complaining about the size of her thighs. She had shit to do!”

And so do you. 

You and I know you can access more meaning in life than a number on the scale could ever provide. 

I am Dr. Elayne Daniels, a Yale-trained clinical psychologist whose book smarts are augmented with firsthand experience. If you wonder if you have an eating disorder, or are concerned about a loved one, please reach out to me with any questions. 

10 Surprising Things All Eating Disorders Have in Common

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 :

  1. 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.
  2. Bread is bad. Fruit is good. I can’t eat carbs. 
  3. I will never find a romantic partner until I am thin. Being thin is my #1 goal.
  4. Being thinnest among my friends is all that matters. 
  5. 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

Myths abound. 

Common ones are that all eating disorders are: 

just a phase

a way to get attention

a lifestyle choice

about vanity

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.