One reason stress gets a bad rap is because it can trigger physical and mental health problems, including eating disorders and depression. Knowing how stress can “cause” eating disorders and depression may help prevent you or someone you love from suffering.
To be clear, stress is not always a bad thing. Especially in the short term, when it may help you feel energized to meet challenges.
In and of itself, then, stress doesn’t mean you’re destined to develop an eating disorder or depression.
But, when demands in life are greater than your coping skills, mind and body are impacted. And usually in a negative way. As in possibly leading to eating disorders and/or depression.
Stress can trigger psychological or physical problems, or both. Makes sense. After all, the mind and body are connected.
Many factors are involved in how stress impacts mind and body. Some of these factors are family history, genetics, emotional support, race, peer relations, education, social constructs, trauma history, temperament, coping skills, finances, among others.
Some factors are a buffer, and others worsen stress’ impact.
Can stress cause eating disorders ?
National surveys estimate that 20 million women and 10 million men in America will have an eating disorder at some point in their lives. That’s a lot of people. We don’t need a national survey to tell us that 100% of people experience stress in their life.
If stress caused eating disorders, the rate of eating disorders would be 100%, or somewhere close to it.
So the next time you hear people wonder if stress causes eating disorders (and depression), you’ll know what to say: “Not exactly.”
But stress can be and often is the straw that breaks the camel’s back.
Stress does not CAUSE eating disorders (or depression) but is a variable in the equation.
There’s a handful of ways stress and eating disorders are linked.
1. Stress can trigger — and seem to cause — eating disorders (and depression).
Worrying about food and weight is central to all eating disorders, regardless of the type of eating disorder. The clear message from social media, peers, and diet culture is that thinner is better, and that what you eat defines your worth as a human. Being a part of diet culture and adopting its belief system create stress (and a $70 billion/year industry).
So, in people with other risk factors, stress can easily lead to problematic coping. Coping by dieting is socially suggested, approved, and even sanctioned.
Staying on a calorically restricted diet is stressful. Even, or especially, when the diet is camouflaged as wellness, clean eating, or a lifestyle change.
Weight loss compliments and admiration from others is a source of stress as well. In 95% of cases, weight loss will be replaced by weight gain. And no more compliments or admiration.
Dieting is one of the main risk factors for eating disorders.
Stated in another way, eating disorders begin with an “innocent” diet.
Stress is part of the perfect storm.
2. Eating disorders create (more) stress.
Having a poor relationship with your body and an unhealthy relationship with food is stressful. (Thank you, diet culture, said no one ever.) Worrying constantly about food and weight causes anxiety. It’s like a 24/7 internal battle that affects everything – your relationships, mental health, physical well being, and self worth. Your fundamental sense of who are you is at stake.
Another way eating disorders create more stress is physically. Put simply: Having an eating disorder is exhausting.
Eating disorders involve harmful behaviors in the name of achieving a cultural aesthetic. Restriction, poor nutrition, purging methods, and other eating disorder behaviors place stress on your body, including your organs. (That includes your heart.)
Eating disorders create a stress fest. But festive it is not.
3. People who develop eating disorders are often prone to stress.
The impact of stress on eating disorders is likely mediated by temperament (e.g. overly controlled; perfectionistic in the case of anorexia; impulsive, outgoing in the case of bulimia).
And certainly mediated by diet culture. Social media has intensified diet culture’s harmful impact. Even Instagram acknowledges the harmful effects of filtered selfies on body image. (“Compare and despair”)
For an eating disorder and depression to develop takes more than stress alone. When other risk factors are in place, and a stressful event occurs, an eating disorder can become activated. Without the stressful event, the eating disorder may not be triggered.
The ‘why now’ question of the timing of an eating disorder usually involves a triggering event. Examples of the kinds of triggering events include a loss of a pet or other loved one, a divorce, an injury or other medical event, or teasing. In other words, some form of stress.
4. The relationship between stress and eating disorders is a vicious cycle.
Stress does not cause eating disorders, but the two combine to create a vicious cycle.
Here is how that happens.
In general, two main eating disorder symptoms are negative body image and a problematic relationship with food.
Having a poor body image and relationship with food is stressful! And that stress in and of itself worsens body image and triggers eating disorder thinking and behaviors.
Hello, vicious cycle.
Stress occurs, and you feel overwhelmed. To cope, you turn to eating disorder behaviors. Then, ongoing negative body image and self talk associated with eating disorders increase stress.
It is a hard trap to get out of. Once you see it, though, you are in a position to make some changes to stop the cycle from continuing.
Stress and Binge Eating Disorder
The most common eating disorder is called Binge Eating Disorder (BED).
BED is characterized by eating large quantities of food (binges) and feeling a loss of control during the binge episodes. Eating is often rapid, and to the point of discomfort. Often the person feels a sense of shame or guilt afterwards. The person does not have compensatory behavior, such as purging, to offset the binge eating. The person will often deliberately restrict intake between binges.
In their lifetime, 3.5% of women and 2.0% of men will have BED.
To put this in perspective: BED is more than three times more common than anorexia and bulimia combined. BED is also more common than breast cancer or HIV.
The good news is that BED is treatable. (And preventable.)
The stress of following diets or other rules contributes to the stress that fuels BED. (Hello again, diet culture.) People with BED in larger bodies face additional stress from weight stigma and discrimination.
To cope with stress, binge eating becomes the relied upon method to manage feelings that would otherwise be overwhelming. Bingeing can provide immediate comfort. The bingeing itself, though, then causes more stress and overwhelm and causes you to feel bad about yourself.
Then, there is the stress associated with fearing weight gain. And of actual weight gain. There is also the stress associated with replacing the food you’ve binged on so no one knows about the binge.
Even physicians are guilty of shaming people with diagnosed or undiagnosed BED. Especially when people are in larger bodies. If that isn’t stressful, what is?
Stress and Bulimia nervosa
Bulimia nervosa is a serious, potentially life-threatening eating disorder. It is characterized by cycles of bingeing, and self-induced purging to undo the effects of bingeing.
Three in 100 American women suffers from bulimia.
It’s common for people with bulimia nervosa to use food and purging to manage feelings they’d rather not feel — including sadness, shame, anger, stress and boredom.
So the person with bulimia feels stressed, binges (for comfort) and purges (for relief) to alleviate the stress. What then replaces the original stress is the stress of being secretive, of cleaning up the ‘evidence’ of the binge or the purge, and of shame.
The physical impact of bingeing and of purging is another form of stress caused by the eating disorder. The list of short term and long term physical effects of bulimia is extensive.
Stress and Anorexia nervosa
Anorexia nervosa is an eating disorder characterized by weight loss, refusal to maintain a medically appropriate body weight, and distorted body image.
People with anorexia tend to restrict calories and good tasting food. Some people with anorexia also exercise compulsively, purge via vomiting and laxatives, and/or binge eat.
Anorexia can affect people of all ages, genders, sexual orientations, races, and ethnicities. One in 200 American women suffers from anorexia.
Although anorexia nervosa most often begins during adolescence, an increasing number of children and older adults are being diagnosed.
You cannot tell if a person is struggling with anorexia by looking at her. A person does not need to be emaciated or underweight to be struggling. Studies have found that larger-bodied individuals can also have anorexia, although they may be less likely to be diagnosed due to cultural prejudice against fat and obesity (yep, diet culture’s effects again).
Anorexia nervosa numbs emotion and creates preoccupation with food, weight, calories, and exercise. The preoccupation is the body’s response to restriction and starvation (both of which are stressful to mind and body).
Simply put, the preoccupation is stressful. It is all the person with anorexia can think of. It is the last thing she thinks of before bed, and the first thing that comes to mind upon awakening. Even dreams are often about food and body size.
Sleep is usually poor, which creates stress in and of itself.
Anorexia is an attempt to feel more of a sense of control in life, and therefore less stress.
However, a ton of stress is created by the symptoms of anorexia. The stress anorexia creates affects both the mind and body. In fact, anorexia has a higher mortality rate of any psych illness. That is stressful.
Can stress cause depression?
Does stress cause depression? Yes and no.
Depression is a mood disorder. Its symptoms include sadness, and/or a lack of interest or motivation in things you used to enjoy. Additional symptoms include lethargy, fatigue, low motivation, poor concentration, sleep problems, or changes in appetite. Depression may include physical symptoms that don’t respond to treatment, such as headaches or gastrointestinal problems. Having any of these symptoms is stressful.
Depression affects about one in 15 adults (6.7%) per year. One in six adults (16.6%) experience depression at some time in their life. Depression can occur at any time. Typically it first appears during the late teens to mid-20s.
Stress affects 100% of adults, yet 100% of adults do not develop depression.
1. Stress can trigger depression
Stress can (seem to) cause depression in a few different ways.
When people don’t cope effectively with stress, they may become depressed. They may feel defeated, ill-equipped, or overwhelmed by the stress. A “why bother” attitude could develop, which is a depression response to stress called learned helplessness.
What happens in learned helplessness is people eventually stop trying to manage the stress because nothing has worked in the past. Not trying leads apathy. All-or-nothing thinking comes next. The person’s self talk is based in distorted thinking. It may be something like, “Nothing I do matters. I suck”.
Chronic stress is especially problematic. It can derail your natural physiological stress response, which means you are not able to manage stress as well. Depression sets in.
Generally, when people feel stressed, their problem solving skills aren’t optimal. Without the stress, the person’s coping and problem solving skills may be effective enough.
Stress can also lead to people neglecting self-care. Or to engaging in behaviors that harm their health, such as smoking or drinking alcohol.
2. Depression creates more stress
The effects of depression can create or intensify stress.
Being depressed is stressful for a bunch of reasons..
Depression disrupts life. It’s often associated with withdrawing from people and instead isolating yourself. And not doing things you usually enjoy doing.
Depression and stress can lead to a vicious cycle
The relationship between depression and stress is bidirectional. Depression can cause stress, and stress can cause depression. Stress makes depression worse, and depression makes stress worse.
3. So how does stress cause eating disorders and depression?
Stress in and of itself does not CAUSE eating disorders or depression.
Rather, stress triggers or intensifies eating disorders or depression. Stress is bidirectional in the case of eating disorders and depression.
At their core, eating disorders and depression are disorders of disconnection.
Feeling disconnected from others or from yourself is stressful.
One way to address disconnection and social isolation is to connect with someone you trust. Let that person (or those people) support you.
Often it’s better for a supportive person to ask an open ended question rather than to tell you what to do or not to do.
The disconnection at the core of eating disorders and depression can be from yourself. And that stress has the biggest potential impact of all.
If talking to friends or family is not helpful or comfortable, please speak with a trained professional.
Learning effective methods to cope with stress decreases risk for eating disorders and depression. And makes for a more meaningful life.
There will always be stress. But it need not be harmful to your well being or quality of life.
Dr Elayne Daniels is a Massachusetts based clinical psychologist specializing in the treatment of eating disorders, body image and associated concerns. She also works with people who identify as Highly Sensitive.. Contact her here to get in touch.
Looking into treatment options for eating disorders for yourself or someone you love can be overwhelming. Even knowing where to start is challenging. In fact, a recent Google search for “treatment options for eating disorders” yielded 11,800,000 results. You read that correctly – over 11 million results.
As hard as it has been for you to get to this point, there are a few things to know about eating disorders before you start looking into treatment options.
1. Eating disorder treatment should not be delayed.
If you have an eating disorder, chances are you’ve had it for a while. People with eating disorders have symptoms for an average of six years before seeking treatment. That’s six years for your mind and body to be at odds with one another.
2. A correct diagnosis is important for treatment.
A correct diagnosis sounds straightforward. It is not.
In fact, it’s common to downplay, overlook, or even dismiss eating disorder signs. (A huge reason eating disorder signs and symptoms are ignored is Diet Culture.)
Symptoms that are easily overlooked include negative self-talk, which by definition is private and not shared with others. That’s what makes identifying when thoughts, feelings, and behaviors are part of an eating disorder so difficult to recognize for what they are. The same kind of thinking is also a part of our weight-focused culture.
Society’s (diet culture’s) messages are super glue strong. And harmful. A person’s weight does not define worth. Even though diet culture insists it does.
You can see how easily the blurry line between ‘normal’ and ‘disordered’ delays diagnosis and treatment. It makes you believe that everything is fine, when in reality everything is not fine.
So how do you even know if you or someone you love may have an eating disorder?
A great place to start is to fill out an online screening questionnaire.
Eating disorder diagnoses: What are they?
Eating disorders are not about weight, vanity, or attention seeking. They’re a way of coping with emotions that would otherwise feel too overwhelming.
Anxiety and/or depression often exist before eating disorder symptoms begin and can delay getting an accurate etig disorder diagnosis.
The category of eating disorders includes:
- Anorexia nervosa (AN)
- Bulimia nervosa (BN)
- Binge Eating Disorder (BED)
- Avoidant Restrictive Food Intake Disorder (ARFID)
- Otherwise Specified Feeding and Eating Disorder (OSFED)
3. Have a treatment team
A typical eating disorder treatment team includes a therapist, dietician, and medical doctor.
All providers should have expertise in eating disorder treatment. Treating a person with an eating disorder is complicated.
Treatment with a therapist and dietician specializing in eating disorders makes treatment success much more likely.
Your treatment team helps with goals and guidelines and is there to support you every step of the way.
You may be familiar with referral websites such as Psychology Today. But did you know there are also places online to look for eating disorder experts, such as the National Eating Disorders Association?
The same applies to finding a registered dietician with an eating disorder specialty. Nutrition therapy for eating disorders is different from general nutrition therapy.
A family therapist may be recommended as well if the patient is living at home and/or is a minor.
Family-based treatment, also known as the Maudsley Model, may be helpful for families of teens with an eating disorder.
By the way
Many PCPs and pediatricians lack proper training in and knowledge of eating disorders. They too are a part of diet culture. Without even knowing it, they spread harmful myths and stereotypes about weight and well being. They mean no ill intent, certainly, However, you can not assume a medical provider is eating disorder savvy.
The person in need of treatment may downplay symptoms and/or refuse help. Partly because of the strong forces of diet culture. And, because an eating disorder always provides some benefit. Or it would not exist in the first place. Doing away with something that has brought relief is scary.
Denial and secrecy often go hand-in-hand with an eating disorder. Sufferers deny they have a problem and are secretive about their symptoms.
Matching treatment intensity to symptom intensity makes for a faster recovery. And, a greater chance of a successful outcome.
Higher levels of care
More intensive treatment is called a higher level of care (HLOC). There are 4 main forms.
Medical stabilization, including refeeding, requires an inpatient level of care. Length of stay is usually a few days to a couple of weeks.
Residential treatment is for people who would benefit from round the clock support and structure but are not medically compromised. Residential programs typically last for up to 3 or so months.
A third level of care is partial hospitalization. Structured group therapy for 6-8 hours/day occurs, and patients then go home to sleep. Meals are included as part of treatment.
The lowest level of care is intensive outpatient. These programs are held for three or so hours, three or so times per week. Length of stay is typically a couple of months. Usually patients have a meal and snack together.
Sometimes people start at the lowest level of care and then return to their outpatient team. Others may need higher levels of care. Sometimes treatment involves cycling through different levels of care. There is no standard sequence of treatment levels.
The recommended level of care is mostly based on severity of symptoms. Within each program, treatment is tailored to the person’s needs. There is no ‘one size fits all’.
Some higher levels of care include additional treatment programming. For example, there may be a trauma specialization track, a substance abuse track, or a specialized program for athletes. The tracks are for people who have an eating disorder along with concerns related to one of the areas of special focus.
It’s best if everyone involved in the treatment communicates with each other as a team. That way, adjustments can be made to treatment as needed. And to minimize the ‘he said she said’ that can happen when direct communication is missing.
4. Treatment planning
A comprehensive approach to treatment is ideal. Eating disorders are complex and require several specialists.
Make a plan for eating disorder treatment. This may include settings goals, providing some education, creating parameters for safety, and coming up with a crisis plan.
Treat physical complications. Health and medical issues need attention. That being said, often the sufferers’ lab results are normal. Normal lab results DO NOT mean everything is fine.
Identify resources. Find out what resources are available. Are there support groups, for example, either online or in person? How about specialized movement classes, such as yoga for eating disorders?
Make sure resources are eating disorder sensitive. For example, taking a rigorous yoga class is not a good idea. However, a gentle class taught by an instructor who’s eating disorder informed could be helpful.
Speak with your insurance company to discuss coverage for treatment, regardless of the level of care needed. The insurance company will pay more over time for someone with an untreated or partially treated eating disorder.
Medications don’t and can’t cure an eating disorder. They work best when combined with therapy.
The most common medications used to treat eating disorders are antidepressants. Especially the eating disorders that involve binge-eating or purging behaviors. Antidepressants may help reduce symptoms of depression or anxiety. These symptoms often co- occur with eating disorders.
Medications for physical health problems caused by the eating disorder may also be required. For example, co-occurring gastrointestinal symptoms (constipation, diarrhea, reflux) are commonly treated with medications.
Therapy is a must to successfully treat an eating disorder. The psychological aspects of an eating disorder can be as difficult or even harder than the physical recovery.
Cognitive behavioral therapy (CBT) is a common and effective treatment for eating disorders. CBT improves attitudes about body shape and weight, replaces dieting with Intuitive Eating, and helps develop coping skills.
5. Have hope
Treatment works! Healing happens!
Generally, treatment is more effective before the disorder becomes chronic. However, even people who have had an eating disorder for many years can and do recover.
Eating disorders rarely, if ever, just go away on their own.
It’s OK if you “slip-up” during treatment. It’s normal. With each relapse comes opportunity to fine tune treatment and re-commit to recovery.
The most important takeaway message: People recover. Fully.
Your loved one (including if it’s you) with an eating disorder can too. The key to healing is being in the right level of treatment as early as possible. And staying hopeful along the way.
I am Dr Elayne Daniels, a MA-based, anti-diet, certified Intuitive Eating psychologist. My passion is helping people conquer eating disorders, feel comfortable in their body, and live a life of meaning. Contact me here for more information.
No one thing causes eating disorders to develop. It’s more like a perfect storm of genetics, biology, psychology, culture, and environment. Lots of factors merge together at the same time.
Genetics is one of many factors in how eating disorders develop.
Genetics contribute for sure! In fact, they predispose individuals to eating disorders.
Eating disorders tend to run in families. And the rate of eating disorders is higher in identical twins than in fraternal twins or other siblings.
Biochemistry is a factor in how eating disorders develop.
Certain neurotransmitters, hormones, and other chemicals are out of range among people with eating disorders. The levels are either too high or too low. These chemicals in the body are what regulate appetite, stress, mood, and sleep.
Among cis-gender girls, early menarche (compared to peers) can be part of the perfect storm.
Psychology plays a role, too.
Psychological factors contribute to how eating disorders develop. People with an eating disorder often also struggle with depression and/or anxiety. Obsessive Compulsive Disorder is particularly common, occurring in 25-69% of women with anorexia.
Other psychological factors include:
- Poor self esteem
- Feeling a sense of hopelessness
Certain personality temperaments put a person at higher risk for an eating disorder. Traits like reward-dependence, harm-avoidance, and sensation-seeking may be part of that perfect storm. Obsessive-compulsiveness too.
Culture is another contributor.
We live in Diet Culture. It’s so pervasive and sneaky. In fact, we often don’t even realize how very much we’re impacted by its toxicity. It’s omnipresent. Ubiquitous. The lens through which we see ourselves and the world.
Dieting, body dissatisfaction and a drive to be thin increase the risk for an eating disorder. Diet Culture encourages all three.
Diet Culture is sneakily disguised as ‘a healthy lifestyle,’ ‘clean eating,’ or a trendy way to eat (like Whole30, Keto, or Noom).
If it has rigid rules or involves math, it’s probably a diet.
Diet Culture contributes to how eating disorders develop in many ways:
- An over-emphasis on appearance, at the expense of valuing inner qualities like kindness.
- Societal standards that promote an unrealistically thin body shape.
- Associating thinness with positive qualities like attractiveness, health, success, and love.
- Media’s focus on dieting and striving for a slim and toned body for women.
- Messages that perpetuate a fear of fat and food; viewing fat as undesirable or foods as “good,” “bad,” or “sinful”.
Intuitive Eating is a better alternative on all fronts. Its first of ten guiding principles is to ‘reject Diet Culture’. Mind you, the principles are not mandates. They’re gentle steps, associated with improved physical and psychological well-being. And unlike anything in Diet Culture!
Environment is an important factor in how eating disorders develop.
Your environment also plays a role in how eating disorders develop.
For example, what was your home environment like? How did family members communicate feelings? Did family members diet? Were/are they weight conscious?
What kinds of extracurricular activities did you participate in? How about the kind of friend group you were part of?
Aspects of an environment that may be relevant to how eating disorders develop:
- Family conflict
- Physical or sexual abuse history
- Activities that focus on weight, such as gymnastics, dancing, running, wrestling
- Peer pressure
- Being bullied because of weight or appearance in general
You have agency over some factors associated with how eating disorders develop, but not all.
In the same way that fish don’t know they’re wet, you may not realize the extent to which you’re immersed in Diet Culture.
However, you do have agency over many aspects of recovery.
With support, you can emerge. And you will. Stronger than ever. And as a true power source.
You will be the fish that went to school (pun intended), recognizes Diet Culture, and knows your way out of the storm.
I am Dr Elayne Daniels, a MA-based psychologist specializing in treating people with eating disorders and negative body image. Join me in ditching Diet Culture! Contact me here for more information.
There are lots of signs of an eating disorder, yet how to know if you have one can be tricky. One of the main reasons you may not know if you have an eating disorder is due to Diet Culture. More about that in a moment.
How to know for sure if you have an eating disorder? Ideally, an informed physician or psychologist would conduct an evaluation of your symptoms. Unfortunately, education and training for eating disorder treatment is woefully inadequate, especially among medical doctors.
Even worse is that a lot of medical professionals don’t actually know how to correctly diagnose an eating disorder. Instead they resort to stereotypes and myths, such as using weight as a main indicator. Or believing that only white teenage girls develop eating disorders.
By the way, in the United States, an estimated 30 million people of all ages and genders have an eating disorder.
So, how do you know if you have an eating disorder?
Knowing if you have one is complicated. Being diagnosed with one can be even more complicated. Again, eating disorders are easily misdiagnosed. And often overlooked by professionals. Many in the medical and psychiatric field do not have training in eating disorders. Or in nutrition. (Can you tell it’s a pet peeve of mine?)
Consider too that an eating disorder is often downplayed by the person suffering from one. S/he may not want it to be identified. Or not recognize that her thoughts and behaviors are part of a bona fid eating disorder.
By the way, you can’t tell by looking at a person if she has an eating disorder. Body size is not an indicator, nor is any specific sign a slam dunk indicator. Girls and boys, nonbinary people, women and men suffer from eating disorders.
You definitely can’t tell by looking at yourself in the mirror if you have an eating disorder. Often your own perception of your body size and shape is distorted.
What is the main challenge of knowing if you have an eating disorder?
A huge challenge for how you know if you have an eating disorder is Diet Culture.
In reality, Diet Culture makes it nearly impossible to distinguish between “normal” and “abnormal” eating and body image. What is considered ‘healthy’ in Diet Culture is often anything but.
Haven’t heard of Diet Culture before? It’s a system of beliefs that equates thinness with worth as a human being. Through the lens of Diet Culture, you’re taught to feel bad about your body. And to judge other people’s worth by their body too. Diet Culture is often disguised as “healthy lifestyle”, “eating clean”, or “Intermittent Fasting”.
No wonder eating disorders are so rampant. Or that what is and isn’t an eating disorder can be tricky to determine.
Diet culture’s solution to any problem is: “Lose weight and you’ll look better, feel better, and be better.”
Taking this insidious message to heart puts you on a fast(er) track to an eating disorder.
Of course more factors than Diet Culture are at play. Regardless, Diet Culture’s messages are pervasive and detrimental. To the point where you may be unaware you’ve internalized them and are being controlled.
Social media has fueled Diet Culture’s impact. (Instagram is considered the most influential. although I suspect TikTok is a contender for first spot.)
What follows is a list of potential indicators of an eating disorder. This is not a complete list! (Resources are also available online to help you determine if you have an eating disorder.)
Possible indicators that you may have an eating disorder include:
1. Preoccupation with food, weight and/or the shape of your body.
- Thinking about food all day – what you ate, wish you could eat, wish you did not eat, and how to compensate for what you ate.
- You’re constantly thinking about your body and comparing yourself to others, especially to people on social media.
- You weigh yourself often, and the number on the scale determines your mood and how the day goes.
2. Not eating certain foods for fear that something bad will happen to you.
- A common example is cutting out particular food groups out of fear that they will cause you to ‘get fat’.
- Another example is believing myths, such as sugar is toxic or addictive.
3. Feeling out of control over the amount of food you’ve eaten, at least once a week.
- You might have binges. If you feel a loss of control when eating, you’re bingeing.
- Bingeing is usually secretive. And is inevitable after a period of restriction.
- Sometimes you may think you’ve binged because you’ve eaten more than you planned.
4. Worrying about the nutrition and calorie content of foods.
- People with an eating disorder tend to get stressed about eating out. They may look at menus online in advance of going to a restaurant.
- More than others, people with an eating disorder are influenced by calorie information on menus.
- Someone with an eating disorder is likely to avoid going to restaurants, or to compensate before and/or after they eat.
- Avoiding social occasions if food is involved is common.
5. Feeling disgusted or anxious when looking at your body or seeing it in a mirror.
- A person with an eating disorder is likely preoccupied with looking at herself in the mirror. Or may go out of her way to avoid seeing her reflection.
- People with certain forms of an eating disorder may wear oversized clothing as a way to hide their size or shape.
6. Constantly comparing your body to friends’, social media influencers, and people you see at the gym.
- And feeling worse about yourself, regardless of the comparison.
- You long for your body to look more like so-and-so’s body. You may even think that if you could look like so-and-so, everything would be perfect! You’d be happy, then. (But not really.)
7. Feeling guilty after eating.
- Food is often categorized as good or bad. In reality, all food is just food. It doesn’t have moral quality.
- Having an eating disorder often means rigid rules.
- Violating any rules leads to guilt. Especially when the rules involve food.
- All-or-nothing thinking is common.
8. Intentionally making yourself vomit or exercise excessively so you don’t gain weight.
- These are called compensatory methods. They’re habit forming. And dangerous.
- The purging methods are secretive.
9. Being very aware of calories.
- You’re vigilant about the calorie or macro content of food, and/or the amount of calories you burn.
- You have rules about how many calories you’re allowed, and you may track the information in your head, on an app, or with pen and paper.
- The less you’ve eaten, the better the day. And the more successful you feel.
10. Needing to check your body’s appearance throughout the day.
- You may frequently mirror check, weigh yourself often, or pinch areas of your body to assess the amount of tissue.
- These are called checking behaviors and can become automatic.
- You engage in these behaviors for reassurance that body parts have not gotten larger.
11. Having other symptoms as a result of your behaviors.
- There are a myriad of medical symptoms and risks involved.
- “Everyday” physical consequences include headaches, fatigue, dizziness, light headedness, irregular heartrate, gi distress, and constipation.
- Depression, anxiety, and other mental health problems are common. Or become worse.
12. Treating your body as if it is an object, rather than as a beautiful expression of your life.
- When you focus on your weight, you are objectifying your body, as if it is a mold of clay to size and shape.
- Withholding food from yourself is punitive.
- What about practicing embodiment? BEING in your body as if your body were the instrument through which you live your glorious life?
Ok. So now what?
Early evaluation and diagnosis, as well as effective treatment, stack the deck favorably for recovery.
And, full, complete recovery is possible!
What if you’re still not sure if you have an eating disorder? Consider talking with a specialist on a hotline through one of the national organizations such as the National Eating Disorder Association.
Whether or not you have an eating disorder, educate yourself on topics such as fat stigma, privilege and other social injustices that make up Diet Culture.
Let’s ditch Diet Culture together. And delight in size and shape diversity.
Imagine actually enjoying food? Welcoming other pleasures? And feeling comfortable in your body?
This IS possible. As you learn to love yourself more, you’ll break free from the constraints of Diet Culture.
As you become more accepting of yourself, you teach others to be more accepting of you too. And of themselves. Before you know it, you’ll be teaching others to break free from Diet Culture too.
Greater inclusivity will reduce the rate and impact of eating disorders. And lead to unprecedented freedom FOR YOU to let your body be.
I’m reminded of Margaret Sanger’s words: “No one can consider [themselves] free who doesn’t own…. [their] own body.”
The first step toward freedom in your body is to admit having an eating disorder.
By letting go of the shackles of Diet Culture, you’ll be able to experience your life – “happiily full” and with abundance. .
Hi! I am Dr Elayne Daniels, 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’re struggling with an eating disorder, live in MA, and want help, please contact me here.
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.
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 providing treatment to people with eating disorders and co-occurring conditions.
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.
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?
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.
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.
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.
- 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.
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
- 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.
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.