It’s Not About the Food: What You Should Know About Eating Disorders

Eating disorders are a group of conditions that have been identified as a medical illness with biological, physical, emotional and psychological components that contribute to how they manifest, how they are perceived and how they are treated.  There is no single cause and, although they are often associated with either an obsessive desire to be thin or an uncontrollable desire to eat, eating disorders are not just about the food. 

As many as 30 million people in the U.S. currently suffer from eating disorders.  Eating disorders have the highest mortality rate of any mental illness; the death rate of anorexia nervosa is 12 times higher than the rate associated with all causes of death of females 15-24 years old. In fact, eating disorders have a higher mortality than all other mental illnesses combined.  (The Elisa Project, n.d.) What this means is that most people know someone dealing with an eating disorder. And you might be surprised at who is suffering from an eating disorder and the nature of their struggle…

Common Myths about Eating Disorders

Much has been learned about eating disorders over the last few decades, but there is still a lot of confusion around them, even within the medical community.  Education and information about this illness is critical for the people who suffer from it as well as their families, their doctors, and the community at large. 

Researcher Cynthia Bulik, Ph.D., debunks the most common myths about eating disorders.

Eating disorders are a choice.

This is perhaps the most damaging myth, Bulik says.  She explains that patients who “go to the emergency room get triaged far down the list because the physician thinks that somehow they chose to have a ruptured esophagus or chose to have electrolyte imbalance.”  She believes that this perception has stuck with anorexia nervosa because people equate “the cultural thin ideal with what they imagine to be anorexia nervosa.”  In addition, Bulik says, while pressure to be thin may initially play a role by encouraging someone to go on their first diet, it is their biology that kicks in from there and anorexia takes over. “If you ask our patients, if something like People magazine or models was what put them on the path to develop anorexia nervosa, the vast majority of them say no.”

Only white, upper-middle class teenage girls have eating disorders.

This myth is dangerous because people outside this limited category (such as males or older women), are often told, even by physicians, that they can’t have an eating disorder.  Eating disorders occur in people across all socio-economic, gender, race, ethnicity and age categories.

Eating disorders are benign.

Bulik co-authored a paper on suicide attempts in Sweden. The study found that the percentage of suicide attempts increases greatly for those who have or had some type of eating disorder. Across the board, suicide attempts by people with eating disorders range from about 8% of people with anorexia nervosa–restrictive type to a high of 17% of people who have had both anorexia and bulimia at some point in their lives (compared to 2% of people with no eating disorder).

You can tell by looking at someone that they have an eating disorder.

“Eating disorders come in all shapes and sizes…You can be normal or overweight and still get a diagnosis of atypical anorexia nervosa if you have lost a lot of weight… You don’t have to be overweight or obese to have binge-eating disorder,” Bulik explains.

Families/Mothers are to blame.

Families, and mothers in particular, have often been blamed for their children developing eating disorders.  To the contrary, “families are often our best allies in treatment,” says Bulik.  “It is our job to help give them the blueprint [for] what they need to do to become allies in recovery.”

Society alone is to blame.

As mentioned above, an accepted cultural ideal that thin is better may lead someone to that first diet, or may exacerbate someone’s pain around binge-eating, but it is not the cause of the eating disorder.  There are many factors that come into play to create that perfect storm, Bulik explains, including genetics, heredity, environment and how they interact.

Genes are destiny

Environment also plays a role – both positive and negative.  Negative influences (those that can increase risk) include sports that have an appearance or weight focus, dieting, weight and obesity stigma, obsession with looks, and teasing or bullying history (not necessarily around appearance or weight).  Positive environmental influences include: modeling for healthy/non-emotional eating, separating body-esteem from self-esteem, role models for body respect, family involvement, and peers who value who you are not how you look.  Bulik stresses that it is important for parents to know that they can’t control everything.  A child can develop eating disorders despite parents’ best efforts.

Eating disorders are for life

Some patients have a preference for saying they are “in recovery,” which implies a lifelong struggle, in order to prevent relapsing. While Bulik says it is important to respect this, data show that eating disorders are treatable.  “[Full] recovery can and does occur at every age,” says Bulik. 

(Bulik, 2014)

Treatment

Because eating disorders are a convergence of multiple factors, treating them requires a multi-faceted approach as well. The National Eating Disorders Association (NEDA) website explains that, “Recommended care is provided by a multidisciplinary team including but not limited to: a psychologist, psychiatrist, social worker, nutritionist, and/or primary care physician.”

According to NEDA, “the most effective and long-lasting treatment for an eating disorder is some form of psychotherapy or counseling, coupled with careful attention to medical and nutritional needs,” and includes: addressing the eating disorder symptoms and medical consequences; the psychological, biological, interpersonal and cultural forces that contribute to or perpetuate the eating disorder; nutritional counseling and education about nutritional needs; and planning for and monitoring rational choices.

The website further explains that the health professionals coordinating and providing care should have expertise and experience dealing with eating disorders and treatment programs should be tailored to the individual.

Because of the complex nature of eating disorders – their biological, social and psychological roots – simply addressing symptoms does not solve the problem. The physical health aspects must be addressed as one component of a systematic treatment addressing the root causes of the disorder.

“Once any severe or emergency health issues are treated and the patient is stable and well enough physically, psychotherapy can be an excellent way to treat eating disorders,” says Sue Kamler, LPC, therapist at Maria Droste Counseling Center.  “Sometimes in-patient therapy (hospitalization or a residential treatment facility) is recommended for people in life-threatening condition, or who need daily help to relearn how to correctly recognize body cues such as being hungry or being full.  But, the majority of people are able to attend outpatient therapy.”  Sue adds that sometimes an eating disorder is secondary to another underlying issue, such as trauma or addiction, which can also be addressed with therapy.

Regardless of exactly how an eating disorder is treated, the key is that treatment must address the disorder and its causes, not just the symptoms. Simply correcting an electrolyte imbalance does little to protect the patient from future health issues (mental and physical) stemming from the eating disorder. That’s why mental health care is the key to treating and defeating the disorder itself and helping people move on to healthier lives.

The earlier an eating disorder is recognized and treated, the easier it is for the person suffering with it to return to a healthy life.  At nearly any stage, however, the condition is treatable. Maria Droste Counseling Center has therapists who work specifically with eating disorders.  If you suspect that you or someone you know is dealing with an eating disorder, contact one of our therapists for assistance.

Common types of eating disorders

The DSM-5 (the manual used to diagnose and classify mental disorders) now identifies three types of eating disorders. There is some overlap in the descriptions, and people can have more than one, or move from one to another over the course of their lives.  All are serious and potentially life-threatening.  All are also treatable. The National Institute of Mental Health (NIMH) describes them this way:

Anorexia Nervosa

Anorexia nervosa is typically characterized by:

• Extremely restricted eating
• Extreme thinness (emaciation)
• A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
• Intense fear of gaining weight
• Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight

Symptoms and Complications of anorexia include:

• Thinning of the bones (osteopenia or osteoporosis)
• Mild anemia and muscle wasting and weakness
• Brittle hair and nails
• Dry and yellowish skin
• Growth of fine hair all over the body (lanugo)
• Severe constipation
• Low blood pressure, slowed breathing and pulse
• Damage to the structure and function of the heart
• Brain damage
• Multi-organ failure
• Drop in internal body temperature, causing a person to feel cold all the time
• Lethargy, sluggishness, or feeling tired all the time
• Infertility
• Death from complications associated with starvation or from suicide.

Bulimia Nervosa

Bulimia nervosa is typically characterized by:

• Recurrent and frequent episodes of binge-eating (eating unusually large amounts of food and feeling a lack of control over these episodes)
• Binge-eating followed by behavior that compensates for the overeating (forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors)
• Ability to maintain what is considered a healthy or relatively normal weight.

Symptoms and complications of bulimia include:

• Chronically inflamed and sore throat
• Swollen salivary glands in the neck and jaw area
• Worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acid
• Acid reflux disorder and other gastrointestinal problems
• Intestinal distress and irritation from laxative abuse
• Severe dehydration from purging of fluids
• Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium and other minerals) which can lead to stroke or heart attack
• Death from complications of the disease or from suicide

Binge-Eating Disorder

Binge-eating disorder (the most common eating disorder in the U.S.) is typically characterized by:

• Loss of control over eating
• Binge-eating not followed by purging, excessive exercise, or fasting
• Extreme weight gain/obesity

Symptoms/complications include:

• Eating unusually large amounts of food in a specific amount of time
• Eating even when you’re full or not hungry
• Eating fast during binge episodes
• Eating until you’re uncomfortably full
• Eating alone or in secret to avoid embarrassment
• Feeling distressed, ashamed, or guilty about your eating
• Frequently dieting, possibly without weight loss
• Health complications from being overweight
• Death from complications of the disease or from suicide

(NIMH, n.d.)

Sources:
The Elisa Project (n.d.) Fast Facts. TheElisaProject.org. Retrieved on March 15, 2016 from: https://theelisaproject.org/fast-facts/

NIMH (n.d.) Eating Disorders – About More Than Food. Retrieved on March 15, 2016 from: https://www.nimh.nih.gov/health/publications/eating-disorders-new-trifold/index.shtml

Bulik, C. (2014) 9 Eating Disorders Myths Busted. NIMH. Retrieved on March 16, 2016 from: https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml

NEDA (n.d.) Treating an Eating Disorder. National Eating Disorders Association. Retrieved on March 15, 2016 from: https://www.nationaleatingdisorders.org/treating-eating-disorder