What You May Not Know About Eating Disorders:
Anorexia and Bulimia are not the only eating disorders: Binge Eating Disorder became a codable diagnose in the latest revision of DSM (APA, 2013). Other Specified Feeding and Eating Disorder (OSFED) and Unspecified Feeding and Eating Disorder (UFED) are the names for other eating-disordered presentations. People who do not binge/purge frequently enough to meet criteria for bulimia would be classified as having OSFED, as would those who binge eat but not frequently enough to be classified for Binge Eating Disorder. UFED represents a more general catch-all category.
Purging can include excessive exercising and more. Purging is a general symptom of bulimia that does not involve just vomiting. People may purge by using laxative, enemas, or diuretics, or by engaging in compulsive exercise. These are all compensatory techniques. Even if you do not engage in these behaviors, if you binge, and then restrict your intake (not eating the day after a night-time binge), you may still meet criteria for bulimia.
Eating disorders in men are on the rise: While the majority of eating disorder patients are female, men can develop them, and we are seeing the numbers among men and boys climbing as the media now presents similarly unrealistic body ideals for men (e.g., the Abercrombie & Fitch models). In addition, historically, men may not have presented in treatment as frequently as women due to shame or failure to recognize their symptoms as disordered (because of their gender). Now, they may be a bit more comfortable seeking treatment as our culture becomes more fluent in eating disorders and there’s more of an understanding that they affect men, too. In the past, we may have underestimated the rates in men because they did not seek help as frequently in women.
You cannot judge from someone’s weight or shape whether or not a disorder exists. Underweight does not necessarily mean a disorder. Without a clinical interview, it is impossible to determine if an eating disorder exists. An underweight person may be ill or hypermetabolic. Those in larger bodies do not, by definition, have a problematic relationship with food. If someone in a larger body does have an eating disorder, it’s impossible to know this person’s diagnosis without assessment. We need to accept natural diversity in body size without pathologizing it.
Eating disorders occur in all age groups and populations. While eating disorders may frequently develop during the teenage/young adult years, older individuals can develop disorders for the first time later in life. We are seeing more and more of this these days. As with men, it may be that older women are feeling more comfortable presenting in treatment, which would explain the jump, but there are other reason as well. The media continues to present an even more impossible body ideal (women are supposed to lose their baby weight within weeks after delivery, older actresses stay lean while the general population doesn’t), all of which affect women beyond their 20’s. Still, we know that eating disorders have genetic and temperamental components.
Some believe an eating disorder to be either a white problem or a “rich person’s disease.” Not true. Eating disorders affect all races, ethnicities, and socio-economic backgrounds.
Eating disorders co-occur with other serious issues. Those who struggle with eating disorders often meet criteria for other psychiatric disorders including anxiety, depression, alcohol/substance misuse, and sometimes exhibit symptoms self-harm or other self-destructive behaviors. Treatment for the eating disorder must involve attention to co-occurring psychiatric illnesses.
Eating Disorder Myths:
Myth: The thinner you are, the healthier you are.
Fact: Weight is not a perfect proxy for health. Some of the best predictors of health include family history, stress, social connection (vs. isolation), and access to affirming medical care. While what we eat and how we move our bodies do have an impact on our health, the relative impact of these behaviors is generally overstated. Regardless, it’s impossible to know someone’s health status just from their weight. There are thin, unhealthy people and larger-bodies healthy people. And regardless of weight, all people can pursue health, particularly when surrounded by supportive resources, systems, and communities.
Myth: Anorexia nervosa is a desirable condition, something to aspire to.
Fact: AN is a horrible physical and psychological disease, that has one of the highest fatality rates of any psychiatric illness. Most of those who meet criteria for AN are unhappy and wish they could go back to the time before they had the disease.
Myth: People with bulimia nervosa, who purge, are ridding themselves of excess calories.
Fact: Purging is not an effective weight-loss technique, and can significantly impact health. Multiple bodily systems are affected, and electrolyte imbalances due to frequent purging can even lead to death.
Myth: Recovery from an eating disorder means loving your body at all times.
Fact: Let’s be honest – many people are dissatisfied with their bodies from time to time, even those who have never been diagnosed with eating disorders. Recovery is a journey and includes a shift in behaviors, thoughts, and feelings. Just because you don’t always love your body, doesn’t mean you haven’t recovered. More important than body love – or even acceptance – are body respect, compassion, and liberation.
Myth: Eating disorders are glamorous and convenient ways to lose weight.
Often, people will say, “I wish I had an eating disorder.” Eating disorders are not successful diets or evidence of indestructible will. They are physical and psychological diseases that take on a life of their own, even when those who struggle become intent on recovery. Most folks with eating disorders would do anything they could to be free of the tyranny of their disorder.