Eating Disorders: fact or fiction?

For some, pain lends itself to intense emotional and physical discomfort and subsequent unhealthy behaviors. The purpose of this blog is to help clarify what are, and what are not, myths or common misconceptions surrounding “eating disorders”. The following are just a few examples of what I hear from parents, friends, kids, clients, athletes, etc.  I hope to then shed light on some of these issues.

 

Only really skinny or really fat people, have an eating disorder

This is false. It also speaks to those who judge others based on physical appearance. That in and of itself, can be harmful and serves to misrepresent and maintain this misconception. It is true that clinically speaking, those with anorexia can have low weight, but that it is not the ONLY symptom. Same with living in a larger body; it does not mean that they only engage in binge eating behaviors. 

The American Psychiatric Association (APA) classifies different types of eating disorders in the Diagnostic and Statistical Manual, 5th Edition (DSM-5): Pica, Rumination disorder, Anorexia nervosa, Bulimia nervosa, Binge eating disorder (BED), Avoidant restrictive food intake disorder (ARFID) and Other specified feeding or eating disorder (OSFED), e.g. atypical anorexia nervosa, bulimia nervosa of low frequency and/or limited duration, binge-eating disorder of low frequency and/or limited duration, purging disorder, night eating syndrome), Unspecified feeding or eating disorder. Symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning (1).

It is important to highlight that one cannot diagnose an eating disorder based on appearance. Social media and cultural messages on eating disorders are not consistently accurate. Those who have eating disorders can be within a “normal“ weight range and are of different shapes and sizes. As well, weight can fluctuate. 

What is also important to point out is that, at the core of eating disorders, is the focus on one’s perceived capacity to influence their weight or shape and its relation to self worth, distortion of body image, as well as pervasive thoughts on ways to avoid gaining weight or to become thinner. Someone at culturally normative weight can present with these three features. In addition, because their weight is within the “normal“ range, symptoms may not be validated by physical appearance. 

Isn’t anorexia predominantly a girl thing?

This is also a misconception. Eating disorders exist across boundaries, such as gender, racial, ethnic, cultural, geographic, socioeconomic status. It is important to recognize this, as those in the field, who are misinformed may not identify a male as having an eating disorder and may therefore be misdiagnosed.

 

This serves to further convey this message to parents or families of male youth. Raevuori, Keski-Rahkonen, & Hoek (2014) reported lifetime prevalence rates of anorexia nervosa (0.2%-0.3%) and of bulimia nervosa (0.1%-0.5%) in young males. Other studies reported prevalence of eating disorders in male university students in the United States (3). However, Mangweth-Matzek & Hoek (2017) noted there were more publications done on female populations across age groups compared to male populations. Being able to recognize that males are marginalized in this area will hopefully lead to more efforts to include them in the studies and, hence, gain access to available treatments (5). 

 

It’s so easy to “fix” EDs; they just have to find the proper diet

Generally speaking, eating disorders are not a choice nor solely a matter of lifestyle. It is not just about signing up for a program to keep you on caloric track or foods you can/not eat. Some programs can trick you into believing you are endorsing healthy habits.

Having an eating disorder is not a choice. The roots of eating disorders are complex. Research has shown that factors such as biology, genetics, psychological, and environmental factors, such as society and culture are important triggers. Families may have an additional, but not exclusive, influential role.

Other issues such as physical illness, bullying, teasing, trauma or other life stressors can have an impact. It is clear that food is not the main issue that contributes to an eating disorder. Family and friends may mean well with this belief. They may think they are encouraging and supporting by advising them to just eat more or just eat less or eat better or exercise more.

 

Try this diet, that diet. This may develop into disordered eating and progress to an eating disorder. The reality is, treatment includes a combination sometimes of medical, psychiatric, therapeutic, and dietary intervention. It takes having an understanding of ineffective habits related to food, eating, and replacing these coping mechanisms with a more balanced approach and attitude towards eating and exercise.

Other Facts?

Eating disorders are serious and can be deadly.

 

Eating disorders are not just about food, and not just in women of a specific age group.

 

People at any weight, can have disordered eating or an eating disorder. 

 

Families alone, do not cause eating disorders. 

 

And, recovery from an eating disorder, is possible.

References

 

1. American Psychiatric Association. (2021) DSM 5: Feeding and Eating Disorders. Retrieved from https://dsm.psychiatryonline.org/doi/10.1176/appi.books.9780890425596.dsm10
2. Raevuori, Keski-Rahkonen, & Hoek. (2014). A review of eating disorders. Current Opinion in Psychiatry, 27(6). https://pubmed.ncbi.nlm.nih.gov/25226158/
3. Lipson & Sonneville. (2017).Eating disorder symptoms among undergraduate and graduate students at 12 U.S. colleges and universities. Eating Behavior.
   https://pubmed.ncbi.nlm.nih.gov/28040637/
4. Mangweth-Matzek & Hoek. (2017).Epidemiology and treatment of eating disorders in men and women of middle and older age. Current Opinion in Psychiatry, 30(6):446-451. https://pubmed.ncbi.nlm.nih.gov/28825955/
5. Murray et al. (2017).The enigma of male eating disorders: A critical review and synthesis. Clinical Psychology Review 57:1-11. https://pubmed.ncbi.nlm.nih.gov/28800416/