Myths You Should Stop Believing About Eating Disorders

As many as 20% of females and 14% of males have an eating disorder at some point in their lives, according to one study in JAMA Network Open. These numbers may seem startling, but individuals with eating disorders often deal with them in silence and are secretive about their behaviors (per The Emily Program). This is due to the stigma surrounding these disorders, which can keep people from seeking help (via The Emily Program). This is why it's important to debunk myths about eating disorders and raise awareness about the true nature of these conditions so that people can get the help they need.

Eating disorders usually develop between the ages of 12 and 25 (via Johns Hopkins Medicine). The symptoms can generally be placed into one of three types: restriction of calories, compulsive eating, or irregular or rigid eating patterns (via National Eating Disorders Collaboration). Eating disorders are complex conditions, have numerous risk factors, and manifest in different ways (via The Emily Program). They also often coexist with other conditions such as mood and substance use disorders, according to a study in the Journal of Psychosomatic Research. Eating disorders are treatable, however, with the right help and support (per The Emily Program).

There are a number of eating disorders (via the Anxiety & Depression Association of America), but you might be most familiar with anorexia nervosa (AN) and bulimia nervosa (BN). In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), both include body dissatisfaction. In addition, AN is characterized by extremely low body weight and having fear of gaining weight. Persons with AN maintain their weight by either severely restricting how much they eat, or by binging followed by purging. Purging is some action done in effort to compensate for the binge, such as self-induced vomiting. The DSM-5 characterizes BN as recurrent binge eating and purging. Binging is not simply overeating that you might do during the holidays (via The Emily Program). It involves eating, uncontrollably, a substantially large amount of food over a short period of time — even if, for instance, the person is uncomfortably full or not hungry (via the American Psychiatric Association).

According to the National Institute of Mental Health (NIMH), there are two other eating disorders that are as common as AN and BN: Binge-eating disorder (BED) and avoidant restrictive food intake disorder (ARFID). BED involves binging but no purging. ARFID is a disturbance in eating patterns — such as low interest in food — that results in malnutrition. The DSM-5 includes a few others. One is purging disorder, which is recurrent purging without binging, according to a study in The Primary Care Companion for CNS Disorders. And yet another is night eating syndrome, or eating whenever awakened in the night, as described by a study in the Journal of Eating Disorders.

Because on the surface eating disorders are about food, it can be easy to think that food is the core of the problem (via Psychology Today). However, the disorders are usually an indication of a larger, deeper issue. Survivors reported in a study in the Journal of Health Psychology that disordered eating is not about food, but rather about their personal experiences. Therefore, they wished that treatment focused on their whole selves, not just eating. 

There are deeper psychological concerns that manifest as disordered eating, a main one being lack of emotion regulation. This is someone's ability to manage and respond to negative emotions (via Cornell University). One study in the Journal of Eating Disorders that included 252 female university students found that problems with managing emotions were associated with disordered eating. The researchers noted two specific emotion regulation problems in particular: unhealthy coping strategies and an inability to identify and describe emotions. If a person is experiencing distress but cannot identify what they are specifically feeling, they cannot proceed to tackle the underlying concerns. Instead, they might turn to food for temporary comfort. 

One review in the journal Nutrients found that specific emotions linked to BED were sadness, anger, and negative interpersonal experiences. Binge eating may be done to lessen these types of negative emotions (via BC Children's Hospital). Or alternately, food may become a symbol of the negatives in life, and so someone might avoid it (per Mind).

Parents are not the sole cause of their children's disordered eating. While some research has found a link between childhood emotional abuse and disordered eating, even children with loving and nurturing parents can develop eating disorders. This is because there are environmental, biological, and social factors at play (per Johns Hopkins Medicine). Moreover, it is a combination of a few factors that is likely to cause an eating disorder. Thus, there is no set list of actions parents can take that guarantees their kid will not engage in disordered eating.

Eating disorders often run in families, so genetics is a strong predisposing factor, according to a review in the Annual Review of Clinical Psychology. Yet another biological risk factor is having a diet-related chronic medical condition (via Advances in Nutrition). For example, after a person starts an insulin regimen for type 1 diabetes, they can quickly gain significant weight. This could lead to unhealthy attempts to control their weight.

Environmental triggers such as bullying and sexual trauma can be risk factors for eating disorders as well (per Johns Hopkins Medicine). And for adolescents, their social group can have a significant influence, as noted in a review in the International Journal of Eating Disorders. The researchers explain that teens might come to value thinness if their peers are thin. Young adults can also take on their peers' behaviors. One study in the Journal of Psychopathology and Clinical Science found that if college students had roommates who dieted, then 10 years later they were more likely to engage in disordered eating themselves.

It can be surprising that athletes are not immune to eating disorders. It might seem like they have to maintain a healthy eating and exercise regimen in order to perform their best. But in fact, a paper in the European Journal of Sport Science says that in some athletic groups, the prevalence of eating disorders can be as high as 45% among female athletes and 19% among male athletes. Some researchers even think that the rate of eating disorders among athletes is actually often underestimated (via the British Journal of Sports Medicine).

The authors of a study published in Medicine and Science in Sports and Exercise hypothesize that the pressure on athletes to achieve and maintain a certain body shape and size can lead to disordered eating. However, this results in poor performance due to malnourishment and lack of energy (via the British Journal of Sports Medicine). Other health consequences can include low bone mineral density and little to no production of sex hormones.

According to one paper in the Journal of Mental Health, one perception of eating disorders is that they are not serious health conditions. However, this could not be farther from reality. Eating disorders are actually one of the deadliest mental health conditions, with most fatalities occurring by suicide or heart problems according to a review in the British Journal of Sports Medicine. Heart problems can result from electrolyte imbalances caused by purging behaviors such as self-induced vomiting.

The review also states that death by suicide makes up about 20% of the deaths of those with AN and about 23% of the deaths of those with BN. As reported by the National Eating Disorders Collaboration, individuals with an eating disorder are at higher risk for psychological distress. A few of the most common mental health conditions that often accompany eating disorders are major depression, anxiety disorders, and substance use disorders. The difficulty of living with an eating disorder and another psychiatric condition can become unbearable, leading to suicidal ideation and acts (via The Emily Program).

If you or someone you know needs help with mental health or is having suicidal thoughts, please contact the Crisis Text Line by texting HOME to 741741, call the National Alliance on Mental Illness helpline at 1-800-950-NAMI (6264), visit the National Institute of Mental Health website, or call the National Suicide Prevention Lifeline by dialing 988 or by calling 1-800-273-TALK (8255)​.

Poor body image can be a contributing factor for some people dealing with eating disorders (via Adolescent Research Review). However, this is not always the case — and generally, a confluence of multiple factors causes disordered eating (via The Emily Program). The COVID-19 pandemic is a fitting example of the interaction between environmental, social, and psychological factors that may lead to an eating disorder. In 2020, calls to the National Eating Disorders Association Hotline increased by as much as 80% (per NPR). In one study in the International Journal of Environmental Research and Public Health, participants gave various reasons for their eating behaviors that started at the beginning of the pandemic. Some of these included compulsive eating from being stuck at home, excessive exercise due to having more free time, and binging as a way to cope with isolation. Researchers in the International Journal of Eating Disorders have hypothesized that higher stress levels coupled with social distancing that increasing loneliness may have increased the risk for disordered eating in those already struggling with mental health conditions. And The Emily Program notes that over time, disordered eating might make changes to the brain that reinforce the behaviors and, in turn, the behaviors develop into a diagnoseable disorder. According to the DSM-5, symptoms for most eating disorders occur for about three months before the diagnosis is made (via The Professional Counselor).

There are a few different ways in which a person can purge food, not only vomiting. According to the DSM-5, purging behaviors include self-induced vomiting, but also using laxatives, diuretics, or other such medications for purposes of weight control. In addition to purging, people with disordered eating may try to regulate their weight through fasting or high amounts of exercise. Some individuals with eating disorders may use more than one these methods — and those who do tend to have greater severity of psychiatric symptoms, according to a study in the International Journal of Eating Disorders.

Another weight-controlling behavior is when someone chews their food but spits it out rather than swallowing, allowing them to enjoy the taste but avoid the calories. One study in Comprehensive Psychiatry found that almost 25% of the participants reported that they have engaged in chewing and spitting as a way to control their weight. Participants in this group were also more likely to have attempted suicide and had more severe eating disorder symptoms overall. 

It might seem like you can easily tell if someone has an eating disorder by looking at them, but that is often not the case. For instance, while regular binging can lead to weight gain, one does not have to be overweight to have BED (per Walden Behavioral Care). And not everyone who is overweight has BED. There can be any number of reasons for weight gain according to the National Institutes of Health (NIH). These include eating more calories than you burn, genetics, health conditions, emotional factors, poor sleep, and circumstances that are not conducive to exercise or a healthy diet.

The same is true for AN — someone's body weight can hide the condition. If a person with AN was overweight and then loses a lot of it quickly, you might encounter them and think that they lost the weight from healthy diet and exercise. A woman named Georgina shares on Mind that this was her experience: She got compliments from people as her weight started to drop after she began restricting calories. It is also possible for someone to not look too skinny but have AN, as was the case one patient's story shared in The BMJ.

The stereotype of a person with an eating disorder tends to be a young, privileged, white woman. This used to be the understanding of young Bryn Austin, who is now director of the Strategic Training Initiative for the Prevention of Eating Disorders (via Harvard T.H. Chan School of Public Health). However, eating disorders do not discriminate based on sex, race, or socioeconomic status. The misconception that they are conditions affecting only females may be due to the fact that men with eating disorders are less likely to seek help (via the Journal of Mental Health). Like women, men can also deal with negative body image for reasons like being teased or societal pressures to look a certain way (per Better Health Channel). 

Eating disorders also cross racial boundaries. A study in the Journal of Consulting and Clinical Psychology indicates that eating disorders are known to be present among African American and Hispanic American populations as well as Caucasian Americans. In terms of socioeconomic status, a study in Eating Behaviors of over 1,500 U.S. adolescents found that disordered eating was present at all levels of household income and parental education. Moreover, among males, disordered eating behaviors were found to be most prevalent in the low socioeconomic status group. Researchers note that cost of care can make treatment inaccessible to those with lower income.

As one study in Journal of Eating Disorders found, eating disorders can be stigmatized by those who do not have the conditions, much like with substance use disorders. While it is not true, substance use disorders are often thought to be just a lack of willpower, not the real chronic brain diseases that they are (via Psychology Today). Similarly, there is growing evidence that brain circuitry is a significant factor in the development of eating disorders as well (per the American Psychological Association). This may help to explain the lack of control felt by those with the conditions. One survivor, for example, shares that she thought she could control her disordered eating on her own, "but slowly it became an addictive and vicious cycle." She knew that without help, nothing was likely to change. 

This is to say, an eating disorder is a medical condition that requires treatment — and the earlier treatment begins, the better (via Yale Medicine). For one thing, treatments are more likely to succeed if the patient comes under care within three years of developing an eating disorder. Furthermore, if eating disorders are not properly treated, many medical complications can develop. These can include more mild physical problems such as acid reflux or chronic inflammation in the throat due to acid exposure from regular vomiting, or serious health issues such as cancer, diabetes, organ failure, and suicide attempts.

Treatment for eating disorders can be challenging, and relapses are common (per The National Eating Disorders Association). However, people do improve and even reach recovery. For example, a study in the Journal of Clinical Psychiatry followed 176 women for 22 years and found that almost 63% of those with AN and 68% of those with BN had recovered. Time for recovery varies person to person (per Walden Behavioral Care). And though the road to recovery can be a rocky one, many navigate it and live full and meaningful lives, especially with emotional and logistical support from family (per NIMH).

In some cases, such as with BN or BED, antidepressants or other type of medication may be a part of treatment, however, psychotherapy is essential (via Mayo Clinic). According to a review published in Current Opinion in Psychiatry, the types of psychotherapy that research has shown to be effective are cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT). CBT involves exploring how your thoughts, feelings, and actions affect each other. By making changes to negative thought patterns and using healthier coping techniques, distress can be lowered (via American Psychological Association). IPT comes from the premise that psychological distress is a result of how a person relates to others. In therapy, people examine their interpersonal patterns and learn ways to strengthen them (via American Psychological Association). Treatment should also address any co-occurring conditions, like depression or anxiety (via NIMH). And because there are biological, psychological, and social concerns when it comes to eating disorders, treatment centers like The Emily Program have multidisciplinary teams of medical providers, therapists, and dieticians to serve the whole person.