Eating Disorders are life-threatening illnesses yet anorexia, bulimia, binge-eating, and the other disorders are still misunderstood and frequently misrepresented
Eating disorders have the highest mortality rate among psychiatric disorders, with anorexia leading with the highest number of deaths among adolescents.
It's estimated that over 1.25 million people in the UK are struggling with eating disorders, and at least 9% globally . Research from the NHS suggest around 6.4% of adults in the UK display signs of an eating disorder.
Rising numbers of inpatient hospital admissions for eating disorders and demand for eating disorder services show there is a crisis unfolding before our eyes, even more so in the face of enforced quarantine this year. Still, somehow, so many myths and damaging stereotypes still surround this serious mental illness.
As an eating disorder therapist and coach, and an anorexia survivor myself, I know how important it is to bust some of the myths surrounding eating disorders, to break down the stigma and dangerous misconceptions, to hopefully help people get the support they so desperately need.
1. You have to be thin to have an eating disorder
This is perhaps the most pervasive myth surrounding eating disorders. Sensationalist reports in the media will pick the most extreme cases of anorexia nervosa, and show unnecessary images of emaciated people (usually young white women). This helps perpetuate a long-standing belief that you have to be very thin to have an eating disorder. This is dangerous for so many reasons, not least that it leads sufferers who aren't visibly emaciated to believe they're not 'sick enough' to look for the help they so desperately need.
In reality, anorexia accounts for around 8% of eating disorders. Bulimia accounts for around 19% of eating disorders, binge-eating disorder (BED) for 22%, and the most common eating disorders, OSFED (other specified feeding or eating disorder accounts for around 47% of cases. In fact, Atypical Anorexia (where patients present with AN behaviours and fear of weight gain but don’t meet the low weight criteria, and, in fact their weight is often within or even above the normal range for their age) is much more pervasive than Typical AN..
There is no weight criteria or guideline for any eating disorder other than anorexia, and most people with eating disorders are at a 'normal' weight or above. This certainly doesn’t mean that their eating disorders aren’t serious: there are severe medical complications with all eating disorders, regardless of weight. We also have to remember that eating disorders are mental illnesses, and what is going on in people’s heads is not necessarily reflected on the outside.
2. The only eating disorder bigger people can have is BED
This is another fiction, created and perpetuated by our fatphobic society, which pigeon-holes bigger people as over-eaters, when the truth is a lot more complex. Many bigger people suffer from restrictive eating disorders, and many smaller people suffer from BED. There is no 'one-size-fits-all' definition of a mental illness, and eating disorders are no exception
3. Anorexia is the only serious eating disorder
Another dangerous myth, because this can stop sufferers who are desperately ill from getting the help they desperately need.
Bulimia is associated with severe medical complications, such as dehydration (which can lead to kidney failure),amenorrhea, digestive and bowel issues, severe tooth decay and gum disease, fits and muscle spasms, and heart problems (such as irregular heartbeats or heart failure).
BED is associated with Diabetes, high blood pressure, high cholesterol, gallbladder and heart disease, cancers, menstrual problems, electrolyte imbalance and heart palpitations
OSFED also comes with the risk of dangerous medical complications, such as electrolyte and chemical imbalances, organ failure, osteoporosis, malnutrition, heart disease, and type II diabetes mellitus, and/or gallbladder disease.
All eating disorders can be life-threatening, not only through medical complications, but also because there is an increased risk of suicide.
4. Gaining weight means someone has recovered or is better
Too frequently, when sufferers weight restore, those around them assume they're fully recovered; this not only includes family, friends and colleagues, but also many medical professionals. This misconception can lead to premature discharge from care and support services, and failure to offer the sort of support sufferers actually need to get them all the way through to a full recovery.
Still fighting with an eating disorder in your head every day when your family and friends assume you're recovered can be a lonely and desperate place, and again can lead to relapse. Eating disorders are primarily a mental illness, with often serious secondary physical symptoms and it takes quite a long time after nutritional rehabilitation for the brain to rewire.
5. It's a white girl's illness
Eating disorders as often seen that affects young white women, but eating disorders do not discriminate: they affect people of all ages, sexual orientations, ethnicities, socio-economic statuses, and genders. In fact, 25% of people with eating disorders are male, although this could be higher because of stigma and under diagnosis. Studies have shown that people of colour are significantly less likely to receive help for their eating issues.
Eating disorders do not discriminate: they affect people of all ages, sexual orientations, ethnicities, socio-economic statuses, and genders
6. It’s all about weight
Superficially the driving issue behind eating disorders seems be a concern about weight and shape. In DSM-V criteria B for a diagnosis of anorexia is an intense fear of weight gain and included for a diagnosis of bulimia are compensatory behaviours to prevent weight gain along with the undue influence of shape and weight on self-evaluation.
Yes, people with eating disorders fixate on weight, and do feel disgust about their bodies, but it is so much more than this, and there are so many driving factors. In the first place, there is a genetic predisposition for eating disorders, and the triggers can be a slow build-up of smaller negative events, or single events as varied and seemingly innocuous as a short diet or bout of gastro-enteritis or as catastrophic as combat trauma or child abuse.
7. Eating disorders are a choice
Eating disorders are severe mental illnesses, and no one chooses to have one.
As I touched on above, we now know there is a genetic factor in the development of eating disorders, and a combination of this genetic predisposition and environmental factors come together to create a perfect storm for an eating disorder to emerge.
Having an eating disorder is having a continual street fight in your own head, living in a constant state of fear, anxiety, hopelessness and despair and this extensive suffering spreads out to families and loved ones.
No one would ever choose to have an eating disorder
8. Eating disorders are just a bid for attention
This is a really common fallacy. Most people with eating disorders go to great lengths to hide their illness, and dismissing it as attention-seeking not only minimizes the intense suffering of the illness, but can deter sufferers from seeking help. A need for help, attention, and support from loved ones is commonly an ongoing issue, but this should in no way be seen as the 'cause' or motivator of an eating disorder.
Seeking help shouldn’t ever be labelled ‘attention-seeking’. Those who are talking about their eating disorders have a greater chance of seeking help than those who keep it secret. Eating disorders are not a phase, or a lifestyle choice, and often people who experience them feel a great amount of shame.
9. People with eating disorders are manipulative
This is a myth I've seen thrown at clients in some negative family situations .Genuine efforts to move forward or garner some respect are dismissed by suggesting they can't be trusted; this also erodes tentative connections sufferers are trying to create to help them find a way out of the hellish isolation of the illness.
Trying to manage the turmoil of the illness while simultaneously appeasing families and medical professionals can result in some deceitful behaviour, just as feeling trapped can result in some angry outbursts. This is behaviour caused by the illness and has nothing to do with the individual. Always make sure you focus any criticism you have at the eating disorder, not the sufferer.
10. You can’t recover
This is a total myth.
Research suggests that 46% of anorexia patients fully recover, while 33% improve. Research into bulimia suggests that 45% make a full recovery, with 27% improving considerably.
I promise you, recovery from an eating disorder is absolutely possible. Each time I see it with a client, it never fails to amaze me. Recovery is always possible, no matter how long you've suffered and how deeply entrenched the behaviours and although it's a difficult journey, it is completely worth it.