Why We Exist
Anorexia Nervosa is primarily defined by extreme weight loss and caloric restriction. Sufferers are often plagued by a fear of weight gain, a distorted perception of their body, and an obsessive need to control their food intake and weight. They usually spend a large amount of time weighing themselves and portioning their food, and they only eat very small quantities of food at a time. Because of these behaviors and perceptions they are unable to maintain a healthy body weight.
Broadly speaking, there are two major types of anorexia. Restrictive type anorexia is when the individual essentially starves his/herself by restricting food intake well below caloric needs. Binge/purge type anorexia is when the individual not only restricts food intake but also engages in binges (uncontrolled eating of an unusually large amount of food) and/or purging behaviors like over-exercise, vomiting, or laxative abuse.
One big misconception about anorexia is that the individual has to be extremely thin. This is not the case – people with a healthy body weight, and even those in larger bodies can and do struggle with anorexia. In fact, many formerly overweight patients who lose a significant amount of weight end up developing anorexia nervosa.
Many physical symptoms of anorexia nervosa include, but are not limited to:
extreme weight loss
abnormal blood counts
elevated liver enzymes
dizziness or fainting
hair that thins, breaks or falls out
absence of menstruation (amenorrhea)
development of fine hair on the extremities (lanugo)
intolerance of cold
irregular heart rhythms
low blood pressure
osteoporosis, the loss of bone calcium, which may result in broken bones
Bulimia nervosa is characterized by recurrent and frequent episodes of binging and purging. Binging is when an individual eats a large amount of food very quickly in one sitting, even to the point of physical discomfort. Binges may be planned or unplanned but regardless lead to a sense of uncontrolled intake of this food. These episodes of eating often trigger shame and self disgust; they are followed by the need to purge in order to rid the body of the food that has been consumed. Purging behaviors include forced vomiting, excessive use of laxatives or diuretics, excessive exercise, fasting, etc.
Like anorexia, bulimia involves a distorted vision of the body and an obsession with food intake. Sufferers often withdraw from friends and activities, creating an alternative schedule around binges, purges, or long exercise sessions.
Many physical symptoms of bulimia nervosa are linked to self-induced vomiting such as:
Damaged teeth and gums
Swollen salivary glands in the cheeks (chipmunk cheeks)
Persistent sores in the throat and mouth
Sores, scars or calluses on the knuckles or hands caused by self-induced vomiting
Scratchy or raspy voice quality
Other symptoms include, but are not limited to:
Abnormal bowel functioning
Menstrual irregularities or loss of menstruation (amenorrhea)
Tingling in the hands or feet
Individuals with binge eating disorders eat excessive amounts of food at one time. During a binge, the sufferer might eat rapidly and uncontrollably even to the point of physical discomfort. Like sufferers of bulimia, these episodes often trigger shame and self disgust; however, individuals with binge eating disorder do not purge. Binge-eating can be related to severe caloric restrictions that lead to uncontrollable hunger, or it can emerge as a self-soothing behavior.
While one in five obese people engage in binge eating, many individuals with the disorder maintain a normal weight.
The most severe symptoms are psychological and include, but are not limited to:
- Lack of control once one begins to eat
Disgust or self-hatred about eating behaviors
OSFED (Other Specified Feeding or Eating Disorder)
Not all eating disorder sufferers have symptoms that neatly fit into one of the above-listed categories. OSFED encompasses a range or mixture of behaviors and symptoms for individuals who do not meet the specific diagnostic criteria for other disorders. This does not mean it is less serious than the other disorders. Around 30% of people who seek treatment for an eating disorder have OSFED.
No single factor can be said to cause an eating disorder. They instead emerge out of a complex combination of socio-cultural, psychological, and biological influences.
Scientists are increasingly identifying biological and genetic components to eating disorders; however, these findings are not comprehensive nor can they accurately predict who will eventually develop an illness.
Certain personality traits may elevate an individual’s risk for developing an eating disorder. For example, perfectionism, obsessive behavior, harm avoidance, reward dependence, and persistence can make someone particularly vulnerable. These are not negative qualities that necessarily can or should be changed, but simply modes of being in the world that can make one susceptible to eating disorders as a means of coping.
In addition to these innate qualities, psychological distress caused by low-self esteem or loneliness as well as mood disorders, like depression and anxiety, can often trigger pathological eating behaviors.
Eating disorders do not evolve in a vacuum within the individual, though, and many social factors contribute heavily to their development. Troubled interpersonal relationships, lack of a support system or place to express one’s emotions, and a history of bullying (especially for weight-related issues) can all play a role as well.
Zooming out even further, cultural contexts often create the perfect storm for these previously mentioned factors to coalesce into eating issues. Unrealistic standards of beauty, the glorification of thinness, and the high value placed on having an “ideal body” foster distorted body images and eating-disordered behavior. The media is often labelled as the culprit for widely propagating these values and ideals. Magazines, advertisements, television, and movies all create a false sense of the “norm” by repeatedly showing the same small range of body types, photoshopping bodies, encouraging weight loss, and constructing a limited notion of beauty.
However, the thin-ideal is not just imposed by the media, but also embedded in the patterns of everyday life. Fat-shaming and other appearance-based discriminations are continually normalized. Moreover, diet-culture is so pervasive that nearly half of college-aged women and nearly a third of college-aged men are dieting to lose weight at any given time. Despite being so widespread, diets are not innocuous and often do lead to pathological behaviors. As Natalia Zunino PhD writes “the most common behavior that will lead to an eating disorder is dieting.”
Another cultural factor that can put individuals at risk is involvement in athletics (a survey of Division 1 NCAA female athletes revealed that over a third expressed disordered eating attitudes that placed them at risk for developing anorexia). While sports should not be blamed for eating disorders and can be an incredibly positive activity, sports culture is a place where certain body ideals and controlling behaviors can sometimes pathologically circulate. Moreover, what is known as “the female athlete triad” (the combination of disordered eating and high intensity exercise that leads to osteoporosis and amenorrhea) can have especially destructive, lasting physical consequences.
Lastly it has to be emphasized that many different demographics are susceptible to these disorders. While representation in the media often gives unbalanced visibility to young, wealthy, white female celebrities, eating disorders impact a huge range of people regardless of gender, sex, age, or ethnicity. Additionally, physical appearance is not always an accurate indicator of these disorders or their severity; individuals can be grappling with dangerous eating and body issues at any weight.
Strategies for Family and Friends
What can I do?
The family and friends of someone who is suffering from an eating disorder can often feel alienated or powerless to help. While the most effective form of support and intervention will vary from person to person, here are a few guidelines.
Educate yourself: You may not be able to understand what your friend or loved one is going through, but you can set the stage for open and productive communication by learning more.
DON’T stay silent: Eating disorders are serious and potentially life threatening; the longer they go on, the harder they can be to recover from. Therefore, if you suspect your friend or family member is struggling, it is important to address it.
But DO plan when to speak: Having a conversation with your friend or family member about their disordered eating can be incredibly difficult, especially the first time you bring it up. Find an appropriate time and a safe space to express your concerns. Don’t impulsively accuse your loved one in the moment if you see them behaving in a unhealthy way, but instead make time for a supportive discussion on neutral territory.
Continue communicating: Bringing up your concerns won't automatically lead to a solution and you may even encounter some resistance from your friend or loved one. Don’t be frustrated or place blame if he/she is not ready for recovery and certainly don’t try to enforce a “cure” yourself. The important thing in this stage is to continue checking in and to be a resource for care.
Remember that you cannot force someone to seek help. But if you are concerned for your friend or family member’s safety it may be appropriate to seek guidance from a medical professional.
What are the options? What does treatment look like?
Recovery from an eating disorder is possible with treatment. The “right” treatment must be developed on an individual basis but will usually include a combination of psychotherapy, nutrition education, and medical monitoring. Sometimes antidepressant medications are also prescribed to aid in the process.
Treatment can either occur on an outpatient or inpatient level. In outpatient treatment the patient lives at home but utilizes the resources of support groups, therapists, and physicians. Inpatient treatment on the other hand means the the patient temporarily resides in a hospital or residential care center. This option is best for individuals who are medically unstable or need close behavioral monitoring at all times.
Seeking treatment as soon as possible is important to minimize the long-term damage that eating disorders can cause and because early intervention can facilitate recovery.
But, unfortunately, treatment can be inaccessible!
Despite the clear benefits and necessity of intensive treatment for eating disorders, it is frequently inaccessible. Many insurance companies refuse or limit their coverage, favoring short term models of intervention even when a lengthier treatment plan is needed. Furthermore, diagnostic criteria are often linked to purely physical aspects of the disorder such as weight and overall medical stability.This means that psychologically vulnerable patients can be released prematurely, making relapse nearly inevitable.
Fighting widespread public misconceptions about eating disorders that view them as purely physical or do not recognize their severity will hopefully eventually counteract their chronic dismissal by these insurance companies.
Contrary to the widely circulated myth that full recovery is impossible, appropriate treatment can make life without an eating disorder truly a reality. Treatment provides tools to fight back against eating disorders by developing self-awareness, new healthy habits, and alternative behaviors for coping. This foundation enables individuals to take ownership of their own recovery and confront challenges within their often trigger-laden personal and sociocultural environments.
This is not to say, though, that it is ever quick and easy. Since recovery is far more than physically maintaining a healthy weight, it can be an intense and intensely difficult process. Progress is not linear and relapses will likely occur along the way. Seeking support when necessary and acknowledging that these setbacks are not failures but moments of growth and learning can prevent a relapse from derailing the recovery process completely.
In addition, the very notion of what “recovered” looks like will need to unfold over time. The process of recovery means empowering and caring for oneself by cultivating new patterns of thought and behavior. Smaller achievements that gradually liberate one from the grasp of the eating disorder should be regularly appreciated and celebrated as they accumulate into a new sense of what is “normal” and open up new horizons. Full recovery is both so challenging and so rewarding because it means generating and embracing an identity that is no longer dependent on the old disordered external measures of value. Recovery will look different for every single person because it is a radically personal means loving, nourishing, and ultimately reclaiming oneself.