Myths about Eating Disorders, Part 2

Eating Disorders are very complex illnesses that affect all aspects of a person’s life. For ‘Part 2’ of this series, I am going to continue looking at some of the myths that inform the “9 Truths about Eating Disorders,” which is a PSA developed by several major eating disorder researchers, foundations, and treatment centers.

I am not going to address them all, but here is a different article from Australia about those myths if you want to read more.

And here is Part 1!

Myth #6:

“Eating disorders aren’t that big a deal” or “people with eating disorders are just attention seeking, right?”

Nope, absolutely not. 

No one would ever put themselves through this for attention. It is dangerous, it is deadly, it is terrible. 

Anyone who says anything like this clearly does not understand the struggles that people with eating disorders go through. Unfortunately, lots of people still think this kind of stuff, even doctors and therapists and professors who don’t really understand eating disorders. It comes up all the time. Our culture has decided that this is not a ‘real’ problem, for various reasons, but that is simply ignorance – or even worse, malice. These people are not engaging (or are sadly incapable of) critical thinking skills. 

This might sound a little harsh, but really? Enough is enough with people thinking this, minimizing and invalidating. Can we please stop saying this? Everyone’s experience is valid, even when you don’t agree with it. Eating disorders are horrible, not only for the person struggling, but for their loved ones.

We really should never say this, especially because more people die of eating disorders, because of medical complications and a high suicide rate, than any other mental illness. It is second only to opioid addiction,  and over 10,000 people die each year in the US. Take into account that the death statistics tend to vastly underestimate this – they say they died of cardiac issues, or organ failure, or something else, so this number is actually much higher.  The mortality rate associated with anorexia nervosa is 12 times higher than the death rate of ALL causes of death for females 15-24 years old.

In addition, most people with eating disorders take great pains to hide, deny or minimize their behavior for fear of how others will react. On average there is about 4 years between when someone starts their eating disorder and when they are able to seek treatment. This makes the negative effects much more complicated, since the sooner someone gets treatment, the shorter their average treatment time.

Truth #6: Eating disorders carry an increased risk for both suicide and medical complications.

Myth #7 & #8:

Eating disorders are a choice.

Behavior is a choice, but not an eating disorder. In case it was not already clear, they are very complex and there is more to it than just nature or nurture. Both influence eating disorder development, just as they influence the development of all biologically based mental illnesses (which include anxiety, depression, bipolar, OCD, and eating disorders). 

40-60% of the vulnerability to an eating disorder is genetic – and the Genome Wide Association Studies research is ongoing. It indicates that there are at least 4 areas of the genome that affect the development of eating disorders, as well as mood disorders and anxiety, and that they are all linked, or polygenic

As far as environment, modeling is the single biggest predictor of future behavior – what this means is that whatever your family shows you to do, you are most likely to do. There are ways to change this, of course, but if a family member is modeling eating disorder behavior, or even just dieting or talking negatively about their body, it is more likely that the kids in the family will as well.

The same is true for a lot of things – abuse, reading habits, vacation preferences, manners, relationship patterns, vocabulary, future expectations, and pretty much anything else that you are shown as a kid. What you parents and the rest of your family do is what you are most likely to do in the future. So if your mom dieted a lot or your dad made comments about people’s weight, you are likely to carry those same thoughts with you into your future. 

If we are aware of it, and actively try to change it, and have support to change it, we may be able to change – but first we need to be aware of it. 

Truth #7: Genes and environment play important roles in the development of eating disorders.

Truth #8: Genes alone do not predict who will develop eating disorders.

Myth #9:

Eating disorders are for life.

In order to address this, we first have to address the idea of what recovery means. Some people, and the DSM, use the word ‘remission’ instead – here is some more info on the differences. For my purposes, “remission” will refer to the 6+ months without any of the criteria for diagnosis being met – meaning that the person does not have any eating disorder behaviors (including restricting, binging, purging, over-exercise, or any other compensatory behavior) or body image disturbance. “Recovery” will the process of achieving and maintaining this, 

The average person struggling with an eating disorder does have to be in active treatment for longer than the average person struggling with another mental illness – about 5 years, when for depression the average therapy is about 5 months.

There are a lot of factors that go into this – recovery from an eating disorder generally requires lifestyle changes in a number of areas and also dealing with other mental health issues that have been exacerbated by the eating disorder (like trauma, depression addiction, and anxiety) as well as the medical complications. Medication is not as effective a treatment for people with eating disorders for similar reasons – it might help with mood or anxiety or sleep, but there is no medication designed to deal with all of the facets of an eating disorder because it is too complicated. 

The sooner someone gets treatment, and the more comprehensive the treatment is, the better. By comprehensive, I mean that they get medical stabilization and restoration (if needed), go through the levels of care as recommended by their treatment team, and do not drop out of treatment, and that they address the other mental health issues that may have contributed as well as any other dynamics in their life that may need to change in order to maintain recovery (like family, relationships, perfectionism, trauma, etc.). 

People can, and do go into remission and maintain recovery – I see it all the time – but it is not linear. There are usually relapses, when people need to go to a higher level of care, or when life circumstances change and symptoms re-emerge. These need to be dealt with, not ignored or avoided, to keep on track. There are often periods of remission, but these can be derailed by various events and stressors – recently, a lot of people struggled in recovery because of the pandemic.

Many people, not just those with eating disorders, struggled with the isolation, lifestyle changes, uncertainty, and all of the other issues that went with it. Sometimes life events (like graduation, marriage, baby, illness, loss, etc.) throw most people for a loop, so these are times when a disorder is likely to rear back up. 

Truth #9: Full recovery from an eating disorder is possible. Early detection and intervention are important.

The main thing I want people to remember is that there is no one size fits all, no one way to think about these things. It is all about perspective and shades of gray.  My goal is to help as many people as possible learn how to do this in the most effective way possible for them, so please reach out if you have any questions or other thoughts you would like to share with me about the “9 Truths” or about your own eating or body image issues.