Skepticism

An Intro to Eating Disorders: Myths

This is a cross-post from Teen Skepchick by Olivia. Check TS from time to time for further posts in our series on eating disorders.

Here at Teen Skepchick we strive to write about things that are relevant to our lives, and thus (we hope), relevant to the lives of other young women. As we’ve gotten to know each other, we’ve come to find that a surprising number of us have struggled with or are currently fighting an eating disorder. Oftentimes, eating disorders are viewed as disorders of the unintelligent or the vain, the cheerleaders or the silly suburban girl. But it’s become obvious to the Teen Skepchicks that even extremely intelligent young women (such as my fellow writers) are vulnerable to eating disorders. Because we have so much to say on the subject, this is just the first in a series of posts about eating disorders, and our thoughts thereupon. As a brief introduction to what eating disorders are, this post will address some common eating disorder myths.

Myth 1: Eating disorders only affect girls/white girls/rich girls/shallow girls/stupid girls.
There are lots of myths about who the typical or only ED sufferer is. Many of us have a picture of a rich, suburban white girl who is beauty obsessed, tanned, thin, and perfect. This is far from the reality about who has EDs. They are not constrained by race, gender, sexual orientation, class, income, family structure, or really any other demographic variable.

Myth 2: People with eating disorders are looking for attention.
There are a couple of facets to this myth. The first problem is that there is almost no overarching claim we can make about what people with eating disorders are looking for, or what they use their eating disorder for. Many people use their eating disorders to hide rather than seek attention, and others have no interest in what other people think. However the underlying myth here is that asking for attention or help when you are struggling, hurting, or lost is a bad thing. Even if some people use their eating disorders to ask for attention or help, all that means is that they have no other way of expressing that. Attention is a very human need, and we shouldn’t fault anyone for it.

Myth 3: You can tell who has an eating disorder by how they look.
There are people with eating disorders all along the BMI scale. While an eating disorder does have a physical component, it is primarily a mental illness, and it is impossible to see a mental illness on someone’s body. In addition, not everyone’s body reacts to calorie deprivation in the same way. Some people never lose to an unhealthy weight, but they are still harming their bodies. Bulimia does not tend to create extreme weight loss, so many people suffering from bulimia look to be at a “healthy” weight. There is no way to identify an eating disorder from appearance alone.

Myth 4: The only eating disorders are anorexia and bulimia.
Eating disorders come in all forms. They are as varied as the people who suffer from them. In addition to anorexia and bulimia, binge eating disorder and eating disorder not otherwise specified are also diagnosable. There is also type 2 (purging type) anorexia, which few people know of. Many times, the symptoms of an eating disorder don’t fall neatly into either the anorexia or bulimia box, but that does not make them any less dangerous. In addition to the obvious symptoms of either restriction or binging and purging, there are a number of other symptoms including over-exercise, abusing laxatives, binging (without purging), chewing and spitting, hoarding food, and any other compulsive behaviors around food.

Myth 5: Eating disorders are about losing weight.
I hope that most people have moved past this impression, because it’s been debunked so many times, but it’s still important to say.Eating disorders are a coping tool. People use them to manage their lives in some way, generally to manage their emotions. This means that eating disorders can be about almost anything: control, perfectionism, depression, punishment, family problems, relationships problems…managing weight is generally a way to manage life, but managing life can mean many things.

Myth 6: Eating disorders happen because of the media/weight obsessed parents/diet culture/etc.
There are many causes for eating disorders, and trying to sum up the cause of “eating disorders” into one simple phrase will never be a useful or informative endeavor. There is a large genetic component to developing an eating disorder, but in addition there is usually some sort of environmental factor. These environmental factors vary. Many people with eating disorders have multiple diagnoses and developed an eating disorder to deal with other mental illness problems. Many eating disorders do have family related origins, but some come about because of pressure in school, athletics, or other places. Of course having a thin-obsessed media does not help many girls with their body image, but if media was the exclusive reason for the prevalence of eating disorders then everyone would have one. Eating disorders come from a complicated interplay of a variety of factors.

Myth 7: Eating disorders are a choice.
Eating disorders are caused by a chemical imbalance in the brain. They are life-threatening illnesses, and in order to recover, most people have to dedicate years of their lives and a great deal of time and energy to their recovery. There is no choice in getting an eating disorder, and it is extremely offensive to anyone with a mental illness to suggest that it is our choice to have or keep our mental illness.

Myth 8: If I just get him/her to eat, he/she’d be ok.
While increasing food intake is an important part of recovery and extremely important for the health of someone with an eating disorder, simply forcing someone with an eating disorder to eat will not help. It does not hit the underlying issues that pushed the person to feel as if they had to harm their body. Unless the mental issues underlying the eating disorder are resolved, the person will immediately revert to their previous behaviors. It is always important to remember that while an eating disorder has physical symptoms, it is a mental illness, and should be treated as such. If you know someone with an eating disorder, be gentle and supportive, don’t yell, force or control, and above all LISTEN because each eating disorder is individual.

Myth 9: Eating disorders are just a teenage phase/diet gone out of control.
Eating disorders are life-threatening illnesses. Anorexia has the highest mortality rate of any mental illness. They have serious health consequences. Eating disorders are not something that a person can simply grow out of because it’s just a phase, or something that they can replace with “healthy weight loss”. The process of recovery from an eating disorder is incredibly difficult and requires a great deal of commitment from the person who has the eating disorder as well as their support people. Dismissing the seriousness of an eating disorder is a way to let a dangerous problem go untreated.

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Mindy

Mindy is an attorney and Managing Editor of Teen Skepchick. She hates the law and loves stars. You can follow her on Twitter and on Google+.

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16 Comments

    1. So currently, overeating isn’t filed in the DSM except as part of bulimia–the bingeing feature of some people with bulimia.
      However.
      It’s likely going to be added….it’s just that there is the risk and debate about obesity and the stigma of calling it a mental illness. It’s not to say that that would be the result–quite clearly being overweight isn’t necessarily a mental health issue. It’s just how does one properly word diagnostic criteria to only catch those who are overeating in a pathological way?
      [It’s rather late in my part of the world–do let me know if I’m not making sense]

    2. Binge eating disorder is actually in the DSM though, and it is considered a mental illness. The difference between saying someone who’s obese or overeats is mentally ill and classifying binge eating disorder as a mental illness is that binge eating disorder is a way of coping with emotions through food and it is out of your control: people who suffer from it desperately want to stop binging but can’t. So yes, for some overeaters it does apply.

  1. I really like what you said in Myth 3. I had thoughts that maybe what I was doing wasn’t completely healthy but I wouldn’t say I had an eating disorder because I “wasn’t that thin.” I thought as long as my BMI was still reasonable then I didn’t really have a problem.

  2. It is great to see this here (as a self-identified skepchick, here’s proof: which may or may not work: https://fbcdn-sphotos-a-a.akamaihd.net/hphotos-ak-snc7/574871_3523762725556_826301185_n.jpg).

    But as ihatemusic pointed out, stating that EDs are the result of a “chemical imbalance” is a gross oversimplification and incorrect. EDs are disorders of the brain (as are all mental disorders, by default), but they are caused by a complex interplay of genes and the environment.

    Also, practically speaking, the only difference between anorexia nervosa binge-purge type and bulimia nervosa is weight.

    Cheers,
    Tetyana
    http://www.scienceofeds.org

    1. I totally agree that it was an oversimplification, sorry.
      I would however disagree with you that the only difference between anorexia type 2 and bulimia is weight. Bulimia is characterized by binge/purge cycles. These have to be regular, and it has to involve both binging and the attempt to remove the food from one’s body (purging, over-exercise, laxatives, etc).
      In contrast, anorexia type 2 does not require this cycle. It’s diagnosable if you have purges without the binging, or if you have binging without the purging. Between binges or purges, someone with an anorexia diagnosis restricts.
      In bulimia, an individual does not generally restrict between their binge/purge cycles, the only part of diagnosis is the binging/purging (in terms of behaviors). Anorexia requires some sort of restriction for a diagnosis.
      I do agree that the lines between eating disorders can easily be blurred, but I do think there’s more to the different diagnoses than just weight.

      1. With all due respect Olivia, you’re not completely correct here, as well.

        If we are going by the DSM-IV criteria, someone with AN-BP has to have either binge-eating or purging, that’s true, the majority of those that binge do purge, and vice-versa. But yes, it is at this point diagnosable if you just have either binge-eating or purging.

        But, restriction is not evaluated, and so someone with BN might be restricting just as much if not more than someone with AN-BP, their weight is just above BMI 17.5/85% of ideal (however that’s calculated). Actually, a lot of bulimics restrict during the day and b/p at night.

        So, anorexia requires low weight, whereas bulimia doesn’t, but there’s nothing there about restriction.

        There is a lot of crossover, though, over/roughly 50% of patients diagnosed with AN go on to develop BN, for example.

        Cheers,
        Tetyana

        1. I should specify, I meant “practically speaking,”, meaning that for the majority, generally, the difference is often minimal. When more 50% of ED patients fit into EDNOS, and NOT AN or BN, it is a good sign that the classification is majorly flawed.

  3. Actually, while this is a really good article (I suffered from an eating disorder myself and I think all your points are very valid), your claim in the last point that “Anorexia has the highest mortality rate of any mental illness” does not match up with reality.

    According to a quick Google search, depression might have as high mortality as 15%: http://www.dnalc.org/view/1394-Depression-Mortality.html while the mortality rate for e.g. Anorexia Nervosa is about 4%: http://www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics/ .
    While it is true that almost 50% of people with eating disorders meet the criteria for depression ( http://www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics/ http://www.mentalhealthscreening.org/info-and-facts/eating-disorders.aspx ), I would still say that the claim is not true.
    It is extremely hard to compare numbers of mortality rate for mental illnesses in general (most of them do not have immediate physical effects like eating disorders do, and you can’t retroactively diagnose depression), but even from this rough Google search I would say that you need better numbers to back up this claim.

    Thanks for the great article anyway! I’ll probably be linking it on to other people who direly need an introduction to eating disorders, but it’d be nice if you could fix this part.

    ;)jokergirl

    1. (And yes, I am aware anad.org makes the same claim, but I am still disagreeing with it. Calculating mortality rates for mental illnesses is hard to begin with, and in the case of overlapping diagnoses like this, I would suspect it is almost impossible.)

      1. I’m interested in where you’re getting your statistics because the most common number cited for mortality rate of anorexia is 20% and NEDA says between 5 and 20% (http://www.nationaleatingdisorders.org/nedaDir/files/documents/handouts/Anorexia.pdf). Every source that I’ve looked at (including the National Eating Disorder Association, which is probably the largest and most reputable source of eating disorder info) says that EDs have the highest mortality rate of any mental illness, so I’m going to trust those sources.

        1. I have quoted some of my sources and I have stated that this is only from a Google search in the original reply.

          But, as I was ALSO stating there, mortality rates of other mental disorders are hard to quantify and therefore this statistic might be quite skewed.
          The 15% suicide rate of depression is, by further Google search on the subject, the standard textbook quoted rate of suicides in the US, based on a 1970 study. However, there are several problems with this:
          – The study was based on a strict definition of depression that has since been expanded and
          – The estimated number of unreported cases of depression in the general population is very high and sources from the NIMH quote between 20-50%, which makes an actual mortality rate hard to quantify.

          All in all, I still stand by the original post. Unless someone comes up with a better way of quantifying death from other mental disorders, this number means nothing, as other mental disorders are simply currently not quantifiable.

          ;)

  4. Mortality rates are notoriously difficult to quantify, for myriad of reasons that are specific and non-specific to eating disorders. Crude mortality rate doesn’t matter as much as standardized mortality rate. 20% of all patients is way too high, though.

    The numbers change a lot depending on the length of study (the longer the study, the smaller the SMR) and the sample (both size and whether it is community-sample (smaller SMR) or chronically ill adult patients).

    http://www.scienceofeds.org/2012/05/04/a-meta-analysis-of-mortality-in-eating-disorders/
    http://www.scienceofeds.org/2012/05/08/ednos-bulimia-nervosa-as-deadly-as-anorexia-in-outpatients/
    and
    http://www.scienceofeds.org/2012/10/10/how-common-are-eating-disorders/

    Tetyana

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