Busting eating disorder myths (part one)

Hi, friends! I’ve been a little quiet on this platform lately, mostly because I’ve been attending to my own healing—physically and emotionally from a mold-related illness and a bacterial infection in my gut! But I am healing and I am grateful. This week is National Eating Disorders Awareness week (#NEDAwareness), I wanted to share some insight and research with you. There is so much misinformation out there about eating disorders, so many myths! Myth-busting sounds fun, so here we go. I’m going to unpack three common misconceptions for you about eating disorders, and my hope is that you’ll learn something new and be a bit more informed.

Let’s get to it! 

Myth #1

Eating disorders are about wanting to be skinny.

Maybe. They definitely can be. The best-known environmental contributor to the development of eating disorders is the sociocultural idealization of thinness (Culbert et al., 2015) and dieting is the most salient predictor in eating disorders in adolescents (Patton et al., 1999). So, yes…AND…they are more complex and nuanced than just that. They can also be manifestations of unresolved trauma. In fact, they usually are. 1 and 4 people who struggle with an eating disorder also have symptoms of PTSD (Tagay, 2014). Eating disorders can be coping strategies, ways of dealing with painful emotions and trying to control them. Several studies have shown that eating disorders can function as an emotion regulation mechanism (Lavender et al., 2015). Eating disorders can be about insecure attachment, as some studies have looked at how ED’s may function as an attachment relationship (Ty & Francis, 2013). They can be about social comparison, anxiety, depression, a family of origin with strict food rules, body image, dieting, obsessive exercise, and weight shaming/bullying. Eating disorders don’t exist in a vacuum. They are often symptoms of a deeper core issue, and those that are suffering are also most likely suffering from other co-occurring issues, mainly mood disorders, anxiety disorders, OCD, or substance abuse. So, while diet culture and really unrealistic beauty standards have certainly led to the development and maintenance of eating disorders, they aren’t the only puzzle pieces at play.

Myth #2

Only rich, white, cisgender women have eating disorders.

No, no, NO! Subclinical eating disordered behaviors (including binge eating, purging, laxative abuse and fasting for weight loss) are nearly as common among males as they are among females (Mitchison, Hay, Slewa-Younan, & Mond, 2014). Eating disorders are not just a women’s issue, and this stigma has made it difficult for men to seek help and receive treatment. More so, transgender individuals experience ED’s at rates significantly higher than cisgender individuals. Eating disorders do not discriminate between gender, nor by sexual orientation. Several studies strongly support the prevalence of eating disorders for gay, lesbian, and bisexual individuals (like too many for me to cite in a single blog post). Eating disorders also affect people from various social-economic statuses and various races. One study shows that teenage girls from low-income families are 153% more likely to be bulimic than girls from wealthy families (Goeree et al., 2011). This same study showed that black teens are 50% more likely than white teens to exhibit bulimic behaviors, such as binging and purging. The moral of the story is that eating disorders affect a diverse group of people. All people matter and all people deserve help.   

Myth #3

Eating disorders have a “look”.

Being “sick enough” is one of the biggest myths out there and it may be the most devastating because it keeps people from seeking help. This is partly due to misinformation about BMI. Several people think that because their weight is “within normal range” they aren’t suffering from an eating disorder/disordered eating. And it’s just untrue. One of my favorite teachers is Jennifer Rollin, MSW, LCSW, and founder of The Eating Disorder Recovery Center. She says, “using BMI to determine if someone is struggling with an eating disorder is like using a Magic 8 ball when you are sick to determine if you need to go to the doctor.” Listen, people. BMI (Bullshit Measuring Index) was created 200 years ago by a mathematician/statistician as a way to categorize people for his research—it was never meant to be an indicator of health. If you know anything about reliability and validity, two important factors in determining the usefulness of an assessment or measure, then what is clear is that the BMI is NOT a valid measure because it is currently being used to measure something that it was not designed to measure.

Here’s another fun fact—in 1998 the World Health Organization decided to lower the BMI (aka, they changed what it meant to be “overweight”). People who went to bed “healthy” woke up “unhealthy”, and those now “unhealthy” people decided to diet to lose weight when it wasn’t at all necessary. And isn’t it curious that the makers of a weight-loss drug funded this change?! Fascinating. And also, gross. Recent studies have indicated that several people with BMI levels at the low end of normal are actually less healthy than those now considered “overweight” (Kolata, 2007). Furthermore, some people who are fat are just as healthy as those considered to be a normal weight. 

BMI tells you nothing about someone’s health and eating behaviors. Eating disorders come in ALL shapes and sizes. Fat people and skinny people have eating disorders. And, you cannot “tell” if someone has an eating disorder based on their body size or “look”. Become aware of your assumptions. You never know even a slice of someone’s story simply by looking at them.

 The DSM-5 (sadly) still uses BMI criteria to define anorexia. In other words, anorexia can only be diagnosed *technically* if a person is at a low weight AND it uses BMI to determine the severity of their eating disorder. Which is bananas. I have a lot of issues with the DSM-5—specifically as it relates to not recognizing developmental trauma disorder—but the way the DSM classifies and determines what is ‘clinically significant’ in terms of eating disorders is also total BS.

Other Specified Feeding or Eating Disorders (OSFED) is now the most commonly diagnosed eating disorder and Atypical Anorexia is now more prevalent than Anorexia Nervosa. And what the research tells us is that it is just as serious as any other type of eating disorder. People with OSFED are just as likely to die as a result of their eating disorder as people with anorexia or bulimia. Adults with ‘atypical’ or ‘subclinical’ anorexia and/or bulimia scored just as high on measures of eating disorder thoughts and behaviors as those with DSM-diagnosed anorexia nervosa and bulimia nervosa. Eating disorders don’t have a “look” and you deserve help no matter what.

 Cheers to busting myths and speaking truth, ya’ll. Part two comin’ in hot later this week!

 Rachel

Resources

Lavender, J. M., Wonderlich, S. A., Engel, S. G., Gordon, K. H., Kaye, W. H., & Mitchell, J. E. (2015). Dimensions of emotion dysregulation in anorexia nervosa and bulimia nervosa: A conceptual review of the empirical literature. Clinical Psychology Review, 40, 111–122.

Ty, M., & Francis, A. J. P. (2013). Insecure attachment and disordered eating in women: The mediating processes of social comparison and emotion dysregulation. Eating Disorders, 21(2), 154–174.

Tagay, S., Schlottbohm, E., Reyes-Rodriguez, M. L., Repic, N., & Senf, W. (2014). Eating disorders, trauma, PTSD, and psychosocial resources. Eating disorders, 22(1), 33-49.

Mitchison, D., Hay, P., Slewa-Younan, S., & Mond, J. (2014). The changing demographic profile of eating disorder behaviors in the community. BMC Public Health, 14(1). doi:10.1186/1471-2458-14-943

Goeree, Michelle Sovinsky, Ham, John C., &  Iorio, Daniela. (2011). Race, Social Class, and Bulimia Nervosa. IZA Discussion Paper No. 5823.