Asking “THE Question”: Is it an Eating Disorder?
Updated: Aug 26
Tomorrow (June 2) is World Eating Disorders Action Day. Considering this day, I wanted to take some time to address the question: how do you know it’s an eating disorder?
This blog post is meant to be informative. Please do not mistake this for medical advice. This information is not direct advice and you should speak to a medical provider for individual evaluation.
Throughout this post, I will share the Nine Truths About Eating Disorders developed by the Academy for Eating Disorders.
What is an Eating Disorder?
Eating disorders are not choices, but serious biologically influenced diseases
(Nine Truths About Eating Disorders; Truth #4)
An eating disorder is a very serious, complex and potentially life-threatening mental illness that results in food behaviors that often impact a person’s physical, psychological, and social function.
Physically, we may see medical complications across body systems (brain, heart, lungs, muscles, liver, kidneys, stomach/intestines, reproductive, etc. It is important to note that symptoms will vary related to the type of eating disorder behaviors and the frequency and intensity of the behavior. However, we should not use normal labs OR the absence of medical complications as an indicator that someone isn’t suffering with an eating disorder. The challenging part of our fat-phobic, diet culture society is that we tend to associate eating disorders with one body type, when in fact many people with eating disorders may look healthy, whether in a straight-sized body or in an infinifat body (or anywhere in between), and still be very ill with their eating disorder.
Many people with eating disorders look healthy, yet may be extremely ill.
(Nine Truths About Eating Disorders; Truth #1)
Psychologically, we see that these symptoms are just as varied. As part of the eating disorder, it is common to observe preoccupation with food or body/shape, rigid food rules, high levels of guilt and shame, and mood swings to name a few. We also know that a person diagnosed with an eating disorder may experience a co-occurring mental health condition that will be addressed as part of their treatment plan. These may include: anxiety, depression, post-traumatic stress disorder, obsessive compulsive disorder, substance use disorders (learn more about eating disorders and substance use from my friends at Bicycle Health), and more. Research has shown us that suicidal behavior is increased among those diagnosed with an eating disorder. We also see preoccupation with food or body/shape, rigid food rules, guilt/shame, mood swings.
Eating disorders carry an increased risk for both suicide and medical complications.
(Nine Truths About Eating Disorders; Truth #6)
Socially, a person with a diagnosed eating disorder may experience a disruption to their personal or professional life. This can take many forms including: low performance at school/work, avoiding social situations where food is involved, isolating from friends and family, difficulty forming new relationships, and more. However, if someone is functioning well at work and maintaining relationships, this does not mean that they aren’t acting on eating disorder behaviors.
An eating disorder diagnosis is a health crisis that disrupts personal and family function
(Nine Truths About Eating Disorders; Truth #3)
What causes an eating disorder?
This is a question I hear frequently from my clients or their loved ones.
Genes and environment play important roles in the development of eating disorders
(Nine Truths About Eating Disorders; Truth #7)
It’s important to know that eating disorders develop from a complex interplay of the following factors:
While there is a family history that includes an eating disorder or disordered eating for many individuals diagnosed with eating disorders, it is important to note that genes alone do not predict who will develop an eating disorder. I have had clients that are the first in their family to be diagnosed with an eating disorder and I have had other clients with an extensive family history. There are also individuals who have a family history of eating disorders but do not develop an eating disorder. This demonstrates the complex nature of eating disorder development.
Genes alone do not predict who will develop eating disorders.
(Nine Truths About Eating Disorders; Truth #8)
Pre-existing mental health conditions, such as those listed above, may play a role in eating disorder development. This is because eating disorder behaviors may act as a temporary numb to the distress caused by these conditions.
When collecting information in an initial assessment, I will ask my clients when their relationship with their food changed. Several of them will cite environmental or social situations. These vary by individual, but some examples include: the COVID-19 pandemic, being bullied at school, being told that they need to lose weight at the doctor’s office, having a friend critique their food.
These factors work together to create the “perfect storm” for eating disorder development.
Who is diagnosed with an eating disorder?
It is important to know that eating disorders don’t discriminate!
Eating disorders affect people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socioeconomic statuses.
(Nine Truths About Eating Disorders; Truth #5)
While eating disorders don’t discriminate, they are underdiagnosed in certain populations such as the BIPOC community or those in the larger bodies. It is important to know that eating disorders affect people of all genders, ages, races, ethnicities, body shapes, sexual orientations, and socioeconomic statuses and therefore a thorough evaluation of food behaviors should be evaluated without bias.
What food behaviors should I look for?
A relationship with food exists on a continuum from relaxed eating all the way to disordered eating.
Relaxed Eating or Intuitive Eating is when a person is able to eat all foods that they enjoy in balance, variety and moderation and in response to their personal hunger and fullness cues. A person’s eating is not directed by external food rules or negative thoughts about food or body.
Disordered Eating is frequently seen in our diet culture. A person’s relationship with food is strained and this is evidenced by their need to use diets or food rules to guide how they relate to food. Food behaviors that may be observed are:
· Skipping meals and snacks
· Calorie counting/Food group avoidance
· Feeling anxious around food
· “Working off” their food by exercising
· Purging behaviors
· Binge eating
· Many more…
With an Eating Disorder, we will see similar behaviors but the behaviors are typically happening more frequently and at a higher intensity. This leads to the physical, psychological, and social consequences discussed above.
What if it is an eating disorder?
Ask for help. As you have read, an eating disorder is a very serious medical and mental illness that needs treatment from an inter-disciplinary treatment team. A treatment team will include:
· The individual with the eating disorder
· Specialty doctors (as needed)
· The support system (Parents/Family/Friends) of the individual with the eating disorder
Eating disorder recovery is a challenging process. It takes consistent effort over time to stop eating disorder behaviors and thoughts and replace these with helpful thoughts and coping strategies. Having eating disorder specialized treatment team members (look for the CEDS certificate for providers) is a great start, but there is high value in involving our support system.
Families are not to blame and can be the patients’ and providers’ best allies in treatment.
(Nine Truths About Eating Disorders; Truth #2)
While eating disorder recovery is challenging, I want to make sure you know it is also possible. As a Certified Eating Disorder Specialist (CEDS) dietitian, I believe that full recovery is possible and have had the pleasure of helping many clients reach their complete recovery.
Full recovery from an eating disorder is possible. Early detection and intervention are important.
(Nine Truths About Eating Disorders; Truth #9)