Rachel Cantrell, MFT Intern

“Eating Disorders are not illnesses”

Eating disorders are a complex medical/psychiatric illness. Eating disorders are classified as a mental illness in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Health Disorders (DSM-IV), are considered to often have a biologic basis, and co-occur with other mental illness such as major depression, anxiety, or obsessive-compulsive disorder.

“Eating Disorders are a choice”

People do not choose to have eating disorders. They develop over time and require appropriate treatment to address the complex medical/psychiatric symptoms and underlying issues.

“The defining characteristic of mental disorder is that the person has lost perspective”

It is important to realize that the person you love are “seeing, thinking, hearing, and feeling things that may not have much basis in reality”. Eating disorder patients usually have distorted and delusional thoughts regarding “their size, shape, food, fat, exercise, self, and others.” They have unwillingly committed themselves to a set of beliefs, that it can be hard to have a what seems to be a rational and logical conversation with the person you care for.
You must learn what brain your talking to, you friend in his or her purest state, or his or her eating disorder self. Continual food talk, discussion of weight, exercise, “healthful lifestyle”, need to approve others etc., you are probably speaking to their eating disorder. At times it can be extremely difficult to distinguish between the two voices, especially when your loved one is extremely sick because the illness and the person become so enmeshed. In all of this it is important to remember that eating disorders are serious mental disorders.

“Anorexia Nervosa is the only serious illness”

All eating disorders can have damaging physical and psycho- logical consequences. Although excess weight loss is a feature of anorexia nervosa, effects of other eating disorders can also be serious or life threatening, such as the electrolyte imbalance associated with purging.

“A person cannot die from bulimia”

While the rate of death from bulimia nervosa is lower than that seen with anorexia nervosa, a person with bulimia can be at high risk for death and sudden death because of purging and its impact on the heart and electrolyte imbalances. Laxative use and excessive exercise can increase risk of death in individuals who are actively bulimic.

“Subclinical eating disorders are not serious”

Although a person may not fulfill the diagnostic criteria for an eating disorder, the consequences associated with disordered eating (e.g., frequent vomiting, excessive exercise, anxiety) can have long-term consequences and requires intervention. Earlys intervention may also prevent progression to a full-blown clinical eating disorder.

“A person with Anorexia Never eats at all”

Most anorexics do eat; however, they tend to eat smaller portions, low-calorie foods, or strange food combinations. Some may eat candy bars in the morning and nothing else all day. Others may eat lettuce and mustard every 2 hours or only condiments. The disordered eating behaviors are very individualized. Total cessation of all food intake is rare and would result in death from malnutrition in a matter of weeks.

“You can tell if a person has an eating disorder simply by appearance”

You can’t. Anorexia may be easier to detect visually, although individuals may wear loose clothing to conceal their body. Bulimia is harder to “see” because individuals often have normal weight or may even be overweight. Some people may have obvious signs, such as sudden weight loss or gain; others may not. People with an eating disorder can become very effective at hiding the signs and symptoms. Thus, eating disorders can be undetected for months, years, or a lifetime.

“Eating Disorders are about appearance and beauty”

Eating disorders are a mental illness and have little to do with food, eating, appearance, or beauty. This is indicated by the continuation of the illness long after a person has reached his or her initial ‘target’ weight. Eating disorders are usually related to emotional issues such as control and low self-esteem and often exist as part of a “dual” diagnosis of major depression, anxiety, or obsessive-compulsive disorder.

“Purging is only throwing up”

The definition of purging is to evacuate the contents of the stomach or bowels by any of several means. In bulimia, purging is used to compensate for excessive food intake. Methods of purging include vomiting, enemas and laxative abuse, insulin abuse, fasting, and excessive exercise. Any of these behaviors can be dangerous and lead to a serious medical emergency or death. Purging by throwing up also can affect the teeth and esophagus because of the acidity of purged contents.

“You can’t suffer from more than one eating disorder”

Individuals often suffer from more than one eating disorder at a time. Bulimarexia is a term that was coined to describe indi- viduals who go back and forth between bulimia and anorexia. Bulimia and anorexia can occur independently of each other, although about half of all anorexics become bulimic.

“Achieving normal weight means that Anorexia is cured”

Weight recovery is essential to enabling a person with anorexia to participate meaningfully in further treatment, such as psycho- logical therapy. Recovering to normal weight does not in and of itself signify a cure, because eating disorders are complex medical/psychiatric illnesses

“Eating Disorders are solely caused by unrealistic images in the media”

While socio-cultural factors (such as the ‘thin ideal’) can contribute or trigger development of eating disorders, research has shown that the causes are multi-factorial and include biologic, social, and environmental contributors. Not everyone who is exposed to media images of thin “ideal” body images develops an eating disorder. Eating disorders such as anorexia nervosa have been documented in the medical literature since the 1800s, when social concepts of an ideal body shape for women and men differed significantly from today—long before mass media promoted thin body images for women or lean muscular body images for men.

“You’re not sick until you’re emaciated”

Only a small percentage of people with eating disorders reach the state of emaciation often portrayed in the media. The common belief that a person is only truly ill if he or she becomes abnormally thin compounds the affected individuals’ perception self body image and not being “good” at being “sick enough”. This can interfere with seeking treatment and can trigger intensification of self-destructive eating disorder behaviors.

From NEDA at http://www.nationaleatingdisorders.org/uploads/file/toolkits/NEDA-TKE-A03-CommonMyths.pdf