“Skinny”. “Wants to lose weight”. “Is a teenager”. This came up on my FB feed the other day via Beating Eating Disorders and really shows the way too many stereotypes and misconceptions about EDs. An ED is a ‘voice’ or compulsion in your head that twists your thoughts and has direct access to your feelings (physical and emotional), and constantly argues and criticises you about anything from food and body image to how you live your life and self image. It’s a mental illness, not just physical symptoms or behaviours and DEFINITELY not a lifestyle choice. So wanted to use this post to challenge some of the stereotypes listed here, relating to personal experience…
Not everyone with an eating disorder: is skinny. This is the single biggest misconception about eating disorders! About 10% of people experiencing an ED have anorexia nervosa (characterised by low body weight) which leaves 90% of people with mild to severe eating issues who may not be underweight and can often be overweight. Eating disorders are mental illnesses, not diets or lifestyle choices. It’s so important to break this myth because it leads to people (often professionals too) ‘discounting’ someone with an eating disorder as ‘not ill enough’ because they are not underweight and then it’s harder to access support, and often people at ‘normal’ weights are just as ill and suffering as people at very low weights. When I was a much lower weight, I actually ate more than I do now, more regularly and didn’t purge or over-exercise because I felt much calmer and more in control than I do now where the ED thoughts are ten times stronger and I feel a lot more anxious, out of control and hating myself to the point where I seriously think about just stopping eating altogether to take back some sense of control on a regular basis but know that if I do, I pass out easily and it’s not helpful for anyone. HATE it! Wish the bitch in my head would just shut up and go away. She’s a lot quieter and less abusive when I’m actually underweight…
Not everyone with an eating disorder: goes to hospital. Another really important myth to break! Although some people with EDs do have to have inpatient admissions, the majority of people don’t and it tends to be only very ‘severe’ EDs with physical health complications like extremely low weight (usually less than BMI 14) leading to heart issues, osteoporosis or other organ issues, significant health complications from bingeing or purging, or other comorbid acute mental health issues which would lead to hospitalisation so most people with eating disorders are either not accepted into services because of lack of funding or availability, or treated on an outpatient basis. Having been on both sides (several inpatient admissions, outpatient treatment in three different services), I can pretty confidently say that from my experience anyway, it’s often a LOT harder as an outpatient because it’s totally up to you to challenge the ED thoughts and behaviours. It’s also a lot easier to relapse and the ED thoughts are stronger and more intense. It’s impossible to judge a person’s experience on their situation or medical history.
Not everyone with an eating disorder: gets diagnosed. In a similar vein to the last point, diagnosis often only happens when people actually seek help or their illness has a severe physical effect which leads to a diagnosis. For me, I was only diagnosed at age 18 having had an ED for 5 years by then and it was from being admitted as an inpatient due to extreme low weight and associated physical health problems. A lot of people have long term EDs which are chronic and life-limiting but don’t lead to hospitalisation and therefore might go undiagnosed.
Not everyone with an eating disorder: is anorexic. As I’ve already mentioned, only about 10% of people with an eating disorder have anorexia nervosa. That’s NINETY PER CENT of sufferers with other types of ED which are often just as dangerous, life limiting and severe as anorexia or even more.
Not everyone with an eating disorder: goes to therapy. I’ve basically already covered this talking about diagnosis and treatment, but if someone doesn’t recognise that they are ill and it isn’t picked up medically, then they’re unlikely to access therapy even if they are extremely ill. It’s also incredibly hard to access NHS therapy with long waiting lists, and most people can’t afford private.
Not everyone with an eating disorder: exercises. EDs are complex mental illnesses, not lifestyle choices or just behaviours. Some people with an ED (particularly bulimia) will exercise compulsively, some won’t. Just like some people binge/purge, others restrict, some have a combination. From a personal perspective, I never exercised at a low weight because it made me black out and meant that I HAD to eat something whereas it was a lot easier just to not eat (my friend and I used to joke that we were ‘lazy anorexics’) whereas now at a much higher weight, I *have* to exercise every day and it can sometimes swing into over-exercise or compulsion. It’s different for everyone!
Not everyone with an eating disorder: makes themselves sick. Like I’ve already said, EDs aren’t defined by behaviours. Some people with an eating disorder make themselves sick, some don’t. Sometimes people will have phases of different behaviours and it’s not necessarily predictable. There’s a misconception that all people with bulimia purge- they don’t necessarily, and some people will counteract a binge with exercise or severe restriction instead. It’s a behaviour that’s common in a lot of people with EDs but definitely not everyone.
Not everyone with an eating disorder: doesn’t eat. Another BIG myth to break! Nearly everyone with an eating disorder DOES eat; they just might not feel comfortable eating in front of people, or only eat certain foods, or at certain times, or any combination. Just because you see someone eating ‘normally’, it doesn’t mean they’re not experiencing a constant brain battle with ED thoughts or urges. Never judge by outside appearances!
Not everyone with an eating disorder: is female. Another massive stereotype that can mean that males with EDs are less likely to try to access support. About 10% of people with diagnosed anorexia or bulimia are male but this might be partly due to lack of support for men or social expectations. It’s also has because a lot of people with eating disorders are undiagnosed or don’t access services so it’s likely to be more than that, and it’s also likely that EDs in men present differently to EDs in women so are less likely to be recognised or diagnosed. Complicated issue!
Not everyone with an eating disorder: calorie counts. Some people with an eating disorder aren’t even aware of calories- it’s a mental illness that takes so many different forms. Again, some people with EDs will calorie count and for a lot of people particularly with anorexia, it’s a big part of their internal brain battle but for other people, it’s fear of certain foods or loss of control that’s the main issue. I keep saying it but everyone’s different! I’ve always calorie counted but for me, it’s more of an autistic trait I think because I also ‘need’ to know how many protein and fibre grams there are in foods I eat, and I often find it hard to know what’s an ‘ED’ trait and what’s autism. Sometimes I really wish diagnoses didn’t exist!
Not everyone with an eating disorder: only eats healthy foods. See previous points!!
Not everyone with an eating disorder: has fear foods. Again, this is important to remember because although a lot of people with an ED will have ‘fear foods’ or avoid certain food types, not all people do and for many people it’s the loss of control over eating which causes the most anxiety rather than the actual foods themselves.
Not everyone with an eating disorder: wants to lose weight. I could go on about this one for hours! There’s a reason that it’s called an EATING disorder rather than a weight disorder which is something totally different. EDs are mental illnesses and although they can often have an impact on weight, they don’t necessarily. Even people with anorexia nervosa, which is characterised by extreme low weight, might not actually ‘set out’ to lose weight when the illness takes hold. My first diagnosis was anorexia and I was very underweight but the weight loss hadn’t been the main driving force of the illness- it was the sense of calm and ‘control’ (I hate saying that; it’s so classic textbook!) over emotions to the point of detachment which was what I wanted to achieve. Even now, more than 16 years after I first developed an eating disorder, I’d take the calm detachment over weight loss any day. For some people, losing weight is the focus; for others, it’s something else entirely. Don’t judge by misconceptions!!
Not everyone with an eating disorder: is obsessed with being skinny. See previous point!
Not everyone with an eating disorder: cries in front of food. Like with the ‘fear foods’ point, people experience anxiety about a massive variety of aspects relating to food or eating and not just specific foods. Some people with EDs will swallow food without registering it as a coping mechanism (I’ve been guilty of that in the past) whereas others can’t bring themselves to chew. Again, everyone is different!
Not everyone with an eating disorder: is a teenager. Oh God, yes!! EDs do not discriminate across age ranges and there are so many different experiences of eating disorders that present completely separately. My ED is different now from when I was a teenager and people with chronic EDs are often in their 30s, 40s, 50s or 60s, and worryingly there’s an increase in older adults developing eating disorders. Don’t believe the media hype!
Anyway, I’m exhausted and emotionally drained from writing this so hope at least some of it makes sense! Will shut up now… :p