There are an absolute abundance, an infinity even, of myths and misconceptions in regards to the nature, cause and course of eating disorders. Sometimes, these misconceptions form much of the stigma that people with eating disorders experience during the course of their illness and recovery from friends, family members, teachers and sometimes, even healthcare professionals. In my time I haven’t heard it all, but I have heard enough of my fair share from various people and their much misinformed musings:
A nurse: “Is it because you want to be on Britain’s Next Top Model?”
“Of course. That’s what it is, I’m trying to fulfil my unrealised dream of becoming a model”
My Mum: “Your fridge is full now so you have no excuse to not eat”
” Aha, because that’s been the problem all along”
A teacher: “She’s not anorexic!” – At the time, no I wasn’t; I had bulimia. That doesn’t mean that it is right or acceptable to pass judgement on whether or not I’m struggling. An eating disorder cannot be judged from appearance alone…and so it is I have made a ‘common myth compilation’ if you like of the first 10 myths to debunk, and with no further ado, in no particular order of commonality, importance or ignorance I introduce, “The First Ten”.
1. People with eating disorders are emaciated.
The media’s portrayal of those with eating disorders would have one firmly assume that in order to be suffering a person must be skeletal. However, when magazines and TV shows are discussing eating disorders, they often go for the “shock” factor in order to gain an attentive audience. However, these cases are often extreme and chronic. Although people with anorexia are severely and unhealthily underweight, they are not necessarily skeletal in appearance – and just because someone doesn’t obviously emaciated does not mean they are not suffering from an eating disorder. In fact, many people suffering from bulimia are of a categorically “healthy weight” as set in accordance with the BMI: they still have bulimia.
2. You can tell if someone has an eating disorder just by looking at them.
An eating disorder is a psychiatric disorder, characterised by a set of beliefs, thought distortions and behaviours. Many of those suffering with an eating disorder do not fit the diagnostic criteria for either anorexia or bulimia, but instead endure a condition known as eating disorder – not otherwise specified (EDNOS). They do not fall neatly into either category, however, their eating is still disordered enough to be detrimental to their mental health and well-being. They may often be of a healthy weight, or slightly underweight instead. Conversely, some people suffer from binge-eating disorder (BED) and often are overweight or obese as a result: yet, similarly, not everyone who is overweight or obese suffers from BED.
3. People with anorexia don’t purge.
There are two types of anorexia. Whilst someone with anorexia will maintain their weight <85% than that expected they may also engage in binge/purge behaviours, e.g. overexercising, fasting, vomiting, or misusing diuretics, laxatives or enemas. This is categorised as a sub-type known as ‘anorexia, binge-purge sub type’.
4. All people with bulimia make themselves sick.
There are various methods of purging the body of unwanted calories such as over-exercise, fasting for extended periods of time, or abusing diuretics, laxatives or enemas. Some people with bulimia who are diabetic may also engage in a behaviour known as insulin manipulation in order to purge their body of sugars via urination.
5. An eating disorder is a lifestyle choice, and therefore not an illness.
Eating disorders are diagnosable psychiatric disorders as classified in the DSM-5. They are illnesses that involve deep disturbance in eating behaviours, in addition to the thoughts and emotions surrounding food and eating. A number of other conditions often accompany a diagnosis of an eating disorder such as depression, anxiety, and OCD.
6. Someone with an eating disorder could stop it if they wanted to, they choose not to.
Anorexia has the highest mortality rates of all psychiatric conditions. The death risk is twice that of schizophrenia, and three times that of bipolar. If sufferers could stop if they wished, do you not think that they might choose to stop a some point before they die of complications?
7. People with anorexia never eat.
People can endure anorexia for years. For some people it can develop during their teens and continue until they are in their 30s, for some it is longer. Obviously, this would not be possible if they never ate anything. People with anorexia severely restrict their intake, or massively over expend on their outtake. Either way, their balance between consumed energy and burned energy is insufficient for their needs, resulting in severe weight loss and/or maintaining a low weight below 85% of that expected for their gender, age and height.
8. Everyone with an ED consistently loses weight.
Some people gain weight as a result of their eating disorder, particularly is they suffer bulimia of BED. For some people with anorexia however, they may not consistently lose weight, but maintain a weight below 85% of that expected for their gender, age and height. They remain anorexic due to a refusal or inability to gain weight. They may remain within a similar weight range for lengths of time, especially as the illness progresses and the body enters starvation mode in which the metabolic rate slows down to accommodate for the extended period of insufficient food consumption.
9. People with anorexia don’t get hungry.
The fact is that people with anorexia do become intensely hungry at times, just like everyone else. People with Although there is some scientific evidence emerging that people with anorexia, or who have had anorexia experience pain signals differently in comparison to healthy individuals, suggesting they may have difficulties picking up on hunger cues within their body due to their brain responses: this does not mean however, that they have a super-human ability to not feel hunger cues at all despite their absolute denial that they are ever hungry. In addition, there has also been scientific evidence suggesting that, due to different responses within their reward systems and centre for self-control within the brain compared to healthy individuals, people with anorexia are able to exert more willpower, for good or ill, meaning that when they are hungry they are able to not give in to their urges and need to eat more so than a healthy person.
10. An eating disorder is chronic picky eating; they just don’t like what is on offer to eat.
There is a difference between picky eating and eating disorders. Even when picky eating becomes chronic and persists, this is known as ‘selective eating’ as opposed to an eating disorder and is entirely unrelated to body shape, weight or image, whilst additionally lacking the psychological and behavioural aspects observed in eating disorders. It may, form the outside, appear that people with eating disorders are merely being picky about food, however, you could place a mountain of their favourite, ‘acceptable’ or ‘safe’ foods in front of them, if they have a certain regime they are eating to, a calorie goal or a set of rules, they will still eat within those self-imposed rules, goals and/or regimes regardless. Unless they do ‘give in’ they will endure the psychological impacting blow within their mind as a result: and if they have bulimia and perhaps binge, this will be compensated for via purging. This is very different behaviour to that seen in selective eating, or “picky eaters”.
Cleveland Clinic, Remuda Ranch, EatingDisorders.org, MentalHealth.org, Psychiatry.org, Alliance For Eating Disorders, WebMD, Mirror Mirror, Joy Project, Health Talk Online, Bulimia Guide, Psychology Today, Raise Healthy Eaters, and Science News.