Eating disorders are highly misunderstood, yet serious, physical and mental illnesses. When seeking treatment for an eating disorder, it’s important to understand what the truth is from the myths about eating disorders out there. Too often, eating disorder myths prevent people from getting the help they need because this complex issue is boiled down to “simple truths” that don’t bear any resemblance to reality.
Let’s review 10 myths about eating disorders.
Anorexia Nervosa and Bulimia Nervosa are based on trying to look good and get attention, while people with Binge Eating Disorder do not care about how they look.
In popular culture, when people think of eating disorders, they typically picture someone extremely thin who is suffering from AN, or someone determined not to gain an ounce who is suffering from BN. The behaviors of people with AN and BN often appear to reflect a preoccupation with weight and body fat. Thus, it may seem that their only concern is looking good. However, one must not be misled by these behaviors. Vanity and attention-seeking are not the motivating factors in eating disorders. With both AN and BN, there is a profound quest for thinness; however, this is fueled by deriving an undue sense of self or self-worth from body size and shape and— particularly with AN— by cognitive distortion around how the body is perceived.
A person with BED may or may not gain weight as a result of binge eating and may or may not be overweight. The drive for thinness, as seen in AN, is not considered a core symptom of BED, and the BED sufferer’s sense of self-esteem may not be as profoundly centered on weight as seen in BN. Furthermore, those with BED do not generally have the distortion around body size and shape that characterizes AN, nor do they compensate for binge eating with inappropriate compensatory behaviors such as purging, laxative abuse, or over-exercising as do those with BN. However, individuals with BED nevertheless tend to suffer greatly from concerns about food, weight, and size, and they may be consumed with loathing for themselves and their bodies.
In working with those who have eating disorders, if we focus solely on weight and appearance and push those with AN or BN to eat “normally” or those with BED to diet, we miss the opportunity to deeply connect and help facilitate true healing. Underneath the behavior of all these individuals, a constellation of emotions and thoughts may be discovered. Upon engagement in a meaningful therapeutic relationship, the underlying sense of alienation, low self-esteem, and profound need for social acceptance become apparent, and the relationship can become the backbone for a constellation of other interventions that can lead to profound growth.
If they wanted to, people who have eating disorders could just stop their self-destructive behavior
This is perhaps the most common misconception. It likely stems from the fact that when a condition is characterized by behavior, as opposed to, say, a physical disability, there is a tendency to assume that the person with the condition has control over it. For example, we see the same kind of misconception with substance abuse— the idea that the individual could just stop cold turkey. With eating disorders, especially BED, family members in a clinical setting often ask of the affected loved one, “Why don’t they just stop doing this?” It is not uncommon for families to plead with their loved ones to stop, bargain with them, or even try to bribe them into stopping.
In reality, eating disorders are conditions in which higher functioning and cognition get “hijacked” by thoughts and feelings associated with eating to the point that individuals no longer have control over their behavior. In all the eating disorders— AN, BN, and BED— at a certain point, the thoughts and feelings become so overpowering that the person is unable to change without getting appropriate treatment.
Eating disorders are only found among young, well-off, Caucasian women
Eating disorders are found in members of every ethnicity and socio-economic background. While the peak time of onset for eating disorders is between the ages of 12 and 25, these disorders can be found among prepubescent children and in adults who are middle-aged and beyond.
Men make up 40% of BED cases. 19 One of the difficulties in diagnosing and treating men with BED is that men tend to think they are not supposed to have eating disorders. Thus, men often feel they will be stigmatized for seeking help. Additionally, binge eating or eating a lot is often viewed as an expected masculine trait, and this can lead men to laugh it off rather than acknowledge they are struggling. One example of how our society perceives eating differently in men and women is the product “Hungry Man Dinners.” It was a staple in grocery store freezers and a big seller for years. It is difficult to imagine a similar product achieving high sales with the name “Hungry Woman Dinners.”
Eating disorders are not that serious
Eating disorders can be life-threatening. In fact, they have the highest mortality rate of all mental disorders. Significant numbers of those with eating disorders die of heart failure, malnutrition, organ failure, or suicide.
A study in the American Journal of Psychiatry (2009), reported eating disorder mortality rates as follows:
4% for AN
3.9% for BN
5.2% for EDNOS*
People with eating disorders are just going through a phase
Having an eating disorder is not a choice someone makes; it is a serious illness that requires treatment. Receiving treatment as soon as possible after the onset of an eating disorder can help shorten the duration of the illness and lessen its severity. Unfortunately, research shows that those with these disorders usually suffer for several years before seeking treatment— with an average of roughly four years between onset and getting help from a medical professional.
People with eating disorders are punishing their families/ Eating disorders result from bad parenting and family dysfunction
Eating disorders result from a complex mix of genetic factors, environmental stressors, social pressure, and trauma. Those with eating disorders are experiencing an illness, not trying to punish or get even with anyone. In this regard, having an eating disorder is no different than having another mental illness such as schizophrenia, or a medical condition such as heart disease.
While certain stressors or triggers within the environment can be a factor in an individual developing one of these disorders, families are not the sole cause, and parents and other family members should not be blamed. We never want to make families feel like they are the root cause of a person’s eating disorder. This can be a very sensitive area, because when a member is suffering from an eating disorder, the family is typically struggling greatly, and possibly feeling tremendous guilt and anxiety.
However, we do a disservice to families when we approach an eating disorder in a way that leaves the family uninvolved and does not explore the role that a family situation can have in the development of any type of mental health condition. It can be incredibly empowering and meaningful when a family is able to come together to look at any interactions, behaviors, impressions, cognitions, or expectations that might actually contribute to their loved one’s suffering.
The trick is helping the family to look at themselves with compassionate curiosity rather than with guilt and defensiveness. When this is accomplished, the family can become important allies in the suffering individual’s healing process.
People with Anorexia Nervosa or Bulimia Nervosa are always underweight/ People with BED are always overweight
People with eating disorders come in every size and shape. Persons with AN or BN do not necessarily appear to be extremely thin or emaciated. Those with BN may not appear sick on the outside, despite the medical and psychological toll of the illness. Similarly, not everyone with BED is overweight or obese. The bottom line is, that you cannot tell by appearance whether a person has an eating disorder.
Eating disorders are incurable
When it comes to treating eating disorders, clinical research lags behind clinical knowledge. Clinicians who have worked in the field for 10 or 20 years know that individuals with these disorders, when given effective treatment, have the potential to recover at any point in their lives. Unfortunately, only 1 in 10 people with eating disorders receive treatment. Effective treatment is a multi-domain treatment in which a person’s medical, psychiatric, psychosocial, and nutritional issues are all addressed concurrently.
With Binge Eating Disorders, patients often seek treatment after having been in and out of numerous weight-loss programs and a lifetime of repeatedly gaining weight, losing weight, and then gaining it back again. Often, numerous doctors have seen these individuals and been so focused on the weight that they have not adequately identified and addressed an underlying psychiatric condition, such as depression, that is driving the disorder. These patients may have been labeled as “treatment resistant” when in fact they simply have not been given the treatment they need. We now know that early intervention with evidence-based care is improving the prognosis for a new generation of patients.
Thin equals healthy / Heavy equals unhealthy
In our culture, we tend to narrowly define health based on weight. However, this does not give a full or accurate picture of what it means to be healthy. The World Health Organization (WHO) defines health as “a complete state of physical, mental, and social well-being, and not merely the absence of disease or infirmity.” Clearly, that entails a great deal more than body weight.
The very idea, common in popular culture, that the thinner you are, the healthier you are, is misguided. The human body requires a certain amount of fat for optimal health— to have a normal endocrine function, normal bone development, and for the brain to work correctly. Physiologically, fat is like an organ system. The idea of wiping out a particular organ system in the name of health makes no sense.
In fact, a body mass index (BMI) below 18.5 is associated with higher mortality rates than BMIs in the “normal” range, defined by WHO as between 18.50 and 24.99. However, even the concept of BMI is often misunderstood. BMI is equally a measure of fat, bone density, and muscle. Thus, a higher BMI may reflect having more lean muscle or denser bones rather than simply having additional fat. Essentially, the BMI frequently has little to do with a person’s global state of health.
Further, people can fall into the “normal range” when it comes to weight and still suffer from AN, BN, or BED. Conversely, there are many people living in larger bodies who are in excellent health— able to run marathons, complete triathlons, or win bike races.
Being athletic or committed to eating healthfully means you are healthy
Our society tends to idolize athletes and admire people who are highly athletic. Yet, contrary to popular belief, being athletic does not ensure an individual is actually healthy. Those who compulsively exercise can experience insomnia, depression, fatigue, and anxiety as well as long-lasting physical injuries and damage. Some extremely active and driven women and girls suffer from female athlete triad syndrome, which includes three interrelated conditions:
Energy deficiency with or without disordered eating
Menstrual disturbances/ amenorrhea
Bone loss/ osteoporosis
In our society, “eating healthfully” is seen in a positive light. Of course, choosing a genuinely healthful lifestyle is admirable. However, some individuals have an unhealthy obsession with healthy eating, referred to as orthorexia— a condition not recognized in the DSM-5, but nevertheless one characterized by symptoms many individuals exhibit. With this condition, people become so fixated on eating exactly the right foods in the right amounts that it turns into an obsession, which can impede their ability to pursue other interests and have close relationships. These individuals can become so restrictive with what they eat that it damages their health.
Hopefully, this list of 10 myths about eating disorders has helped you understand eating disorders more thoroughly. To review, here are 10 myths about eating disorders:
Anorexia Nervosa and Bulimia Nervosa are based on trying to look good and get attention, while people with Binge Eating Disorder do not care about how they look.
If they wanted to, people who have eating disorders could just stop their self-destructive behavior
Eating disorders are only found among young, well-off, Caucasian women
Eating disorders are not that serious
People with eating disorders are just going through a phase
People with eating disorders are punishing their families/ Eating disorders result from bad parenting and family dysfunction
People with Anorexia Nervosa or Bulimia Nervosa are always underweight/ People with BED are always overweight
Eating disorders are incurable
Thin equals healthy / Heavy equals unhealthy
Being athletic or committed to eating healthfully means you are healthy