Trigger warning: eating disorders, body image, and medical illnesses
Image is courtesy of The Counter.
Eating disorders are severe yet quiet illness that many people experience. Eating disorders involve heightened disturbances in eating behaviours, following strict diets, binge eating food in secret, regurgitating after meals, or counting calories. It's difficult watching someone you care about go through such a thing, especially when the solution seems to be simple. But, eating disorders are much more layered than unhealthy diet habits. They attempt to deal with emotional issues and involve distorted, harsh attitudes about weight, food, and body image. These destructive thoughts and feelings fuel the damaging actions. It's imperative to know that eating disorders are treatable.
Eating disorders can affect anyone. They often appear during the teen years or young adulthood, but they may also develop later in life. You may not even notice that someone has an eating disorder, hence the term "invisible illness". They may appear healthy when they are incredibly ill. Research suggests that genetic, biological, psychological, and social factors can impact and raise a person's risk of developing.
Types of Eating Disorders
Anorexia Nervosa
Anorexia nervosa (commonly referred to as anorexia) is an eating disorder that CAN be distinguished by unhealthily low body weight, an intense fear of gaining weight, body dysmorphia- a distorted perception of weight and body image. People with anorexia highly value controlling their weight and shape by using extreme efforts to interfere with their lives significantly. To have this control to prevent weight gain or continue to lose weight, they will usually restrict the amount of food they consume. They may control calorie intake by regurgitation after eating, dieting, starvation, or other ways. Excessive exercise is another way they will attempt to lose weight. No matter how much weight is lost, the person will continue these harmful actions in fear of gaining weight. Anorexia is an unhealthy way people tend to try to cope with emotional problems. With anorexia, they often equate thinness with self-worth.
A few symptoms of Anorexia Nervosa:
Limiting food intake leading to significantly low body weight in the context of age, development, and physical health
Intense fear of weight gain
Excessive fasting and/or excessive exercise to interfere with weight gain
Insomnia
Dizziness or fainting
Binge Eating Disorder (BED)
This eating disorder is characterized by recurring episodes of eating large quantities of food (often very quickly and potentially to the point of discomfort), experiencing shame and guilt, and losing control during the binge. For a fleeting moment, those who suffer from BED can find that binge eating is calming, easing emotional distress or feelings of stress, depression, or anxiety. But then reality sets back in, and feelings of guilt and self-loathing floods them. Binge eating also contributes to obesity and weight gain, which further strengthens compulsive eating. It becomes a vicious cycle: eating to feel better, feeling even worse, and then turning back to food for relief.
A few symptoms of Binge Eating Disorder:
Regular intake of large amounts of food accompanied by a sense of loss of control over eating behavior.
Consuming food until feeling uncomfortably full, eating alone because of feeling embarrassed by how much one is eating
Feeling disgusted with oneself, depressed, or very guilty after an episode
Recurring episodes, around once a week
Bulimia
Those with bulimia may binge by eating large amounts of food with a loss of control over their eating and then purge in an attempt to get rid of the extra calories in an unhealthy way. To eliminate calories and prevent weight gain, individuals with bulimia may use different self-induced vomiting methods. Bulimia causes individuals to judge themselves harshly and severely for their self-perceived flaws. Because it’s related to self-image and not just about food, bulimia can be difficult to overcome. An effective treatment is possible to help someone feel better about themselves, take on healthier eating habits and reverse serious complications.
A few symptoms of Bulimia:
Being preoccupied with your body shape and weight
Great fear of gaining weight
Repeated episodes of eating abnormally large amounts of food in one sitting
Feeling a loss of control during bingeing — like you can't stop eating or can't control what you eat
Forcing yourself to vomit or exercising too much to keep from gaining weight after bingeing
Using laxatives, diuretics or enemas after eating when they're not needed
Fasting, restricting calories or avoiding certain foods between binges
Using dietary supplements or herbal products excessively for weight loss
Other Specified Feeding and Eating Disorders (OSFED)
Many people with eating disorders do not fall within the guidelines for a specific ED, such as anorexia, bulimia, and binge eating. Therefore, classified as OSFED. To be diagnosed as OSFED, a person must present feeding or eating behaviours that cause significant distress and impairment in development or functioning areas but do not meet the full criteria for any other eating disorder.
A few symptoms of Other Specified Feeding and Eating Disorders:
Atypical Anorexia Nervosa: All criteria are met except despite significant weight loss, the individual’s weight is within or above the normal range
Binge Eating Disorder of low frequency and/or limited duration
All of the criteria for Bulimia Nervosa are met, except that the binge eating and inappropriate compensatory behavior occurs at a lower frequency and/or for less than three months.
Purging behaviour to influence weight or shape in the absence of binge eating
Night Eating Syndrome: Recurrent episodes of night eating. Eating after awakening from sleep, or by excessive food consumption after the evening meal. There is an awareness and recall of the eating. The behavior is not better explained by environmental influences or social norms. The behavior causes significant distress/impairment, and is not better explained by another mental health disorder (e.g. BED).
Avoidant Restrictive Food Intake Disorder (ARFID)
ARFID is similar to anorexia in that both of them involve consumption limitations. The difference is that ARFID does not involve any distress about body shape or size or fears of gaining weight, unlike anorexia. Those with ARFID do not consume enough calories to grow and develop properly and maintain essential body function. ARFID can result in problems at school or work due to eating with others and extended times needed to eat.
A few symptoms of Avoidant Restrictive Food Intake Disorder:
Dramatic weight loss
Limited range of preferred foods that becomes narrower over time (i.e., picky eating that progressively worsens)
Fears of choking or vomiting
No body image disturbance or fear of weight gain
Conversations with Survivors
I had the opportunity to discuss eating disorders with a few people. I asked them a set of questions to understand how it impacts their lives and how those without eating disorders can make a safer environment for them.
How has your eating disorder impacted you in your day to day life?
“It honestly impacts every aspect of day to day life. At the height of my eating disorder my thoughts were just consumed with food, calories, when i could eat, what I could eat, etc. It became extremely difficult to focus and succeed in school because the only thing I cared about was my body and food. Not only that but since I was restricting my caloric intake so much I became tired and irritable. People would talk to me and I’d snap over nothing. I started to become too tired to play with my dog and go out with friends. I lost a majority of friends from it because I’d find excuses not to hang out and if I did I was usually on edge and not a lot of fun to be around. people don’t usually realize how much of our social life revolves around food and since I was terrified of someone realizing, I just avoided everyone and any situation with food.”
- Maddie, 17
“ I mean it really affected everything I did. When it was really bad I wouldn’t eat until 2o’clock the earliest and even then I would honestly just have three sticks of celery. The reason why I chose celery was because it was one something that was considered healthy that I could convince my parents to buy and the fact that you burn more calories than it actually has while eating it. Which gave me a calorie deficit right off the bat. I guess you could say my only meal would be supper which was anywhere from 5:00 to 5:30, there I would eat like, I guess a little less than a regular person plateful and then after that I ate absolutely nothing for the rest of the night. At this point I wasn’t just in a calorie deficit I was starving myself. I used to keep a journal that I would hide from everybody and within the pages I calculated every single thing I consumed (not including water). I made sure that I never went over 400cals, if I did I would just starve myself more the following day. It wasn’t just my unhealthy obsession with the food I ate, I was affected by the people around me and the people I saw. You know what I mean, whether it’s on some form of social media or just in the real world. You see somebody with your ideal body, someone with the body you want and the body that you don’t have and that just kind of well influenced me to keep on pushing myself harder. I also spent hours and hours going through YouTube videos and Tiktoks. I was going through just trying to find the quickest way to lose weight, and I didn’t care about what it might entail.”
- anonymous
“Well thinking about eating gives me tons of anxiety not because I’m afraid of food but of the amount I'm going to eat. I hate eating in front of people so I tend to eat in my room or somewhere not visible. Just in general I have anxiety anytime I have to make a meal so the stress is tolling.”
- Emmy, 17
What’s something you wish others would know who are not impacted with an eating disorder?
“I wish they knew it’s an actual disorder. A lot of people will say “just eat it’s not that hard.” But for someone w a restrictive ED it’s the hardest thing in the world. Our brain is in a constant struggle and when I started to recover, eating was awful. I was so worried about what I was eating and my ED brain would start to tell me that I was worthless and incapable of doing anything right. I also wish they knew binge eating is just as bad a disorder as the more popularized anorexia and bulimia. And that not everyone with an ED looks emaciated and is deathly skinny. I maintained a normal weight throughout but that doesn’t mean I wasn’t struggling and suffering from malnutrition.”
- Maddie, 17
“The simplest of words, no matter how small, will still push somebody to the extreme and have an impact on them. No matter if the comment you made wasn’t meant to be hurtful or you didn’t mean for that person to take it in whatever way you said it. EDs are unbelievably competitive, more than I think the average person knows. And when you have a constant drive, nothing a person can say or do will stop you. I don’t care if there's a risk of me literally passing out or collapsing suddenly and being sent to the hospital. That’s a risk I’m willing to take to get the results I want. Because if it works for that person and they got results it should work for me right?”
- anonymous
“Eating disorders are not just about not eating or purging. My ED is binge eating and it’s hard sometimes because when I tell people they don’t validate it as they do with the more common ones. Every kind of ED is valid and not providing enough information on all of them is harmful.” - Emmy, 17
How can those around people with EDs (friends, family, schools) help their loved ones through their circumstance? What are your preferences?
“I usually like to work through my problems alone so for me what helps is them just being supportive and understanding. I don’t talk about it a lot but when I do I like it when they just listen and ask how they can help, because it’s different for everyone. For me distraction is a big thing. Like if I’m going out with friends and we’re gonna eat I like when they keep me distracted and talking so i can’t really think about what i’m eating. Also never comment on my body. Like saying “you look healthy” is automatically seen as “I’m fat” and saying “you look skinny” only reinforces the ED behaviors because I’m “succeeding.”
- Maddie, 17
“Honestly I wish I could give you the perfect answer of how to get the people around you to help. You need to have a good support system and you need to have people who, although they don’t understand exactly what you’re going through, they are still there supporting you and helping you get better. A couple of them would “force” me to eat whenever we hung out not aggressively but they would purposely stop off somewhere with food so we could eat because they knew I wasn’t actually eating. They knew that if they were present and ate with me that I would eat. As much as I want to say there’s things schools can do, I don’t know if I can. Because it’s not like they can force us to eat and the thing is there’s so many different types of eating disorders and just educating us on them isn’t going to do anything all that life changing, especially if somebody is already having that problem. All that is going to do is make them feel singled out and make them feel guilty and worse about themselves and quite frankly probably give them more ideas and push them to go a lot farther than they should be. Honestly for me nothing was going to change unless I wanted it to. I had to be the one who wanted to get better. I had to push myself to get over my fear. And by fear I mean I would literally feel so guilty if I had any type of “junk food.” I had to learn that it was OK and that having “junk food” is better than not eating. My “junk food” wasn’t just candies and chips and chocolate, it was bread, potatoes, anything dairy. I couldn’t even get myself to eat eggs. No juice no pop no tea no hot chocolate I only drink water. It was up to me to want to change my mindset and get out of the situation I was in. If the person who’s dealing with this problem isn't interested in making a change nothing will happen. I’m not saying it’s easy, I still sometimes fall back and don’t eat at all. And honestly those days are really difficult and I bully myself for it because I know how stupid that is. My recommendation is surrounding yourself with people who want you to get better, no matter how big or small of a group that might be. This person or group of people will be with you every step of the way and help you break your habits. But the first step to any of this, is you have to be ready to make that commitment and make that promise to yourself because if you don’t believe in yourself in the first place, no one else will.”
- anonymous
“I would say researching the type of ED they have and understanding why we eat the way we do. Also not pointing out and criticizing while we are trying to get better or eating properly. Or asking how they can help. Knowing that you’re in a safe environment is the best thing you could do to help.”
- Emmy, 17
How to help
Friends and family can significantly impact encouraging loved ones with eating disorders/body image to seek help. Whether they are unaware that there is a problem, are afraid or ashamed to seek help, or are uncertain about giving up their concerning behaviours, many people find it challenging to seek help.
If you are concerned about the eating habits, weight, or body image of someone you care about, it is understandable that this may be a challenging and scary time. It's not always easy to discuss eating concerns, especially with someone you are close to. However, you are doing a great thing by looking for more information. It's essential to reach out and make sure those struggling have a healthy and positive support system.
Here are some tips to support your loved ones if they struggle with an eating disorder:
Acknowledge to your loved one that they are not to blame.
Recognise how difficult the illness is for your loved one.
Educate yourself about eating disorders where you can.
Ask your loved one how they are feeling and what they are thinking, rather than making assumptions.
Avoid discussing weight, shape, food, and diets in front of your loved one, and model a balanced relationship with your own food and exercise.
Remind yourself that things can change and reassure your loved one that recovery is possible.
Ask your loved one what you can do to help. Your loved one may respond that you can just “leave them alone” or that you can’t do anything to help, so here it can be helpful to remind them you can hear their distress and how difficult things are, and you are there if they need you.
Recognise any ‘accommodating or enabling behaviours’. Behaviours that you do to help reduce your loved one’s distress from the eating disorder.
References
About. (n.d.). Retrieved February 08, 2021, from https://nedic.ca/about/
Bulimia nervosa. (2018, May 10). Retrieved February 08, 2021, from https://www.mayoclinic.org/diseases-conditions/bulimia/symptoms-causes/syc-20353615
Eating disorders: About more than food. (n.d.). Retrieved February 08, 2021, from https://www.nimh.nih.gov/health/publications/eating-disorders/index.shtml
How to help a loved one. (2018, July 31). Retrieved February 08, 2021, from https://www.nationaleatingdisorders.org/learn/help/caregivers
Melinda. (2020, September). Helping someone with an eating disorder. Retrieved February 08, 2021, from https://www.helpguide.org/articles/eating-disorders/helping-someone-with-an-eating-disorder.htm
Petre, A. (2019, October 30). 6 Common Types of Eating Disorders (and Their Symptoms). Retrieved February 08, 2021, from https://www.healthline.com/nutrition/common-eating-disorders#causes
Tips for supporting somebody with an eating disorder. (n.d.). Retrieved February 08, 2021, from https://www.beateatingdisorders.org.uk/supporting-someone/supporting-somebody
Types of eating disorders. (2018, February 20). Retrieved February 08, 2021, from https://www.freedeatingdisorders.org/patient-family-support/types-of-eating-disorders/
Types of eating disorders. (n.d.). Retrieved February 08, 2021, from https://adaa.org/eating-disorders/types-of-eating-disorders
What are eating disorders? (n.d.). Retrieved February 08, 2021, from https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders
Article author: Alizeh Qaiser
Article editors: Sherilyn Wen, Maria Giroux