This week is National Eating Disorders Awareness Week! Okay so there is nothing exciting about eating disorders BUT there are plenty of reasons why awareness is important, mainly the fact that eating disorders are one of the deadliest mental illnesses. So here you go, a little ED Awareness from my experience working with individuals with eating disorders over the last year.
In school, we (dietitians) are taught very little about eating disorders beyond the basics of the difference between Anorexia and Bulimia Nervosa and how to refeed someone who is underweight. So basically nothing. Dietitians are typically terrified of working with individuals with eating disorders because it seems so difficult to understand. Lets start with the basics. Below is the diagnostic criteria found in the DSM-5 (the manual of all mental disorders used by psych professionals) for the three main types of eating disorders.
Anorexia Nervosa
- Restriction of energy intake relative to requirements leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
- Intense fear of gaining weight or becoming fat, even though underweight.
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or the denial of the seriousness of the current low body weight.
Bulimia Nervosa
- Recurrent episodes of binge eating characterized by BOTH of the following:
- Eating in a discrete amount of time (within a 2 hour period)large amounts of food.
- Sense of lack of control over eating during an episode.
- Recurrent inappropriate compensatory behavior in order to prevent weight gain (purging).
- The binge eating and compensatory behaviors both occur, on average, at least once a week for three months.
- Self-evaluation is unduly influenced by body shape and weight.
- The disturbance does not occur exclusively during episodes of anorexia nervosa.
Binge Eating Disorder
- Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
- a sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)
- The binge-eating episodes are associated with three (or more) of the following:
- eating much more rapidly than normal
- eating until feeling uncomfortably full
- eating large amounts of food when not feeling physically hungry
- eating alone because of feeling embarrassed by how much one is eating
- feeling disgusted with oneself, depressed, or very guilty afterwards
- Marked distress regarding binge eating is present.
- The binge eating occurs, on average, at least once a week for three months.
- The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.
I think what will be most surprising is that all of these disorders have one thing in common- they actually have nothing to do with food. Eating disorder symptoms of restricting, binging, and purging are all coping mechanisms for something else. Let me repeat that. Eating disorders have nothing to do with food. So simply telling someone with anorexia to just eat a burger or binge eating disorder to just go on a diet is a freaking joke, it doesn’t work like that. I know that this part is really difficult to understand. It’s hard to imagine that someone who obsesses over calories or consumes large portions of food in one sitting isn’t actually focused on food but that is the truth. An eating disorder is a coping mechanism. It gets confusing because they will constantly bring the focus back to food or weight but that is in an effort to avoid the other problems that are going on. And to be honest, sometimes the person is so sick that they don’t even realize other things are going on. This is what happens to the body during starvation. Our body is smart and will try to figure out a way to obtain more food. This can manifest itself in obsessing even more about food, cooking and feeding other people, watching cooking shows, or deciding to go to college for something like culinary arts or nutrition.
It’s an extremely complex disease and each person’s experience with the disease is different. This article, 20 Things Someone With an Eating Disorder Wishes They Could Tell You, is helpful to understand how the individual is feeling. The other thing that is helpful is not assuming and flat out asking. If you know someone has an eating disorder and you’re sitting with them at a meal ask them what they are feeling. Don’t try to argue with them or convince them out of that feeling. Offer validation and encouragement (Ex: I know this feels really scary to you right now but I’ve seen you do scary things before and I know you can do this.) When you aren’t sitting down to a meal ask them what helps to get them through a meal. For someone with anorexia it may be distraction with conversation, TV, or music whereas someone with binge eating disorder may find it more helpful to be mindful during meal times and really focus on enjoying the food. Someone with bulimia could be either or both, depending on the situation. Just ask.
The biggest thing is to do something about it as early as possible. The earlier an eating disorder is recognized and that individual receives treatment the better their chances for recovery. There is a 50% relapse rate with eating disorder symptoms. 50%, dudes. Trust me, you don’t want a loved one to suffer with terrible illness for a lifetime. Early intervention is the key.
Signs you or someone else has an eating disorders:
The list of signs is different depending on the type of eating disorder but you can find a lot more information here. If you feel like a loved one has some strange behaviors around food or voices a lot of concerns around food and weight peruse the list a bit.
What to do about it:
Say something. Eating disorder thoughts are likely already telling the person that no one cares about them and keeping quiet just reinforces those thoughts. I regularly see clients with eating disorders in my private practice and you can sign up for a consultation by emailing us here. In addition to connecting this individual to a dietitian they should also be connected with a primary care physician and a therapist specializing in the treatment of eating disorders. More resources for helping individuals with eating disorders can be found below.
Resources:
National Eating Disorders Association NEDA
Bulimia Nervosa Resource Guide for Family and Friends
The National Association for Males with Eating Disorders, Inc.
Families Empowered and Supporting Treatment of Eating Disorders (F.E.A.S.T.)