National Eating Disorders Week is this week in the United States, from February 25-March 3. National surveys estimate that 20 million women and 10 million men in America will have an eating disorder at some point in their lives. While many eating disorders occur during adolescence, data shows increased cases in younger children and older adults than ever before.
COME AS YOU ARE
This years theme for National Eating Disorders Week is “Come As You Are”. In particular, this message encourages people at all stages of body acceptance, body love and eating disorder recovery to share their story, and that their stories are valid, even if not stereotypical. Connection is a key to recovery, and knowing that you are not alone in this world, or in your experience, can make all the difference.
WHAT IS AN EATING DISORDER?
An eating disorder is defined by any of a range of psychological disorders characterized by abnormal or disturbed eating habits. Most commonly, we think of Anorexia Nervosa or Bulimia Nervosa, but there are a range of other categorized eating disorders, in addition to a wide array of disordered eating characteristics.
Some of the most common eating disorders as identified by DSM-5 include:
- Persistent restriction of energy intake relative to body weight.
- Intense fear of gaining weight or becoming fat.
- Body dysmorphia
- Would eat huge amounts of food
- Would compensate by purging, or by severely limiting food after, or may use laxatives or abuse diet pills. Extreme exercise is also a form of bulimia.
- Distorted body image
Binge Eating Disorder
- Occurs in the ABSENCE of compensatory behaviors
- Occurs, on average, at least 1x per week for at least 3 months
- Eating rapidly, when not hungry, until uncomfortably full
- Associated with feelings of disgust, depression, guilt and/or shame
Avoidant/ Restrictive Food Intake Disorder (ARFID)
- ARFID is similar to anorexia in that both disorders involve limitations in the amount and/or types of food consumed, but unlike anorexia, ARFID does not involve any distress about body shape or size, or fears of fatness.
- Beyond picky eating, people with ARFID do not consume enough calories or nutrients for proper growth and development, and in adults may lose the ability to maintain basic body function.
Other Specified Feeding or Eating Disorder (OSFED)
According to the DSM-5 criteria, to be diagnosed as having OSFED, a person must present with a feeding or eating behaviors that cause clinically significant distress and impairment in areas of functioning, but do not meet the full criteria for any of the other feeding and eating disorders.
While no one knows for sure what causes eating disorders, a growing consensus suggests that it is a range of biological, psychological, and sociocultural factors.
THE GRAY AREA OF DISORDERED EATING
While some people may fit neatly into one specific category, many people fall within the characteristics of several disorders, as well as those who disordered eating patterns may not represent a full-spectrum eating disorder. Even if someone does not exhibit all the behaviors of a full-blown eating disorder, their disordered eating should still be taken just as seriously.
In fact, the gray area between diet and disordered eating is increasingly murky. Two other areas where disordered eating is identified includes:
- Cutting out an increasing number of food groups from ones diet (for example: all carbs, all fat, all dairy, all animal product)
- Increased concern about the health of ingredients, and only being able to eat foods that are deemed “healthy”
- Obsession over foods that may be served at upcoming events and related anxiety
- Body image concerns, whether they are present or not
- Using exercise as punishment for what you ate, instead of a celebration of what your body can do
- Exercise that significantly interferes with daily activities, important events, etc
- Intense anxiety or depression if you aren’t able to work out
- Exercise continues despite injury or illness
As with all eating disorders, the sooner the behaviors are addressed, the more likely it is to have a positive outcome.
WHAT DOES SOMEONE WITH AN EATING DISORDER LOOK LIKE?
Here’s the thing… not everyone looks like they have an eating disorder. In fact, someone struggling with an eating disorder generally won’t even display all of the below signs and symptoms at once. Warning signs vary across eating disorder, and it’s still not always a cookie cutter display of a specific disorder.
Here is a general overview of some of the types of behaviors that may indicate a problem:
- Preoccupation on weight loss, dieting, calorie intake or macros, and/or control of food
- Skipping meals or taking small portions of food at regular meals
- Strong shifts in dietary practices (i.e. cutting out entire food groups)
- Withdrawal from usual friends and activities
- Obsession with body size and shape
- Extreme mood swings
- Noticeable fluctuations in weight, both up and down
- GI complaints including constipation, bloating or acid reflux
- Menstrual irregularities
- Dizziness, fainting
- Dry skin and hair, brittle nails
- Dental problems
- …and much, much more
It started with diet pills when I was 16 years old. Xenadrine- a weight loss pill with ephedrine (now banned in the US). At some point during my Junior year of high school, I remember trying to throw up a clementine that I’d eaten for dinner while working a shift at a local grocery store.
My senior year of high school, I didn’t throw up, but I did live off of SlimFast bars and considered myself “healthy” during that time. My eating was repetitive, but certainly not ‘healthy’.
A few examples of meals I frequently ate:
- A SlimFast bar and green apple (for breakfast and/or lunch)
- A blueberry bagel with cream cheese and big chocolate chip cookie, guzzled down with a blue Powerade. Sometimes just the cookie and Powerade. Sometimes just the bagel and Powerade.
- One day, I went through the drive-thru at McDonald’s several times, picking up a large Diet Coke each time I went through. That’s alI had that day.
- Another day, I remember being proud that all I ate all day long was a 12-inch sub from Subway.
In college and years beyond, I had mostly binging, or binging and purging tendencies. Restricting calories was too difficult, although I certainly dabbled in that. I learned that 100-calorie oatmeal (with one packet of Splenda), 40-calorie cans of green beans, and celery with fat-free Italian dressing were my favorite foods when I was trying to “eat well” (read: as few calories as possible)… and of course the usual SlimFast bars and green apples. I even eventually added Fiber One bars into my regular diet. I actually enjoyed the feeling of being hungry. Standing up and getting dizzy, or having a headache from dehydration or lack of proper nutrition didn’t phase me in the slightest.
When I’d cave, and begin a binging and purging period, I quickly learned which foods I could easily throw up and would eat those foods often. I also learned which foods hurt to throw up and avoided those. I identified a two hour eating window and would eat as much as I could during that time period before making myself throw up as much of it as I could.
Sometimes I’d throw up once in two or three weeks. Other times, I’d throw up twice in one day for several days in a row. There were plenty of “better” periods, but there were definitely bad periods. I wasn’t in control. I had a lack of control.
While the effects I experienced weren’t nearly as bad as they could have been, I still faced effects of my disordered eating:
- I cracked the skin at the crease of my mouth from opening my mouth as wide as possible to throw up.
- I left knuckles raw or blistered from inducing vomiting.
- Although I never put two and two together, my hair was dry and brittle; I had skin issues; and my nails were brittle and always cracking.
- My face and throat often felt puffy and swollen.
- I felt “foggy” and tired.
- I avoided friends; instead spending time at my home, alone, where I frequently spiraled into another cycle.
The chance for recovery increases the sooner that an eating disorder is identified and a treatment plan is put into place. In general, treating an eating disorder involves a combination of psychological and nutritional counseling, done in an inpatient or outpatient setting. Treatment is considered most effective before the disorder becomes chronic, but even people with long-standing disorders can and do recover.
Personally, I was very lucky to be able to recover without any inpatient or outpatient treatment, but I am not the norm, and to this day still struggle with aspects of any eating disorder that manifested in my youth. People with eating disorders often have perfectionist tendencies- it comes with the control of your eating. It can manifest in other areas of your life by bashing yourself when you let yourself (or someone) down.
While my relationship with food screams a different story than it did for a decade, I will always need to check in with myself, and make sure that my habits aren’t toeing a gray area that could become dangerous.
If you, or someone you know, is suffering from an eating disorder or any form of disordered eating, please know that there are options. The NEDA Hotline is available for support, resources, and treatment options at (800) 931-2237.