The Surprisingly Diverse Eating Disorder Community by Kathryn Hammel
One of the amazing things about working with clients is being able to see them come back to themselves. As the layers of the eating disorder are discarded the individual starts to move back into their own. A brightness can return with all of the amazing connections the individual makes now that the eating disorder is being shed. It’s especially at this point that the individual can offer such a great perspective on recovery and their own eating disorder. Below is a piece written by someone who did just that: Moved into recovery and was able to speak so well on the topic. This blog does such a great job reminding us that eating disorders come in many shapes and sizes and that all individuals deserve to get better. Although this writer is not an eating disorder treatment professional she writes beautifully on the topic. I hope you enjoy Kathryn’s words as much as I do!
-Lisa Carroll, MS, RD, LDN
For anyone who has ever struggled with eating disorders (ED), you understand the desire to restrict. You want to be the thinnest. The lightest. The sickest. With unrealistic restrictive ED stereotypes placed on physicality, this desire grows stronger as you feel separated from your illness and distant from your goals, urging you to further worsen both your mental and physical health. For those of you who are unfamiliar with EDs, these stereotypes can alter your view of this mental illness, causing you to forget its severity. That all being said ,restrictive eating disorders hold no specific physical standard;
EDs may come in any form for any person.
Many people can name the two most common types of restrictive EDs: anorexia nervosa, which is restriction through little to no eating, and bulimia nervosa, which involves restriction through binging and purging. In your head, picture what these definitions look like. Did an image of an underweight teen girl appear? If so, that is understandable; that is even the first image the internet displays when you search for the word “anorexia.” Even though some EDs can look like this, not all do.
Many forget to even consider the fact that males suffer from EDs. According to the National Centre for Eating Disorders, “Males may account for approx 1-5% of patients with anorexia nervosa… Males account for 5-10% of patients with Bulimia Nervosa” (National Centre for Eating Disorders). Even though this number may look small to some, it still represents real people who are battling this illness. Regardless, this number, combined with the fact that male EDs tend to look different than “typical” ones, contributes to males’ lack of representation in society for EDs. In an interview conducted with Lisa Carroll, MS, RD, LDN, a dietitian and ED specialist at Lotus Therapy Group, I asked what group she thought was least represented in terms of EDs, to which she replied, “I think males. There are a lot more males that struggle with eating disorders… There is exercise bulimia which a lot of males do where they’re purging calories through exercising” (Carroll). Though other genders do take part in exercise bulimia, the majority of male EDs, specifically, resemble this. Of these male victims of exercise bulimia, many do not understand that what they are experiencing is an illness. They either want to better themselves or reach certain physical results, so they push their bodies past the limit. This dangerous “hard work” is rarely talked about because of the no-excuse mindset in exercisers; they do not want to feel guilty for not giving all they have to offer. Not to mention, if results are met, males would not want to share how physically and emotionally draining their ED journey was. Instead, they are going to boast about their fitness lifestyle of never taking a day off, which is actually a common ED mindset. Because of this praise and transmission of unhealthy thoughts, EDs become more frequent, and fewer males are encouraged to speak out against or acknowledge their EDs. Even though males may not look like the typical ED patient given their gender and possibly muscular physique, they still experience this illness and deserve recognition.
When it comes to other uncontrollable factors such as age, EDs continue to not hold back. Liza Torborg of Mayo Clinic Communications notes, “Societal pressures to be thin are linked to eating disorders in older adults just as they are in adolescents and younger adults. These feelings may be compounded by factors such as excessive life stress, menopause concerns and fear over age-related appearance changes” (Torborg). Take older women, for example, though their ED can be a result of aging or menopause as Torborg explained, these factors may also just be the reason people abstain from getting well. Even though the sufferer is the one who experiences the sickness, the job to recognize ED behavior should belong to the people around them. Let’s say an older woman seems to be developing odd eating patterns, mood swings, and an irregular period: all symptoms of a common restrictive ED. This woman’s family and friends will not think of an ED, though, they will think of menopause.Because bodies – especially women’s bodies – naturally change as they undergo puberty or grow into late adulthood, EDs become overlooked and unrecognizable. The person can be seven or eighty-two; it does not matter.
If ED behaviors are presented, they must be acknowledged.
Without proper representation, males, people of mixed ages, people differing in sexuality, and any other ED minority struggle to find help. Prevention & Treatment Resource Press, an infographic company, markets a pamphlet titled Healthy Directions: Eating Disorders Pamphlet. This pamphlet does include text, but the eye-catching images really sell their message. Only one out of eight images features a male, while the others include young, white, and underweight girls (Prevention & Treatment Resource Press). Being that pamphlets like this are some of the most accessible ways to receive information on EDs, it should be a priority that they are catered to a variety of people. Without proper treatment resources, these minorities feel even more isolated in this isolating sickness, causing it to be more difficult to speak up and ask for help. If the ED makes it a priority to affect people from all backgrounds, so should we. Not giving recognition to all afflicted with EDs will only continue the cycle of struggling as fewer will be able to acknowledge the fact that they have a problem, and fewer outsiders will be encouraged to pay attention to ED behaviors in different types of people.
Characteristics like age and gender show how EDs are surprisingly diverse, but one factor that every ED sufferer shares is the need to lose weight. In terms of the disorder itself, weight is just a symptom. Health professionals throughout the country base mental health diagnoses on the American Psychiatric Association’s test The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. In listing the criteria for this test, Dr. Kevin Flemming writes, “For anorexia nervosa to be diagnosed, a number of criteria need to be met… The sufferer’s weight is significantly low, less than the minimal normal or expected body mass…The sufferer displays an intense fear of gaining weight… The sufferer displays a distorted view of their body weight and shape…” (Flemming). Even though these are only the criteria for anorexia nervosa, the same goes for other restrictive EDs in the fact that their diagnoses revolve around behavioral issues. Unprofessionals may perceive these criteria as if the patient has to be underweight in order to receive a diagnosis, but this could not be further from the truth. The patient should just display a noticeable drop in their own weight, so doctors know to what extent the mental disorder affected them. This weight is used by doctors of both mental and physical health to keep track of the patient’s condition in preventing iron deficiencies, low bone densities, or organ issues, not as a way to classify if someone is skinny enough to have an ED. People who are unfamiliar with EDs – and this can even include those who practice medicine – have no place to label whether or not someone has an ED since they do not understand each sufferer’s thought process. You cannot just put a person on a scale to know if they have an ED; you have to be able to look into their mind, requiring a much more thorough analysis.
Though I have just explained how weight holds little significance in diagnosing EDs, I must emphasize how much it affects those who do suffer. Since many sufferers do not have the conventional look or weight of an ED patient, they either become too scared to ask for help or are misdiagnosed by professionals who do not fully understand EDs. During the interview, Carroll also states, “A doctor might know of eating disorders, might even know how to diagnose eating disorders using the DSM-5, but they might not really know a lot about them… they’re not going to say that this (an ED sufferer with a BMI of normal or overweight) is an eating disorder” (Carroll). This upsetting yet common practice not only leaves sufferers without the professional help they need, but it also fuels their EDs even more. In their eyes, the doctor has told them that they are not small enough – that there is still more work to be done. All the ED wants to do is restrict, and because these professionals are misinformed, the ED wins. If and when that person does start to see physical side effects because of this experience, they will not want to seek out professional help again. Carroll went on to say, “Another big part about the stigma is that when someone does not feel that their weight is low enough, they might not think that they have an eating disorder… they think that internally it is not a problem” (Carroll). Invalidating an ED, whether it be done by a professional, another person, or even ourselves, just allows the sickness to progress. During my own ED, I told myself that I was fine, but little did I know that was the ED speaking. I was not medically underweight, so I had no place to complain. Then, I quickly saw myself begin to suffer from stress fractures, self-criticism, and isolation. Even though society preaches to ask for help, they make it such an unrealistic concept with their stigmas and impossible standards. It is time to ditch weight stigmas and embrace the ED’s unlimited diversity.
Maybe we stigmatize out of ignorant generalizations, or maybe we do so out of our own insecurities. Regardless, we must start bringing attention to all who suffer from EDs, not just to the clearly unhealthy bodies that captivate and shock us. A disorder of the mind deserves a proper recovery, and even though we as a society cannot heal everyone, we can at least create an environment where each affected person receives recognition, care, and most importantly, kindness.
