What is an Eating Disorder?

Eating disorders are classified as mental illnesses, which can be complex and potentially life-threatening depending on the severity. These disorders are marked by certain thoughts and attitudes regarding good, eating, body image, as well as behavioral changes. They can be found in anyone, regardless of age, weight, shape, gender, sexuality, culture, or socioeconomic status1.

Something important to note, especially for loved ones who may not understand the reasoning behind the individual’s actions, is that these disorders are not simply about unhealthy habits related to food. At the core of these disorders are attempts to deal with emotional problems. Individuals with eating disorders utilize food in one way or another to deal with their uncomfortable emotions2.

Impacts of Eating Disorders

Eating disorders have been linked to severe medical and psychological problems. Suicide is particularly a major cause of mortality for individuals with eating disorders, with those suffering from anorexia nervosa being 31 times more likely to commit suicide that the general population. Individuals with bulimia nervosa are 7.5 times more likely than the general population to attempt suicide. The impacts of the eating disorder often affect more than just the individual themselves though. Family and social supports of the person can be affected by factors such as financial commitments and conflict within interpersonal relationships. The mortality rate for individuals with eating disorders is around six times higher than the general population1.

Types of Eating Disorders

Anorexia

Anorexia involves the individuals starving themselves out of fear of becoming overweight. These people may even be underweight, yet they never believe they are ‘thin’ enough. These individuals may severely restrict their calorie intake, become obsessive with exercise, utilize diet pills, or purge their food.

Bulimia

Bulimia involves the person going through a cycle of binge eating followed by purging. These people have episodes of out-of-control binge eating, which then leads to purging themselves of the excess calories. These individuals may vomit, exercise excessively, fast, or take laxatives, in order to avoid gaining weight.

Binge Eating Disorder

Those dealing with Binge Eating disorder overeat compulsively, often consuming thousands of calories in short periods of time. Despite feeling shame and guilt over these events, they feel unable to control their ability to stop eating, even when feeling uncomfortably full. These episodes are oftentimes done in secret and if confronted they may try to hide or lie about their actions2.

Warning Signs of Eating Disorders

It is important to recognize that many people deal with self-esteem issues related to their weight or appearance. However, there is a definite difference between self-consciousness and eating disorders. There are different warning signs for: restricting food or dieting; bingeing; purging; and distorted body image/altered appearance.

Restricting Food or Dieting

  • Eating small portions, specific foods with low-calories, banning entire categories of food, such as carbs or fat.
  • Counting calories obsessively, requiring the need to read food labels before eating, and weighing out portions.
  • Restrictive rituals involving food, such as rearranging food on the plate or cutting/chewing food a disproportionate amount.
  • Excessively making excuses to avoid meals or situations that involve food. For example: saying their stomach is upset, they are not hungry, or ate a big meal earlier.
  • Taking dietary pills, stimulants such as Adderall or Ritalin, or illegal drugs, such as speed, crystal meth, etc.

Bingeing

  • Hoarding/hiding stashes of food, such as junk food or sweets.
  • Secrecy and isolation regarding food; eating a normal amount around others, while bingeing later in privacy.
  • Excessive amounts of empty food packages and wrappers, possibly found hidden at the bottom of trash cans.
  • Disappearances of large amounts of food in incredibly short periods of time.

Purging

  • Dismissing themselves directly following a meal or making frequent trips to the bathroom.
  • Showering, bathing, or running water after eating to hide the sound of themselves purging.
  • Taking laxatives, enemas, or diuretics.
  • Fasting or compulsive exercising, specifically following eating.
  • Discolored teeth.
  • Frequently complaining of sore throat, upset stomach, diarrhea, or constipation.
  • Taking breath mints, using mouthwash, or putting on perfume excessively in order to disguise the smell of vomit.

Distorted Body Image/Altered Appearance

  • Preoccupation with body or weight; ex: weigh-ins constantly, inspecting and criticizing their body, and spending long periods of time in front of the mirror.
  • Wearing multiple layers or baggy clothing in order to hide weight.
  • Frequent comments about feeling overweight or fat, as well as fears of weight gain.
  • Significant weight loss, rapid weight gain, or consistent fluctuation of weight2.

How to Talk to Someone about Concerns regarding their Eating Disorder

  1. Educate Yourself: This may involve reading books or articles regarding eating disorders, as well as understanding the in’s and out’s of the particular disorder your loved one is experiencing. Ensuring that you know the differences between facts and myths regarding these disorders can show that you care, as well as allow for you to thoughtfully educate them on any inaccuracies that may be fueling their distorted thoughts.
  2. Pick an appropriate time/place: It is important not to make the individual feel like their personal business is being laid out in front of others. Make sure you talk to them about this subject in private, as well as in a circumstance where you can discuss your concerns without being rushed or interrupted.
  3. Plan out what to say: When going into a serious conversation, it can be nerve-wracking to know what to say and what not to say. If you take time ahead to plan out what you would like to say, possibly even coming up with bullet points you would like to cover, this can allow for a more productive conversation and may alleviate some anxiety on your own part
  4. Explain your concern and reasoning: Be honest with the person regarding why you are concerned. Use ‘I’ statements that can help to show what you are observing from your own standpoint. This can show you are coming from a place of worry, rather than coming off as accusatory.
  5. Prepare yourself for resistance and denial: Understand that for someone with an eating disorder, their thoughts may be incredibly skewed on the subject. Many people may be in denial about this being a problem or feel as though they are being judged. Know going into the conversation that they may resist what you have to say and may even become upset with you. It is important to recognize that this potential reaction is not a reason to avoid the conversation, but rather, know going into it that this may be the outcome.
  6. Avoid making promises: It is possible that for individuals who are hiding their eating disorder, that they may ask loved ones who figure this out not to tell anyone. While it may be tempting in that moment to agree to keep this information private, it is important not to make these kinds of promises. Keep in mind that there could come a time where it is necessary to tell someone about what they are doing in order to make sure they are safe. Eating disorders can be deadly, therefore, they have to be taken seriously.
  7. Question their reasons for change: Eating disorders may involve a desire for their body to look a certain way. It can help to question if there is a reason for this person is trying to change their body image in this way. This could be due to scrutiny from someone else, such as friends or family who are making comments regarding the persons weight or appearance. It also may not have to do with body image at all, but could in fact be related to other factors, such as a stressful home or work environment. Helping to find what is triggering the behaviors can assist in finding healthy alternatives that can lead to positive change.
  8. Be patient and supportive: People who feel cornered by a problem may get defensive or entirely avoidant of the issue. If you notice that they are pulling away, do not be afraid to keep trying. It may take time for them to open up about what is happening, however, showing you are there for them and have concern can help them to see their actions are impacting others as well2.

Treatment for Eating Disorders

Part of what loved ones can do for those suffering from eating disorders is to encourage them to seek treatment. There are three main treatment modalities, many times used in combination with one another: medical treatment, nutritional counseling, and therapy.

Medical Treatment

It is imperative to first and foremost treat any underlying health conditions. Depending on the individual, hospitalization or residential treatment may be necessary for those who are incredibly malnourished, dealing with medical complications, suffering from severe depression or suicidal ideations, or those resistant to treatment. For those who do not meet these criteria, outpatient treatment may be a more suitable option.

Nutritional Counseling

Nutritionist and dieticians may be able to assist those with eating disorders by designing appropriate meal plans, setting dietary goals, and helping them to reach/maintain a healthy weight. The nutritionist may also be able to provide education to the individual regarding proper nutrition.

Therapy

Therapy is necessary in order to treat an eating disorder. The goals of therapy involve identifying negative or distorted thoughts/feelings, which relate to the eating behaviors. These thoughts/feelings can then be replaced with healthier attitudes related to eating and body image. Another goal of therapy is to teach the person how to deal with unpleasant emotions, stress, and interpersonal relationship difficulties in a productive way2.

Supporting a Loved One in Recovery

Learn about Eating Disorders

By showing your loved one that you have done your research regarding what they are going through, you are able to understand the facts regarding these disorders, such as the risks associated, the motives that can be behind them, and triggers for relapse. It also can prevent the individual from giving false information, as well as allowing you to correct any misconceptions they may be carrying around.

Avoid Discussing Body Image, Weight, Dieting

Recognize that for someone with an eating disorder, topics such as body image, weight, and dieting can be triggering. Regardless of the subject of the topic, discussing these topics in front of the person can make them feel self-conscious. This also can give the person false ideas regarding your own values or judgments. Keep in mind this does not only refer to criticisms, but compliments as well. While it may seem like an innocent enough comment to you, statements regarding someone’s weight or image could impact the person greatly.

Avoid Accomodations for the Disorder

It may feel like the best thing to do involves making accomodations to support the person with the eating disorder. However, this can actually reinforce their distorted thoughts. Think of it this way: triggers are always going to be around. The point is not to entirely  eliminate triggers altogether, just to limit them while learning how to cope. It is important that the person learns how to deal with triggering situations, rather than avoiding them altogether. In addition to this point, it is also unfair to others to completely change plans or routines based on this one person. If the routine has been to get family dinner at Sunday nights, that does not need to change.

Ask to be Involved in Treatment

It is more than okay to ask your loved one what you can do to support them through their recovery! It can be imperative for them to have a support system as they learn how to cope in healthy ways. Oftentimes individuals with eating disorders feel shame or guilt. Knowing they have support and are able to confide in others can lift this stigma and allow for that shame to be alleviated3.

Finding Help

If you are attempting to navigate helping a loved one with an eating disorder, or if you yourself are suffering from an eating disorder yourself, our therapists through Online-Therapy.com provide Cognitive Behavioral Therapy (CBT) and can assist in overcoming symptoms of concern.

Our platform offers a complete online therapy toolbox which includes time with a personal therapist who can support you throughout your journey. If this is something you have interest in, we would love to hear from you.

References

Help Guide. Helping Someone with an Eating Disorder. (https://www.helpguide.org/articles/eating-disorders/helping-someone-with-an-eating-disorder.htm). Accessed on 08/10/22.

Monte Nido Treating Eating Disorders. Supporting vs. Enabling: Do’s and Don’ts for Families and Supporters of People in Eating Disorder Recovery. (https://www.montenido.com/eating-disorder-recovery-families-supporters/). Accessed on 08/16/22.

National Eating Disorder Collaboration. What is an Eating Disorder? (https://nedc.com.au/eating-disorders/eating-disorders-explained/the-facts/whats-an-eating-disorder/). Accessed on 08/10/22.