What’s Normal Eating Behavior and What Isn’t?
How can you know if your concern about your diet and your body’s shape is veering toward — or may already be — an eating disorder? You can’t just look in a mirror. Despite what many people think, you don’t have to be female or skinny — or fat — to have an eating disorder. You don’t even have to look as though anything is wrong. “Weight can be an indicator of an eating disorder, but it certainly isn’t the only one,” says Ilene Fishman, a licensed clinical social worker in New York City and Montclair, New Jersey, who spent a decade during her adolescence battling — and eventually recovering from — her own severe anorexia.
Anorexia This disorder is marked by extreme control over calorie intake, an intense fear of gaining weight, and often an unrealistic view of body size and shape.Bulimia Also known as binge-purge syndrome, bulimia is marked by frequent, rapid overeating followed by purging to avoid gaining weight. Purging may include forced vomiting, obsessive exercising, and misuse of laxatives and diuretics.Binge-Eating Disorder This disorder is marked by frequent out-of-control eating in a short amount of time, often until the person feels uncomfortably full. Binge-eating disorder often occurs in secret because of self-disgust and embarrassment. People with this condition don’t purge.
The Disorder Healthcare Providers Often Miss
Healthcare providers often overlook the signs of an eating disorder, and many even say things that could make the disorder worse. Not asking a patient who has lost a significant amount weight about his or her eating habits, and instead praising them for finally getting their weight under control, is one common scenario, says Nanci Pradas, PhD, a psychotherapist in private practice in Bedford, Massachusetts. Many doctors also prescribe medication for depression without considering how a patient’s mental state might be affecting their eating behavior.
Prognosis of Eating Disorders
A person’s prognosis will depend on the type of eating disorder they have, the severity, and other factors. The specific therapies a person requires will depend on the type and severity of the disorder.
Psychotherapy
Psychotherapy, also known as “talk therapy,” helps someone with an eating disorder learn to replace harmful thoughts or habits with healthy ones. Cognitive behavioral therapy (CBT) is a common form of psychotherapy that involves encouraging patients to recognize unhealthy habits and develop problem-solving and coping skills.
Nutrition Counseling
Medical experts can help you develop a healthy eating plan to fit your individual needs.
Medications
Sometimes, medications can help control anxiety, urges, or unhealthy thoughts. Antidepressants and anti-anxiety drugs may be given to someone who struggles with an eating disorder.
Hospitalization
People that develop serious health problems due to an eating disorder may require hospitalization. Additionally, some clinics offer intensive, in-patient treatment programs.
Alternative and Complementary Therapies
Prevention of Eating Disorders
Learning about the signs, symptoms, and risksAvoiding crash diets and unhealthy weight loss behaviorsAvoiding negative self-talk and learning to appreciate the body’s functionalitySeeking help if behaviors become problematic
According to NEDA, eating disorders have the highest mortality rate of any psychiatric illness. An estimated 20 percent of people with eating disorders eventually die from complications such as irregular or very low heartbeat (arrhythmia), sudden cardiac arrest, severe liver disease, or suicide. Even those who survive may face serious health issues, including but not limited to:
Irreversible bone lossMuscle loss and weakness, including in the heart muscleAnemiaSevere dehydration, which can lead to kidney failureDry skin and hair lossSlowed digestion (gastroparesis)Fainting, fatigue, and overall weaknessMenstrual irregularities or loss of libidoDepression
But that has started to change in recent years. More and more celebrities are stepping forward to reveal the toll that the culture of thinness has taken on them, helping to increase awareness about eating disorders and reduce the stigma. Among them are:
Gabourey Sidibe The Oscar-nominated star of Precious and American Horror Story: Apocalypse vividly describes how she used bulimia to cope with depression in her memoir This Is Just My Face: Try Not to Stare. “My emotions were out of control, and all I could do was cry about it for hours,” she wrote. “One day, I cried so long and hard that I started vomiting. When I was done, I wasn’t crying anymore. I wasn’t even thinking about what had made me cry to begin with. I felt empty, which was a great thing — before this, I’d felt too full of emotions. … I wasn’t even trying to lose weight — that’s not the way it works. I was trying to stop myself from crying.”Kesha In an interview in Vogue, the pop star recalled what led her to seek in-patient treatment for bulimia at Timberline Knolls Residential Treatment Center in Lemont, Illinois, in 2014. “There was a lot of not eating — and I started thinking [that] being hungry to the point of feeling almost faint was a positive thing. The worse it got, the more positive feedback I was getting. Inside I was really unhappy, but outside, people were like, ‘Wow, you look great.’”Lily Collins Collins suffered with anorexia and bulimia as a teenager, then risked a relapse years later by losing a significant amount of weight to play a character with anorexia in the movie To the Bone. In 2017, she told Collider that she chose to play the role to bring awareness to eating disorders. “This was something that I needed to talk about and bring to the attention of more people. … It is still considered quite taboo to talk about, and yet it’s becoming more and more prevalent within today’s society, and not just with women.”
National Eating Disorder AssociationNational Association of Anorexia Nervosa and Associated DisordersThe Alliance for Eating Disorders AwarenessOrthorexia
Additional reporting by Julie Marks.
