When you hear this phrase, “a person with an eating disorder,” what type of “person” comes to mind? Seriously. Close your eyes right now for five seconds and imagine this person before you continue reading.
I’m going to take a guess at what you imagined. There’s a good chance you imagined a young, teenage girl, maybe somewhere around thirteen to sixteen years old. She’s probably pretty thin. Maybe too thin. She likely doesn’t eat much and is always dieting. I would also bet she’s white and moderately to highly affluent. Was I right? I’m hoping I wasn’t, but I imagine for some of you, my description was pretty spot-on.
Why is this? Why does our society have such a stereotype for people with eating disorders? There are many factors that have contributed to this stereotype, but one major contributor has to do with the depiction of eating disorders in our media. In the 1990’s, the media began to highlight eating disorders as a real concern. Movies, TV shows, articles, and books began to shed light on this life-threatening illness. While this was helpful in increasing awareness about eating disorders, the stories and characters depicted were predominately white, teenage, affluent girls who were struggling with Anorexia Nervosa. All of a sudden, the public began to associate eating disorders with this narrow population. Unfortunately, this association has stuck, even though it’s not entirely accurate. Eating disorders do not discriminate. They affect all genders, orientations, races, socioeconomic levels, body types, and ages. They also include various behaviors with food, not just restriction. Let’s start to break down these stereotypes by looking at five eating disorder myths and what researchers have discovered.
Myth #1: Anorexia is the only eating disorder. Restriction is the only eating disorder behavior.
This is one of the most common misconceptions. As mentioned above, when people think about eating disorders, they often think of someone who doesn’t eat or eats very little. Surprising to many people, Binge Eating Disorder (BED) is the most common eating disorder and has an estimated lifetime prevalence rate of .2% – 3.5% for females and .9% – 2.0% for males (Stice & Bohon, 2012). BED is more common than breast cancer, HIV, and schizophrenia, and is more than three times more common than Anorexia Nervosa and Bulimia Nervosa combined (National Eating Disorders Association – NEDA). BED is characterized as recurrent and frequent episodes of binge eating, defined as eating an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances AND a sense of lack of control.
In addition to restriction and binge eating, other behaviors go along with eating disorders. These may include: vomiting after eating, laxative abuse, frequent diet pill consumption/abuse, compulsive/obsessive exercise, over-exercise, obsession with clean eating, eliminating foods or food groups, food aversion, chewing and spitting, manipulating insulin, frequent body checking, obsessive calorie counting, obsessive weighing of oneself, and eating rituals, just to name a few. Just because these behaviors exist does not necessarily mean a person has an eating disorder; rather, it’s important to be aware of these various behaviors and use them as red flags to ask more questions. If a person associates only restriction with eating disorders, there’s a good chance he or she will miss warning signs in themselves and loved ones who struggle with other behaviors.
Myth #2: Only females get eating disorders.
This statement is absolutely false. Men DO get eating disorders. Although they are less common than females, males constitute about 25% of all eating disorders (Sweeting et al., 2015). Males represent approximately 11% – 25% of individuals with Anorexia Nervosa, 8% – 25% of Bulimia Nervosa, and 40% of Binge Eating Disorder (NEDA; Sweeting et al., 2015). Moreover, subclinical eating disorder behaviors (i.e., eating disorder behaviors that are not severe/frequent enough to meet diagnostic criteria) are nearly as common among males as they are among females (NEDA).
Recently, more men in the media have opened up about their eating disorders and/or past eating disorder behaviors, including Dennis Quaid (actor), Billy Bob Thornton (actor), Richard Simmons (fitness guru, actor, and comedian), Russel Brand (actor), Elton John (singer), Caleb Followill (singer), Zayn Malik (singer), and Joey Julius (collegiate football player), just to name a few. Again, if your mind took you to thinking all these men had Anorexia Nervosa and restricted, you would be wrong. Some of these men struggled with Anorexia Nervosa; however, several struggled with Bulimia Nervosa and others with Binge Eating Disorder. Learn more about men and eating disorders, including risk factors and warning signs here.
Myth #3: Only teenagers struggle with eating disorders.
Although many eating disorder symptoms and behaviors appear during adolescence, individuals can be impacted by these behaviors and preoccupations with their body and food throughout the lifespan. Researchers and clinicians have reported children as young as seven or eight meeting criteria for an eating disorder diagnosis. Similarly, more studies and anecdotal evidence are highlighting that many adults, even into their late 60s and 70s are struggling with eating disorder symptoms.
Margo Maine, PhD, a well-known clinical psychologist and author in the eating disorder world, shared some ideas as to why older adults may struggle with eating disorders. She offers that some of these older individuals may have struggled since youth and never sought help and/or recovered, some may have recovered and have relapsed, some may have struggled with food and weight for many years but the behaviors have become more severe over time, and finally, some, after facing challenges of adulthood (e.g., pregnancy, divorce, death, empty-nesting), develop rituals related to diet and exercise which progress into a full-blown eating disorder. Unfortunately, there is a lack of research to know exactly what percentage of the population struggles with eating disorders in the older adult population; however, researchers found eating disorder symptoms in 13% of women ages 50 and above over a five-year time period (Gagne et al., 2012).
Myth #4: Only people in the U.S. and white people get eating disorders.
Believe it or not, eating disorders are not a recent phenomenon. Many people think this is a disorder that has developed due to Western media and cultural values focused on thinness. While these do have an impact, we cannot say they are to blame as the primary cause. Writings and articles have noted examples of females starving themselves for religious reasons during the medieval period (i.e., taking fasting to an extreme to be closer to God), and some even being elevated to sainthood after their death (Davis & Nguyen, 2014).
Race is another harmful stereotype as much of the general public assume only white people are impacted by eating disorders. Unfortunately, even helping professionals and researchers have held this belief, causing the treatment and research to be biased and lacking in this area. Recently, researchers and practitioners have questioned this belief and found the prevalence of eating disorders is similar among Non-Hispanic Whites, Hispanics, African-Americans, and Asians in the United States, with the exception that anorexia nervosa is more common among Non-Hispanic Whites (NEDA).
Myth #5: You can tell by looking at someone if they have an eating disorder and how bad it is.
This eating disorder myth is so prevalent in our society. Even family members and clients themselves fall into this trap of believing this myth. Would you ever tell a family member, “Are you really sure you have cancer? You look healthy. Maybe the doctor was just being dramatic.” Or would you and say, “Wow! You really look like you have dementia.” Of course not! That seems absurd, right? Well, this is exactly what people do with eating disorders; assume one can judge if a person has or does not have this disorder based on their weight, and then make an assumption about how “bad” it is. As a psychologist who has worked with many clients with eating disorders, weight alone does not tell me how “sick” or “healthy” a person is. Although the research is inconclusive, one study reported mortality rates for 1,885 individuals diagnosed with eating disorders over a period of time. They identified crude mortality rates were 4.0% for Anorexia Nervosa, 3.9% for Bulimia Nervosa, and 5.2% for eating disorders not otherwise specified (Crow et al., 2009). These statistics highlight the seriousness of the disorder, regardless of a person’s weight.
As you can see, we have a lot of work to do to combat the incorrect beliefs and assumptions that exist in our society about eating disorders. I challenge you to notice yours and others’ biases and assumptions in this area and question them. Are they accurate? Additionally, if you or someone you know is struggling with disordered eating or an eating disorder, contact Crosswinds Counseling. We can help!
References:
Crow, S.J., Peterson, C.B., Swanson, S.A., Raymond, N.C., Specker, S., Eckert, E.D., & Mitchell, J.E. (2009).
Increased mortality in bulimia nervosa and other eating disorders. American Journal of Psychiatry, 166, 1342 – 1346. doi: 10.1176/appi.ajp.2009.09020247
Davis, A.A., & Mguyen, M. (2014). A case study of Anorexia Nervosa driven by religious sacrifice. Case
Reports in Psychiatry, 2014, 4 pages. doi: 10.1155/2014/512764
Gagne, D.A., Von Holle, A., Brownley, K.A., Runfola, C.D., Hofmeier, S., Branch, K.E., & Bulik, C.M.
(2012). Eating disorder symptoms and weight and shape concerns in a large web-based convenience sample of women ages 50 and above: Results of the gender and body image study. International Journal of Eating Disorders, 45, 832-844. doi: 10.1001/eat.22030
National Eating Disorder Association (NEDA) – https://www.nationaleatingdisorders.org/
Stice, E., & Bohon, C. (2012). Eating Disorders. In Child and Adolescent Psychopathology, 2nd Edition, Theodore Beauchaine & Stephen Linshaw, eds. New York: Wiley.
Sweeting, H., Walker, L., MacLean, A., Patterson, C., Räisänen, U., & Hunt, K. (2015). Prevalence of eating disorders in males: a review of rates reported in academic research and UK mass media. International Journal of Men’s Health, 14(2), 10.3149/jmh.1402.86. http://doi.org/10.3149/jmh.1402.86
