Eating disorder definitions are typically clinical and boring, but the truth is that eating disorders are complex and multi-layered. The people who develop eating disorders are worthy of so much compassion and love. I hope this article brings some color to the conversation and helps you understand eating disorders more clearly.
I’m sharing all my knowledge of decades living with an eating disorder and several years in full recovery. I’ve built on my own experience with many years spent researching and studying eating disorders. And I’ve also interviewed hundreds of professionals who treat eating disorders, people who have eating disorders, and parents who have kids with eating disorders.
From my perspective, the information currently available about eating disorders is clinical, dispassionate, and biased. These rigid clinical diagnoses and behavioral descriptions of eating disorders keep us locked in place. We miss the larger truth of why eating disorders occur and what comprehensive treatment looks like.
What follows is a wholehearted description of how I see eating disorders right now. This is personal but also factual. I’m not going to give you a boring, dispassionate account of the technicalities of eating disorders. Rather, this is an attempt to share the human reasons we suffer. And, hopefully, how we can find our way to recovery.
Remember that each eating disorder is unique. Therefore, this article is just one lens through which to view eating disorders.
What is an eating disorder?
An eating disorder is a set of beliefs and behaviors that disrupt a person’s relationship with food and their body. It is a mental disorder that includes obsessive and compulsive thoughts and behaviors, including*:
- I need to weigh less and eat less
- If I control my weight/body I will be good
- There are good and bad foods
- People who eat/weigh too much are bad
- If I don’t control my weight/body I’m bad
- Eating too little/too much
- Compulsive exercise
- Measuring/counting food
- Following a strict food plan
- Banning major food staples (e.g. carbs, fat, meat)
- Ignoring physical signs of hunger/fullness
- Lying about and hiding disordered food behaviors
*These beliefs and behaviors apply to most eating disorders except ARFID
We live in a disordered eating culture. Therefore, sometimes I think the best way to define an eating disorder is to define the opposite. So here’s my definition of a non-disordered approach to eating and weight:
Someone who does not have an eating disorder believes their body is fine as it is. They trust their hunger and fullness cues. And they follow their appetite rather than a set of rules about what to eat, how much to eat, etc. While they don’t necessarily “love” their body, they accept it and treat it with respect. They pursue their own individual health holistically (body & mind) without weight goals or expectations.
Who gets eating disorders?
The common belief is that eating disorders impact white, wealthy teenage girls. However, we know that eating disorders impact people of all ages, genders, race, and socioeconomic status. Our stereotypes about what eating disorders look like make it harder for both professionals and parents to recognize an eating disorder.
Eating disorders don’t have a single “look.” They may look like a:
- 45-year-old Asian mother who has a successful career and three children. She gains and loses weight each year with the enthusiastic support of everyone around her. Her eating disorder hides in plain sight.
- 16-year old white girl who is a vegetarian, gets straight-A’s, does cross-country running, and is medically underweight. Her doctor has told her she can’t run with the team, so she runs in circles around her bedroom.
- 28-year old Black mother who is food insecure. She struggles to feed her two young children and herself. She is plus-sized and feels constant pressure to lose weight.
- 34-year-old white man who can’t miss a single day of going to the gym. He rarely eats anything other than plain oatmeal, protein shakes, and steamed chicken with vegetables. His rigid lifestyle gives him little time to socialize, and he refuses to meet friends at restaurants.
- 12-year-old Hispanic boy who has autism and has fallen off his growth curve for both height and weight. The list of foods he will eat keeps shrinking, and he’s currently only accepting chicken nuggets from McDonald’s and baby carrots.
- 67-year old white grandmother who maintains her age-24 figure. Her email signature includes “I’m one stomach flu away from my goal weight.” She tells her granddaughters her diet secrets regularly.
- 14-year-old Indian girl who has always been on the chubby side. She learned to purge last year and though it hasn’t helped her lose weight, she can’t stop.
Eating disorders vary, and there is no standard “look.” It’s important that we expand our understanding of eating disorders so we can adequately diagnose and treat everyone who is suffering.
What causes eating disorders?
A combination of biological, psychological, and social factors contribute to eating disorder development.
- Genes appear to play a role in eating disorder development. There is not a single gene recognized as the cause of eating disorders. But there are numerous genes that researchers have identified as common among people who develop mental disorders. This may explain why eating disorders typically show up alongside other disorders like anxiety, depression, substance abuse, etc.
- Epigenetics is a sort of code that triggers genetic activity. A person may have the genes that underlie mental disorders. But researchers agree that genes alone don’t cause mental disorders. Epigenetic triggers come from environmental conditions beginning in utero. They can even pass through generations in a family. It appears that epigenetics can be shaped by trauma, abuse, and neglect (physical and emotional).
- Neuroception is a body-based sensation of being either safe or unsafe. Developed by Dr. Stephen Porges, neuroception means that neural circuits in the body distinguish safety or threat and cue the body to respond physiologically, emotionally, and cognitively. When neuroception senses emotional and physical threats, the body responds with a state of fight, flight, freeze, or shutdown. This impacts every aspect of the physical and emotional experience of being alive. A person who has an eating disorder is often living in a heightened state of threat, sensing danger in their body and mind and seeking comfort and safety in their eating disorder behaviors.
- Anxiety is a common partner to eating disorders. Since it can be hard to spot, it may be helpful to know what anxiety looks like. In its more active form it looks like perfectionism, people-pleasing, and codependency. In its less active form it may look like procrastination, avoidance, and withdrawal. Other signs include chronic shame, stress, and worry.
- Emotional regulation skills are likely protective against eating disorders. Emotional regulation is something children learn from parents beginning in infancy and extending through early adulthood. When adequately developed over time, a person becomes able to self-regulate. Sometimes we miss emotional developmental milestones. When this happens, a person will have trouble self-soothing and responding appropriately to everyday stress and disruption.
- A person who has an eating disorder may believe that their identity – who they are – is based primarily on what they look like and what they do. This belief can lead a person to try and “perform goodness.” When this happens, a false self takes over and the true self is hidden in shame and unworthiness. This can happen when a family and/or society teaches a person that they need to change who they are and how they behave to be loved. Healing takes place when the true self is allowed to emerge and be loved as-is.
- Mental disorders often appear in clusters, and eating disorders are part of a larger psychological ecosystem. Disorders that commonly show up with eating disorders are autism, attention deficit hyperactivity disorder, anxiety, depression, suicidality, self-harm, substance abuse, and obsessive compulsive disorder. These disorders should be addressed holistically. Otherwise, an eating disorder may fail to recede, morph into something else, or return after treatment.
- Families are a child’s first social group. And family norms and structure shape how a child feels about themselves and the world. Families don’t cause eating disorders. However, family beliefs and behaviors about emotions and bodies can contribute to an eating disorder. For example, many parents are not aware of the role of emotional co-regulation. Therefore their kids may miss emotional developmental milestones. Additionally, many families accidentally enforce and encourage disordered eating. Therefore they may pass along harmful messages about food and bodies based on their own cultural training.
- There is a strong connection between diet culture and weight stigma and eating disorders. These two conditions lay the groundwork for the thoughts and behaviors that comprise an eating disorder. Diet culture is founded in the belief that bodies can and should be weight-controlled using food restriction and exercise. Weight stigma is discriminatory acts and beliefs against people who live in larger bodies. Diet culture and weight stigma are pervasive in our culture. And they are likely the driver behind increasing rates of eating disorders in the United States. Since the BMI levels were arbitrarily lowered in 1998, the weight loss industry has grown dramatically. In 1985 the U.S. weight loss industry was valued at $10 billion in annual revenue, but today it is worth at least $72 billion.
As a culture we assume weight loss is a personal goal, but it is in fact a money-making industry.
- Cultural group oppression:
- There is evidence that people who are not heterosexual and/or cis-gender are at higher risk of eating disorders. LGBTQ+ people are chronically oppressed in our culture. And self-repression is often required to maintain physical and emotional safety in a hostile culture.
- While eating disorders can impact anyone, females are at higher risk than males. The most likely reason for this is the cultural oppression of females in a patriarchal, male-dominated culture. The chronic objectification of the female body leads women to self-objectify. Then they naturally fall into unhealthy pursuit of the “thin ideal” or “wellness culture.”
- People of color are much less likely to receive a diagnosis for an eating disorder. But they are at least as likely (if not more likely) to have symptoms. The trauma of living as a person of color in a white-dominant culture likely contributes to eating disorders.
Most eating disorder treatment fails to address the social aspects of the disorder. The focus is on eradicating the behaviors of the eating disorder and “fixing” the person with the disorder. But in fact we have social problems that drive and sustain eating disorders. I believe we must address the social aspects of eating disorders in order to reduce the number of eating disorders and improve treatment outcomes.
Why do people get eating disorders?
There are so many factors that contribute to eating disorders. One way to view them is as coping mechanisms. I believe eating disorders develop in response to unmanaged stress and emotional dysregulation. In our culture, stress is chronic, and many people are raised without adequate emotional regulation development. Thus, coping behaviors become essential to function within our high-pressure society. Eating disorders join shopping, gambling, gaming, sex, using drugs and alcohol, and other addictions, compulsions, and obsessions as a way to cope with life.
An eating disorder is just another way to numb a person from the pain of being human in our society. Dieting* is constantly prescribed and weight loss is celebrated. Thus, an eating disorder often begins with a well-intentioned plan to feel better and meet societal goals. There are many false and misleading health claims associated with diet plans and weight loss. And these actively promote eating disorder beliefs and behaviors.
While not everyone who diets will develop an eating disorder, almost all eating disorders** begin with a diet.
*defined as any effort to lose/control weight using food and/or exercise
**with the exception of ARFID
What are the most common types of eating disorders?
According to research published by Hay et. al. in 2017, the rates of eating disorders are as follows:
47% OSFED. The most common eating disorder is a catch-all category called other specified feeding or eating disorder (OSFED). This category includes a mix of eating disorder behaviors.
22% BED. The second most common eating disorder is binge eating disorder. This often involves a restrict-binge cycle in which a person restricts food and then binge eats.
19% Bulimia. This often involves a restrict-binge-purge cycle. A person restricts consuming calories for an extended period of time. Next, they eat and then seek to purge the calories consumed with vomiting, laxative use, and/or over-exercise.
8% Anorexia. This is characterized primarily by restriction and being medically underweight. It is the only mental disorder that has a BMI requirement for diagnosis.
5% ARFID. The only eating disorder that is not technically associated with a desire to lose weight. ARFID typically involves restricting food and appears to be due to sensory and emotional drivers.
While these categories may be helpful, it’s important to remember that all eating disorders are mental disorders. This means that regardless of the specific behaviors, effective treatment must get beneath the behaviors to address the underlying thoughts, beliefs, and emotional dysregulation that drives them.
A path forward
This description of eating disorders hopefully adds some flavor and nuance to what you’ve seen elsewhere. But of course each eating disorder is unique. And I can’t possibly capture the vast nature of these complex mental disorders in a single article. I hope that if you have an eating disorder, you get help and find your path to healing.
And if you love someone who has an eating disorder, please remember that there is a lot you can do to help recovery. Eating disorders are so much more than a personal problem, which means loved ones can make a significant impact.
Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.
She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.