But far more — as many as one in 10 — experience some form of disordered eating. These subclinical conditions can still be dangerous, since they may progress to a full diagnosis or be signs of other problems.
Below, we debunk some of the myths surrounding these often-misunderstood conditions, then explore ways to free yourself from an unhealthy focus on food.
Myth: Eating disorders are a choice. Reality: In fact, the inability to control behavior toward food is what defines an eating disorder. Those who suffer from binge eating disorder or bulimia often go to great lengths to hide their struggles. “Most bulimics who have been bulimic for a while … get pretty self-punitive,” says Edward Abramson, PhD, the author of “Emotional Eating: What You Need to Know Before Starting Your Next Diet” (Jossey-Bass, 1998). “They are angry with themselves for doing it, even though they think they shouldn't be doing it.”
In anorexia, the refusal to eat may have external triggers — today, weight concerns are common. But researchers have pointed out anorexia also appeared among spiritual figures in the Middle Ages, who believed it to be a sign of moral purity. Whatever the initial cause, not eating quickly becomes an end in itself. As a result, some researchers believe anorexia is a disorder based in perfectionism and control.
Myth: Eating disorders aren’t real illnesses. Reality: Though often taken lightly, anorexia has the highest mortality rate of any mental disorder, and bulimia and binge eating can permanently damage the gastrointestinal system. Often, they accompany other issues or diagnoses, says Abramson, such as depression, substance abuse, or borderline personality disorder.
Science is still working to understand these conditions. “Many instances of bulimia respond to antidepressant medications. Perhaps there's something underlying that's in common with depression and bulimia. Some folks have speculated that bulimia is … just a different manifestation of depression,” Abramson says.
There's no clear answer yet, but the consensus is that they’re serious disorders, not a passing phase.
Myth: Eating disorders only affect teenage American girls. Reality: Researchers at Harvard and Michigan State universities have documented cases of anorexia as far back as the 12th century — in every region in the world, from Iran, Egypt, and the United Arab Emirates to China, Malaysia, Korea, and Japan. They also found anorexia incidence rates to be similar across all regions.
Binge eating was also common, often accompanying anorexia. But bulimia may be a 20th-century construction. Its incidence rose precipitously in the second half of the 20th century, and only in Western contexts. The researchers note that only in the 20th century, with our ample access to food and privacy, has eating (and purging) without limits or detection become possible.
Myth: The media is to blame. Reality: Yes, and no. There’s a distinction between preoccupation with weight — which is nearly ubiquitous in Western culture — and developing a full-blown eating disorder.
So, yes: the media certainly plays a role in many women’s — and increasingly men’s — preoccupation with their weight and appearance, as well as feelings of low self-esteem and lack of positive body image. These attitudes can lead to chronic dieting and other borderline dangerous behaviors.
However, of all people exposed to Western media, only a small percentage develop a full eating disorder. (Estimates vary, but generally hover around 1 percent for anorexia, 3 percent for bulimia, and 5 percent for binge eating disorder.) As a result, there must be some additional cause for these conditions.
That means the media cannot be to blame for the most severe disorders. Experts are increasingly examining genetic links, since anorexia is known to run in families.
Eating disorders are treatable, but recovery is more likely the sooner symptoms are addressed, say experts. If you’re concerned about your own behavior, or a friend’s, don’t delay: seek medical care and support.
A crucial part of recovery is developing a healthy body image. “Self-esteem,” says the National Eating Disorders Organization, “is a universal vaccine that can immunize a youngster from eating problems, body image distortion, exercise abuse, and many other problems.”
Here are a few tips on how to get there.
Don’t diet, and eat well-balanced, nutritious foods only when you’re hungry. Learn about emotional eating, and explore better ways to respond to life’s ups and downs. If you slip in efforts to eat more nutritiously, don’t despair — simply forgive yourself, appreciate your efforts to improve, and resolve to try again.
Educate yourself about images in the media. Surround yourself with positive affirmations about weight and appearance. Beauty comes in all shapes and sizes. Focus more on achievement and intrinsic measures of value, which build self-esteem, by seeking what makes you happy and celebrating your accomplishments. Surround yourself with friends who value who you are, not how you look.
Find a form of physical exercise you enjoy. Whether it’s yoga, hiking in nature, or team sports — all that matters is that you enjoy the activity and are likely to keep it up. In moderation, physical activity can be an avenue to a highly positive body image, helping you get to know and value your body and its strength. Look for role models, such as coaches or yoga instructors, who demonstrate healthy eating habits, self-care, and respect for their body.
March 20, 2015
Christopher Nystuen, MD, MBA