I have decided to write a series of articles for those with mental health disorders because I have been there before and I have listened to so many people make snap judgments about others based on their disorders; or snap judgments about disorders itself based on societal misconceptions. For the last 5 years I have worked with both children and adults who have suffered and who are now in recovery from Eating Disorders (Anorexia and Bulimia); and I have worked with ‘outsiders’; those who are either friends, coworkers, educators, of family members of those with Eating Disorders because they want to be educated with the correct information so that they can be more supportive rather than bullying of those in need of their support. Yet, still there are some people who are so closed minded that they refuse to even attempt to understand what it is that people with Eating Disorders go through on a daily basis. In addition, to having published 4 self-helps books, I have also managed dozens of support groups on Facebook including ones for ‘outsiders.’ My hope is that with these series of articles on Mental Health Disorders, is that they will help to re-educate society with facts while also addressing the many myths associated with cultural misconceptions. There are so many people who want nothing more than to find the courage to admit they have a problem and to ask for help; however, because of the way that so many ‘outsiders’ have identified a specific characteristic or ideal physical appearance has inhibited those in need from finding that courage. Things like guilt and low self-esteem are two of the most dangerous types of emotions that can cause a person to downward spiral in their addiction or in this case, eating disorders. Most of the information below will be pulled from my third published book, “Reflections: An Eating Disorders Recovery Workbook (2013).”
National Eating Disorder Week (2015) is February 22–28. As serious as this illness is, I have yet to understand why we only get one week in February and not an entire month?
What are Eating Disorders?
While eating disorders comes in many different types from anorexia nervosa to bulimia nervosa, binge-eating disorder, and eating disorders not otherwise specified (EDNOS), I will be focusing on anorexia and bulimia nervosa because I have walked in those shoes. I suffered from anorexia for nearly 28 years and bulimia for about 10 years during the tail end of the anorexia. While it is very common for people with anorexia to develop bulimia, it is less common but not unheard of for those with bulimia to develop anorexia. Thus, the myth about not being able to have more than one eating disorder has been disproved. I have been recovered from both eating disorders for nearly 13 months now and to those out there wondering if there is a bright light at the end of the tunnel? The answer is, “YES!”
“Refers to an Eating Disorder that involves extreme dieting tendencies, food and fluid restriction, an illogical fear of gaining weight, body image distortion (especially when involving the use of mirrors and scales), obsession with weighing oneself on a daily basis (some will weigh their clothing separately), obsession with counting calories and fat counts, tendency to wear larger sized clothing than needed, constant need to compare self to others, constant need for perfection, constant need to pull on skin of the body with the distortion that it is fat, and a tendency to experience severe chills, and recurring illnesses due to a weak immune system. They tend to experience frequent episodes of dizziness, memory problems, headaches, and lethargic. Self-Esteem plays a large part in the assessment of anorexia. People with anorexia tend to engage in excessive exercise habits and/or the use of diet pills and diuretics. It is more common for those with anorexia to develop bulimia later on in life, as opposed to those with bulimia to develop anorexia. Those with anorexia tend to hide food and prefer to eat in isolation of others. They are likely to consume no more than 500-600 calories per day and if they exceed this amount, then they are likely to substitute meals on the following days that have fewer calories.”
“Refers to an Eating Disorder that involves frequent self-induced purging, binging and emotional eating. People with bulimia tend to consume large portions of foods and calories of more than 2,000 in one sitting or upwards of 50,000 in a day. Subsequently, they tend to feel guilty and ashamed from the binge and are likely to resort to either self-induced vomiting (finger down throat), the use of diuretics or laxatives. Those with both anorexia and bulimia are also likely to engage in excessive exercising. Each of these tendencies is also known as crash dieting. Bulimia is often associated with a personal desire for control; especially when they feel as if life is unraveling around them. Those with bulimia tend to have issues with anxiety, impulse control and mood disorders. Like anorexia, they tend to feel uncomfortable eating around others. With bulimia, their weight tends to frequently change from one extreme to another. They tend to have frequent electrolyte imbalances with low levels of potassium. (I highly recommend having bottles of Gatorade, Powerade, or children’s pedialyte on hand to replenish electrolyte). Continuous bulimic engagement can lead to gum disease, tooth and enamel decay from stomach acid regurgitation, puffy cheeks, swollen glands, dry mouth, severe dehydration, and gastro-esophageal reflux disease (GERD).
“Self-induced purging tends to involve the use of laxatives, diuretics, and vomiting. Some people will purge after eating as a form of dieting. I would purge whether I had food in my body or on an empty stomach. Looking back, this was playing with fire because it was a quick way to decrease my potassium and sodium levels that could have easily triggered a stroke or heart attack. But, for me it was not about dieting, it was the control side of bulimia. Like many people with bulimia who have control issues, if I felt like something in my life felt out of control such as finances, school, relationships, depression, Post-Traumatic Stress Disorder (PTSD), etc., then I would turn to my bulimia as an outlet because even though I was punishing my body, it was the one thing in my life that I had a constant control over. Similar to those who cut, we do not always connect the dots and see that we are doing more harm than good to our body both physically and mentally. This is why purging can be lethal to anyone with bulimia whether or not they have food in their body.”
Just to be clear, people with anorexia and bulimia typically do not hear voices. “An ED Voice is what people with eating disorders commonly refer to as their psyche in a third person mentality. Sometimes it is easier to talk about their illness in a third person which is why someone is more likely to say something like, “ED wants me to lose weight;” “ED thinks I am fat;” “ED is bothering me;” “I hate ED!” After all, it is more difficult to say, “I feel fat;” or “I need to lose 10 pounds because …” Anorexia and Bulimia Nervosa are a disease and nobody wants to admit that they have a disease, especially when they can simply think of it as someone else’s disease instead. If someone you know has referred to “ED” please understand that they are not hearing voices (at least not in this instance).”
“Stereotypes and Eating Disorders”
1) Myth: Anorexia only affects teenager girls.
Truth: Anorexia is not gender specific. Typically, with females, anorexia tends to manifest during adolescents but it has been known to affect women of all ages who have issues with body image and self-esteem as well victims of violent crimes who use anorexia tendencies to cope with their problems. With male adolescents, they are more likely to engage in anorexia tendencies as the result of competitive sports that require them to maintain a specific weight range such as wrestling and football. More often than not, males who wrestle in high school will engage in extreme dieting measures in order to make specific weight classes but this is not a predisposition for anorexia.
The eating disorder aspect manifests when they use the weight loss as an outlet for emotional or stressful difficulties that they are dealing with. Due to the stigma that tends to be associated with the gender side of anorexia, teenage males are more likely to use sports as an excuse for their extreme weight loss or gain. Males, who suffer from anorexia or less likely to openly admit it to others; but to be honest, there are a good majority of females with anorexia who feel ashamed to admit it to others as well. Unfortunately, we live in a society where social norms tend to perceive males to be muscular or slightly overweight and for females to be skinny and toned.
2) Myth: Anorexia is only associated with people who do not eat in order to remain thin.
Truth: One reason for hiding an eating disorder from friends and family members is because they are worried that if someone finds out about ED, then they could find out other personal issues such in cases where they may be a victim of child abuse or sexual violence. More often than not, eating disorders manifest as the result of some type of victimization with the eating disorder as nothing more than a negative coping skill.
3) Myth: Anorexia is only associated with food.
Truth: Yes and No; for many, anorexia has little or nothing to do with food but rather about the fear of gaining weight. Personally, I cannot go to restaurants because when I do, I tend to project my views of body image on to others around me. Typically, I will find myself looking around the restaurant from table to table; looking at each person’s height and approximate weight and how much food they are consuming and then I project as if I were them, eating as they do. In the event that I do order food, I will attempt to order small portions or side dishes and on top of the that, I will usually eat my food in a matter of minutes because I would rather eat it as fast as I possibly can so that I no longer need to look at it on my plate. As for me, it is not about the food being consumed or number of calories but rather has everything to do with my body image and self-esteem.
On the other hand, many people who suffer from anorexia are consumed by calories and even though, 2,000 calories is the normal recommend amount per day by many nutritionists and dietitians, those with anorexia will typically consume no more than 600-800 calories on an average per day. If they do, then they are likely to engage in extreme dieting or exercising to offset the calorie intake. The thing to remember is that food is not the enemy; ED is the enemy of food.
4) Myth: If their thighs are touching, they are anorexic
Truth: Everyone has their own body chemistry and exterior makeup and whether someone’s thighs are touching or they are not is a stereotype and not a determinant for anorexia.
5) Myth: Having an Eating Disorder is a choice and not a way of life
Truth: Eating disorders are a potentially life threatening illness.
6) Myth: Poor nutrition by parents and parenting skills are to blame
Truth: There is no proven correlation that suggests parents are to blame; however, with eating disorders that are used a means of control, there is often some underlying traumatic reason for why the disorder began (child abuse; physical, emotional, sexual, death of a loved one, bullying, etc).
7) Myth: Eating disorders are nothing more than a cry for help
Truth: People who live with anorexia or bulimia typically go to great lengths to hide their illness from others and if their illness is in fact discovered then chances are it was either by accident or they were backed into a corner. The last thing they want is for others to find out.
8) Myth: Some people with anorexia or bulimia have been cured after having one or both for less than a month or so
Truth: I listen to people all the time make claims how they had anorexia for only a few weeks. First of all, that was not anorexia but likely a crash diet. I have also listen to women say that they were bulimic for about a month just before finding out that they were pregnant. Chances are that was nothing more than morning sickness.
The following information has been released from the National Eating Disorder Association (NEDA):
Eating Disorder Information; (DSM-IV)
- Refusal to maintain body weight above 85%
- Intense fear of gaining weight
- Severe changes in Body Image associated with Denial
- Recurrent binge episodes (Binge-Eating Disorder tends to be associated with Bulimia Nervosa)
- Abusive Dieting Methods (crash dieting, restriction, binges, purges, excessive exercise, diet pills and laxatives)
- Low self-esteem, guilt, and shame
- Distorted body image (mirrors, scales)
- Emaciated (classic skin and bones appearance to others; viewed as fat by the suffer)
- Cold a lot even during high temperatures
- Preference to larger sized clothing to hide physical appearance from themselves and others
Do’s and Don’ts by ‘Outsiders”
- Never tell them what they want to hear but don’t sugar coat it either
- Never tell them they look like they gained/lost weight (neither is good)
- Never tell them they ate too little or too much
- Never blame the person for having an eating disorder
- Do not nit pick; “Have you eaten anything today?” Once the suffer knows that others are aware of their illness, they will be likely to feel attacked and distort the manner in which someone is trying to help them. This is very common during the beginning of recovery
- Never compare their recovery time table to someone else. It is their recovery time table and theirs alone. I typically compare recovery from eating disorders with those who are in mourning of the loss of someone. Some people mourn for a few days to a week; others mourn for months; years; decades; and some never stop mourning. The point is that everyone is different and no two recovery plans will be the same for everyone
- Never ask them if they are planning to purge what they just ate. This will seem like they are being taunted and then they will likely feel guilt and shame if they do not purge.
- Never compare eating disorders’ recovery to any other type of addiction recovery (Believe it or not, eating disorders have the highest mortality rate over any other addiction. A person can quit drugs, smoking, alcohol, gambling, etc., but they cannot quit eating).
- If you judge a book by its cover, you could miss out on something interesting inside
- Do be supportive. As an ‘outsider’ this can be the worst thing to do because you probably do not want to see them throw their life away and die from their eating disorder which does happen way too many times to count but sometimes by doing nothing is doing something. You want them to hold themselves accountable rather than you holding them accountable but at the same time, you do not want to bully or belittle them.
- They have likely been religiously weighing themselves or even their clothing, the best thing that an ‘outsider’ can do for someone who is trying to recover is to either hide the scale, toss the scale, or find a compromise such as, “If you still want to use the scale every day then cover up the numbers with a towel. This way, it will help them to be less fixated with numbers while at the same time being less triggered by the numbers (pounds, kilograms, stones, etc.).
- Do help limit their need to count calories. If possible, take a piece of dark colored paper or duck tape and cover it over all nutritional facts on food packages. People with eating disorders tend to fixate on calories, sugars, and fat counts.
- Do encourage them to either go to a counselor but not necessarily family therapy because they need to feel like they can freely open up to the counselor. Depending on confidentiality laws, do not expect for the therapist to report back to you with anything that was said during the sessions but you should be able to ask how they are progressing (this applies to family members only) and the therapist can also be held accountable for a child’s treatment.
- Do encourage them to join a support group (in person; virtually online such as Facebook) but do not join the same groups as them because again; they need to have a safe haven to openly talk about how they are feeling or experiencing to a group of people who have more than likely been where they are.
For those suffering from Eating Disorders:
- Learn to count your blessings not the illness
- Starve your self-hatred not your body
- Hate the disorder not yourself
- You do not need to see the whole staircase in the beginning, only the first step and if you fall back several steps, then stand back up and take the next step again and again until you will no longer fall backwards
- The next time that you think of healthy things, do not forget to include yourself
- Believe in better
- When you feel like giving up, try to remember why you have held on this long
- Learn to calm your mind
- The bad news is that you cannot always make people love or like you; agree with you or see things as you do but the good news is that is doesn’t matter
- Remember that you will come across ignorant and uneducated people who will cause you to feel less than a person but you need to remember that is ‘their’ reality not ‘yours!’
- Remember that you may not be able to change your past or even the present but one day you will be able to change your future
- Courage does not always roar, sometimes it is the voice in the back of your head reminding you that tomorrow is another day at life
- Repeat after me; “I choose Self-Love, New Beginnings, Enriched Self-Esteem, Endless Possibilities, Positive Attitude and Self-Worth, Self-Acceptance, Life, and I ALWAYS choose RECOVERY!”
“Nothing is IMPOSSIBLE, because the word itself says, I’M POSSIBLE!”
— Audrey Hepburn
If you need someone to talk with, please call the NEDA Information and Referral Helpline at 1-800-931-2237
Information about support groups can be found at the The National Association of Anorexia Nervosa and Associated Disorders (ANAD) website under the link for support groups. If you would like additional assistance, please feel free to reach out to me at Joshaubseth@Activist.com