National Eating Disorders Association

Even for professionals who have been treating them for years, eating disorders can be baffling and confusing illnesses. Adding to this confusion is the fact that eating disorders are surrounded by a large number of myths and misconceptions. It can be difficult for some people to take an eating disorder diagnosis seriously. This section will help dispel some of the most common misunderstandings about eating disorders and those affected by them. You may wish to print out this section and share it with others (other family members, friends, teachers, coaches, physicians, etc.).

Eating disorders are a choice. I just need to tell my loved one to snap out of it.

Eating disorders (EDs) are actually complex medical and psychiatric illnesses that patients don’t choose and parents don’t cause. The American Psychiatric Association classifies five different types of eating disorders in the Diagnostic and Statistical Manual, 5th Edition (DSM-5): Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder (BED), Avoidant Restrictive Food Intake Disorder (ARFID) and Other Specified Feeding or Eating Disorder (OSFED). Several decades of genetic research show that biological factors play a significant role in who develops an eating disorder. EDs commonly co-occur with other mental health conditions like major depression, anxiety, social phobia, and obsessivecompulsive disorder.

Doesn’t everyone have an eating disorder these days?

Although our current culture is highly obsessed with food and weight, and disordered patterns of eating are very common, clinical eating disorders are less so. A 2007 study asked 9,282 English-speaking Americans about a variety of mental health conditions, including eating disorders. The results, published in Biological Psychiatry, found that 0.9% of women and 0.3% of men had anorexia during their life, 1.5% of women and 0.5% of men had bulimia during their life, and 3.5% of women and 2.0% of men had binge eating disorder during their life. The consequences of eating disorders can be life-threatening, and many individuals find that stigma against mental illness (and eating disorders in particular) can obstruct a timely diagnosis and adequate treatment.

Eating disorders are a choice.

The causes of an eating disorder are complex. Current thinking by eating disorder researchers and clinical experts holds that eating disorders are caused by both genetic and environmental factors; they are bio-sociocultural diseases. A societal factor (like the media-driven thin body ideal) is an example of an environmental trigger that has been linked to increased risk of developing an eating disorder. Environmental factors also include physical illnesses, childhood teasing and bullying, and other life stressors. Historical data reveals that some of the earliest documented cases of eating disorders were associated with religious fasting. Additionally, they may run in families, as there are biological predispositions that make individuals vulnerable to developing an eating disorder.

I need to figure out what I did to cause my child’s eating disorder.

Organizations from around the world, including the Academy for Eating Disorders, the American Psychiatric Association, and NEDA, have published guidelines which indicate that parents don’t cause eating disorders. Parents, especially mothers, were traditionally blamed for their child’s disorder, but more recent research supports that eating disorders have a strong biological root. Eating disorders develop differently for each person affected, and there is not a single set of rules that parents can follow to guarantee prevention of an eating disorder, however there are things everyone in the family system can do to play a role in creating a recovery-promoting environment. Psychologists have seen improvements in the speed at which children and adolescents begin to recover when including parents in the treatment process.

It’s just an eating disorder. That can’t be a big deal.

Eating disorders have the highest mortality rate of any psychiatric illness. Up to 20% of individuals with chronic anorexia nervosa will die as a result of their illness. Community studies of anorexia, bulimia, and eating disorder not otherwise specified (EDNOS, now called OSFED) show that all eating disorders have similar mortality rates. Besides medical complications from binge eating, purging, starvation, and over-exercise, suicide is also common among individuals with eating disorders. People who struggle with eating disorders also have a severely impacted quality of life.

Anorexia is the only serious eating disorder.

When researchers examined the death rates of individuals with any eating disorder diagnosis who were being treated as outpatients, they found that bulimia and EDNOS (now OSFED) had mortality rates that approached the high rates seen in anorexia nervosa. During the study, roughly 1 in 20 people with eating disorders died as a result of their illness. Individuals who abuse laxatives or diuretics or force themselves to vomit are at significantly higher risk of sudden death from heart attacks due to electrolyte imbalances. Excessive exercise also can increase the risk of death in individuals with eating disorders by increasing the amount of stress on the body.

Since I don’t see my loved one engaging in eating disordered behaviors, I don’t need to worry about them.

Many eating disorder sufferers go out of their way to hide symptoms of their illness, either out of shame or because they are afraid someone will make them stop. It’s not uncommon for loved ones to be caught off guard at how severe and pervasive the eating disorder behaviors are when a diagnosis is made or when people close to the sufferer become aware they are struggling. If you are aware a loved one is struggling it is important to express concern, with empathy and compassion, and encourage the individual to seek help.

My loved one isn’t ready to recover from their eating disorder, and there’s nothing I can do until they are.

Some eating disorder sufferers have difficulty recognizing that they are ill or appreciating the severity of their situation. Still others may desperately want to stop their behaviors but are afraid. While expressing a readiness and willingness to recover is a positive sign, treatment doesn’t need to wait for your loved one to be ready. If your loved one is under the age of 18, and even if they aren’t, it is crucial to begin treatment as soon as you are aware of the problem. Early intervention is consistently associated with higher recovery rates. If the individual struggling is an adult, family and friends should continue to express concerns about the negative impact of the eating disorder on their loved one’s life and encourage him/her to seek professional help.

As a parent, there’s not much I can do to help my child recover.

Research continues to consistently find the opposite is true: parental involvement in a child’s eating disorder treatment can increase chances of recovery. Some forms of treatment, like Family-Based Treatment (FBT) (also known as the Maudsley Method), require that parents temporarily take control of the child’s eating and monitor for purging until a healthy weight and regular eating patterns are established. Other loved ones can continue to provide support to the eating disorder sufferer by helping to reduce anxiety over eating and reminding them they are more than their illness. Even if you decide FBT isn’t right for your family, there are still plenty of ways for you to be involved in your child’s or loved one’s treatment.

My family member won’t recover until they uncover the reason they developed their eating disorder.

While some people can point to a reason or event that they believe caused their eating disorder, plenty of people with eating disorders don’t have a specific reason. Nor is there any evidence that uncovering the cause of an eating disorder is correlated with recovery. Regardless of why someone may have developed an eating disorder, generally the first priorities of treatment are to restore normal eating and weight.

If my loved one insists they are fine, I should believe them.

Problems with accurate self-awareness are one of the hallmarks of EDs, so your loved one may not have the self-awareness required to recognize a problem. Thus, the individual struggling may genuinely believe they are fine when they are acutely ill. Other people may deny the presence of an eating disorder even when they know they are ill because they are afraid of treatment. Regardless of the reason, it is important to insist on treatment by a trained mental health professional and regular medical follow-up with a physician who is well-versed in eating disorders. (See page 20 for more information on medical tests.)

Strict rules about eating or fad diets aren’t a problem.

What appears to be a strict diet on the surface may actually be the beginning of an eating disorder. Even if the symptoms do not meet the criteria for a clinical eating disorder diagnosis, disordered eating can have serious medical consequences, such as anemia and bone loss. Individuals dealing with serious disordered eating may benefit from intervention and treatment to address their concerns before it becomes a full-blown eating disorder. Chronic dieting has been associated with the later development of an eating disorder, so addressing these issues right away may prevent a fullblown eating disorder.

As long as someone isn’t emaciated, they are not that sick.

Most people with an eating disorder are not underweight. Although most people with eating disorders are portrayed by the media as emaciated, you can’t tell whether someone has an eating disorder just by looking at them. These perceptions can perpetuate the problem and may cause distress in eating disorder sufferers for fear of not being “sick enough” or “good enough” at their disorder to deserve treatment. Additionally, you cannot determine if an individual is struggling with binge eating disorder (BED) based on their weight. It is important to remember that just because a sufferer is no longer emaciated, or has lost weight in the process of treatment for BED, it doesn’t mean they are recovered; an individual can experience a severe eating disorder at any weight.

The main eating disorder symptom I have to worry about in my loved one is weight loss.

Although anorexia nervosa and other restrictive eating disorders are characterized by weight loss, many people with eating disorders don’t lose weight and may even gain weight as a result of their disorder.

Eating disorder behaviors only focus on food.

Individuals with eating disorders generally have an unhealthy focus on food and weight, but the symptoms of an eating disorder can extend far beyond food. Numerous scientific studies have shown links between eating disorders, perfectionism, and obsessionality, which can lead to a fixation on grades, sports performance, etc. Although many sufferers report that eating disorder behaviors initially help them decrease depression and anxiety, as the disorder progresses, the malnutrition caused by eating disorder behaviors can ultimately increase the levels of depression and anxiety that can affect all aspects of life.

My loved one doesn’t claim to feel fat. Can they still have an eating disorder?

Absolutely. Body image distortions are very common in eating disorders, but they are far from universal. Clinical reports indicate that young children are much less likely to have body image disturbance, and plenty of teens and adults also don’t report this symptom.

Since eating disorders are linked to biology, my loved one doesn’t have much hope for recovery.

It’s important to remember that biology isn’t destiny. There is always hope for recovery. Although biological factors play a large role in the onset of EDs, they are not the only factors. The predisposition towards disordered eating behaviors may reappear during times of stress, but there are many good techniques individuals with eating disorders can learn to help manage their emotions and keep behaviors from returning.

I have a son. I don’t have to worry about eating disorders because they’re a “girl thing.”

Eating disorders can affect anyone, regardless of their gender or sex. Although eating disorders are more common in females, researchers and clinicians are becoming aware of a growing number of males who are seeking help for eating disorders. A 2007 study by the Centers for Disease Control and Prevention found that up to one-third of all eating disorder sufferers are male. It’s currently not clear whether eating disorders are actually increasing in males or if more males who are suffering are seeking treatment or being diagnosed. Because physicians don’t often think that eating disorders affect males, their disorders have generally become more severe and entrenched at the point of diagnosis. There may be subtle differences in eating disorder thoughts and behaviors in males, who are more likely to be focused on building muscle than on weight loss. They are also more likely to purge via exercise and misuse steroids than females are. Although gay, bisexual, and transgender males are more likely to develop an eating disorder than straight males, the vast majority of male eating disorder sufferers are heterosexual.

My child is too young to develop an eating disorder.

Eating disorders can develop or re-emerge at any age. Eating disorder specialists are reporting an increase in the diagnosis of children, some as young as five or six. Many eating disorder sufferers report that their thoughts and behaviors started much earlier than anyone realized, sometimes even in early childhood. Picky eating is common in young children, but doesn’t necessarily indicate an eating disorder. Although most people report the onset of their eating disorder in their teens and young adulthood, there is some evidence that people are being diagnosed at younger ages. It’s not clear whether individuals are actually developing eating disorders at younger ages or if an increased awareness of eating disorders in young children has led to improved recognition and diagnosis.

Now that my loved one is no longer a teenager, I don’t have to worry about an eating disorder. They’ll grow out of it.

People can struggle with an eating disorder regardless of their age. Research literature has identified a subset of people with eating disorders who seem to recover spontaneously, without treatment. However, many people who struggle with eating disorders and disordered eating in their teens continue to struggle into adulthood unless they receive treatment. Men and women at midlife and beyond are being treated for eating disorders, either due to a relapse, ongoing illness from adolescence or young adulthood, or due to the new onset of an eating disorder.

I’m not worried about my friend because everyone eats too much ice cream sometimes. Everyone must have binge eating disorder.

Binge eating disorder only affects 3.5% of women, 2% of men and up to 1.6% of adolescents, and it is not the same thing as occasionally eating more than is comfortable. Those who are struggling with binge eating disorder engage in recurring episodes – at least once per week over three months – in which they eat significantly more food in a short space of time than most people would, and experience a sense of loss of control over their eating behavior. The frequency and severity of the disorder have a significantly negative impact on the individual’s life, with many sufferers experiencing co-occurring conditions such as major depression and anxiety.

My son has bulimia, so he won’t develop another type of eating disorder.

Many with eating disorders will suffer from more than one disorder before they ultimately recover. Roughly half of all people with anorexia will go on to develop bulimia. Some individuals show signs of both anorexia and bulimia simultaneously, regularly binge eating and they may also purge while at a low weight (this is clinically classified as anorexia, binge/purge type). Still others transition from one diagnosis to another, a process known as diagnostic cross-over. All may involve life-threatening consequences.

Purging only involves self-induced vomiting.

Purging includes any method of removing food from the body before it is fully digested. Many times, an individual is driven to purge to compensate for what was perceived as excessive food intake. While selfinduced vomiting is one of the most common ways that an individual will purge, it’s far from the only method. Individuals can also use laxatives and enemas, as well as use non-purging compensatory behaviors, such as abusing insulin, fasting, and excessive exercising. Individuals can also purge by using more than one method. Each method carries its own particular risks, but all involve potentially life-threatening electrolyte imbalances.

Once my daughter with anorexia gains weight, she will be fine.

Weight and nutritional restoration are only the first steps to anorexia recovery. Once an anorexia sufferer has returned to a weight that is healthy for them, they can usually participate more fully and meaningfully in psychotherapy. Other psychological work usually needs to be done so the person can manage difficult emotions without resorting to anorexic behaviors. Weight recovery alone does not mean the eating disorder is cured.