by “I had an eating disorder early in life. I was 11, 12 when I was diagnosed with my first eating disorder,” says Anne Poirier, author of The body happy and one who today, at “almost 60,” has struggled with her disorder for most of her life. the hospital.”
That was lucky for Poirier, because eating disorders weren’t much openly discussed in the 1970s. Still, she tells Yahoo Life, “rules around eating, eating secrecy, hiding exercise, weighing myself a lot, and body checking” were all patterns she exhibited through her disordered eating as a young girl. And without even realizing it, things started to take a turn.
“One of the hardest things about getting an eating disorder is that in the beginning, when things start with disordered eating, you get a lot of compliments and people take notice. So you kind of feel validated for what you’re doing, and I think that’s one of the biggest pitfalls is because it’s a reward cycle,” recalled Poirier, who regularly shares her story as part of the National Eating Disorders Association’s (NEDA) Lived Experience Task Force. “Then, suddenly, it turns a corner, and sometimes it gets recognized, and sometimes it doesn’t. Inside the person, I often think, they don’t even realize they’re falling in until it’s almost too late.”
For her, being late meant a hospital stay, where she was diagnosed with anorexia and forced to address her behavior.
“I actually got good enough to get out,” she says. “I backed off so I was functional — still preoccupied with food and body image, but not so much absorbed in it. So my personality came back, if that makes sense. Even still, 40 years of her life were riddled with eating disorder relapses and periods of what is now known as “disordered eating” – the distinction between which only recently came into focus for Poirier, and is still largely misunderstood by the general population.
Disordered eating versus eating disorders
With so much focus on serious cases of eating disorders like anorexia and bulimia, it’s important to be aware of even the most subtle eating disorder symptoms — which can refer to everything from risky dieting behaviors to frequent body image thoughts — and how they can be precursors to a diagnosable eating disorder.
According to Janet Lydecker, professor of psychiatry at the Yale School of Medicine, the distinction between the two is difficult but necessary to make. She points out that because disordered eating is so ubiquitous and normalized in society, it takes extra effort to get it recognized as something problematic.
“So many people in our country have eating disorders,” she says, pointing out that it’s not an official diagnosis, but a description of unhealthy behaviors or behaviors related to eating and body image issues. “Just the preoccupation that Americans have with weight, and with weight being part of attractiveness, and a source of strength, especially, but not exclusively for women, there’s a lot of pressure we all feel in this culture to manipulate our bodies.
Christine Peat, an associate professor of psychology at the University of North Carolina and director of the National Center of Excellence for Eating Disorders, says eating disorder problems are often minimized due to the lack of a diagnosis. But, she tells Yahoo Life, “Even if you have an eating disorder versus a full-blown eating disorder, it doesn’t mean you don’t need help.”
A diagnosable condition, meanwhile, has a set of distinguishing criteria.
“When it becomes a full-blown eating disorder, there is always some kind of impairment. So it’s either a physical health disorder or it’s extreme distress or something where important aspects of a person’s life are compromised, like friendships or family relationships or school performance,” explains Lydecker.
In retrospect, Poirier recognizes times when her life was impacted during the more serious periods of her illness, including a time when her job was on the line, though she didn’t seek a diagnosis each time.
Lydecker explains that the process of doing this involves an assessment consistent with the Diagnostic and Statistical Manual of Mental Disorders (DSM), the authoritative guide of the American Psychiatric Association. Jessica Taylor, site director of the Renfrew Center, an eating disorder treatment facility, says analyzing the “frequency, intensity, and duration of what the behavior is” can be considered a cheat sheet for understanding the process.
Only through an assessment can an eating disorder be diagnosed and placed in one of the few existing categories.
“Anorexia nervosa is what most people think of when they think of eating disorders. Anorexia is an extreme restriction on what a person allows themselves to eat during the day. It is usually associated with weight loss and is accompanied by a fear of gaining weight or becoming fat, despite the weight loss and extreme restriction that prevails,” explains Lydecker.
Bulimia nervosa is when people binge and then purge. After a binge, she says, “they feel that loss of control and they feel like they’re overeating at that point, and then it’s followed by a purge, so something to get rid of the calories expended during the binge.” to get a body. The typical one most people will recognize is the self-induced vomiting, but it can be many things. It could be using laxatives or diuretics inappropriately, it could be fasting, it could be extreme or driven exercise.
Where it gets more complicated, according to Peat, is with binge eating disorder. “That’s exactly like bulimia, except there’s no purging after the binge. So it’s characterized by regular binge eating, where it happens a lot and people are very upset about it,” she says.
In addition, there are behaviors that fall into lesser-known categories listed in the DSM, such as Other Specified Feeding and Eating Disorders, or OSFED, and Avoiding Restrictive Food Intake Disorder, or ARFID.
Stigmas and stereotypes
Perceived ideas about eating disorders are “one of the biggest barriers we see in terms of people accessing care,” Peat said.
“People certainly still assume it’s a food problem,” says Lydecker. She points to the assumption that a person’s motivation behind an eating disorder may be vanity, which only has to do with their appearance and then let it rule their life – when in fact it is a mental disorder.
Yet it is the physicality that makes such conditions more difficult to understand.
“Eating disorders often carry a greater sort of medical risk than some of the other mental illnesses out there. Of course that does not apply to all. But sometimes, because there’s such a heavy physical component, people forget that it’s actually mental illness,” says Peat.
Even as they struggle, people can be misled by the mental image so many still have of people with eating disorders — especially white, cisgender women who are privileged and visibly underweight. “Not only does it affect people’s ability to self-identify with an eating disorder, but it also affects caregivers,” Peat explains. “And it’s not because they’re not doing their job, or because they’re maliciously excluding people. But I think, you know, we’re only as good as the information we get.”
That is precisely why anyone involved in the life of a child or young adult should be aware of what the symptoms of an eating disorder may look like, in case the individual does not recognize it themselves. “One of the really pernicious aspects of eating disorders is that when people have them, they seem to be helpful, they seem to get where they want to go,” says Lydecker. “So it can be difficult for someone with an eating disorder to see some of the destructive aspects of the disorder.”
Poirier recalls believing “I was doing something good for myself” when I engaged in harmful patterns. She often “needed someone outside of me to let me know something was wrong with me,” though admittedly she made it harder by becoming more deceitful.
The stigma surrounding mental illness at the time of her initial diagnosis in the 1970s made her unwilling to seek that help again in the future.
“For some people it can be a sense of relief to have a diagnosis because it gives them a way forward, it gives them a sense of, OK, this is the condition I have, these are the treatments that are available are for this condition, so this gives me a place to start,” explains Peat. “However, some people have talked about feeling trapped by having a specific diagnosis and feeling that they might be seen as a diagnosis versus an individual.”
That stigma persists today, although a diagnosis is necessary for proper care.
Care and recovery
“Recovery, like the actual eating disorder, will be very individual to the person,” explains Lydecker. “Recovery can be lengthy, with some recovering quite quickly. And then others will have to re-treat several times. Sometimes it’s because the treatment wasn’t fully accepted the first time around, it wasn’t exactly what the patient needed. And other times it’s because life is so hard and additional stressors built up that triggered the eating disorder again.
This is where it is helpful to remember that eating disorders are mental disorders. And while there are different levels of care depending on the severity of the problem, psychotherapy is generally the most effective — including therapy to prevent eating disorders from becoming full-fledged eating disorders.
“Without treating eating disorders as a mental health issue, you miss that opportunity to connect or connect the thoughts that are going on and the underlying understanding of who an individual is or how they see the world and how the eating disorder plays a even appreciate it.” Lydecker explains. “Eating disorders have such power over individuals once they become entrenched that it’s really almost a separate entity controlling them.”
Progress, she adds, starts with behavior cessation and eventually addresses issues of body image, emotional regulation and self-esteem that are at the heart of the problem. And as ubiquitous as these issues are, awareness and education about eating disorders is vital.
“The negative body image and negative self-talk are formed early. Those are the points that we have to work through so that it doesn’t take over your life in an external way, with the control of eating and the control of exercise and the purging and the bingeing, all that,” says Poirier. , noting the importance of Eating Disorders Awareness Week, which ends on Sunday. “It’s an important week to try to keep getting information out there so people can recognize it and get help and not have the stigma around it. To seek help for themselves, because it is not a good way to live.
If you or someone you know is struggling with an eating disorder, call the National Eating Disorders Association hotline at 1-800-931-2237.
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