Here are the most important things about eating disorders I wish our doctors and other medical experts knew:
1. Men have eating disorders too.
This isn’t just a female issue. We are seeing an alarming increase in the male population struggling with eating disorders. Anorexia’s signature weight loss makes it easier to diagnose than some other eating disorders. Men can also struggle with what’s called the Adonis Complex, where they build muscle and weight but have a dysmorphic view of their body shape, always believing it to be too small. This can cause an enormous amount of shame, all while appearing to be the medical picture of health. Due to the fact that their bodies have a set point, where they can no longer gain an ounce of muscle, or keep up with the rigorous training to keep that muscular body, they often get injured, or depressed. The suicide rate is ever increasing in this population. Obviously, this exists throughout the body building population, but also in males who have just started to put on muscle. It’s important we ask about how patients FEEL about their bodies. The answers will surprise you! Cachectic teens will feel different, sometimes than how they appear, and you WILL run into the body builder, who thinks he is too small. Take their answers seriously, as this IS their truth. These can all be signs of disordered eating.
2. No one chooses to have an eating disorder.
Imagine walking backwards, away from a bear who is slowly approaching to eat you. You fall into a hole, and instantly feel safe. The bear cannot eat you, but you are now in a hole that is difficult to get out. Eating disorders aren’t about vanity or control. They are about feeling safe, something we rarely have to worry about. “Just eating” ACTUALLY feels like coming out of a safe place just to be mauled by a bear. Understand eating disorders are a chemical “hole” people fall into, that may be unpleasant, but is the safest place for them. Don’t take this lightly, and remember educating them about the hole they are in is a waste of both your times. They know this hole inside and out, and intelligently made the decision to feel safe rather than be vital and happy. Realize they are stuck between these two things, and DO want out, but they never JUMPED, per se, into this hole.
3. Not every overweight person has an eating disorder.
It’s the first thing people say after finding out I work with eating disorders. “I eat too much, THAT’S my disorder.” I have to say, it gets annerving, hearing this all the time. Being overweight does not necessarily MEAN you have an eating disorder. There are plenty of people in ALL weight categories that have disordered eating. Genetics, or a medical complication, or simply overeating over time could be the reason someone holds extra weight. Many people who are overweight also could be struggling with a type of eating disorder you may not have guessed. I had a patient who weighed over 500 pounds who was restricting with all the signs and symptoms of Anorexia Nervosa, EXCEPT the weight. Once I talked to her about her ANOREXIA, she was able to fully recover. Go back to asking them the very non medical question, “How do you feel about your body in general.” You don’t have to research eating disorders, become an expert, etc. They’ll actually TELL you most of the time.
4. They’re not all liars and manipulators.
The truth with eating disorders, and what they allow people to know is synonymous with how much they trust someone. The truth for anyone who is scared can often vary. To the doctor who says, “Now, come on, your too thin NOT to have an eating disorder,” an anorectic patient might think, he’s not smart enough to handle what I’m going through, he has OBVIOUSLY already made up his mind, and doesn’t DESERVE my trust/truth. When we can create a safe environment for patients to tell the truth, it becomes easier to open up. Asking them how THEY feel about their bodies puts them in the driver’s seat, which, spoiler alert, they always were and are. Asking it this way shows you acknowledge that fact, which can shortcut their recovery process by eons.
5. There is no one WAY to recover.
Insurance sure thinks so though! Weight regulation is one of the top predictors of “recovery,” a.k.a. not needing insurance reimbursement any longer. No one recovers from eating disorders the same way, however, the closer someone gets to getting cut off from treatment, the more nervous they get, and can easily relapse, simply because they may be medically ready, but not psychologically. Some people will need treatment their whole life, whereas others fully recover and move forward with a healthy life and a healthy relationship with food. Medical signs and symptoms can be misleading, as labs and the body mass index of a person with a severe eating disorder can often be within normal limits.
Again, make sure to add it to your assessment. “How do you FEEL about your body, in general.”
If you or someone you love has an eating disorder, it’s important to make sure you understand the dangers and the importance of treatment. Whether it’s bulimia, anorexia, binge eating disorder, or something else, these are serious illnesses.