Eating disorders are an equal opportunity offender: Rates are increasing among all ages, ethnicities, and genders. The most recent numbers suggest more than 30 million people struggle with an eating disorder, according to the National Association of Anorexia Nervosa and Associated Disorders. The group of disorders includes conditions such as anorexia nervosa, bulimia nervosa, binge eating disorder, and compulsive exercise. The issue is that there are many misconceptions about eating disorders, says Nancy Zucker, PhD, an associate professor in psychiatry and behavioral sciences at Duke University School of Medicine and founder and director of the Duke Center for Eating Disorders in Durham, North Carolina.
The biggest myth “is that eating disorders are all about people’s concern with appearance,” says Zucker. “But I really think that’s the thing that leads people astray. These are really disorders of the self.” Often the conditions are about trying to take a measure of control in a world that feels out of their control.
Eating disorders can be potentially life-threatening or have long-lasting effects on an individual’s health, according to the National Institute of Mental Health. For example, anorexia can lead to health conditions such as anemia, malnutrition, or low blood pressure, while binge eating can damage self-esteem while raising the risk of weight gain and heart disease. shame, secret eating, and frequent dieting. It’s important to remember that not all eating disorders lead to extreme weight loss—or gain. Learn more about spotting eating disorder symptoms that have nothing to do with weight.
Rigidity with food types
When a person is cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products), it may be a sign of an eating disorder, says Zucker. This is called orthorexia. She feels the food industry encourages rigid thinking by promoting one kind of food over another—”it cycles between carbs are bad, now fats are bad,” she says. Elimination diets can make things worse for people with eating disorders. “The diets can eliminate 85 percent of the foods that you’re allowed to eat.”
Ignoring the body’s cues
When people make rigid rules about what they eat, they begin to override the body’s signals of hunger and fullness, says Zucker. In a 2016 study, published in Biological Psychiatry, researchers analyzed brain function in a small sample of 23 women who had recovered from anorexia and a group of 17 healthy women who never had the condition. The researchers found that women with anorexia—even those in recovery—didn’t respond to hunger signals in the same way as their healthy counterparts. Their decreased response meant they were less motivated to eat.
Isolation when eating
It’s natural for friends and family to offer support or voice concerns if a person is making unhealthy choices. That’s why people struggling with an eating disorder tend to isolate themselves, especially when eating. “Eliminating entire food groups makes it really challenging to eat out, to eat with other people, to explain your eating habits,” says Zucker. “It creates a lot of social pressure and discomfort.”
Tero Vesalainen/Getty ImagesExcessive exercise
According to the National Eating Disorders Association, signs of compulsive or excessive exercise can include behaviors like prioritizing workouts over important activities, scheduling exercise for inappropriate times or settings, or exercising despite having an injury or other medical issues.
“Exercise is a wonderful thing that is associated with improvements in depression and mood and in cardiovascular health,” says Zucker. But for people with an eating disorder, the idea the “more is better” can take over, and exercise can begin to dominate their life.
“No days off” mentality about exercise
Again, this speaks to not listening to what your body is telling you, says Zucker. Not being able to skip a workout or giving yourself a break could be a sign of a disorder. “If you’re inflexible about it, it’s going to get in the way of other things in life that are valuable,” she says. “And there are days where your body is clearly telling you today should be a rest day. But the rigidity and the rules about exercise get in the way. You’re unable to say ‘You know what? I need to listen to my body. Today is going to be a rest day.'”
Strict rules around trying new foods
It can be very difficult for a person with an eating disorder to switch up their eating and try something that isn’t part of their routine. Zucker explains, that they have “this very stuckness in terms of the unwillingness to take a taste of something else or have a bite of dessert or things like that.” There’s a rigidity about the diet, she continues, “It just gets so black and white, if the person seems like they feel threatened and scared by a deviation like that. ”
Skipping family meals
With everyone’s busy schedules, it’s easy for every member of a family to find themselves eating over the sink or in the car, and not gathering around a table to dine together. But skipping out on meals is a way to hide disordered eating, Zucker says, “I think, the one thing if I were to say, how do you prevent an eating disorder or catch it early is you make sure that you’ve got regular check-in times, that are part of the family rituals or routines.”