Monday, February 22, 2016

Eating Disorders: what they are, what they are like, what helps, what doesn't help

What Eating Disorders Are Like For Me
I want to preface what I am about to write with the following disclaimer: the only experience I can attest to in this department is the one I've lived personally. I will be sharing information about other disorders as well, but anything I write about my experience pertains only to me. There is a large variety in the type and severity of eating disorders, as well as the underlying root causes of them.

There is a misconception that eating disorders only affect women and young girls, but the reality is that men and young boys can suffer as well. Men are less likely to seek treatment. It is estimated that 24 million people in this country suffer from eating disorders.

I've written in the past about how when the anxiety rises up in my world, when things start to spin out of control and I feel like I can't manage anything, my default is to stop eating.

I just stop.

The only way that I can explain it is that when I can't control anything else in my life, at least I can control what I put into my body and what I do with my body. It's deeply rooted in anxiety for me personally, connected to a lifetime of being overweight, of always feeling like I was the one that didn't fit in.


It's something that I've done since I was a teenager, something that peaked when I was around 14. When I was in the worst place with it, I was exercising obsessively as well, usually three times a day, writing down every single thing I did and for how long. I weighed myself multiple times a day. There were days that all I ate was a few pieces of lettuce.

It didn't take too long for me to start doing damage to myself physically. I'd lost weight, sure, but since I was starting from a place of being overweight, no one was ever concerned. In fact, I was often congratulated about it. Boys paid more attention to me. Family and friends told me how good I was looking, which just reinforced the negative self talk in my head about how disgusting I was to begin with.

I started having chronic headaches, so frequently that my doctor ran all kinds of tests on me. He was concerned it was a brain tumor. He also congratulated me on the weight loss, never putting the two together.

I fainted in church one Sunday morning after the whole world starting spinning, and only when that happened did I realize just how much I was hurting myself.

I was still fat, by the way.

I joke, in my self deprecating way, that I suck at being anorexic. It's a commonly held belief that the only people who are anorexic are thin. I'm proof that you can be fat and still be anorexic. Breaking the mold, I am.

It's something that has reared its ugly head more than a few times since those days. As soon as I start to lose control of anything else, I find myself spacing meals out further and further, strangely comforted by the grumbling in my stomach.

As an adult, I confronted my issues head on many years ago, and I know that the first thing I need to do when I start leaning towards this path again is to talk about it. I need to say, out loud, that I'm doing it again. I hold myself accountable because I have to.

Types of Eating Disorders
Eating disorders are one of the most misunderstood areas of mental health. While the issues and symptoms presented and perceived from the outside are physical in nature, the causes are not. The root of disordered eating is mental, and not always clearly understood. For some people the root may be in depression, for others in anxiety, for others in OCD. The treatment of eating disorders requires a solid understanding of the situation of each individual.

Anorexia is characterized by restriction of food intake, obsession with weight loss and may include habitual weighing of one's self as well as prolonged periods of exercise. Those suffering may go to severe extremes to lose weight, seem perpetually concerned with losing more. The conventional wisdom says that anorexics are always thin, but I take issue with that part of the definition.

Bulimia is characterized by periods of binge eating followed by purging the stomach contents through forced vomiting. People dealing with bulimia have negative self images heavily tied to weight, and are more likely to be at or above what is considered a healthy weight.

Binge Eating Disorder is characterized by recurring periods of binge eating, often very quickly and in very large quantities, followed by immediate feelings of shame. Those suffering feel like they can't control themselves and regulate food intake.

Night Eating Disorders are when a person who eats a normal amount, or perhaps even less than ideal amounts of food during the day, then binge eats at night. They often wake at night, unable to go back to sleep until they eat again. There is also a subtype where the person is actually sleepwalking and not consciously aware of the eating.

Body Dysmorphic Disorder is not in itself an eating disorder, but a subtype of anxiety that is frequently associated with eating disorders. Those suffering obsess about their physical appearance in an unhealthy manner, often with a distorted view of how they actually appear. For example, a very slender woman might look in the mirror and feel as though she is looking at a morbidly obese woman.

There are other eating disorders having to do with compulsions to eat things that are not food such as pica, but I am not very familiar with them personally. Thankfully, they are quite rare.

Things That Can Help With Eating Disorders
Ideally, the treatment of eating disorders is interdisciplinary in nature, with a cohesive team of providers that may include psychiatrists, psychologists, therapist, nutritionists and doctors. 

Medical Care - Eating disorders are widely considered the most deadly mental health condition. As many as 5% of those suffering will die as a result, whether through malnutrition, organ failure, or substance abuse. Those suffering are also at an increased risk for suicide. How treatable these conditions will be correlates pretty directly with how early in the development they are caught and diagnosed. There are medications that can treat the underlying issues leading to the eating disorder itself (such as anxiety or depression). Depending on the severity of the disorder, a medical doctor may order blood tests to check for organ function and other indicators of damage. Inpatient care may be necessary in some cases.

Therapy - In individual or group settings, therapy to address the underlying issues leading to disordered eating is often the most important component of treatment.

Family/Home Centered Care - The constant nature of eating disorders means that the person suffering truly needs to be surrounded by people who understand the condition and are vigilant about looking for indicators that the disorder may be worsening. This is especially important for parents dealing with eating disorders in children.  For reasons that aren't yet fully understood, eating disorders often run in families as well.

Support of Friends and Family - As simple as it sounds, telling the person suffering that you are concerned for their health and safety and that you love them makes a huge difference. Having people who understand the roots of the disorder and do not blame the person suffering are a tremendous asset in the fight.

Things That Do Not Help With Eating Disorders
Hell, most of these are just good tips in general. We should all do this stuff, regardless of whether we are dealing with an eating disorder personally or with someone we love...because the reality is that someone might be suffering in silence, and you might be planting seeds of body image issues in children.

  • Focusing on their weight. They're already totally focused on that, and don't need other people obsessing about it too.
  • Micromanaging their food intake. It's tempting to want to know exactly what they are eating and when, but that can actually make things worse, not better.
  • Mocking them for being thin or fat. Just don't. How about as a society, we just stop judging people based on appearances in general?
  • Taunting them, saying "just eat something". Also not helpful.
  • Blaming them. Saying they just need to get over it. 
  • Shaming them about their condition. Shaming anyone for anything doesn't make a situation better, and can often make things worse.
  • Don't talk about how you tried this great diet and lost weight or know about someone who lost a bunch of weight. 
  • Don't tell them they need supplements or oils or whatever you're selling. 
  • Don't try to minimize their condition or act like it's normal. For example, routinely skipping breakfast because you are busy doesn't mean you "get" what anorexia is like.
  • Don't comment on weight loss or gain, even in regards to celebrities. It's all putting subconscious issues in their head.
  • Don't tell them they are too thin or too fat to wear certain clothing. 
  • Watch how you speak about yourself as well, particularly around children.
Recovery is possible. Healing is possible. 
For me, I know that anorexia will always be a part of who I am. It will probably always be something lurking in the shadows, waiting for an opportune time to show up again. I have to be vigilant. 

If you or someone you love is suffering, there is help out there. Here are some resources for more information.

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