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It is a myth that eating disorders are all about looking in the mirror and no tliking what you see. Eating orders are more complex, more common, and more deadly than most people know.

Tens of millions of people around the world suffer eating disorders. In the United States, eating disorders are diagnosed at some time in the life of 3.5 percent of women and 2.0 percent of men. Eating disorders aren't just a misguided attempt to achieve a different look in the mirror. They are associated with deeper aspects of emotional life and variations in brain circuitry, and have health implications about much more than just weight.

Eating disorders tend to be associated with perfectionism

Both food avoidance and food addiction are linked to a phenomenon researchers refer to as "maladaptive" perfectionism. Perfectionists tend to try to "will themselves thin". They don't usually develop eating rituals or induce vomiting.

Certain eating disorders are more clearly associated with depression

Bulimia and self-induced vomiting are more likely to be tied to depression than to perfectionism. They are also much more likely to be linked to suicide, even more than anorexia. People who suffer bulimia are inclined to self-harm even when they are of normal weight.

Binge eating disorders tend to run in families

Binge eating (eating to excess at least twice a week, nighttime eating) has a strong family predisposition. Studies of twins find a genetic component, and many people with binge eating disorders have a history of emotional abuse.

In teens and young people, binge eating disorders often have triggers, such as a move, a major stress at school or work, or divorce. Heavy television watching often makes the problem worse by providing images of people satisfying emotional needs with food.

Loneliness is an important component of binge eating disorders

Medications generally won't work unless the need for social support is addressed. Loneliness isn't just a matter of being physically alone. It is a state of not feeling that your social relationships meet your emotional needs. People who don't feel they have social plans often opt to fill in the emotional gap with eating.

People who eat to deal with the emotional pain of loneliness often harbor a fear that others will think they are dieting without success, so they overeat in public as well as in private. No one wants to look like a loser, so eat another piece of cake.

Bariatric surgery won't cure a binge eating disorder

Reducing the size of the stomach is a only a temporary solution unless binge eating's psychological and neurological causes are also addressed. Usually treatment for depression is required. Obesity is not an eating disorder, and not all eating disorders, even binge eating disorder, result in obesity.

Many candidates for bariatric surgery try to hide psychiatric issues from their surgeons out of fear of being excluded from surgery. In the longer term, bariatric procedures won't be successful unless psychological issues with eating are addressed.

People living with anorexia who have the least weight loss often have the worst symptoms

In anorexia, the more you weigh, the worse you feel. Doctors often define the severity of an eating disorder by the the extent of weight loss, but a more person-centered rather than weight scales-centered treatment plan will get better results.

"Mild" eating disorders are more likely to be fatal than anorexia and bulimia

A study of 1885 patients of the Outpatient Eating Disorders Clinic at the University of Minnesota found that death resulted in 3.9 percent of bulimia patients, 4.0 percent of anorexia patients, and 5.2 percent of people who had milder "eating disorders not otherwise specified". The physical and emotional adjustments of rapid weight loss accounted for excess mortality, researchers believed.

"Manorexia" is commonly missed in emergency rooms

Doctors usually associate anorexia with young women, not with young men. Males may be misdiagnosed with heart ailments and given unnecessary cardiac catheterizations, or sent through a battery of tests for cancer or chronic infection, when their symptoms are really caused by anorexia. There are even cases of young men who were implanted with pacemakers when their real health issue was anorexia.

Eating disorders in teenagers often follow serious infections

When a teen comes down with an infection serious enough to require a hospital stay, an eating disorder may follow. "These relationships appear to be both time- and dose-dependent, meaning that the onset of eating disorder diagnosis is greatest in the first three months following the infection, and the more infections, the greater the risk," said Lauren Breithaupt of Massachusetts General Hospital in Boston to Reuter's Health. "Both neuroinflammation and pathogens may be at play."

Binge eating in type 2 diabetics is often a cry for emotional support

It isn't enough to hand out anti-diabetes medications for type 2 diabetes, and it never helps to blame diabetics for developing a disease that is influenced by genetics, family dynamics, and food insecurity as well as personal choices. When type 2 diabetics not only can't stick to their diets but even eat more, emotional support is needed.

Eating disorders always involve more than meets the eye. They are never all about food. They always require compassion.

  • Lavender JM, Mason TB, Utzinger LM, Wonderlich SA, Crosby RD, Engel SG, Mitchell JE, Le Grange D, Crow SJ, Peterson CB. Examining affect and perfectionism in relation to eating disorder symptoms among women with anorexia nervosa. Psychiatry Res. 2016 Jul 30.241:267-72. doi: 10.1016/j.psychres.2016.04.122. Epub 2016 May 4. PMID: 27208513.
  • Smith KE, Ellison JM, Crosby RD, Engel SG, Mitchell JE, Crow SJ, Peterson CB, Le Grange D, Wonderlich SA. The validity of DSM-5 severity specifiers for anorexia nervosa, bulimia nervosa, and binge-eating disorder. Int J Eat Disord. 2017 Sep
  • 50(9):1109-1113. doi: 10.1002/eat.22739. Epub 2017 Jun 17. PMID: 28623853.
  • Wildes JE, Ringham RM, Marcus MD. Emotion avoidance in patients with anorexia nervosa: Initial test of a functional model. Int. J. Eat. Disord. 2010. 43:398–404.
  • Photo courtesy of SteadyHealth
  • https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/28623853/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4912862/

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