The Real Facts About Eating Disorders

I am a psychologist specializing in children and teens who have an eating disorder such as anorexia nervosa, bulimia nervosa and avoidant restrictive food intake disorder, or ARFID. When I tell people what I do for a living, I’m often bombarded by harsh, judgmental comments such as “they could stop if they wanted to” or “there must be something wrong with that mother.” When I tell them I work in the Bronx, the comments are often along the lines of: “You must not be that busy – only rich, white kids have eating disorders!” In discussing this with other psychologists and mental health professionals, I am frequently met with “I could never treat them – they are so difficult.” The most difficult part of hearing these statements, especially by fellow mental health practitioners, is that they perpetuate the stigma associated with eating disorders that lead many to self-blame and delay or avoid treatment. My mission is to promote the actual facts about eating disorders to mental health professionals, parents, teachers, kids, pediatricians and the public. So here some of the things everyone should know:

Eating disorders can be fatal.

Anorexia nervosa is the most fatal of all mental health disorders, with approximately 50 percent of those deaths attributed to suicide. Anorexia nervosa and bulimia nervosa have high rates of suicide, self-injury, cardiac-arrest, early-onset osteoporosis, kidney failure and pancreatitis, just to name a few. Binge eating disorder often leads to morbid obesity and other health problems resulting from obesity, including diabetes, heart disease and high blood pressure. If these facts surprise you, you are not alone. Most mental health specialists are not aware of the high fatality rates and suicidality among patients with an eating disorder.

Eating disorders come in all shapes, sizes and genders.

When you think about a person with an eating disorder, whom do you picture? At least 10 percent of people diagnosed with an eating disorder are men and boys, and this number is probably an underestimate, as often boys and men are not screened for eating disorders and tend to under-report symptoms. Also, often surprising to many people is the fact that the highest prevalence of bulimia nervosa is among Hispanics, regardless of their level of income. Finally, eating disorders occur among people of all weights and sizes. There is no way to tell from looking at someone whether or not they have an eating disorder.

Eating disorders start for many reasons.

Emerging research supports a genetic predisposition to an eating disorder. That being said, genetics alone do not cause an eating disorder. The most common way an eating disorder starts is with a diet. For most people, the diet works or it doesn’t work, and they do not develop an eating disorder. For others, rapid weight loss can trigger an eating disorder. Once the eating disorder takes over, it’s very hard for someone to escape the grip on their own. Some find comfort, even companionship, with their eating disorder and have difficulty breaking up with their friend. Many of my patients tell me that restricting, binge eating and purging give them relief from other stressors in their life. Although this relief is short term, it’s difficult for many to break this cycle. Still another way an eating disorder, such as ARFID, might start is with a choking episode or a severe allergic reaction. Following this, some children are afraid to eat some or all foods. Even though they may not have a concern about how their body looks, they lose a lot of weight, and medically their body doesn’t know (or care) how the weight loss started or what’s maintaining it – our bodies just know they’re malnourished.

Eating disorders rarely occur in isolation.

Weight, shape and eating are only part of the story when it comes to eating disorders. It’s rare for someone to have a diagnosis of only an eating disorder. Eating disorders are associated with anxiety, depression, post-traumatic stress disorder, history of sexual abuse, substance abuse and personality disorders. Treatment must look at the big picture. Without this, as one problem gets fixed, other problems tend to pop up quickly.

Eating disorders can be treated.

One of the most dangerous myths about eating disorders is that they can’t be treated and that once you have an eating disorder, you can never be fully better. You can be free from your eating disorder. Yes, eating disorders are serious and some are difficult to treat at times; however, we have effective treatments for patients suffering with an eating disorder, and the treatments really work.

So What Can I Do If I Think My Child Has an Eating Disorder?

  • Seek help: Early intervention is the best way to treat an eating disorder. Even if you think it’s “not quite” an eating disorder, have your child evaluated as soon as possible.
  • Seek help from someone who knows how to recognize and treat eating disorders. Not all mental health practitioners and pediatricians have specific training in eating disorders. Ask the person evaluating your child how many patients with eating disorders they treat, and ask if they have specialized training in this area. See if the treatment they are using is evidence-based. This means that there’s scientific research supporting the effectiveness of the treatment.

The most important advice I give to parents who are worried their child might have an eating disorder is to listen to your instincts. Most parents know their children better than the doctors. If you’re worried that your child might have an eating disorder and your doctor minimizes your concerns, get another opinion. It’s critical that you feel heard by your team and that they make you and your child feel hopeful that things will get better.

You can find a list of therapists who specialize in eating disorders through the National Eating Disorders Association or through the Academy of Eating Disorders. Don’t wait until it’s too late; get help today.