Written by: Natasha P. Trujillo, Ph.D., Executive Contributor
Executive Contributors at Brainz Magazine are handpicked and invited to contribute because of their knowledge and valuable insight within their area of expertise.
It is an unfortunate reality that eating disorders are on the rise, and have been steadily increasing since COVID. Eating disorders are life-threatening, biologically-based mental disorders. They encompass maladaptive emotional, behavioral, social, and biological focus on food, body size/weight, and body image. They are non-discriminatory, meaning that they can grab ahold of anyone regardless of race/ethnicity, gender, sexual orientation, class, religious affiliation, country of origin, or other social identities.
Specializing in eating disorders gives me a front-row seat to hear the brave stories of individuals working their way towards recovery. It is a daily occurrence to speak to my clients about the impact others’ perceptions and awareness of eating disorders have on them. The communities and systems they are a part of impact their experiences and their relationship with their eating disorder. There are both micro- and macro-expectations about what ideal bodies should look like. We also live in an alarming diet-culture-consumed society. We are bombarded with the latest products and tools to change the way we look in nearly every way. These norms then get interwoven with individuals’ internal battles with self-esteem and self-worth, often leaving them feeling invalidated and misunderstood. Here are a few examples of common difficulties:
“Over the break when I was home, my family told me how much healthier I look now that I’ve put on some weight.”
“My partner told me how jealous they were that I could eat so much without gaining weight.”
“My parents don’t understand what’s happening, they just become angry and tell me I just need to eat/stop eating and get over it.”
“No one understands how hard I have had to work to get to this point in my recovery, and they get so disappointed any time I struggle. I’m not allowed to make mistakes.”
“I’m tired of being seen as a walking eating disorder. There’s more to me than the problems I have with food.”
“I don’t actually need help because my doctor consistently tells me my BMI is in the normal range. I don’t even have an eating disorder.”
“I have to completely restructure my life around food, meaning my life around everything. Although I want recovery, I am losing so much in giving up the control and comfort my eating disorder gave to me.”
“I’m terrified of learning to trust myself and be in a healthy body again.”
I could fill hundreds of pages with these types of assertions. These comments shed light on just how much misinformation is out there about eating disorders and give you a small glimpse into some of the incredibly difficult work those seeking recovery have to face in therapy.
5 Things to understand about eating disorders
Although this list is not exhaustive, my goal is to share five general summaries of the nuances of eating disorders that need to be better understood.
1. Recovery is long, difficult, and nonlinear
Eating disorder recovery is a moving target – a consistent up-and-down process. It involves ALL parts of the individual – biological, psychological, emotional, and spiritual AND their closest supports. There are many successes and setbacks and appropriate levels of care may vary from in-patient hospitalization through outpatient services. Individuals seeking recovery must learn how to break down bad habits just as much as they have to build up new habits in the behavioral, cognitive, and emotional realms. They are also fighting against external beliefs and expectations about what bodies are accepted and desired, which can complicate their efforts to reach a natural, healthy point that is best for THEIR body. This process needs to be normalized.
2. Eating disorders come in all shapes and sizes
You simply cannot look at someone and know by image alone if they have an eating disorder, or even what type of eating disorder they may have. People in larger bodies may restrict, people in smaller bodies may binge, and everything in between. It can be shame-inducing to assume, based on someone's image, how and to what extent an eating disorder may be dominating their life. Please check your assumptions and try to avoid comments in general about someone's body. Even well-intentioned comments like "you look so much healthier now" to a person working towards recovery can be loaded with messages that can activate eating disorder thoughts/behaviors. This well-intended comment about “health” can be heard as “My body looks too different now, I hate it” or, “I am out of control.” Message sent is not always message received.
3. Saying "just eat" or "just stop eating" are not helpful
Eating disorders are usually about WAY more than just food. They can also be about control, coping with trauma, managing anxiety or depression, managing obsessive or compulsive tendencies, trying to balance unrealistic expectations of oneself, managing interpersonal conflict, and so much more. Just as with any vice, simply saying do more or do less of a behavior is not as black-and-white as it may seem. If you don't know what to say, it's OK to ask someone what kind of support they need. Make it a habit of your own to check in with how someone is doing, and how they can best use your presence in that moment. Sometimes it’s simply to listen, sometimes it’s to help hold them accountable, and sometimes it is to give them direct feedback. You don’t know until you ask.
4. It can often take a village
Since eating disorders are biological, psychological, and socioemotional, one type of provider often isn't enough to help restore an individual’s overall wellness adequately. Members of a solid treatment team often include a licensed mental health professional, a registered dietician, a primary care physician, a psychiatrist, and oftentimes others such as a physical therapist, family therapist, eating disorder recovery coach, and other specialists as needed. This can mean recovery is both time-consuming and expensive and can be overwhelming and chaotic, to say the least. Unlike other types of vices, ED recovery can't take the approach of simply avoiding or not avoiding food and white-knuckling it altogether. Continued exposure to work through the barriers preventing adaptive behaviors is vital, and it takes a multitude of supportive individuals and a collective mission to aid in the journey.
5. There is grief and loss that comes with choosing recovery from an eating disorder
Over time, even though eating disorders are harmful, they often serve intensely useful emotional and mental purposes. Habits develop for a reason. Because the nature of eating disorders often induce isolation, people suffering frequently develop a type of companionship with their eating disorder. The benefits it has brought them can lead to a misunderstood sense of loss that is CRITICAL to discuss on the road to recovery. An athlete who used to restrict food may be terrified that their once optimal performance is now gone forever. A man may have to completely change his morning routine which brought much comfort and anxiety relief to avoid disordered patterns with food. A teenager may lose the support and community they once felt from their sports team due to having to engage in structured meal support separate from teammates, while also resisting their changing body. All coping skills, good or bad, can have gains and losses associated with them. The full picture must be seen.
How to talk to someone who may have an eating disorder
With these 5 ideas in mind, here’s what you can do to support yourself or someone you may know struggling with disordered eating or an eating disorder.
Educate yourself and raise awareness. Remember, the mind is a muscle that must be strengthened.
Normalize the difficulty of topics and aspects of culture that can make it challenging to acknowledge and talk about eating disorders. For example, body image, restricting, binging, purging, and compulsive exercise can all be shameful behaviors that are scary to talk about and require high levels of vulnerability.
Speak up. If you are concerned about someone, take the risk and say something. Consider who needs to/can be involved in the conversation. Be curious but respectful of their boundaries. Focus on concern for their well-being, NOT their body size/shape. Stress the importance of the functioning of their body and proper fueling for health AND performance (particularly important for athletes and performers). Emphasize health and quality of life over performance. Support rest and recovery days from challenging workouts.
Dos and don’ts in conversations about eating disorders
Lastly, if you’re concerned about initiating such a discussion, here's a handy guide to the dos and don’ts during these important conversations:
The Dos:
Pick a good time to talk in private.
Ensure you are coming from a place of concern and express that concern.
Be prepared for denial and resistance and validate it.
Talk about the importance of mental health just as you would physical health.
Mention how receiving support can actually propel someone to be more successful, to stretch them rather than shrink them, perhaps farther than they've ever imagined.
Be patient and supportive.
Remember it is OK to make mistakes. You won’t be perfect. Take ownership if something you said was harmful and problem-solve how to move forward.
The Don’ts:
Avoid ignoring the potential issue altogether.
Avoid threats and ultimatums.
Avoid oversharing about yourself unless this is asked for.
Avoid commenting on appearance or weight.
Avoid making assumptions, shaming, and blaming (you don't have all the facts).
Avoid giving simple solutions. (e.g., “All you have to do is accept yourself.”).
For more information about eating disorders, please visit the National Alliance for Eating Disorders in the United States or the National Centre for Eating Disorders in the UK.
Natasha P. Trujillo, Ph.D., Executive Contributor Brainz Magazine
Dr. Trujillo is a counseling and sport psychologist dedicated to helping individuals, teams, and organizations build awareness of self, others, and the world to reach their full potential in and out of their craft. She owns a private practice where she seeks to educate, consult, and provide mental health and sport psychology services that are evidenced-based and collaborative. She works primarily with athletes, performers, and high-achievers to help them find balance in their pursuit of success and acceptance of their own humanity. She strives to help people learn how to simply “be”, and get better at what they do. She has specializations in grief/loss, eating disorders, trauma, anxiety, & identity development.
