Misunderstandings about Eating Disorders

March 2023

Mental Health

"Understand that even if someone is much better, thoughts may still come and there are some days which will still be tough."

 

1. Do all eating disorders (EDs) involve being underweight?

No, they do not. Eating disorders present themselves in a multitude of ways. While being underweight is a possible indicator/symptom of an ED (such as Anorexia), being underweight is not a necessary condition to getting diagnosed with an eating disorder. While it is not possible to go in depth into all the different types of EDs, being at normal weight or overweight does not mean that someone's eating disorder is not valid nor less serious.

 

2. What does having an eating disorder feel like? Is it just refusing to eat?

Unlike what many are compelled to believe, eating disorders are not about vanity, nor are they "just about food". One may experience an extreme obsession over food, nutrition, calories and feel the intense necessity to stick to certain food rules. While food may seem like the central issue here, it boils down to gaining a sense of control and safety (see the next question for more information).

It can also revolve around extreme forms of exercising — such as waking up in the middle of the night to squeeze in a workout even after already having exercised. Some other eating disorders such as bulimia revolve around cycles of bingeing on food followed by compensatory behaviours such as purging or restricting food intake.

People with eating disorders want to avoid engaging in these behaviours, and often feel shame, loneliness, and exasperation when they do. Logically, we know that they are harmful to our health and impose strains on our mental and physical health.

It often feels like a constant battle, with voices in your mind telling you what to do and what you cannot, and criticizing you whichever way you choose. Yet, the voice of the eating disorder somehow convinces you that if you listen to it, you will feel happier, bolstered along by a sense of accomplishment and selfworth when you manage to restrict yourself, to not eat, or purge, or squeeze in exercise.

Often, people may pass up on social gatherings just so that they would not be placed in a situation where they are forced to eat or know that they will have to go through all the mental turmoil from deciding how to not eat. That is why it is a disorder — it's not something that one can just "stop" doing or "snap out of" because there are a myriad of mechanisms and reasons for the maintenance and cause of an eating disorder. Co-morbidities are also common where an eating disorder is coupled with a diagnosis of depression, clinical anxiety, or OCD.

 

3. Are eating disorders a result of being unhappy with your physical appearance?

Not exactly. Being unhappy with one's physical appearance does occur in eating disorders, but it goes further than that. Just based on physical appearance, it is not a simple "I look so fat". Almost as often, people with EDs also have body dysmorphia which could intensify issues with body image.

Body dysmorphia involves cognitive distortions which alter the perception of one's own image of their bodies. What people with body dysmorphia see in their image is vastly different from what their bodies look like in reality.

The obsession with food and physical appearance is a manifestation of issues that are more profound and affects the life of someone in recovery in unseen ways. Some predictors of eating disorders are traumatic life experiences and being in highly critical environments (including those involving receiving negative remarks about weight or body).

At the heart of it, all eating disorders are about control — a coping mechanism providing some form of comfort (to a certain extent) amid things that are not within control. In a complicated way — through physical changes such as hormonal and cognitive changes involving the brain as well as its relation to emotions — eating disorders become a "safe space" to deal with adverse life circumstances.

 

4. Why can't you just eat more food?

There are many reasons as to why "just eating" is far from the way to recover. Fundamentally, eating disorders are a lot more than just about food. It really is not that simple, considering how eating disorders can affect biological mechanisms in our bodies.

One example is how hunger signals of people with eating disorders do not function normally or optimally, and this affects the ability to interpret, experience and trust the body's signals. It might be baffling that "just eating" rarely helps given how eating comes naturally for most people.

However, for those with eating disorders, the experience can range emotionally from feeling like a chore to being somewhat terrifying. This is so because eating evokes a slew of negative, loud, and involuntary thoughts which confuse and trap us in what feels like a mental cage. Am I eating too much? How many calories is in this? How do I make sure I can control my food? If I eat this now, I might as well eat everything and compensate for it later. Is this even a normal amount of food? What if I start eating and I cannot control myself?

There are many other thoughts that may run constantly or on autopilot in the mind of someone with an eating disorder. It does not help when feeling full is accompanied by feelings of anxiety, shame or disgust while being able to compensate (such as purging, over-exercising) and restrict is paired with feeling accomplished and happy.

 

5. How do I support someone I know in recovery?

I think one thing you can do is to read up more about eating disorders, and what they are about so that you can gain a better understanding of what your friend is going through. Eating disorders are something that can only be truly understood if you are diagnosed with one, hence it is best to refrain from saying things like "I completely understand".

Also, often people with eating disorders may have behaviours that you may not understand. Be patient and accepting: give your friend a safe space to talk about what it may mean to them, or what function the behavior serves. This is especially crucial when it comes to food rules or some "abnormal" (at least to you) requirements they have around food and eating.

While it is good to challenge them, do so at a pace that they are comfortable with, and encourage your friend along the way. It is not an easy or smooth journey, and recovery is not an end point, but is rather a continuous, everyday process.

Understand that even if someone is much better, thoughts may still come and there are some days which will still be tough. When these moments descend, assure your friend that you will still be here for them, continuing to be a pillar of support even if they relapse along the way.

 

6. How do you know if you have fully recovered?

From my perspective, recovery is not an end point, nor something that once you "reach", you will never fall back into again. Often, even someone who has been in recovery for years will still deal with the ED thoughts or voices daily.

Hence, I see it more as being able to better deal or cope with the loud thoughts and voices, learning better strategies to manage emotions, and learning how to delay behaviour that fuels the eating disorder – for instance, strategies to cope with feelings of being full.

So even though the voice that says "you ate too much, you need to purge to be better, to feel good" and more is present and nagging, you are in a position to deal with them and not give in. Do not be discouraged if there have been relapses along the way – it is common to everyone in recovery.

Rather, I encourage you to see how far you have come and focus on all the small joys and victories you have gained over your ED along the way. Remind yourself that you did it before, and you will do it again!

 

By Tammy

Tammy is studying psychology at NUS and aspires to be a clinical psychologist. Passionate about mental health issues, she hopes to be able to help as many as she can. She empathizes with those who are experiencing such struggles, as she herself has had to deal with ill mental health. Reading, dancing and going to the gym are activities that she enjoys, and she shares that her favourite carbohydrate is bread.