Eating Disorders in Layman’s Terms

What's the Main Cause?

Most people probably know someone or have suspected they know someone with an eating disorder.  However, most people don’t get why anyone has an eating disorder.  People I talk to about my job often ask me what the main cause of eating disorders is.  It’s not that straightforward.  There are many contributing factors which could lead to an eating disorder.  One could have some or all of these:  

1. Genetics
2. Parents’ or friends’ beliefs about and behaviors with food
3. Comments from others about their body size or food intake
4. Depression or other mental illness
5. Emotions which trigger lack of or increase in appetite
6. Wanting a sense of control
7. History of trauma or abuse
8. Dieting gone horribly awry
9. Focus on the media’s ideals of body image
10. Distorted body image (body dysmorphia)
11. Desire to avoid or numb out using eating disorder behaviors

Why Can’t They Just Eat?

Even though I don’t know perfectly how the people I work with feel and believe, let me try to explain as best I can how the eating disordered mind works.  These are common obsessive thoughts consuming their time:

1. I don’t deserve food.
2. Too much food (which could mean normal portions of food) will make me fat.
3. That type of food (which could mean anything with calories) will make me fat.
4. I can’t enjoy the taste of food.
5. I need to feel empty.
6. If I eat, I’m weak.
7. I am bad if I eat “bad” food.
8. I am disgusting if I eat “bad” food.
9. It is better to not eat than to put “unhealthy” food in my body.
10. If I eat this type of food, I need to get rid of it by purging (through vomiting, exercising, or using laxatives).
11. I am in control when I restrict and am out of control if I eat (or eat more than what I have in my head is okay to eat).
12. If I give in to eating bad food, I’ve blown it and may as well eat a lot of it.  Then afterward, I will never eat it again.
13. I need to weigh ___.
14. I’m fat.
15. I am never thin enough.
16. If I eat foods high in fat or sugar, I will instantly gain a lot of weight.

The list could go on.  In addition, some develop an eating disorder of a different kind where there is less fear about food and more emotions causing decreased desire to eat.  I've counseled some so depressed that they don't eat even though they love food.  Some are so anxious that they feel nauseated and may involuntarily vomit when they eat a normal amount of food because the anxiety is so high.  This is one reason why treatment for the eating disorder requires not only therapy and dietary counseling but also medications. 

Behaviors Indicating an Eating Disorder

1. Unhealthy obsession about food, calories, and weight
2. Frequent talk about weight and food
3. Tendency to cook or bake a lot but not eat the food they prepare
4. Going to the bathroom right after eating
5. Eating very slowly and picking at food
6. Eating in secret
7. Telling people they have already eaten so they don't have to eat in social settings
8. Telling people they have allergies to certain foods or are vegan or gluten-intolerant or have some other dietary restriction so as to make it more socially acceptable to avoid eating
9. Excessively exercising

Physical Results

1. loss of hair or poorer growth and condition of hair
2. slower growth of nails or brittle nails
3. inability to regulate temperature
4. lanugo
5. decreased immune function
6. poorer wound healing
7. bruising easily 
8. impairment in ability to create hormones and neurotransmitters
9. decreased libido
10. bone loss
11. muscle loss
12. tingling
13. dizziness
14. headaches
15. shakiness
16. decreased heart function
17. electrolyte imbalance
18. a number of digestive issues ranging from diarrhea, constipation, gas, cramping, bloating, and acid reflux
19. possibility of ulcers or esophageal tears if inducing vomiting
20. decreased energy, concentration, and memory
21. swollen glands from purging
22. dryer skin and lips
23. increase in sensitivity in teeth or increase in cavities due to loss of enamel from lack of protein in the diet or from purging
24. muscles spasms, weakness, and cramps
25. loss of menstrual cycle for women
26. permanent brain damage

Can't I Tell Just By Looking?

You cannot tell just by looking whether someone has an eating disorder or not.  The women I work with can be any size or shape.  It can be easy to identify that someone has an eating disorder who is severely underweight or morbidly obese.  (I wish that we would call it "morbidly underweight" as well.)  Any of the symptoms listed above are experienced by all weight ranges if the eating disorder behaviors are severe enough.  The worst thing someone with an eating disorder could hear from a doctor is, "You don't look like you have an eating disorder."  And some of them are brilliant enough to say that.