So You Think You Have an Eating Disorder.

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I get this email/message at least a handful of times a week:

I think I have an eating disorder. I don’t know what to do. I don’t know if I’m sick enough/thin enough/bad enough to get help. I’m afraid. What do I do?

Paraphrased, of course.

I’m honored to be in a position where people, even complete strangers, feel comfortable enough to reach out and seek advice from me. Holding space for someone going through a difficult time is, well, difficult. But I always know where to start: acknowledging and praising their bravery for speaking up and taking the first steps towards advocating for their own health and happiness.

If you’re reading this, there’s a good chance you think you might be struggling with an eating disorder or disordered eating of some kind. I want to tell you (yes, you) that I’m proud of you. Even taking what seems like the smallest step of Googling “Do I have an eating disorder?” or messaging someone on Instagram for help is an incredible leap in your recovery journey, which may only be just beginning. You are incredibly brave for seeking help, and I want you to know that this does not go unrecognized.

It’s becoming difficult for me to personally respond to each of the emails and messages I receive with as much depth and clarity as I strive to offer, and I want to create an article here that can serve as a resource for anyone and everyone struggling with the beginning of their recovery process. Please know that if I directed you here personally, it’s not because I don’t honor your time and bravery, but rather because I know that by linking you to a more in-depth resource, I’ll be able to offer you far more insight and tangible tools than I would through a direct message or even an email.

If you think someone in your life may be struggling with an eating disorder, it’s my hope that this resource can be one you use not only for the benefit of your own education, but perhaps as a starting point for a tough conversation that may come somewhere down the line. I’d also like to direct you to another resource I’ve created that is more geared towards family members and loved ones of eating disorder patients, which can be found here.


Do I have an eating disorder?

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This is a scary question that many people, particularly young women, find themselves asking at some point in their lives. For better or for worse, depending on the medium through which it is expressed, eating disorders have found their place in the public eye over the past few decades. Whether we’re exposed to them through ill-informed jokes on television, through documentaries of various forms and intentions, or through novels and magazines, they’ve become a fairly recognizable health concern.

But while many, if not most of us, today are at least somewhat aware of the existence of eating disorders, not many of us are fully informed as to what an eating disorder exactly is. The nuances of eating disorders are still struggling to be understood by seasoned researchers and professionals, let alone the general public. Because of this, asking, “Do I have an eating disorder?” can be rather fruitless without some general background information.


What are the different kinds of eating disorders and their symptoms?

For starters, there are many kinds of eating disorders, each of which have vastly different symptoms, root causes, and treatments. Let’s break them down:

Anorexia Nervosa

This is one of the more popularized eating disorders that we tend to see in popular media and touted as an aspect of celebrity culture. There are many famous instances of anorexia nervosa that have captured public attention and catapulted eating disorders into the public eye, such as Portia de Rossi and Karen Carpenter. And while it’s arguably a good thing that more awareness has been drawn to Anorexia Nervosa, it does have the added downside of increasing the amount of misinformation spread in regards to the illness itself.

So what is Anorexia Nervosa? 

“Anorexia” in and of itself is a lack of appetite. “Anorexia Nervosa” is a mental illness categorized by unhealthy weight loss, distorted body image, restrictive tendencies surrounding food, and overwhelming fear of or preoccupation with eating, exercise, and weight gain. There are some signs and symptoms that make Anorexia Nervosa diagnosable as dictated by the DSM-5 (a diagnostic manual used by mental health professionals):

  • Restriction of energy intake relative to the requirements of their body and unique context (i.e., not eating enough for their needs).
  • Intense fear of gaining weight or becoming overweight (even if there appears to be no cause for concern that this will occur).
  • Denial of current bodyweight (i.e., if they are unhealthily underweight, they refuse to acknowledge it).

Source: Diagnostic and Statistical Manual of Mental Disorders (DSM–5)

It’s important to note a few things before proceeding further. For one, a mental health professional has certain certifications that allow them to formally diagnose someone utilizing the DSM, meaning that while looking over the criteria can help you decide if you need to seek help, it doesn’t certify you to diagnose yourself or others.

For another, Anorexia Nervosa has both mental and physical symptoms, which are used in conjunction to make a diagnosis. This does not mean that someone has to look a certain way to have an eating disorder. It’s best to look at these two categories of symptoms/warning signs as two separate categories:

Behavioral/Emotional Warning Signs:

  • Sudden, dramatic weight loss.
  • Wearing exclusively oversized clothing or layering clothing to stay warm/hide their body.
  • Refusing to eat certain kinds of foods that they once enjoyed.
  • Denial of hunger or need to eat.
  • Prepares elaborate meals or cooks for others without eating themselves.
  • Withdrawal from social situations or friends.
  • Maintaining a strong need for control in all situations.
  • Exemplifies rigid thinking.
  • Intense, pervasive perfectionism.

Physical Warning Signs:

  • Fatigue.
  • Difficulty concentrating.
  • Dizziness or fainting.
  • Persistent coldness.
  • Sleep problems.
  • Menstrual problems.
  • Fine hair growth.
  • Weakness.

Source: https://www.nationaleatingdisorders.org/learn/by-eating-disorder/anorexia

Bulimia Nervosa

Bulimia Nervosa is another eating disorder commonly misunderstood and poorly portrayed by the media. A common trope is one of thin, popular cheerleaders or teenage girls throwing up after eating their school lunch as just “another way to stay thin,” without any acknowledgement of the emotional strife involved in such a behavior. Similarly, Bulimia Nervosa does not have to include vomiting whatsoever, but rather is categorized by binging and purging/compensatory behavior.

So what is Bulimia Nervosa?

Bulimia Nervosa is an extremely serious manifestation of an eating disorder that has incredibly detrimental effects on the physical body of the sufferer. Unlike Anorexia Nervosa, which is more focused on restriction of food altogether, Bulimia Nervosa has a greater emphasis on “making up for” the food that is consumed (oftentimes compulsively) by the sufferer. The DSM-5 outlines the diagnostic criteria for Bulimia Nervosa as follows:

  • Frequent or recurrent episodes of binge eating (i.e., eating in a discrete period of time an amount of food that is far greater than the average person would consume in a similar amount of time, with a sense of a lack of control over the amount of food consumed).
  • Recurrent, harmful compensatory behavior for the food consumed (e.g., consuming laxatives, overexercising, inducing vomiting, fasting, etc.).
  • This behavior occurring, on average, at least once a week for three months.

Source: Diagnostic and Statistical Manual of Mental Disorders (DSM–5)

It’s important to note a few things before proceeding further. For one, a mental health professional has certain certifications that allow them to formally diagnose someone utilizing the DSM, meaning that while looking over the criteria can help you decide if you need to seek help, it doesn’t certify you to diagnose yourself or others.

For another, Bulimia Nervosa has both mental and physical symptoms, which are used in conjunction to make a diagnosis. This does not mean that someone has to look a certain way to have an eating disorder. It’s best to look at these two categories of symptoms/warning signs as two separate categories:

Behavioral/Emotional Warning Signs:

  • Evidence of binge eating, such as excessively large purchases of food or hidden food wrappers/containers.
  • Evidence of purging behaviors, like rushing to the bathroom after meals or purchasing of laxatives.
  • Fear of public eating or reliance on eating alone.
  • Maintains a rigid and excessive exercise regime unchanged by any external factors like the weather or illness.
  • Frequent “body checking” in mirrors.
  • Expressing fear of weight gain or disgust with their current body.

Physical Warning Signs:

  • Weight fluctuations (both up and down).
  • Dizziness.
  • Stomach/digestive problems.
  • Fainting.
  • Sleep problems.
  • Weakness.
  • Menstrual problems.
  • Persistent or reoccurring sore throats.

Source: https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bulimia

Binge Eating Disorder

I’ve heard many eating disorder patients and sufferers express the idea that Binge Eating Disorder is the most “shameful” eating disorder, because it oftentimes doesn’t result in weight loss. This is a common issue with eating disorders and the way they are publicly perceived: they are highly influenced by our society’s belief that “thinner” always equals “better.” For many, it is wrongly believed that more restrictive disorders such as Anorexia Nervosa reflect strong willpower or better self-discipline than disorders such as Binge Eating Disorder, resulting in many sufferers being too ashamed to seek out the help they deserve.

So what is Binge Eating Disorder?

Binge Eating Disorder is one of the more recently recognized forms of an eating disorder, and is quite similar to the binge eating presented in Bulimia Nervosa, without the compensatory/purging behaviors following. Diagnostic criteria used by mental health and medical professionals is as follows:

  • Frequent or recurrent episodes of binge eating (i.e., eating in a discrete period of time an amount of food that is far greater than the average person would consume in a similar amount of time, with a sense of a lack of control over the amount of food consumed).
  • Binge eating that includes some of the following behaviors:
    • Eating much faster than normal.
    • Eating far more than is comfortable physically.
    • Eating alone (due to embarrassment or shame).
    • Feeling ashamed or disgusted with one’s self.
  • Binging without compensatory behaviors such as over-exercising or abusing laxatives.
  • This behavior occurring, on average, at least once a week for three months.

Source: Diagnostic and Statistical Manual of Mental Disorders (DSM–5)

It’s important to note a few things before proceeding further. For one, a mental health professional has certain certifications that allow them to formally diagnose someone utilizing the DSM, meaning that while looking over the criteria can help you decide if you need to seek help, it doesn’t certify you to diagnose yourself or others.

For another, Binge Eating Disorder has both mental and physical symptoms, which are used in conjunction to make a diagnosis. This does not mean that someone has to look a certain way to have an eating disorder. It’s best to look at these two categories of symptoms/warning signs as two separate categories:

Behavioral/Emotional Warning Signs:

  • Evidence of binge eating, such as excessively large purchases of food or hidden food wrappers/containers.
  • Fear of public eating or reliance on eating alone.
  • Expressing fear of weight gain or disgust with their current body.
  • Frequent “body checking” in mirrors.
  • Constantly trying new diets and fads.
  • Dramatic fluctuations in weight.
  • Turning to food as comfort for emotional distress.

Physical Warning Signs:

  • Noticeable fluctuations in weight.
  • Stomach pains or gastrointestinal distress.

Source: https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bed

Orthorexia

Orthorexia is relatively new on the scene of discussions about eating disorders. Although the term was firs coined in 1998, it’s still not formally recognized by the DSM-5. Orthorexia is a great exemplar for the fact that mental illness is most often normal behavior taken to an extreme degree. While it’s normal and common to care about one’s health and strive to eat/exercise in a healthy way, orthorexia takes it to the extreme in a way that is, ironically, detrimental to one’s health.

Behavioral/Emotional Warning Signs:

  • Compulsively checking nutrition labels on food.
  • Cutting out large categories of food without fair reason.
  • Spending hours a day thinking about food.
  • Obsessing over what food might be served at public events or gatherings.
  • Unusual preoccupation with or interest in the health value of what others are eating.
  • Obsessive following of health celebrities, blogs, or social media accounts.
  • Body image concerns.
  • Rigid exercise and diet rituals.

Physical Warning Signs:

  • Noticeable fluctuations in weight.
  • Signs of under-recovering from exercise.
  • Changes in menstruation.

Source: https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia

There are other manifestations of eating disorders and disordered eating, but the ones listed above are the most common ones I see people reaching out for and expressing confusion over.

So what should you do with this information?

If reading the descriptions and diagnostic criteria for one of these eating disorders reminded you of yourself or someone you love, it might be time to seek out the help of a professional who can offer you a formal diagnosis. Oftentimes, it takes seeing the medical definition of these diseases to fully comprehend just how unhealthy our behavior has become, as these changes can happen slowly over time.

You may walk away from reading this information feeling scared, helpless, or even more confused. Those are perfectly legitimate emotional reactions to have. Know that seeking the help of a professional does not necessarily mean you entire life has to change at once: it may simply begin with working with a therapist to process the emotions you’re feeling right now. If you need someone to talk to right away, try calling the NEDA hotline (available Monday-Thursday from 9am-9pm EST and Friday from 9am-5pm EST) at (800)-931-2237, or chat online with a NEDA representative here.

If you need help finding an eating-disorder specialized therapist or medical professional, try using this search engine.


Common Myths Surrounding Eating Disorders

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“Eating disorders are a choice.”

This is a harmful, although unfortunately common, misconception about eating disorders. Although many of the behaviors associated with eating disorders may seem like a choice from an outsider’s perspective, such as eating certain foods or exercising in a certain way, they are compulsive and find their roots in mental illness. Eating disorders have many causes- biological, social, and and environmental- but personal choice is not one of them.

Biologically, eating disorders may come at least partially from our genetic makeup, and even run in families. Socially, media representations of body ideals can influence disordered eating. Environmentally, the culture and circumstances we grow up in can impact our likelihood of developing all different forms of mental illness. It’s never okay to assume that someone simply has an eating disorder “by choice” when in reality, we may never fully understand what’s going on in someone else’s life.

“Eating disorders are just extreme diets.”

Another harmful, yet common misconception. Eating disorders, while related to diet in the sense that they’re related to what we eat, are not fad diets. As mentioned above, eating disorders have many complex and interrelated factors that make them very different from a healthy person simply deciding to try out a Paleo Diet or a Gluten Free Diet.

While some patients may believe they are simply dieting, diagnostic criteria mentioned earlier in this guide help professionals separate those who are “dieting” from those who are legitimately experiencing an eating disorder.

Similarly, eating disorders are not “good ways to lose weight for your prom/wedding/etc.” Eating disorders are illness that take a lifetime to navigate, not a way to shed some pounds before your upcoming event.

“Only vain people develop eating disorders.”

Although eating disorders can result in preoccupations with appearance, they in no way mean someone is “vain” or “self-absorbed.” These kinda of symptoms are the result of far deeper causes and concerns than they can appear from the surface. Oftentimes, controlling one’s appearance is a way to overcompensate for other areas of their lives that feel out of control: an abusive relationship, the loss of a loved one, or their economic situation, for example.

“You have to look a certain way/be ‘sick enough’ to get help.”

There is no way to tell someone has an eating disorder simply by looking at them. People of all ages, ethnicities, social classes, shapes, and sizes suffer from eating disorders. There is also no such thing as not being “thin enough/sick enough” to seek treatment. If disordered behavior is causing you any level of emotional distress, you have a right to and should seek out help from a qualified professional.

“Recovery isn’t even possible anyway.”

Recovery is possible, it just needs some redefining. Recovery does not mean never having another disordered thought ever again, it means continually working towards a place of greater peace with your body, your food, and yourself. It absolutely does get easier as time goes on, and it’s entirely possible to get to a place where food and your body no longer feels like the enemy.

Recovery looks different for everyone. For some people, a few months of therapy gets them to a healthy space. For others, it may take a far longer and more involved process to feel comfortable. Everyone will find different resources in their journey that work for them. For me, yoga was a huge factor. But for others, things like writing, painting, dancing, or journaling may play bigger roles in their recovery.

Read more about my definition of recovery here: https://yogamaris.net/2016/10/13/mental-illness-is-not-a-fatal-flaw/

“Only girls have eating disorders.”

Wrong. Many men and gender non-binary folk have eating disorders. According to a 2007 study by the Center for Disease Control and Prevention, as many as 1/3 of all eating disorder sufferers are male, and in 2015 a study of undergraduates in the United States found that in the past year, transgender students were the most likely to be diagnosed with an eating disorder (source).

“I can recover by myself.”

Everyone needs help, and everyone needs different kinds of help. There is no point in tackling this journey on your own when there are so many resources out there to support you.

NEDA has a hotline (available Monday-Thursday from 9am-9pm EST and Friday from 9am-5pm EST) at (800)-931-2237, or you can chat online with a NEDA representative here. You can also use this search engine to find a treatment resource/professional nearby in your area.

Speak to a friend or family member you trust. You can even send them this very guide and tell them you’re concerned that you’re expressing some of the symptoms mentioned above. You deserve all the support in the world.


Tips For Telling Your Family/Partner/Friend That You May Have an Eating Disorder

Find the right time to talk.

Choose a time and a space that feels safe for you to open up about your concerns, and give this person a heads up that you’d like to find a time to meet them there. For example, tell a friend you have a lot on your mind and you’d like to meet them at your favorite coffee shop to talk over tea. Or ask your parent if you can go for a walk, just the two of you, to talk.

Don’t try to talk to someone while they’re busy, while you’re at a crowded social event, or while in an excessively public space. This is a big topic to broach, and you want to give both of you room to fully express and process any emotions that may arise.

Set clear expectations for how you’d like the conversation to go.

Set boundaries and give them concrete ways to understand what you’d like to get out of this conversation. If you’re simply looking for someone to hold space for you, try starting with:

“I’d like to get something off of my chest. I’m not looking for advice just yet, and I’d appreciate if you could just listen to me without trying to fix any problems I might bring up. Later down the line I might ask you for advice, but today I just need someone to listen.”

If you are looking for more concrete help from someone, try saying:

“I need your support in finding resources to help me through something difficult happening in my life right now. This is a hard time for me, and I feel nervous finding help alone, and I’m hoping you can be there for me while I try to find professional support.”

It’s also helpful to address right off the bat what concerns you have about reaching out for help:

“I’m afraid that when I tell you this, you will react with judgement or make me feel ashamed for telling you. It would also really hurt me if you tried to tell me I was overreacting. I’m not accusing you of doing these things, I just want you to be aware of how I’m feeling.”

This might help “prime” your friend/family member to think carefully about how they react to what you might say.

Offer them resources.

Try sending them this guide or my other guide, or linking them to another credible resource about eating disorders. Many people aren’t aware of how little they know about this big topic, and empowering them with knowledge can help them be an even more effective resource for you.

Try writing them a letter.

If talking to someone face-to-face is too difficult, try writing them a letter. This has the added bonus of giving them some time to process their own emotions before they respond to you, while also giving you more time to think about how you want to articulate your need for help.

Be prepared for a less-than-ideal reaction.

Not everyone will know how to handle such a sensitive topic. They may hold prejudices or stigmas about mental illness due to their upbringing or lack of relevant education. Some people, oftentimes parents, will express anger as a way of dealing with their own fear over the situation. Know that this is no way reflects your worthiness of receiving help and support.


Frequently Asked Questions

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I’m afraid that they will make me gain weight in recovery.

Gaining weight does commonly occur in recovery from Anorexia Nervosa, and is oftentimes entirely necessary to the health of the individual. This is a common fear of patients going into recovery, and one I certainly had in the beginning of my journey. Know that this is a valid fear, and one that will take lots of time and practice to navigate.

A big tip that you may find helpful is to practice separating the “eating disorder voice” from who you really are. I wrote an in-depth guide to practicing this exercise along with an open letter here: https://yogamaris.net/2017/01/26/an-open-letter-you-are-not-your-eating-disorder/

Oftentimes, people come to me expressing the fear that their treatment team is making them gain more weight than they “need to,” and express frustration that they know better than their team what body is best for their health and happiness. If this is something you’ve experienced, I recommend you read my piece here: https://yogamaris.net/2018/05/10/socialization/

Is yoga right for me in my recovery journey?

Yoga is a practice of mindfulness, which has huge benefits for those struggling with forms of mental illness that induce feelings of anxiety and stressful obsessions. Yoga really encourages us to exist in the present moment, which means separating from obsessions over the past or anxieties about the future. For someone with an eating disorder, this can help them deal with obsessions over a previous food choice, for example, or deal with anxieties about food choices they will have to make in the future.

Yoga also teaches self-love and self-care, things that are truly integral to recovery from an eating disorder. Yoga isn’t about changing to way our body looks, or even about obsessing over how it “should” work or function: it’s about accepting it for what it is while continually challenging ourselves in new ways. Sounds a lot like recovery, right?

Yoga can be a really positive resource for you as you navigate this journey, in many different forms. The mental benefits you can receive from yoga through mindfulness, meditation, and reconnection to your body may help you reduce stress, and a great introduction to this is the book “The Yamas and Niyamas” by Deborah Adele.

Yoga also helps us develop a gratitude for our body, which can be very helpful during times where we are sick and often feel as though there is something “wrong” or “broken” about us. The practice of yoga is based on a respect for the body that carries us throughout this world, and I think that can be one of the most overlooked tools during times of recovery.

Physically, yoga is fabulous because it comes in all different forms, levels, and styles. In the beginning of your recovery, restorative practices like yin or gentle flow would be wonderful for reducing stress and mobilizing the body gently. Eventually you may be able to develop strength and stamina in a Vinyasa or Ashtanga practice.

I relapsed/engaged in a disordered behavior. Should I just give up?

No! This is an absolutely normal and necessary step towards finding your recovery. When we slip up, it’s a powerful opportunity to reassess what’s going on and identify a new trigger that we will now be better equipped to navigate. Recovery isn’t all or nothing, it simply means that you’re actively working towards learning how to reclaim control over your life from your eating disorder.

I write more about this idea and what to do when you “slip up” here: https://yogamaris.net/2017/02/23/what-do-i-need-right-now-more-on-the-reality-of-eating-disorders/

Is recovery worth it?

Yes. A million times over, yes. When you’re in the thick of an eating disorder, it’s incredibly hard to imagine that recovery will make life better, because the eating disorder loves to lie to us. It preys on our fears and insecurities and hopes that we’ll let it stick around so it can keep feeding off of our energy like a parasite. The eating disorder is a liar, and the harder we work to separate ourselves from it, the brighter life becomes. Things that you never thought could bring you joy again like enjoying a dessert with a friend or skipping a workout on vacation can. And life becomes so much brighter once it does.

It’s not easy. It takes time. But it’s worth it.


 

Recommended Readings

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Below are articles I’ve written that I’ll often refer people to when they reach out via email or direct message. The reasoning behind this isn’t self-promotion, dismissal, or laziness, but rather the simple fact that these are 1,000+ word articles that I can’t retype each time I’d like to share their sentiment. I hope they are helpful!

Talk About the Shit You Don’t Want to Talk About

More Shit You Don’t Want to Talk About

People Are Talking About Eating Disorders

Why We Need to Use Empowerment as a Treatment Tool

On Seeing Yourself in Hi-Def

Seasons of Recovery

More on the Reality of Eating Disorders

On Weight Gain, Body Ideals, Before-and-Afters, and More

Questions for a Recovered Anorexic

The First Steps to Removing the Stigma From Mental Illness

What They Don’t Tell You About Having an Eating Disorder

An Open Letter: You Are Not Your Eating Disorder

Mental Illness is Not a Fatal Flaw

The Privilege of Eating Disorder Recovery.

A Spiritual Journey.

How Recovering From My Eating Disorder Led to Discovering My Life’s Purpose.

What I Wish My Family Had Known When I Was Diagnosed With an Eating Disorder: How to Support Loved Ones Beginning Their Recovery Journeys.

The Spirit of Recovery is Wildness.

The Way We Speak About Ourselves Matters.

Being the “Perfect Patient:” Why Seeing a Therapist Can Be Scary In Recovery

Self-Love and Recovery Comes From Within You, Not Anyone Else.


I believe in you.

I really, really do. I know that you are brave enough to take on this journey, and I know that you are completely worth it. This world will be so much brighter when you’re able to fully shine and share with the world who you truly are. There are people out there to support you, no matter how hard you have to look to find them, and I promise that you are never truly alone. At the very least, there’s me.

If your question wasn’t answered in this guide, please drop me a note below, send me an email at marisdegeneryoga@gmail.com, or message me on Instagram at @yogamaris and let me know that you read the guide, but had a question you’d like to see added to it.

With love and light,

Maris

 

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