Eating disorders (EDs) are “biopsychosocial” illnesses, meaning each individual case stems from complex interactions of biology, psychology and socialization. They vary widely and are defined by the National Institute of Mental Health as “severe disturbances in people’s eating behaviors and related thoughts and emotions.” Extreme low weight is by no means a requirement for an ED diagnosis. According to the National Association of Anorexia Nervosa and Associated Disorders, “Fewer than 6% of eating disorders are medically diagnosed as ‘underweight.’”
Despite the traditional belief that EDs affect mostly wealthy, Caucasian, heterosexual, young females, they actually affect people from all demographics and ethnicities. According to studies published by Mitchinson, Hay and Mond (2014) and Kilpatrick, Ohannessian and Bartholomew (1999), Asian, Black, Hispanic, Native American and Caucasian youth have reported attempting to lose weight at similar rates. Given the myths that surround EDs, death rates are often elevated in marginalized communities, often due to late diagnoses and poor access to care. EDs require specialized treatments, and early intervention is key. Treatment requires an in-depth understanding of the physiological, nutritional and psychological issues that contribute to, and result from, ED behaviors. Medical intervention is often necessary, as virtually every function of the body, from cardiovascular to neurological to bone, hair, teeth, skin and vision, can be affected. This is especially true for young, underweight patients who are still growing and developing.
Recovery or recovered?
Is full ED recovery possible? According to Dr. Patricia Price, a Rochester psychologist specializing in the treatment of EDs, the answer is a resounding “yes.” Price, who openly shares her own recovery with patients, families and others, suggests that to be “fully recovered,” the individual must be completely free from their ED and also accept their natural body shape and size. She uses the term “in recovery” to describe the time between a patient’s initial diagnosis and approximately 2-5 years after full symptom remission.
For Price, the recovery phase lasted from age 13 until her mid-20s. Price’s ED followed a common pattern, beginning with restrictive anorexia nervosa and gradually moving through various ED diagnoses, before all symptoms gradually resolved. Evidence suggests the psychological factors that maintain EDs are similar across diagnoses, and when these factors are disrupted, full recovery is possible (Fairburn, 2008). At age 28, Price changed careers from school teaching to attain her doctorate in psychology, in order to help others recover.
Prevention and “talking back”
Advocacy and education are important preventative measures against EDs. Parents can play a major role in both ED prevention and recovery. Parents should not be afraid to talk back to societal pressures that idealize thinness and diet culture. Also, Price adds, “Don’t be afraid to speak up, even when you might be speaking up to a respected professional.”
Despite a 2016 recommendation by the American Academy of Pediatrics that physicians avoid recommending any form of restriction, Price notes this directive is not always followed. While physicians never mean to do harm, many focus mainly on obesity prevention. When pressed, most admit to having little or no formal training in EDs. Other harmful messaging comes from television, social media and even well meaning friends and relatives.
It is important to remember that eating disorders are not anyone’s fault. Anywhere from 28-74% of risk for ED development is through genetic heritability, which means prevention is not always possible. It is equally imperative to remember that treatment options are available and there should be no stigma in seeking help, whether for yourself or a loved one. With acknowledgment and timely, skilled treatment, the road from “recovery” to “recovered” is possible.