Anyone who’s ever been diagnosed with an eating disorder or witnessed a loved one struggle knows one of the toughest parts of recovery is navigating the misunderstandings around the nature of eating disorders. No, eating disorders are not a vanity issue, a lifestyle choice, a diet gone wrong, or a “phase.” Eating disorders are serious brain diseases with high mortality rates. And it’s time we start recognizing them as such.
“It’s important for folks to understand that eating disorders are a serious mental illness, because then we’ll treat them with the same urgency as any other mental illness, like depression, anxiety, or PTSD,” says Equip Lead Peer Mentor Zaynah Mahon. “The sooner we start accurately treating eating disorders as mental illnesses, the sooner treatments can be accessible to everyone.”
Equip therapist Jonathan Levine points out that like all brain diseases, eating disorders do not give those suffering the ability to opt out or simply “decide” to get better. “Understanding that eating disorders are mental illnesses is critical for three main reasons: empathy, awareness, and recovery,” he says. “Assuming that eating disorders are a phase or strictly vanity-related is dangerous, because it neglects to factor in that you're dealing with a brain disease. And like with all brain diseases, you can't think yourself out of it. It takes action, support, and treatment for the majority of people with eating disorders to recover.”
So, is an eating disorder a mental illness?
As research has repeatedly demonstrated, eating disorders are complex illnesses that involve biological, psychological, and social risk factors. Studies have shown that eating disorders physically change the reward circuitry in the brain and alter gray matter and brain structure. “When you're dealing with an eating disorder, the brain is severely impacted,” Levine says. “What ‘makes sense’ to a nourished brain will not follow a malnourished brain's logic. The eating disorder brain is, by definition, irrational.. In order for the reward system to kick back online and the brain to heal, you need nourishment.”
With a deeper understanding of the science behind eating disorders, it’s clear that writing these illnesses off as aesthetic pursuits is not only grossly misinformed and inaccurate—it’s also dangerous. “Eating disorders are among the deadliest mental illnesses, second only to opioid overdose,” Mahon, who is in recovery, says. “When I was still suffering from an eating disorder, I was mentally ill. The eating disorder didn’t want a certain body type or number on the scale. It would have kept me sick until I was dead. Whenever I did reach a ‘goal weight,’ my brain only desired more, which means that nothing would ever be truly good enough.”
Underscoring Mahon’s point, Levine points to the severity and entrenched nature of eating disorders. “Let's look at the facts: if eating disorders are not ‘true’ mental illnesses, why are they historically treatment-resistant?” he asks. “Why doesn't simply telling someone to eat heal a restrictive eating disorder? Why does the average duration of an episode of anorexia last five to seven years? If eating disorders weren't a ‘real’ mental illness, none of this would be true.”
To fully understand the experience of living with an eating disorder, Levine advises putting yourself in the shoes of someone suffering. “Try envisioning someone else's voice in your ear, telling you deeply harmful, shameful, and untrue things about yourself, your body, and what you need to do,” he says. “It can feel like a total eclipse of the self. Many people with eating disorders don't want to recover— eating disorders are “egosyntonic.”Someone may be at risk of dying from not eating and still think that it’s the only way forward, that eating is worse than organ failure. That's how loud an eating disorder can get by impacting the brain.”
The role of culture and society in eating disorders
It’s undeniable that we exist in a diet culture-driven society where disordered behaviors like food restriction, overexercise, and obsessive thinking about one’s body are normalized. Given this, it’s understandable that some people might think eating disorders are simply a reaction to cultural expectations—but this explanation oversimplifies eating disorders by ignoring the many other contributing factors. After all, if harmful diet culture messaging was the sole cause of eating disorders, wouldn’t everyone have one?
“It’s true that media and diet culture can play a role in the development of eating disorders, but not on their own,” Mahon says. “ There are social factors that folks can’t opt out of that can contribute to the development of an eating disorder. For example, not having regular and secure access to food can absolutely contribute to disordered eating.” She also points to genetics, noting that anywhere from 28-74% of eating disorder risk is through genetic heritability.
While society, culture, and media all play their own role in the development and proliferation of eating disorders, Levine is clear that these issues are “biopsychosocial” phenomena. “What I mean by that is, eating disorders are partly genetic (biology), partly mental health-related (psychological), and partly cultural (social)—rarely does just ‘one’ thing lead to an eating disorder,” he says.
How to start shifting the perspective on eating disorders
By learning more about the science of these illnesses and talking openly about their prevalence, we can start to chip away at some of the biggest myths about eating disorders—all of which are doing a disservice to those in need of healing. Anyone who suspects they or someone they love may be experiencing symptoms should be encouraged to take the issue as seriously as any other disease and seek help immediately.
“Stay curious and be mindful,” Levine advises parents and other support figures. “Watch out for sudden or rapid shifts in eating habits, mood, sleep regulation, and how one talks about their body, as these could be warning signs. Most importantly, be consistent and supportive. Eating disorders are cunning and adept at pushing buttons to remain in power—don't be afraid to be firm and loving.”
For those experiencing the very real, at times debilitating symptoms of an eating disorder, Mahon encourages swift action and deep self-compassion. “Regardless of what anyone says about your eating disorder or their feelings on the intensity of your suffering, you are in fact sick enough to get help,” she says. “You don’t have to wait until you’re sick like someone else. If you are even for a second thinking of skipping lunch because you want to fit into your outfit for prom, or you think you need to run just one more mile even though you haven’t eaten, you need to ask for help. Tell a friend, an adult you trust, a crisis text line, anyone. Don’t wait for it to feel like a more serious problem."
If your'e concerned that you or a loved one is struggling with an eating disorder, it's important to get prompt treatment. Talk with a trusted medical provider or schedule a consultation with an Equip team member.
- Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020.
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