Anorexia nervosa is an eating disorder that often results in extreme thinness or starvation. While these can be symptoms of anorexia, there are also many misconceptions and myths about anorexia that can lead to a delay in seeking help. Therefore, it is important to get a clear picture of myths and facts about anorexia nervosa and learn how to recognize and treat the disorder.
1. Myth: Anorexia is all about starvation
Fact: Anorexia is connected to deeper psychological concepts and beliefs.
Anorexia is associated with extreme restriction or avoidance of food that can lead to starvation-related outcomes, such as malnutrition or stunted growth. However, the underlying motivation for these behaviors is usually not related to food at all. In many cases, extreme restrictive behaviors are related to anxiety, perfectionism and control. A person with anorexia may feel that food is one aspect of their life that they have control over, or that control over their eating and body weight demonstrates admirable qualities, like self-discipline or work ethic.
Feeling in control may alleviate some of the feelings of anxiety or lack of self-worth that are common in anorexia nervosa. Extreme control over food may make a person feel more worthy or acceptable. Therefore, starvation behaviors only represent the surface of a more complex problem. Addressing these deeper beliefs is an important component of anorexia treatment.
2. Myth: Someone needs to be dangerously thin to have anorexia
Fact: People who appear a normal weight can still be diagnosed with anorexia.
People may assume that someone with anorexia nervosa must be extremely thin to be diagnosed with an eating disorder. It is common to associate anorexia with an image of extremely low body weight, low muscle density or a gaunt appearance. Due to this association between anorexia and weight, people may also assume that naturally slender people meet criteria for anorexia.
Indeed, one of the central diagnostic criteria of anorexia nervosa is low body weight relative to what would be considered appropriate for a person in the context of their age, sex and physical health. However, this is not the sole criteria for a diagnosis of anorexia. People just outside of what is considered a normal weight range for their age and sex can be diagnosed with anorexia.
A diagnosis of anorexia is linked with a range of problematic behaviors surrounding weight, including restricted eating, reluctance to gain weight, and relating self-worth to appearance and body shape. These behaviors do not always result in extreme or visibly low body weight. In fact, some people with severe anorexia may appear to be a normal body weight; this does not, however, mean that their illness is not serious or does not require treatment.
3. Myth: People with anorexia do not eat
Fact: People with anorexia do eat, but often practice extreme calorie restriction and food avoidance.
It is often assumed that people with anorexia simply do not eat, or eat only the absolute minimum amount of food necessary for survival. While extreme energy restriction is common in anorexia, it is not the case that people with anorexia do not eat.
Certainly, anorexia is characterized by extreme restriction and eating much less than is required for the body to function optimally. However, in many cases, people with anorexia eat regularly and frequently, although this eating behavior must follow strict rules. For example, a person with anorexia may:
- Consume only certain “safe” foods (i.e. foods they know to be within a certain caloric limit, below a certain threshold of fat, etc)
- Keep a rigid food log where they track every calorie they consume and scrutinize opportunities for reduction
- Satisfy hunger with non-caloric beverages (i.e. coffee, tea, diet coke)
- Avoid energy-dense foods or foods that are high in fat
These behaviors are maladaptive and can lead to a lack of energy and nutrients to properly fuel the body and keep bodily systems working optimally. People practicing these behaviors may suffer extreme health consequences related to undernourishment, even if they are eating regularly.
4. Myth: Men don’t suffer from anorexia
Fact: Hundreds of thousands of men suffer from anorexia.
Anorexia is typically considered a female disorder, and it is often believed that men cannot suffer from anorexia. Although anorexia is more common in women, anorexia can most certainly be diagnosed in men. Men account for as much as 10% of those suffering from an eating disorder.
Anorexia in men may have a slightly different symptom presentation, with many cases of male anorexia related to body dysphoria or aspiring to be lean and muscular, rather than extremely thin. Men are not immune to the pressures of social expectations, and can also experience feelings of dissatisfaction related to their body shape. Men can experience the anxiety, fear and self-criticism associated with disordered eating, and anorexia can be equally as debilitating in men as in women. However, the stigma associated with male anorexia may lead to delays in men seeking and receiving treatment, which can impact their long-term health.
5. Myth: Anorexia is a choice
Fact: Anorexia is a psychiatric condition linked to maladaptive thought patterns and compulsions.
For those who have not experienced an eating disorder, extreme restriction of food may appear to be a matter of choice. However, behaviors related to anorexia are often linked to much deeper thoughts and beliefs.
Anorexia is an eating disorder based in low self-worth, self-doubt and extreme fear of weight gain. A diagnosis of anorexia must meet specific criteria as set out in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Version 5), and personal choice is not included in these criteria.
The behaviors common in anorexia are often a result of these complex beliefs and anxieties. These ideas and beliefs are often deep-seated, and require therapy and counseling to unpack. In some cases, restrictive behaviors may be compulsive in nature, where a person cannot easily stop the maladaptive behaviors. In this way, it’s important to consider that there are complex biological and psychological reasons for anorexia that are not simply a matter of personal choice.
6. Myth: Anorexia is just a cry for attention
Fact: People with anorexia do not restrict their food intake for attention.
In Western societies, thinness is often perceived as a positive and attractive quality. Due to this, some may believe that people with anorexia become extremely thin to seek praise or attention.
Anorexia is a severe and debilitating psychiatric condition that is to be taken seriously. The negative outcomes of anorexia can include loss of bone density, heart complications, organ failure, or in severe cases, death. These outcomes are not to be taken lightly and are far more serious than attention-seeking behavior. By reducing anorexia to an attention-seeking disorder, people suffering from the disorder may feel ashamed or embarrassed, which can worsen their condition and prevent them from seeking help.
7. Myth: You cannot die from anorexia if you exercise to keep your heart strong
Fact: Anorexia is linked with a higher risk of death, and exercise may increase this risk.
In general, exercise is a great strategy for developing a strong heart and cardiovascular system. However, this is not true for people with anorexia, and exercise may be a high-risk behavior for people with this eating disorder.
In cases of anorexia where a person is often malnourished, there is often not enough energy or nutrients consumed for the heart to properly function and strengthen during exercise. Because the function of the heart may be compromised from lack of proper nutrition, it has to work harder to maintain its regular functions.
Exercise places stress on the heart; in healthy individuals, this is a great benefit and should be encouraged. However, the hearts of people with anorexia are already working harder than usual when at rest, and exercise can place a dangerous amount of stress on an already hard-working heart. Although there is some evidence that supervised exercise may have some benefit in anorexia, people with anorexia should be extremely cautious with exercise, particularly if they have not achieved a healthier weight or are undergoing treatment. Exercise should be avoided or closely supervised to minimize any unnecessary stress on the heart and to avoid serious complications or death.
8. Myth: Anorexia is a phase that can be outgrown
Fact: Anorexia is a serious psychiatric disorder that is unlikely to resolve without professional treatment.
Anorexia tends to begin for the first time during adolescence, which is believed to be related to some of the changes associated with puberty and growing societal pressure surrounding weight and body shape. The rates of anorexia are often lower in adulthood; however, this does not mean that anorexia is a passing phase that is likely to be outgrown.
Anorexia is a serious psychiatric condition that is linked to harmful ways of thinking and problematic coping strategies. These thoughts and behaviors are often deeply ingrained and can take a considerable amount of time and effort to unlearn. Because of this, it is rare that anorexia will enter remission without treatment, or that thought patterns or symptoms will disappear with age. Eating disorders can be difficult to treat and often worsen with age or become more severe the longer that someone has anorexia.
Thankfully, there are various treatment options available, such as family-based therapy, cognitive behavioral therapy and nutrition counseling. These treatments can be life-saving for a person suffering from an eating disorder. If you or someone you love is experiencing symptoms of anorexia and co-occurring substance use disorder, contact The Recovery Village to discuss treatment options today.
Lavender, J. M. et al. “Daily patterns of anxiety in anorexia nervosa: associations with eating disorder behaviors in the natural environment.” Journal of abnormal psychology, 2013. Accessed May 22, 2019. Lloyd S. et al. “Perfectionism in Anorexia Nervosa: Novel Performance Based Evidence.” PLOS ONE, 2014. Accessed May 22, 2019. Zipfel, S., et al. “Anorexia nervosa: aetiology, assessment, and treatment.” Lancet Psychiatry, 2015. Accessed May 22th, 2019. Mayer, L. E. et al. “Eating behavior in anorexia nervosa: before and after treatment.” The International journal of eating disorders, 2012. Accessed May 22th, 2019. Ng, L.W. & Wong, W. P. “Is supervised exercise training safe in patients with anorexia nervosa? A meta-analysis.” Physiotherapy, 2013. Accessed May 23, 2019.
Lavender, J. M. et al. “Daily patterns of anxiety in anorexia nervosa: associations with eating disorder behaviors in the natural environment.” Journal of abnormal psychology, 2013. Accessed May 22, 2019.
Lloyd S. et al. “Perfectionism in Anorexia Nervosa: Novel Performance Based Evidence.” PLOS ONE, 2014. Accessed May 22, 2019.
Zipfel, S., et al. “Anorexia nervosa: aetiology, assessment, and treatment.” Lancet Psychiatry, 2015. Accessed May 22th, 2019.
Mayer, L. E. et al. “Eating behavior in anorexia nervosa: before and after treatment.” The International journal of eating disorders, 2012. Accessed May 22th, 2019.
Ng, L.W. & Wong, W. P. “Is supervised exercise training safe in patients with anorexia nervosa? A meta-analysis.” Physiotherapy, 2013. Accessed May 23, 2019.
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