Why do Eating Disorder stigmas matter?
Updated: Aug 29, 2019
This is one of those times when ignorance is not bliss. At least not for everybody. When it comes to Eating Disorder stigmas, what we don't know can hurt us and the people we care about.
Why does stigma matter?
Eating disorders (EDs) have been given less attention in the growing body of research around mental illness stigma. Given that EDs are on the rise, I hope this changes. Understanding and addressing stigmas are huge factors in people getting the treatment they need. And equally key in getting freedom from the shame that surrounds EDs.
Stigma happens when an "individual with a deeply discredited attribute is rejected, stereotyped, or discriminated against by society." 1 Understanding this bias is the first step in changing perceptions from fear-based to fact-based and hopefully all the way to compassion-based. As it stands now, stigma around EDs is very real and very damaging.
Stigmas keep people from seeking out help. Thirty million Americans will struggle with an ED at some point in there life. 2 Yet only 1 in 10 people with eating disorders get treatment. 3 This is a big deal.
Eating disorders are dangerous and those of us with them need treatment from professionals and support from our friends and family. Stigma hinders both of these avenues of healing. Anorexia Nervosa (AN) has the highest mortality rate of any psychiatric disorder (with one in every five people with AN dying from primarily cardiovascular complications or suicide). 1 Mortality rates for AN are 12 times higher than the annual death rate for all other causes in females 15-24 years old. 4 AN has received the most attention in the research, but every type of ED comes with a host of painful, embarrassing and life-threatening conditions and complications. To say that the mental, emotional, spiritual and social damages are severe would be an understatement.
Research shows that the more people with an ED are exposed to stigmatizing attitudes, the deeper they go into their ED, the longer they stay there, the more terrible they feel about themselves and the less likely they are to get the help they need. 5
What do eating disorder stigmas look like?
The stigmas around eating disorders sounds something like this...
Eating disorders are not really a thing. People with an ED should be able to pull themselves together and they are responsible for their causing their own ED. 5, 6
Eating disorders are a lifestyle choice and recovery is simply a matter of altering a negative behavior 1
Anorexia Nervosa (AN) is a mild disorder, with symptoms like restrictive eating and dramatic weight loss which are socially desirable and not a big deal. They can just as easily start eating and put on some weight. (ibid)
Treatment doesn't take that long so people that seem to struggle with their ED long-term are just dragging it out for attention. 4
People with EDs are difficult to talk to or empathize with. 6 It's hard to empathize with them when they just choose not to control themselves. It really comes down to a shameful lack of self-control. It's their fault. 1
Eating disorders are strictly a female problem and are rooted in vanity and obsession with appearance. It's not a big deal. We're all trying to be thinner, they're just trying harder. 1, 5
If a stigma becomes internalized we begin to believe these things about ourselves. It's called self-stigma. With the general lack of education and awareness about EDs, it is highly likely that even people effected by ED don't even have solid facts to make sense of their own experience. Without that solid foundation and filter, it's hard to counter the barrage of stigma.
Here are some of the extremely damaging attitudes people with an ED encounter.
Internalizing messages like these has a major impacts on people and their recovery.
"I should be able to just pull myself together", "I don't have a real condition", "I'm responsible for my condition", "I'm incompetent", "I'm disgusting", "I'm only attention-seeking", "I'm shameful" and "I have no self-control". These were the top eight chosen responses to the question, "How damaging have the following attitudes/beliefs been to your psychological or physical well-being?". 5
How likely is it for somebody believing those things to feel safe and valuable enough to be vulnerable and ask for help? How likely would you be? What about your kid?
What is at the root of it?
This is a complicated topic with lots of roots and reasons. I've picked out just a small handful of possibilities. What's at the root of the stigma around EDs?
A societal ideal of thinness and a lack of accurate information that leads to trivializing (and shame).
A misconception about the cause of on-set and controllability (i.e. self-control, lifestyle choice, etc.) that leads to blame (and shame).
A lack of exposure to, and therefore empathy for, people struggling with an ED that leads to stereotyping (and shame).
See a theme here? Whatever the root is the "fruit" is often shame. Shame breeds fear, blame and disconnection. Shame doesn't help anybody to heal or change. Shame denies us the life-giving empathetic connection that heals.
Myth-busting the stigma.
Access to accurate information is key. So let's start there. Here is some research-based information in response to the stigmas above.
Myth #1: EDs are not really disorders.
Truth #1: EDs are a clinically recognized disorders in the DSM-5 in the same way that other mental illnesses and disorders are, i.e. depression, schizophrenia, anxiety, bi-polar disorder, etc. Currently, the DSM-5 recognizes Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder, and OSFED, (Other Specified Feeding or Eating Disorder). Diagnostic criteria for Orthorexia is being considered for inclusion in the DSM.
Myth #2: EDs are self-inflicted and controllable so the person with the ED is to blame. It's really just a shameful lack of self-control.
Truth #2: Research on EDs show that there is a genetic and biological component. There are differences in brains actively in an ED and in even ED recovery. For example, alterations in brain structure, cognitive deficits (i.e. set shifting), impairments in emotional functioning, brain metabolism and neuro-chemistry. Many of these deficits are similar to mood disorders and anxiety disorders. Studies have found profound disturbances of brain serotonin, neuropeptide systems and brain neurocircitry. Specifically in the circuits that modulate appetite, mood, cognitive function, impulse control, energy metabolism, autonomic and hormonal systems. 4
Myth #3: EDs are quickly and easily treated so anybody in recovery long-term is just wanting attention.
Truth #3: Although it's not always the case, studies have shown that the longer a person has an ED before getting treatment, the longer the recovery process takes. If an ED progresses to the point of hospitalization, the person usually goes through a progression of treatment from an in-patient treatment center all the way to an outpatient Therapist and/or Registered Dietician. Having access to an ongoing support system is important for a full recovery. Each recovery is unique and involves a complex set of factors. However, a common theme is that recovery takes longer without a healthy support system.
What do we do about it?
Do an honest self-evaluation. Do you hold any of these stigma beliefs. With such a persistent stigma, if this is your first time being exposed to this information, it's highly likely that you'll recognize at least one of these stigmas in yourself.
Pay attention to what you're saying. How do you talk about body image, thinness, weight loss, EDs, bingeing, purging, etc. Do you find yourself using disdainful, blaming, envious, outraged or shaming language? If so, what is the underlying belief there? What happens when you fact-check that belief?
Research it for yourself. Want to know more? Still have questions? Still think that maybe there is some truth behind ED stigma? Dig deeper and see what you find.
Ask God how He sees this person. If you're thinking, "I don't know anybody with an ED so I have a hard time empathizing or really understanding." I think we can all empathize with a struggle, but when faced with a person or a picture of somebody who might or does have an ED it can help to ask God, "How do You see this person?" There is amazing power in perspective shifts that align more with how God sees us. Especially when He knows us so well and is so absolutely full of love and compassion and kindness toward us. I think we can all use a little more of that.
1 Kambanis, Paraskevi Evelyna, "Exploring the Stigmatization of Anorexia: A Focus on The Structural, Interpersonal, and Individual Levels of Stigma" (2016). Student Works. Paper 11.
2 National Association of Anorexia Nervosa and Associated Disorders, Inc. (ANAD) Eating Disorder Statistics (accessed March 27, 2018).
3 Mirror Mirror Eating Disorder Hope Eating Disorder Statistics (accessed March 27, 2018)
4 Klump, K. et al. "Academy for Eating Disorders Position Paper: Eating Disorders Are Serious Mental Illnesses" (2009). International Journal of Eating Disorders 42(2), p97-103.
5 Griffiths, S. et al. "The prevelance and adverse associations of stigmatization in people with eating disorders" (2014). International Journal of Eating Disorders. DOI: 10.1002/eat.22353
6 O’Connor, C., McNamara, N., O’Hara, L, & McNicholas, F. "Eating disorder
literacy and stigmatising attitudes toward anorexia, bulimia and binge eating disorder among adolescents" (2016). Advances in Eating Disorders: Theory, Research & Practice. Advance online publication. DOI: 10.1080/21662630.2015.1129635