One of the biggest myths about eating disorders revolves around choice: Eating disorders are a lifestyle choice. People have control over their actions. If they really wanted to get better, they would. If they really wanted to eat one more bite of food or stop bingeing on cookies, they could.
Several years ago, at a meeting at the National Institute of Mental Health, renowned eating disorder expert Cynthia Bulik, Ph.D, said that the myth of choice is perhaps the most damaging myth that her patients have had to deal with. “We still see this when patients go to the emergency room and they get triaged really far down the priority list because the physician thinks that somehow they chose to have a ruptured esophagus or they chose to have electrolyte imbalance.”
In reality, no one chooses to have an eating disorder. Eating disorders are serious, stubborn, complex and life-threatening illnesses, caused by a combination of biological, genetic, environmental and psychological factors. They also commonly co-occur with other conditions, including clinical depression, bipolar disorder, anxiety, obsessive-compulsive disorder and substance abuse.
As eating disorder specialist Jennifer Rollin, MSW, LCSW-C, writes in her powerful piece, “No one would choose to feel intense anxiety about eating certain foods, to the point where it starts to isolate themselves from the people that they care about. No one would choose to binge eat until they feel sick, with pain in their stomach and feelings of guilt, shame, and self-hatred. No one would decide to binge eat and then purge through vomiting or exercise, to feel completely trapped in the exhaustion and pain of the restrict/binge/purge cycle.”
In honor of National Eating Disorders Awareness Week, which starts today, we spoke with Rebecca Wagner, Ph.D., clinical director of the Eating Recovery Center in Houston, Texas. She talks more about what makes individuals vulnerable to developing an eating disorder and how parents can help.
Q: Why do people still think that eating disorders are a choice?
A: For the most part, people misunderstand eating disorders. They think it’s an illness about food, vanity, and if people wanted to stop they could. Rather, eating disorders are maladaptive coping skills to deal with distress and are rooted in negative core beliefs about oneself.
Typically, negative core beliefs develop from dramatic events such as bullying, loss, abandonment, neglect or abuse that happened early in a person’s life. Examples of negative core beliefs include feelings of worthlessness, being unlovable or undeserving. These negative beliefs then become the basis on which a person’s decisions, thoughts and actions stem from.
Q: Eating disorders tend to run in families. Genetics plays a pivotal role in increasing someone’s susceptibility to developing an eating disorder. What are other factors that contribute to making a person vulnerable to an eating disorder?
A: Anyone who experiences stress in their life is vulnerable to developing an eating disorder since food is used to cope with stress. That means anyone could develop the disorder. However, people who are most vulnerable are those that do not have other effective coping skills to deal with distress, feel emotions more intensely or have a history of trauma.
Q: Thankfully, we can intervene with some risk factors and reduce them. How can parents reduce certain risk factors/causes?
A: It is important that families increase their awareness about how eating disorders develop and what they look like. In general, parents can help their children by validating their emotions and experiences. Validation does not mean that you agree with your loved one’s perspective. Rather you try to understand their experience from their perspective. This requires that the parent takes a stance of curiosity in which they ask questions trying to elicit from their child what it is that they are actually thinking and feeling in a particular moment rather than assume they know what they’re feeling. Parents can ask questions such as: Can you help me understand?
They can also teach them adaptive ways to manage stress. The best way to teach kids how to manage stress is for parents to role model their own stress management techniques. Examples of stress management include: having hobbies that one engages in on a regular basis; being able to experience and express emotions in a respectful healthy manner; and deep breathing.
Q: What else would you like readers to know about eating disorders not being a choice?
A: Eating disorders are often shame-based and isolating illnesses. So you might not know that your loved one is struggling. However, early detection and treatment produce the best outcomes so the sooner someone gets treatment, the better their chance of full recovery. That’s why knowing the signs of an eating disorder and getting help early from eating disorder specialists like Eating Recovery Center is so important.
Again, what causes eating disorders is a very complex topic. The Center for Eating Disorders at Sheppard Pratt has a thorough outline of different factors.
On Wednesday, we’ll share another interview, which focuses on early detection, symptoms to watch out for, and effective treatment.