Truths and Misconceptions: Eating disorders

Stephanie Campbell, MSW, Social Worker in LHSC’s Adult Eating Disorders Service (AEDS)

February 1, 2024

An eating disorder is a mental health issue that presents with eating and eating related dysfunction. 

“Eating disorders are complex and often misunderstood,,” explains Stephanie Campbell, MSW, Social Worker, Adult Eating Disorders Service (AEDS) at London Health Sciences Centre (LHSC). “They are often comorbid with other diagnoses, can change over time or in different circumstances and are debilitating and distressful for those who struggle with disordered eating.” 

“When a person has disordered eating, it can impact mental, physical and social health and cognitive functioning,” Campbell explains. “Food fuels the body and provides essential nutrients so the brain can function well. Without appropriate food intake, eating disorders can spiral and negatively impact a person’s entire life.” 

Misconception: An eating disorder is always about attaining a specific body image. 
Truth: “Often an eating disorder may involve striving to meet a specific societal expectation or underlying personal belief about how one’s body ‘should’ look, but that is not always the case,” Campbell says.  

There are other eating disorders that do not revolve around body image, one specifically known as “avoidant restrictive food intake disorder,” or ARFID. 

ARFID diagnoses are complex and are about avoiding or restricting food intake due to, for example, having a high sensitivity and aversion to specific foods for sensory reasons (e.g., textures, smells, flavours), fearing negative consequences after eating that include stomach pain, vomiting, or choking and a general lack of interest in eating. The National Eating Disorder Information Centre (NEDIC) has more information about ARFID on their website. 

Eating disorders are not vain and are not simply about one’s appearance. Concerns about achieving a certain ideal body often reflect deeper anxieties about achieving a sense of belonging, acceptance or feeling good enough.

Misconception: Having an eating disorder is a choice. 
Truth: “People don’t like being preoccupied with food, shape, and weight – they are in distress,” notes Campbell. An eating disorder is a mental health concern that presents with certain behaviours, and for those who may not understand the complexities of an eating disorder, this can appear as a simple choice when it is not.” 

Eating disorders develop in a way that can be described as cyclic. 

Approximately 10 per cent of eating disorders develop out of inadvertent weight loss. For example, if an individual unintentionally loses weight due to an illness that others are unaware of, they may receive compliments about their appearance that can reinforce beliefs about health, weight, and attractiveness. This may cause the individual to continue under-eating behaviours, or start new behaviours, in an effort to maintain or further suppress their weight, even if they had a normative relationship with food and body image before. 

Emotional dysregulation can also create a cycle within disordered eating behaviours. If a person is emotionally dysregulated, a lack of consistent food intake can cause or exacerbate emotional distress and disordered eating. A common example is anxiety and nausea – anxiety may cause nausea, which may cause a lack of appetite or food aversion. The person may then decide they are too nauseous and anxious to eat, and under-eating will continue the cycle of psychological stress and dysregulation. 

There is no single cause for the development of an eating disorder. There are some risk factors which include, but are not limited to: perfectionism, family history, biology, low self-esteem, body dissatisfaction, food insecurity and experiencing or witnessing stigma regarding weight. 

Misconception: You can tell by looking at someone whether they have an eating disorder or not. 
Truth: “We see all different types of body shapes and weights with eating disorder diagnoses,” Campbell says. “The way a person looks does not always indicate whether they restrict, binge, purge, use laxatives, over-exercise, or avoid food, or whether they even have an eating disorder at all.” 

All eating disorders are problematic because they have significant, negative impacts on a person’s health and life. 

“A person can survive with an eating disorder their entire life and not show clear physical evidence of negative health consequences but eating disorders can end catastrophically for others. There’s no way of knowing whose body will be tolerant of eating disorder symptoms,” explains Campbell. “Eating disorders are the second leading cause of death for mental health concerns, so we take all symptoms and diagnoses very seriously.” 

Misconception: Eating disorders are women’s diseases. 
Truth: “Anyone in any race, class, gender or age can be affected by mental health concerns. Since eating disorders are classified as mental health diagnoses, they are no exception to this,” Campbell says.  

While girls and women represent a large number of individuals seeking treatment for eating disorders, men and boys also experience eating disorders. 

Research shows that there are specific marginalized groups that may have a higher risk of developing an eating disorder.  

“Around 60 per cent of individuals diagnosed with autism spectrum disorder (ASD) meet criteria for an eating disorder diagnosis,” Campbell says. “This is a complex topic though and can be challenging to identify between symptoms of an eating disorder or what may be undiagnosed ASD, as they have strong similarities in symptom presentation.” 

Eating disorders among members of 2SLGBTQIA+ communities occur, on average, at three times the rate of the general population. “For transgender individuals, specifically, eating disorders are four times more likely,” notes Campbell. “There are unique reasons that can cause the higher prevalence of eating disorders for members of these communities.” 

For 2SLGBTQIA+ individuals, mental health distress may stem from experiences related to home-related stress, trauma and trying to fit into a stereotypical or desired gender image. NEDIC has more information about eating disorders within 2SLGBTQIA+ communities on their website. 

NEDIC also has more information about BIPOC communities’ unique experiences with disordered eating on their website. 

“It is important that we continuously challenge how we talk about people’s bodies and food intake. Distress, trauma, physical and emotional pain and dysregulation can be aspects of the experiences of those with eating disorders,” says Campbell. “It’s important to be kind and compassionate to those struggling and check in with your loved ones if you notice what could be disordered eating habits.”