Common myths about eating disorders

This information is intended to help dispel all-too-common misunderstandings about eating disorders and those affected by them. If your family member has an eating disorder, you may wish to share this information with others.

Overview of Common Eating Disorder Myths

Below are 24 myths about eating disorders accompanied by YouTube videos to address each of them. Topics include purging, body image, dieting, appearance, age, gender, sexual orientation, socioeconomics, treatment and recovery. This page may take extra time to load due to the large number of embedded videos below.

Myth: A person cannot have more than one eating disorder

Wrong. Unfortunately, a person with bulimia nervosa can develop anorexia, too—and may sometimes go back and forth between the two. The word “bulimarexia” was coined to describe this situation. Research shows that more than half of people with bulimia nervosa also become anorexic at some time during their illness.

Myth: A person is not really sick from an eating disorder until he or she looks like it.

Only a small percentage of people with eating disorders reach a state of emaciation. The common belief that a person is only seriously ill when he/she becomes abnormally thin can mess with the affected person’s perceptions of body image. The individual may even think he/she isn’t “good” at being “sick enough.” This can interfere with seeking treatment and can trigger more intense, self-destructive eating-disorder behaviors. And people with bulimia nervosa may not look out of the norm at all with regard to weight or appearance, or they may be overweight.

Myth: Bulimia is less serious than anorexia nervosa

All eating disorders can have damaging physical, emotional, and psychological consequences. Both bulimia and anorexia are serious mental health disorders listed in the psychiatric diagnostic manual, called the DSM-5. Although too much weight loss can become life threatening for a person with anorexia, people need to realize that bulimia nervosa can also become life threatening. Why? Purging—that’s when the person throws up, uses a laxative, or over-exercises to get rid of food in the body. This can cause electrolyte imbalances, esophagus or stomach ruptures, and malnourishment of major organs, including the brain. People with bulimia nervosa have an increased risk of suicide, too, compared to their peers without an eating disorder.

Myth: Bulimia nervosa affects men and women the same way.

While some symptoms may be similar, several hallmarks distinguish symptoms in males from those in females. Symptoms often show up at a younger age in males than in females—although they can also show up at a much later age than is typical in females, like the mid-20s. Females are more likely to focus on weight loss; males are more likely to focus on muscle mass. Although issues like altering diet to increase muscle mass, over-exercise, or steroid misuse are not yet criteria used to diagnose eating disorders, a growing body of research indicates that these factors are associated with eating disorders in many males.

Myth: Eating disorders are caused by unhealthy and unrealistic images in the media

While sociocultural factors, such as idealized body images, can contribute or trigger disordered-eating behavior, research has shown that the causes are many and include biologic, social, and environmental contributors. Most people exposed to media images of thin “ideal” body images don’t develop an eating disorder. Cases of eating disorders like anorexia have been found in medical literature going back to the 1800s, when social concepts of an ideal body shape for women and men differed a lot from today—long before the media promoted thin body images for women or lean muscular body images for men.

Myth: Eating disorders are a choice

Wrong. No one chooses to have an eating disorder. An eating disorder develops over time, and the behaviors that are coping mechanisms for underlying problems become habits. Undoing those behaviors requires understanding what drives them. And that requires having a whole team on tap to treat whatever aspect of the illness needs attention at a given time. It may be a medical doctor one time, a psychiatrist other times, and a psychologist over the long haul, plus others, such as nutritionists. A person with an eating disorder chooses whether to seek treatment, but no one sets out saying to themselves “I want to develop an eating disorder.”

Myth: Eating disorders are not an illness

Eating disorders ARE illnesses. Serious ones. What makes an eating disorder especially tough is that it involves physical, emotional, medical, and psychological aspects. These aspects all need attention and treatment. And there can be more than one psychological disorder going on, like bulimia and depression. Or bulimia and anxiety. Or bulimia and obsessive-compulsive disorder (OCD). Eating disorders are actually listed in the diagnostic manual that psychiatrists use called the DSM-5, which contains all the criteria doctors use to diagnose an eating disorder.

Myth: People age 25 or older are too old to develop an eating disorder

First-time eating disorder illnesses can and do occur in people who are in their late 20s, 30s, 40s, and older. These illnesses are not limited only to younger ages at onset.

Myth: Kids age 13 years or younger are too young to have an eating disorder

Sadly, eating disorders can occur in kids as young as seven or eight years old. Often, the signs are not recognized until middle to late teens. The average age at onset for anorexia is 17 years; the disorder rarely begins before puberty. The average age that bulimia is diagnosed is usually between 15 years and the early 20s, although some cases aren’t diagnosed until well into adulthood—like 30s or 40s.

Myth: Dieting is normal adolescent behavior

While fad dieting or body image concerns have become “normal” aspects of adolescent life in Western and other cultures, dieting or frequent and/or extreme dieting can be a risk factor for developing an eating disorder. It is especially a risk factor for young people with family history of eating disorders and depression, anxiety, or OCD. A focus on health, well-being, and healthy body image and acceptance is preferable to diets. Any dieting should be closely monitored.

Myth: Anorexia is “dieting gone bad”

Anorexia has nothing to do with dieting. It is a life-threatening medical/psychiatric disorder. Many people with a diagnosis of bulimia also become anorexic sometime during the course of their illness.

Myth: A person with anorexia never eats at all

Not true. Most people with anorexia eat, but they tend to eat tiny portions, low-calorie foods, or strange food combinations, like limiting themselves to ketchup and mustard. Some may eat candy bars in the morning and nothing else all day. Others may eat lettuce and mustard every 2 hours. The disordered eating behaviors are as individual as each person. Totally stopping all food intake is rare and would result in death from malnutrition in a matter of several weeks.

Myth: Purging helps lose weight

Purging does not get rid of ingested food. Half of what a person eats during a binge episode actually remains in the body after self-induced vomiting. Laxatives make a person lose weight through fluid and water loss, and the effects are temporary. For these reasons, many people with bulimia nervosa are average or above-average weight.

Myth: Most people with bulimia nervosa purge by throwing up

Throwing up is just one form of purging. People with bulimia nervosa also use other ways to purge. The goal is to empty the stomach or bowel contents to compensate for excessive food intake. Purging methods can include vomiting, enemas and laxative abuse, insulin abuse if the person is also diabetic, fasting, and excessive exercise. Any of these behaviors can be dangerous and lead to serious medical emergencies or even death. Purging by throwing up also can hurt the teeth and esophagus because of the acidity of purged contents.

Myth: Males who have an eating disorder tend to be gay

Sexual orientation has little to do with developing an eating disorder. This notion arises from stereotypes about male body image and attributing that to gay men. Don’t assume a guy with an eating disorder is gay. Heterosexual men develop eating disorders, too. However, recent research does suggest that individuals in the LGBT community show higher prevalence of eating disorders and a greater risk of eating-disordered behaviors than their non-LGBT peers, especially during teen years.

Myth: Only males who are also athletes develop bulimia

While participating in certain sports may confer a greater risk of developing an eating disorder for males, males who are not athletes also develop eating disorders. Eating- disordered behaviors may be a way of trying to control situations that feel out of control or beyond control.

Myth: If a person doesn’t have a textbook diagnosis of bulimia nervosa or anorexia, it can’t be that serious or life threatening.

Although a person may not meet all the criteria for eating disorders listed in the psychiatric diagnostic manual, even disordered eating, which may include frequent vomiting, excessive exercise, anxiety, and depression, has long-term consequences and requires attention and treatment. Early intervention may also prevent a person from developing a full-blown eating disorder.

Myth: Eating disorders are uncommon and affect only females

The statistics have changed over the years, and it’s hard for researchers to get exact numbers because most people with an eating disorder don’t want anyone to know. But eating disorders affect more individuals than many people realize. A recent international review of studies on bulimia nervosa prevalence reported the percentages of affected people. Those percentages translate to between 151,800 and 759,000 males in the U.S. and between 2,355,000 and 4,553,000 females. Studies also found that bulimia is more prevalent among Latinos and African Americans than non-Latino whites. And some researchers and clinicians think eating disorders are underreported in some populations, like males, because males are known to be less likely to seek help for disordered eating. Recent research has also found that eating disorders are found in some groups not previously considered as being at special or higher risk. This includes military personnel and veterans and the LGBT community. Among all people with any type of eating disorder, about 10% to 15% are male. In the case of anorexia, males account for about one-fourth of cases. For binge-eating disorder, cases of males and females are thought to be about the same.

Myth: A person with an eating disorder can be spotted just by appearance

Not really. People with an eating disorder can be really good at hiding the signs and symptoms—to the point where they may go on suffering for months, years, or even a lifetime without a friend or family member realizing it. A person with anorexia may be easier to spot, but loose clothing can conceal their body. Bulimia is harder to “see” because individuals often are normal weight or even overweight. Some people may have obvious signs, such as sudden weight loss or gain; others may not.

Myth: Eating disorders are about appearance and beauty

Definitely not. They have little to do with food, eating, appearance, or beauty. For example, the illness continues long after a person with anorexia has reached a “target” weight. Eating disorders are related to psychological issues such as control, perfectionism, and low self-esteem. For some people, they are also thought to have a biologic component.

Myth: Eating disorders are an attempt to seek attention

People who see the behaviors associated with eating disorders may think this because they don’t really know much about eating disorders. Eating- disorder behaviors are signals from the affected person of very serious struggles and a need for help. Eating disorder causes are complex and include environmental, cultural, and biologic factors. People with an eating disorder often go to great lengths to conceal it. They may feel ashamed, have low self-esteem, or feel compelled to use behaviors like purging to try to achieve control over some aspects of their life. However, they really need understanding, medical and psychological help, and compassionate support without judgement.

Myth: People rarely recover from eating disorders

The good news is that many people eventually recover after receiving treatment, but recovery can take months or years, and relapses may occur. So eating disorders are sort of chronic conditions, and once they develop, they deserve attention over a lifetime. Recovery rates and times vary widely. Early intervention with appropriate treatment can improve the outcome for any eating disorder. Although anorexia nervosa is associated with the highest death rate of all psychiatric disorders, research suggests that about half of people with anorexia nervosa recover, about 20% continue to experience issues with food, and about 20% die over the long term due to medical or psychological complications.

Myth: Only whites in upper socioeconomic levels get eating disorders

At one time, researchers thought eating disorders were “culture-bound syndromes” pertaining mainly to white females in Western, industrialized societies and at upper income levels. Now we know that disorders occur in most countries, including non-Western, low-resource countries. An increase in eating disorders across cultures and countries has been associated with cultural transition and globalization, including modernization, urbanization, and media-exposure promoting beauty ideals. Eating disorders have been recognized and diagnosed in countries throughout the world.

Myth: People don’t die from bulimia nervosa

Unfortunately, people do die from the complications of bulimia nervosa. This can happen because of physical effects or the psychological effects that result in suicide. Recent research shows that people with bulimia nervosa are seven times more likely to die by suicide than their peers without an eating disorder. Research also indicates that bulimia nervosa over a lifetime is independently associated with suicide over a lifetime when no other coexisting psychological disorder is present. More studies are needed to clarify these risks. Purging behaviors also increase the risk of death and sudden death. Purging can adversely affect the heart and electrolyte imbalances. Laxative use and excessive exercise can increase risk of death in people who are actively bulimic.