Deeper Than Looks

“People can start out one way, and by the time life gets through with them, they end up completely different.” (~Sue Monk Kidd)

I think there’s this misconception out there about having an eating disorder… You might be thinking about all the ways a person looks, am I right?

They’re emaciated and bony, tired-looking with gaunt facial features, you think. Sometimes, you’re right. But a lot of times, you’re not.

When I entered treatment for anorexia, I was only 70-percent of my “ideal” body weight, as opposed to the at least 85-percent my treatment team desired. I understood that there would many many types of people there, but I figured they’d all look like I did, too – which was, underweight, timid, and tired of it all.

But, I was surprised that many people suffering alongside me looked… normal. And, they weren’t about to discharge either. They were also in the thick of their fight.

Many people who suffer from bulimia, for example, see vomiting as a means to rid themselves of the food they’ve eaten, and see it as a weight management tool, rather than losing weight. Other poor relationships with food are represented by binge eating disorder where people eat massive amounts of food but don’t try to rid themselves of it. And, there’s orthorexia where people are terrified of eating “bad” or “unhealthy” food and have an obsession with eating only healthy food.

Can you see how many of these types of eating disorders would allow the person with the disease to not look totally emaciated, and leave them even overweight? Sure thing.

A lot of times I get the question:

I think I know someone with an eating disorder, but how do I know for sure?

Well, I’m going to talk about one specific disease – anorexia – and then a few general ones, from my experience. Only a doctor can know for sure. The diagnostic criteria for anorexia are as follows:

  1. Restriction of energy intake (food/calories) relative to the person’s requirement, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health;
  2. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight; and
  3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

None of these refer to specific weight loss or a number or look a person must achieve to be diagnosed with anorexia nervosa. Instead, it talks about restriction (a behavior), fear of gaining weight or being fat, and distorted body image.

Since many of these things don’t show up from a panel of bloodwork or on the scale, as a friend or family member who spends a lot of time with someone you care about… you’ll probably notice an alarming difference in behaviors and engagement in life.

Here are other signs and symptoms, many of which I experienced, too:

  • Amenorrhea – a huge one, especially among young athletes. Primary is when a person hasn’t had her period before the age of 16, and Secondary is when she has her period and then loses it for three months or more. This is also related to something called the Female Athlete Triad. I had this and lost my period for six years. Once I got it back, I grew 1.5 inches at age 23.
  • Irritability; Loss of interest; Depression
  • Sleep disturbances
  • Weakness; Fatigue; Muscle loss; Faintness; Dizziness
  • A feeling of “fullness” 
  • Polyuria (producing abnormal amounts of urine/frequently going to the bathroom)
  • Intolerance of cold; having cold hands
  • Hyperactivity
  • Bradycardia (slower than normal heart rate- mine was consistently in the 30s); Hypotension (low blood pressure); Elevated cholesterol 
  • Dry skin; Brittle nails; Hair loss
  • “Yellow skin” (especially palms)
  • Lanugo hair (fine hair produced all over your body to stay warm- I had this, it’s real!)
  • Muscle loss
  • Dehydration (can result in kidney failure)
  • Constipation; Infertility; Low bone density (osteopenia/osteoporosis); Edema

As you can see, it’s not a vanity issue. It’s not a gain-weight-and-you’re-better thing. Part of the reason it’s the most fatal mental health disease is that, aside from someone suffering committing suicide, many of the symptoms can lead to heart attacks, heart damage and/or failure, and kidney failure. And, they can happen even after weight has been restored.

If someone is acting avoidant around social situations, or changing behaviors around food, perhaps it’s time to have a hard conversation… because you care. After I was discharged from treatment, many of my friends told me they noticed I was different but didn’t know the problem for sure. They didn’t know how to act or what to say.

Just say it. Offer support and help. The conversation doesn’t need to be long, but the effects can begin to help someone regain their life.