"But I'm Not Skinny": How Anorexia Nervosa Is Typically Characterized By One Body Shape
Updated August 28, 2020
Medically Reviewed By: Laura Angers
Anorexia Nervosa is most often known as a disease that targets young women, leaving destruction and pain in its wake. When the words come to mind, most people picture a young woman who is tall, thin, and perhaps even emaciated, and perched with one foot atop a bar in a ballet class. Although this may very well be a possibility, it has also been something of a problem for people with eating disorders, as many people with these disorders do not fit the typical idea of body weight and appearance.
What Are Eating Disorders?
An eating disorder is any type of disordered eating that significantly and negatively impacts an individual. Eating disorders vary in exactly how they are expressed; Anorexia Nervosa, for instance, is marked by severely restricted eating patterns. Bulimia Nervosa is marked by regular eating patterns or even binge eating patterns, followed by periods of purging, in order to “make up” for the food that has been consumed. Binge eating disorder is another eating disorder, most commonly characterized by periods of binge eating (or eating past what would be considered “normal” in a single sitting), but without the purging or over-exercising behaviors considered typical to Bulimia Nervosa and Anorexia Nervosa, respectively. There are other types of eating disorders that typically fall under the category of “Eating Disorder-Not Otherwise Specified,” or ED-NOS.
While eating disorders were once considered uncommon and were not recognized as a legitimate mental health disorder, increasing bodies of evidence have revealed the true, legitimate nature of disordered eating, as a very real (and in need of treatment) disorder. While the official document classifying mental health conditions has had eating disorders identified within its pages for quite some time, there is still a great deal of education and understanding needed in the public and in clinical settings, to increase the number of individuals who are able to recognize, pinpoint, and diagnose all types of eating disorders.
Eating Disorders and Stereotypes
Stereotypes abound within eating disorders, many of them painful and harmful in their assumptions. Traditionally, eating disorders were seen as something that harmed young, white, affluent girls—perhaps dancers, models, or other individuals whose hobbies and careers placed a high emphasis on appearance. Although it may be true that people whose bodies are constantly the source of scrutiny in work and daily life are more prone to eating disorders, it is both disingenuous and misinformed to suggest that eating disorders are entirely relegated to these narrow parameters. Instead, eating disorders can affect people of all ages, races, socioeconomic statuses, and backgrounds.
Body weight often plays a significant role in stereotypes, with most people identifying individuals with eating disorders as gaunt and young, with sharp bones jutting through the skin, and arms and legs little more than bone. Although this can be true, in some cases, not all body types and sizes respond in the same way or in the same time frame to restricted eating, as in Anorexia Nervosa, or other forms of food restriction and disordered eating. For this reason, people with eating disorders are not only small, emaciated females, but can be all genders, all ages, and a wide variety of weights—including individuals who are considered clinically overweight or obese.
The stereotype that anorexia only affects affluent people is also common—and also untrue. Eating disorders do not discriminate based on socioeconomic status, and can just as readily creep into the lives of people living in poverty as those living lavishly. The issue is not one of money or privilege but is instead a feeling of being out of control—control that an eating disorder seems to promise to give back.
The Harmful Effects of Stereotypes
Stereotypes have numerous harmful effects but are still frequently used as baselines from which to learn more. In daily life, stereotypes are often harmful because they perpetuate unrealistic and inaccurate depictions of people, people groups, and experiences. People may find themselves treating others based on preconceived notions—borne of stereotypes—rather than speaking to, behaving toward, and engaging with them based on who they are and what is actually known about them. In relationships, work, and friendship, stereotypes can be enormously harmful, and can quickly deteriorate relationships and goodwill.
Stereotypes can also be harmful to mental health work. Although mental health professionals are trained to avoid dealing in stereotypes, they can still work their way into understandings of different mental health disorders, which can lead to inaccurate diagnoses, or a lack of diagnosis altogether, both of these scenarios potentially harmful in their conclusion. Stereotypes can be particularly problematic when eating disorders are involved, as people who do not fit the standard physical mold of an eating disorder are often overlooked, ignored, or misdiagnosed, allowing disordered eating to continue. Without treatment, eating disorders can be extremely dangerous and may even be fatal.
The “One Body Type” Myth
The myth of a single body type is a pervasive one in both popular culture and the mental health field; many people with eating disorders go undiagnosed because they do not fit the narrow confines often given to the body types and weights associated with eating disorders. Again, perhaps due to its perceived prevalence among models and ballet dancers, Anorexia Nervosa and other eating disorders are often whitewashed and downplayed, while being frequently ascribed to individuals who are young, white, and extremely slender in appearance. Although this view of eating disorders is a persistent one, it has long been problematic, and has long ignored the reality of eating disorders and who they actually affect—namely, any segment of the population, rather than a single, small sliver of the population.
The myth of a single bodyweight is not only persistent: it is actively harmful. Clinicians may be unwilling to diagnose individuals who display symptoms of disordered eating—restricting food, over-exercising, fixating on dieting, and exercising—while those individuals are of a weight that is considered normal or excessive. Although an entirely separate diagnosis has been created for individuals with Anorexia Nervosa who do not fit the diagnostic criteria of low BMI and emaciation (called Atypical Anorexia), the myth of a single body type and bodyweight has continued, creating barriers for individuals of larger weights and sizes to receive the correct diagnosis and subsequent treatment.
Eating Disorders and Co-Morbidities
Eating disorders like Anorexia Nervosa often have co-morbid conditions, which can help clinicians better understand (and more thoroughly diagnose) people struggling with the symptoms of eating disorders. Co-morbid conditions are mental or physical health conditions that exist concurrently with eating disorders. Although any condition can exist alongside eating disorders, there are some conditions that are more likely to be co-morbidities. These include:
- Obsessive-Compulsive Disorder. Obsessive-Compulsive Disorder is an anxiety disorder characterized by ritualistic behavior, intrusive thoughts, and compulsive behavior. The symptoms of OCD lend themselves to the proliferation of eating disorders, as both share some symptoms of compulsive behavior and fixation.
- Body Dysmorphia. Body Dysmorphia is often confused with eating disorders. Body Dysmorphia is a condition characterized by a drastically unrealistic view of one’s body—a view that is highly distorted and unimproved by sight. Body Dysmorphia might focus on a single flaw (a large nose, unattractive arms, knobby knees), rather than a generalized view of the body. An individual with very little bodyweight suffering from Body Dysmorphia might feel intense shame and disgust for their body, despite there not being any acceptable reason to do so.
- Major Depression Disorder. Major Depression Disorder has been linked to eating disorders, and people with depression may be more likely to suffer from disordered eating.
- Anxiety Disorders. Anxiety disorders in general are common co-morbidities with eating disorders and may include General Anxiety Disorder, Social Anxiety Disorder, and Post-Traumatic Stress Disorder.
Mood disorders are the most common co-morbid conditions that occur alongside eating disorders, and it is not typically a matter of identifying one or the other as the initial disorder. Instead, many eating disorder treatment plans include methods to treat co-morbid conditions. Recognizing these conditions is important, as creating a comprehensive and effective treatment plan relies on treating all aspects of mental health, rather than focusing on just one, because symptoms of one can powerfully impact symptoms of another.
Moving Away From Size in Diagnosing Eating Disorders
Historically, shape and size have been useful determiners when searching for evidence and symptoms of an eating disorder, but it is no longer a core, reliable indicator of an eating disorder. As food has grown increasingly complex with the proliferation of highly processed foods and hyper-palatable foods, the relationship to weight and food has grown increasingly complex. Caloric deficits and nutrient deficiencies do not necessarily occur at the same rate, which can have an effect on body weight and composition, and individuals who develop anorexia while at an elevated weight may not show the physical symptoms of the condition as quickly as those of “normal” weight, or those who are already underweight.
Size can play a role in the diagnosis of Anorexia Nervosa—but it might not. Clinicians must suspend a focus on body size when evaluating for eating disorders and should place greater emphasis on the symptoms of disordered eating themselves. Finally, a greater understanding of eating disorders is necessary for the general public, as the notion that eating disorders are disorders unique to the young and slender could negatively impact the loved ones of people struggling with an eating disorder, effectively obscuring the presence of disordered eating. If you or a loved one shows symptoms of an eating disorder like Anorexia, even without the proposed weight, reach out for help today.