Why eating disorders go unnoticed and undiagnosed
I’m just dieting, is what I told myself for years before I finally capitulated to reality. Because the truth was, I was just dieting. Until I wasn’t.
I, like many, had taken dieting to the extreme. And to be honest, there was no reason for me to be on a diet in the first place. I wanted something I could control, and food and my body seemed like the most accessible way to feel in charge.
Disordered behaviors are sneaky, secretive, and shameful, which is just one of the reasons they tend to go unnoticed and, therefore, undiagnosed.
In the United States, nearly 30 million people will have an eating disorder at some point during their lifetime but, according to ANAD statistics, only 27% of affected women will receive treatment.
Why is there such a substantial gap between the prevalence of eating disorders and the attempted treatment of them?
In this post, I’ll explore why eating disorders are so difficult to acknowledge as a problem and eventually diagnose, and why some never get diagnosed at all.
Why eating disorders go unnoticed
By the individual
They rationalize their behaviors
In today’s pervasive diet-centered culture, it can be easy not to notice when behaviors society considers normal (even “healthy” in some cases) can turn disordered. These behaviors are constantly reinforced by messaging that promotes thinness as aspirational, and we may carry out this aspiration without even knowing it.
Gut check: If you’ve recently made a lifestyle change in an effort to “get healthier”, ask yourself: What is the motivation behind this decision? Is it truly to improve the health of your body, or is it to change your body’s shape because you feel like your current shape is unacceptable by your or society’s standards?
They don’t fit the stereotype
In decades past, the media has shown us singular representations of eating disorders and the types of people they affect. If an individual has been subjected to these images but doesn’t fit this physical, gendered, racial, or socioeconomic example, they may brush off their behaviors as unproblematic.
Secrecy is at the root of eating disorders
Eating disorders thrive in secrecy, shame, and denial. The longer it’s kept a secret, the stronger it gets, in some cases. The moment we start to reveal the secret, the eating disorder starts losing strength, but denial and shame often prevent us from ever getting to this place.
By others
Once again, they don’t fit the stereotype
This can happen with both the individual and their loved ones. Most of us have preconceived notions of what someone with an eating disorder should look like. We like to think we’d be able to spot an eating disorder with our eyes. But the truth is that people of all body types can be engaging in disordered behaviors.
Family members or friends may not know that a person has bulimia nervosa because they don’t appear underweight but disordered behaviors are often hidden and may go unnoticed even by those close to them.
They think eating disorders are a choice
When uneducated about eating disorders, loved ones might see their family member’s symptoms as a “choice” that can be remedied simply by changing their eating habits. Whether the root of this belief is denial or ignorance, it’s incorrect and it’s unhelpful.
Why eating disorders go undiagnosed
By the individual
Stigma
Despite the increasing societal normalization of seeking mental health treatment, some people still feel shameful or embarrassed when they realize they need help. They may fear judgment from family, friends, or themselves, which can delay or deter them from beginning their treatment journey.
Lack of understanding of symptoms
Even with available treatment options, it may take years for an individual to recognize they have a problem. This can severely delay the moment at which they decide they need treatment.
According to the National Eating Disorders Collaboration: “It is estimated that treatment for an eating disorder is sought an average of 5-15 years after the onset of the disorder.”
Don’t think they are ‘sick enough’
This might sound preposterous (and that’s because it is), but some eating disorders treatment centers won’t admit patients unless their weight falls below a certain threshold or they’re actively experiencing other life-threatening symptoms.
We know that eating disorders present in countless ways (not just in people with low body weight), yet this belief that a person is not “sick enough” to warrant help can convince individuals that they don’t have a problem.
A clear example of this can be found with atypical anorexia. A person who presents with atypical anorexia is typically at an “average” weight yet they engage in the same behaviors as someone with anorexia nervosa. But because their weight might be considered “healthy” by some healthcare practitioners, they might be denied treatment more often than people who are visibly underweight.
Access to care
If and when individuals feel ready to seek treatment, they may find that options are few and far between. There are still many pockets of the country and world that experience mental healthcare droughts, forcing individuals to travel hundreds of miles for treatment or resorting to virtual healthcare, which isn’t always the best solution for eating disorders.
Ambivalence about care options, recovery
The recognition of disordered eating behavior doesn’t necessarily beget the onset of treatment. Individuals may feel disillusioned by their treatment options, have had negative past experiences with doctors, or feel hopeless about any effort to recover.
By treatment professionals
Lack of knowledge about eating disorders
Strides have been made in terms of educating healthcare professionals about the severity and symptoms of eating disorders, but there is still a long way to go. Primary care physicians must be trained in identifying the complex signs of disordered eating and must know how and when to intervene for optimal treatment outcomes.
Treatment of each symptom, not as a whole
When a patient presents to a physician with multiple symptoms that are seemingly unrelated, the physician might try to treat the individual symptoms rather than taking a holistic look at a confluence of symptoms and how they relate to one another. Because of the breadth of symptoms that can occur when someone is engaging in disordered eating behaviors and because so many non-eating issues can result from disordered behaviors, diagnosing an eating disorder can be a bit murky.
What to do if you’re worried about your behaviors
Despite these barriers to recognizing eating disorders, seeking treatment, and receiving a proper diagnosis, if you’re concerned about your or a loved one’s behaviors, take a breath and examine the honest reasons behind these behaviors. Depending on how intrusive the thoughts and behaviors have become, it’s important to understand that getting out of this will be difficult to do on your own and that it’s perfectly OK to seek help. Visit the Rules & Resources page to find help near you.
Helpful tool: While this is not a catch-all diagnostic tool for eating disorders, this self-assessment from The Emily Program can help you identify whether your beliefs and behaviors might be something worth examining more closely.
Pause & Prompt
I’m afraid to look more closely at my thoughts and behaviors because…
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Why so many eating disorders go undetected and, therefore, untreated.