Myths

Research indicates that there are generally low levels of mental health literacy in the community; however, general beliefs and misunderstanding about mental health affect community responses to eating disorders.

It is important that everyone understands the facts about mental health and eating disorders. This leads not only to a more aware and accepting community, but also improves prevention, early identification and help-seeking.

Five Common Misconceptions about Eating Disorders.

Myth #1: Eating disorders are not serious; they are a lifestyle choice or about vanity.

The association between body dissatisfaction and eating disorders can sometimes lead people to mistakenly believe that eating disorders are prompted by vanity and represent a lifestyle choice to attain body ideals.

Truth: Eating disorders are serious and potentially life-threatening mental illnesses

They are not a lifestyle choice or a diet gone 'too far'. A person with an eating disorder experiences severe disturbances in their behaviour around eating, exercising and related self harm because of distortions in their thoughts and emotions.

Eating disorders not only involve considerable psychological impairment and distress, but they are also associated with wide-ranging and serious medical complications, which can affect every organ in the body.

The mortality rate for people with eating disorders is up to six times higher than that for people without eating disorders. The increased risk of premature death exists for all types of eating disorders, however people living with anorexia nervosa have the highest mortality rate of all psychiatric conditions due to both psychological and physiological complications [1].  

Myth #2: Dieting is a normal part of life

Research shows that most people, particularly adolescents, are confused about eating disorders. People recognise that eating disorders are potentially harmful; however many also consider body dissatisfaction and dieting as normal parts of our society.

Truth: Eating disorders almost invariably occur in people who have engaged in dieting or disordered eating. Dieting is also associated with other health concerns including depression, anxiety, nutritional and metabolic problems, and, contrary to expectation, with an increase in weight. 

While dieting practices are unhealthy at any life stage, particular attention has been paid to dieting in adolescence. Puberty is a time of great change biologically, physically and psychologically.

Teenagers are often vulnerable to societal pressures and can often feel insecure and self-conscious, which are factors that increase the risk of engaging in extreme dieting behaviour. Approximately a third (31.6%) of Australian adolescents engage in disordered eating behaviours within any given year [2] and Australian adolescents engaging in dieting are five times more likely to develop an eating disorder than those who do not diet [3].

Myth #3: Eating disorders are a cry for attention or a person ‘going through a phase’

Truth: People with eating disorders are not seeking attention.

Due to the nature of an eating disorder a person may go to great lengths to hide, disguise or deny their behaviour, or may not recognise that there is anything wrong.  Eating disorders are not a phase and are difficult to resolve without treatment and support. Sadly, among people with a diagnosable eating disorder, approximately 23% - fewer than one in four - access eating disorder treatment [4].

Regardless of the age of onset, there is often a considerable period of time between onset and treatment. It is estimated that treatment for an eating disorder is sought between 5-15 years after the onset of the disorder [5, 6].  

A reduction of this delay can result in improved health and quality of life. Early diagnosis and intervention can greatly reduce the duration and severity of an eating disorder and so seeking professional help at the earliest possible time is crucial to better outcomes.

Myth #4: Families, particularly parents, are to blame for eating disorders

There is a common, historic misconception that family members can cause eating disorders through their interactions with a person at risk.

Truth: There is no evidence that particular parenting styles are a direct cause of eating disorders.

There is evidence that eating disorders have a genetic basis and people who have family members with an eating disorder may be at higher risk of developing an eating disorder themselves. This is similarly true for other mental health and health conditions. 

Family and friends play a crucial role in treatment-seeking and in the care, support and recovery of people with eating disorders. Clinical guidelines for best practice in managing eating disorders encourage the inclusion of families at each stage of treatment for adolescents with eating disorders, from the initial assessment to providing recovery support.

For adolescents, Family Based Treatment is currently the treatment with the strongest evidence base. Both Family Based Treatment and Supportive Family Therapy have been found to be effective in the treatment of anorexia nervosa.

The effects of an eating disorder are often felt not only by the person experiencing it, but also by their family and support network. Carers, including parents, partners, friends, grandparents, children, siblings, grandchildren, neighbours or any other person caring for someone with an eating disorder, often feel: 

• Distressed about what is happening to themselves, the person they care for, and their family

• Burnt out from the demands of caring for someone with an eating disorder on top of family life and work commitments

• Guilty about their 'role' in the illness and may fear they are in some way responsible

• Confused about the best way to help, both daily and in the long term goal of recovery

• Anxious and afraid about the physical and psychological changes in the person they care for

• Fearful of daily routine such as meal times

• Frustrated by being unable to fix or resolve the eating disorder

• Unable to continue doing things they used to enjoy

• Hopeless about their ability to provide support

All of these feelings are valid and normal. Caring for someone with an eating disorder is a huge responsibility and comes with considerable personal strain. Learn more here.

Myth #5: Eating disorders only affect white, middle class females, particularly adolescent girls

Truth: Eating disorders can occur in people of all ages and genders, across all socioeconomic groups, and from any cultural background

It is true that the peak period for the onset of eating disorders is between the ages of 12 and 25 years, with a median age of around 18 years [7, 8]. One key group with a high risk of eating disorders is women, particularly those going through key transition periods (e.g. from school to adult life, pregnancy and menopause). This high risk has led to a misconception that eating disorders only happen in this population. Recent data suggests that the prevalence of Binge Eating Disorder may be nearly as high in men as in women [9]

While research on the prevalence of eating disorders/disordered eating in gender non-binary and transgender people is limited, emerging research suggests that gender non-binary and transgender people have a two to four times greater risk of eating disorder symptoms or disordered eating behaviours than their cisgender counterparts [10, 11, 12].

Eating disorders occur:

• Across all cultural and socio-economic backgrounds

• Among people of all ages, from children to the elderly

• In both men and women

• Population studies have suggested that males make up approximately 25% of people with anorexia nervosa or bulimia nervosa and 40% of people with binge eating disorder. In a recent study lifetime prevalence for anorexia nervosa in adolescents aged 13 – 18 years found no difference between males and females

In addition to women and adolescents, there are other groups in the community who are also at a higher risk of developing an eating disorder, for example:

• People who engage in particular sports (e.g. gymnastics, athletics, rowing), dancers and models

• People who are experiencing high levels of stress

• People who have other mental illnesses, such as anxiety or depression

• People who have other physical illnesses, such as diabetes and polycystic ovary syndrome

• Eating disorders are not limited to any one group of people and the prevalence of eating disorders in specific high risk groups should not distract the community from the importance of recognising eating disorders in other populations

Learn more here.

References

[1] Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Arch Gen Psychiatry. 2011;68(7):724-31. 
Add link or side box to The Facts section of website (Who Is Affected, ED in Aust) 

[2] Hay P, Mitchison D, Collado AEL, González-Chica DA, Stocks N, Touyz S. Burden and health-related quality of life of eating disorders, including Avoidant/Restrictive Food Intake Disorder (ARFID), in the Australian population. J Eat Disord. 2017;5(1):1-10. 

[3] Patton GC, Selzer R, Coffey C, Carlin JB, Wolfe R. Onset of adol escent eating disorders: population based cohort study over 3 years. BMJ. 1999;318(7186):765.

[4] Hart LM, Granillo MT, Jorm AF, Paxton SJ. Unmet need for treatment in the eating disorders: a systematic review of eating disorder specific treatment seeking among community cases. Clin Psychol Rev. 2011;31(5):727-35.  

[5] Oakley Browne MA, Elisabeth Wells J, Mcgee MA, Team NZMHSR. Twelve-month and lifetime health service use in te Rau Hinengaro: the New Zealand mental health survey. Australian & New Zealand Journal of Psychiatry. 2006;40(10):855-64.  
 
[6] Hamilton A, Mitchison D, Basten C, Byrne S, Goldstein M, Hay P, et al. Understanding treatment delay: perceived barriers preventing treatment-seeking for eating disorders. Australian & New Zealand Journal of Psychiatry. 2022;56(3):248-59.  
 

[7] Hart LM, Granillo MT, Jorm AF, Paxton SJ. Unmet need for treatment in the eating disorders: a systematic review of eating disorder specific treatment seeking among community cases. Clin Psychol Rev. 2011;31(5):727-35.  
 
[8] Volpe U, Tortorella A, Manchia M, Monteleone AM, Albert U, Monteleone P. Eating disorders: What age at onset? Psychiatry Res. 2016;238:225-7.   

[9] Hay P, Girosi F, Mond J. Prevalence and sociodemographic correlates of DSM-5 eating disorders in the Australian population. J Eat Disord. 2015;3(1):1-7. 

[10] Gordon, A. R., Moore, L. B., & Guss, C. (2021). Eating disorders among transgender and gender non-binary people. In Eating Disorders in Boys and Men (pp. 265-281). Springer, Cham. 
 
[11] Diemer EW, Hughto JMW, Gordon AR, Guss CS, Austin B, Reisner SL. Beyond the Binary: Differences in Eating Disorder Prevalence by Gender Identity in a Transgender Sample. Transgender Health. 2018;3:1, 17-23 
 
[12] Giordano S. Eating yourself away: Reflections on the ‘comorbidity’ of eating disorders and gender dysphoria. Clinical Ethics. 2017;12(1):45-53.  doi:10.1177/1477750916661977 
16. Feder S, Isserlin L, Seale E, Hammond N, Norris ML. Exploring the association between eating disorders and gender dysphoria in youth. Eat Disord. 2017; Jul-Sep;25(4):310-317. doi: 10.1080/10640266.2017.1297112