The orange mountain of crumpled Reese’s Peanut Butter Cup wrappers perforated 2016 alumna Caylea Ray’s vision, eliciting something even deeper than the guilt that had led her to her present state. Although she weighed an approximate 90 pounds at the time, Ray’s sudden binge confirmed that she had become her biggest fear: fat. This fear, however, stemmed from much deeper issues that many tend to overlook when faced with the topic of eating disorders.
“I developed anorexia when I was 15, and it developed because I was dealing with depression. Once I started to feel better mentally, I began to gain weight, but I didn’t like that I was gaining weight, so I started to make myself sick,” Ray said. “I was extremely depressed at the time…I was dealing with a lot of stress with school and family life.”
In most cases, there is no one single factor that causes an eating disorder. A number of psychological risk factors have been identified to contribute to unhealthy eating patterns, Dr. Ellen Fitzsimmons-Craft, an instructor at the Weight Management and Eating Disorders Program at Washington University in St. Louis, MO, said. These causes include body dissatisfaction, perfectionism and personality features like obsessive thoughts and a need for control. Other components, such as early childhood eating problems, sexual abuse and an elevated body mass index (BMI) have also been identified to contribute to the occurrence of eating disorders.
Despite the wide array of potential causes, some people are predisposed to and have a higher likelihood of developing an eating disorder.
“There is general agreement that the etiology of eating disorders is influenced by biological, psychological and social factors,” Dr. Fitzsimmons-Craft said. “In terms of biology, eating disorders that run in families and genes account for a good portion of liability. There are also neurobiological abnormalities present among those with eating disorders, but it is unclear whether these features contribute to the development of eating disorders or are their result — whether they are ‘traits’ or ‘scars.’”
Although Ray’s depression worsened as her eating disorder progressed, it was more of a contributor to her downward spiral into anorexia nervosa. This disorder is characterized by a fear of gaining weight and the effort to control one’s weight through dangerous methods such as calorie restriction and overexercising. Bulimia, which Ray developed later on, includes binging on large amounts of food and later purging, or forced vomiting.
For nearly 30 million people in the United States, these exhausting patterns of disordered eating are a part of daily life. As for those who have never experienced an eating disorder, understanding the mindset of someone who has can prove difficult and has opened the door to many misconceptions. Dr. Linsey Utzinger, a professor at the Stanford University School of Medicine, explained that peers and family members often have difficulty being empathic and nonjudgmental toward those with eating disorders because they believe developing an eating disorder is a choice. She said they must remember that people develop eating disorders just like they do any other kind of illness.
“Many people think you can tell that someone has an eating disorder just by looking at them, and this is very inaccurate, as many people with eating disorders are not underweight but may be very ill,” Dr. Utzinger said. “I also think people tend to underestimate the seriousness of eating disorders, as they can be very severe and life-threatening.”
Dr. Fitzsimmons-Craft explained that eating disorders do not affect people based on gender, age, race or socioeconomic class, and just because someone is back at a healthy weight does not mean they are fully recovered. Additionally, Dr. Kristine Luce, also a professor at the Stanford University School of Medicine, debunked the common misconception that people with anorexia say they think they’re fat to get attention and reassurance that they are thin.
“When people are malnourished, the brain cannot visually see the body accurately, and they actually see themselves much heavier,” Dr. Luce said. “It takes about 18 months after they return to normal weight to accurately see their body size.”
Not only does lack of nutrition cause people to see themselves inaccurately, but it can also lead them to obsess over aspects that may seem minute to others. After going through her eating disorder of two years and almost fully recovering, Ray now looks back in amazement at some of the things that made her life seem like it was going to end.
“There was one time my sophomore year when I weighed myself before I was supposed to leave for class, and I wasn’t in the 90 pound range anymore. Even though I only weighed 100 pounds, I lost it,” Ray said. “I started crying hysterically in the bathroom, and I refused to go to school that day because I didn’t want anyone to see that I had gained weight.”
Ray’s lowest point came when she had to be hospitalized for her depression. During her stay at the Missouri Psychiatric Center, Ray didn’t eat for four days and got down to her lowest weight of 87 pounds. The fact that her doctors didn’t try to force feed her signified to Ray that they didn’t actually care about her.
Although Ray began to recover around her junior year of high school and hasn’t purged in a year, she still deals with thoughts pertaining to her eating disorder and doesn’t know if she will ever be completely free of them. She thanks her mom and her teachers for listening to her talk about her struggles, and she encourages others in similar situations to find someone to share their problems with. Dr. Utzinger also urges open communication.
“If you think you might have an eating disorder and need help, tell a parent, trusted adult, your doctor or friend what is going on and ask for help. More specifically, ask to see a psychologist or therapist who specializes in eating disorder treatment. On the other hand, if you suspect that a friend might have an eating disorder, you might start by talking to them privately and explaining that you’re worried,” Dr. Utzinger said. “Ask questions about what is going on rather than trying to offer advice or tell them how to help themselves. Offer to help your friend get connected with the school counselor or talk to his/her parents. Because of the way eating disorders work, sometimes people with them do not want help, so trust your gut, and if you believe there is a problem, tell your parents or another adult. We know that catching eating disorders early and intervening may offer the best chance of success.”
Luckily, Ray realized she needed help and has since rewarded herself for staying strong and overcoming her illness.
“I got a tattoo of the eating disorder recovery symbol to celebrate two years of being purge-free,” Ray said. “I have since messed up and relapsed once since my two year anniversary, but that’s a part of recovery. You’re not a failure if you end up purging again; you’re on the road to recovery, and it’s difficult.”
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