disorder.

intro.

Your phone dings. It’s a text from your friend. “Want to go get food with me?” it reads. Your heart drops. You think back to earlier that day, to the donut you couldn’t stop yourself from eating. Before you can think twice, you’ve calculated how many calories you’ve eaten that day. The answer brings on a rush of guilt. You’ve become numb to the hunger gnawing at your stomach, but nonetheless the thought of food persists in the back of your mind. Overwhelmed, you turn your phone over and try to push the thought of eating out of your mind.
You know what you’re doing is unhealthy, but you can’t bring yourself to stop.

background.

Eating disorders have the highest mortality rate of any mental illness, with approximately one person dying as a direct result every hour, according to the National Association of Anorexia Nervosa and Associated Disorders. Currently, over 30 million people suffer from eating disorders in the United States.
Recently, the Globe released a survey regarding disordered eating to CHS students. Eight percent of those who responded have been diagnosed with an eating disorder, and 58 percent say they know someone who has one. Because of the stigma and misinformation surrounding these disorders, only one in every 10 people struggling receives the necessary support, as reported by the Eating Disorders Coalition.
While there are many types of unhealthy and dangerous eating habits that can be classified as disorders, they cannot all be placed into distinct categories. There are, however, three main manifestations that professionals most commonly encounter in patients.
The first is anorexia nervosa, more commonly known as anorexia. This eating disorder is characterized by restricted food intake, an intense fear of weight gain and severely distorted body image. Due to such restrictive eating habits, people with anorexia are often, but not always, underweight.
Bulimia nervosa, or bulimia, is similar to anorexia in that those afflicted are acutely aware of their body. Conversely, however, those struggling with bulimia experience repeated episodes during which they uncontrollably eat excessive amounts of food, followed by periods of purging, fasting or extreme exercising in an attempt to counteract the effects of these binges and prevent themselves from gaining weight. As such, people with bulimia are often a normal weight.
Binge-eating disorder is the most common eating disorder in the United States. It is characterized by repeatedly consuming large quantities of food in a short amount of time, even when not physically hungry or even when full. As with bulimia, these periods are denoted by a perceived lack of control and lead to overwhelming guilt and shame. Those with binge-eating disorder will turn to food to cope with these emotions, furthering the cycle. Unlike people with bulimia, though, people struggling with binging do not purge after eating, often leading to obesity.
Eating disorders are thought to be caused by a combination of genetics, environmental pressure and personality traits, as those with eating disorders are likely to also suffer from depression, anxiety, obsessive-compulsive disorder and substance abuse.
According to Monica Wolters of McCallum Place Eating Disorder Centers, “While one patient may have developed their eating disorder as a result of a trauma, another individual may have developed their eating disorder as a result of a strong and enduring diet culture within their family. There are also instances of athletes developing eating disorders due to coaches insisting that weight loss will improve results. Because environmental causes vary widely amongst individuals, it compounds the difficulty in understanding and awareness [of eating disorders].”
At the root of all eating disorders, however, is a need for control, according to Rebecca Lester, Associate Professor of Sociocultural Anthropology at Washington University in St. Louis.
“I think for all eating disorders, they are a way [for patients] to manage their lives, whether it is by not eating, or by binging and purging,” Lester said.
Because teenage years are marked by uncertainty and lack of autonomy, eating disorders are often associated only with teenage girls being picky or going through a phase. This misconception dissuades many of those who are struggling from reaching out for help, leading to severe underdiagnosis.
“We definitely hear a lot of misconceptions,” said Katelyn Viscuso, the Intake and Admissions Director at McCallum Place. “But… the reality is that anyone can struggle–any gender, from any culture or race… Eating disorders come in all shapes and sizes.”

psychology.

“They can be hard, and scary, but eating disorders can develop quickly, and [they] are life-threatening. They are one of the deadliest mental illnesses, so we really stress early intervention,” Katelyn Viscuso said. She is the Intake and Admissions Director at McCallum Place, an Eating Disorder Treatment Center in St. Louis.
Body image and eating concerns have proven to be prevalent within the Clayton School District community. From a Globe survey polling CHS students, 58 percent are personally acquainted with (an) individual(s) who have an eating disorder. With eating disorders affecting a large portion of the school community, it is crucial to understand the psychological background of eating disorders.
Eileen Vollmer, the Intensive Outpatient Coordinator for the St. Louis Behavioral Medicine Institute, cites genetics as a major factor to being diagnosed with an eating disorder.
“The research does show that there’s a strong genetic component to most eating disorders. That means if mom or grandma or great-grandma or somebody in the family had an eating disorder, then you are genetically predisposed to having an eating disorder yourself,” Vollmer says.
In addition, Vollmer states that certain tipping points could prompt eating disorders, such as a sharp decrease in body weight.
“We will see people get very sick, for example, with the flu or with mono, and in the course of getting sick, they accidentally lose weight and they go below their ideal body weight. There’s something about being below your ideal body weight that triggers anorexia and triggers wanting to restrict more. Sometimes an illness like that can prompt someone to sort of stumble into an eating disorder, even though they never intended to, just by going below their body’s set point,” Vollmer said.
Other triggering factors could include a rapid transitioning point in one’s lifetime, or a traumatic event. These all contribute to the development of an eating disorder by spiking an unhealthy reaction in an individual, with or even without a family history of eating disorders.
“[This] can be a transition, or trauma. Maybe you go from eighth grade to high school, or maybe your family moved…[It is] not really any one simple thing. There are lots of factors that can sort of ‘pull the trigger’ on an eating disorder,” Vollmer explained.
Eating disorders, although varying on a case-by-case scenario, often follow a set of stages.
“Generally, the first two phases [involve] denial. People will put them on the scale and they will be obviously very underweight by any chart. And they will mentally deny that they have a problem at all, or they don’t like the label of an eating disorder. Most people start out in denial. Part of what we have to do is educate them (and their parents, if they’re adolescents) and convince them this is serious,” Vollmer said, “Eating disorders are strange in that people can start off with anorexia. And then it can actually turn into binging and purging. It can really morph into different forms of eating disorders. There’s not really one specific trajectory because each person is so unique when they come in.”
Within these phases, heavy emotions of fear and control manifest in detrimental ways, with Viscuso clarifying that, “Everyone’s story is so different, and everyone is affected in a different way. What we commonly see is an intense fear of weight gain, or a fear of eating certain foods. This fear will often spiral and turn into a great deal of anxiety for the individual.”
She adds by explaining the ‘control factor’ that many of those with eating disorders struggle with.
“For some, food feels like the only thing in their life they can control, so they attempt to control what they will/won’t consume. There’s a lot of shame and self-depreciation that one experiences when they are struggling. People often will be hard on themselves and put additional pressure on themselves to be perfect,” Viscuso said.
Furthermore, there is a consistent relationship between eating disorders and other mental health issues, which can, in turn, enhance the effects of the eating disorder.
“Nearly everybody that presents an eating disorder has a co-occuring disorder; deprived depression and anxiety are the two most common ones we see. There’s almost always a dual diagnosis: eating disorders, and then a secondary diagnosis of anxiety or depression,” Vollmer said.
Obsessive Compulsive Disorder (OCD) has a relationship with eating disorders because of the brain’s tendencies to mimic OCD qualities while in a starved state, or through an actual co-existence of clinical OCD and eating disorders.
“Interestingly, OCD seems to like to link up with eating disorders quite a bit. A brain that is starved through malnourishment can get very rigid and almost act in an OCD fashion,” Vollmer said. “People may exhibit strong OCD behaviors that actually can go away or subdue after their ideal body weight is restored and they’re eating regularly after their blood sugar stabilized. That presents something that looks like OCD, but it is actually just the product of what is called the hungry brain…Clinical OCD does occur quite often with eating disorder and that makes it a little trickier to treat, a little more difficult, but still very treatable.”
The culture that surrounds eating disorders can greatly influence an individual struggling with this illness, especially with respect to seeking information and treatment. Foremost, the social stigma that encompasses eating disorders forces more obstacles in the pathway towards treatment.
Rebecca Lester, Associate Professor of Sociocultural Anthropology at Washington University in St. Louis, believes that the pressure to portray a certain image further intensifies the self-aware component to eating disorders, especially in the age of social media.
“I think it would be difficult, how you present [yourself] to the world, not really how you feel or what skills you have, but how interesting you are. You want to portray a certain kind of thing to the world and how many likes you get. This kind of imagery seems like it could be easily fed into the eating disorder and [prompt thoughts] about not feeling good enough and wanting to have some validation that you are feeling okay,” Lester said.
Gender roles also play an important part in eating disorders, with a common belief being that only teenage girls are affected by eating disorders. This notion prevents individuals outside of this demographic from reaching out for help, serving as an additional barrier to the necessary psychological help that eating disorders often entail.
“[A common misconception is that] boys don’t get eating disorders, but they do. They may not have it as often or as prevalently as females, but they do have it. They might take different forms. Sometimes, it can be about having enough muscle mass or a certain amount of muscle mass,” Vollmer said.
The approach towards an individual with an eating disorder is particularly crucial in appropriately showing your support and opening up a comfortable dialogue between yourself and the individual concerned.
Psychologically, eating disorders are extremely complex, especially as they greatly vary between individuals. However, particularly with the focus on image as the climate of today’s society, eating disorders have become more prevalent and need to be properly addressed without stigma.
“Eating disorders don’t go away. They don’t fix themselves. If you suspect you have a problem, you probably do. There’s no harm in getting it screened and checked out. You’re being directed to people that can help you and walk with you. It’s not something you should go through alone.”

personal stories.

evan.

For CHS senior Evan*, the root of his body issues was media. He would watch superheroes in Marvel movies with their six-packs and toned muscles and compare their bodies to his own. Holding these glorified looks as an ideal, he began to strive to achieve them. However, once the pressure of perfection built, his goal manifested itself into episodes of stress, which came in the form of eating. When Evan ate, he felt guilty.
“I would be like, ‘Well I ate too much and I’m gonna gain weight, I need to get rid of this,’ and I would make myself throw up,” Evan said.
Evan did this periodically. There would be stretches of time throughout which his relationship with food improved, and there were certain phases where he would relapse and fall back into the cycle, often when trying to regain control in his own life.
“The disorder is that, in some ways, very assuring, because it’s something you can control when it feels like there are things in the world you can’t control. And you can see the changes within yourself,” Evan said.
Evan recognized that this was a problem. So, he talked to his parents about getting professional help. However, they dismissed his concerns. While they considered the idea of a therapist, they didn’t ever follow through. Evan believes that their lack of concern may have to do with his gender.
“I think the attitude that my parents have, why they don’t accept or believe me, is [that they think] boys don’t have [eating disorders],” Evan said.Evan thinks that this mindset is a symptom of society’s emphasis on disordered eating of females rather than males, and a stigma that only women can be uncomfortable with their bodies. Part of Evan’s struggle with asking for help came from a need to maintain a ‘masculine’ image and remain stoic in the face of emotion. Much of this, Evan believes, stems from modern media.
“You’ll be at the grocery store and seeing the Men’s Health magazines–how to get shredded and stuff like that. Everyone wants to get big,” Evan said.
For changes to be made in regards to how young people view food, Evan believes that society’s outlook on nutrition needs to be altered.
“This calorie counting, “I have to eat this or I can’t”, it’s bad for me, but at the same time, everyone’s messed up with all the processed food we eat. I don’t know what the answer is,” Evan said.
Evan’s struggle with body image has somewhat stabilized, but it’s not steady. As a male, he is learning to validate his feelings as well as the way that he looks. One thing is certain to him, however: for people to accept their bodies, the mindset of society needs to change–in more ways than one.

julia.

“It was Mother’s Day and I had passed out in the bathroom. When I sat up, I just kind of asked myself why I did this to myself,” said CHS junior Julia*.
Julia has struggled with restrictive eating since sixth grade. Initially, the graphic personal stories featured in the eating disorders unit during health class, combined with negative self-image, triggered her first episode. However, more recently, a need for control provided the spark.
During relapses, Julia’s entire life revolves around her eating schedule.
“When you’re in a relapse, food is the most important thing in your life,” Julia said. “It occupies every thought that you have besides school. And it makes your mind super foggy… Every time you eat, it feels like you’re surrendering to the disorder.”
While relapsing, Julia becomes obsessed with regulating her consumption. Her disordered thinking alters how she views herself.
“When you’re gauntly thin, you still will look in the mirror and see that you want to lose more weight. [During relapses] I found myself following really thin models on Instagram… just as [a reminder that] ‘this is how pretty you could look,’” Julia said.
Although she has fought her disorder for years, many of Julia’s friends do not notice that anything is wrong until she confides in them. During her relapses, Julia often receives positive comments about her body that fuel her disorder. “Whenever I relapsed, carefully prepped every meal and worked out religiously, I got so many comments from people saying that I look great, that they wish they had my dedication, but… I physically could not refrain from doing those things without experiencing overwhelming anxiety and guilt,” Julia said.
Julia believes that society’s weight loss mentality contributes to people’s unhealthy relationships with food. While eating disorders are not openly praised, restrictive diets and unrealistic body standards are celebrated on social media and other platforms.
Julia refrained from seeking help for years because of this mindset.
“When you are experiencing depression or anxiety, you want that feeling to go away. But, with an eating disorder, it gives you this high… you feel like you’re doing something right,” Julia said.
Julia began her recovery process by reaching out to her close friends and parents. Recently, she also received support from her therapist and physician. Although her friends and family encouraged her to get help, Julia had to decide whether she wanted to recover herself.
Her recovery hasn’t been linear.
“Since I started seeking treatment, I have had a relapse and [I] worry about the future sometimes when I won’t have all the resources like my parents and my therapist ready to help me when this happens,” Julia said.
One aspect that makes recovery extremely challenging is relearning how to have a healthier relationship with food and body image.
“[During recovery], you are trying to undo all of this disordered thinking you’ve acquired over the duration of your relapse… you have to come to terms with the fact that weight gain is not a negative thing,” Julia said.
Julia’s eating disorder has caused her to form dangerous habits that she has to fight every day. As someone who knows how difficult recovery is, Julia’s advice to others who are struggling is to reach out.
“Even if you don’t want to seek help, just talk to other people about it. Keeping it all inside is not good.”

emily.

There are two types of days for CHS junior Emily*: days when she allows herself to eat and days when she does not. She is constantly aware of her body shape, and any perceived deviation from the unrealistic ideal she strives for has the potential to ruin her day, or even her week.
Feeling self-conscious isn’t a new phenomenon for Emily–she had been hyper-aware of her body shape since the age of five. A self-described “chubby kid,” Emily first noticed her body was different from those around her in first grade. During her second year in elementary school, Emily’s parents divorced. To cope, she began to channel her anger and distress from the separation towards her physical appearance.
She would get out of the shower and find herself standing sideways in front of the mirror, criticizing every aspect of her body, especially her stomach. She would search for baggy clothes in the mornings to hide her body as best she could.
It was not until eighth grade, however, that Emily began to actively try and change her body. With the help of a calorie tracker, Emily restricted her eating and quickly shed water weight, which reinforced her determination to continue to cut calories. Soon, though, Emily found it harder and harder to shed pounds. She began skipping meals in hopes of flattening her stomach. This self-destructive thinking spiraled into Emily believing that she could only have two meals a day: a choice between lunch or dinner.
“I loved to go to sleep feeling hungry, because that meant I could eat the next day,” Emily said.
Although Emily’s restrictive eating habits would keep her from eating proper meals during the day, she would frequently binge on snacks or junk food at her mother’s house, either due to stress or hunger. Guilt from binging would lead Emily to starve herself further, continuing the vicious cycle.
Emily’s family knew she was grappling with self-image, but never commented on her drastic weight loss until her grandmother visited one summer and was disgusted by the frailty of Emily’s body. Despite her grandmother’s shock, Emily’s parents never truly understood the depth of their daughter’s struggles and were therefore unable to offer adequate support.
“My dad told me as long as I was healthy and strong, I would be okay,” Emily said.
The reactions Emily received from her friends mirrored those of her parents. Even after admitting her problems to friends, many did not believe her or make any attempts to understand what she was going through; they would instead tease or laugh at her.
“People don’t think that if you’re skinny or thin you can [also] have an eating disorder, and that’s really frustrating,” Emily said.
Although Emily had a primary care physician during this time, she felt ashamed to “complain” about her body and confide in her doctor. Her hesitance to seek help was exacerbated when, in the second semester of freshman year, Emily’s family took her to see a psychiatrist. Dismissive, the psychiatrist chastised her for believing she had an eating disorder and told her she would be fine.
She would not.
To this day, Emily goes through phases where her every decision is plagued by thoughts of calories and how much she weighs. An ever-present force in her life, Emily’s eating disorder continues to shape her life in damaging and painful ways.

cassandra connor.

More than a third of incoming seventh graders will have Mrs. Cassandra Conner as their science teacher. Many of her previous students can recall Conner telling them about her time in the military, as well as revealing that her reason for leaving was a mysterious injury.
What many students do not know, however, is that a physical injury is not the only thing Conner left with.
When Conner sustained an injury during her time in the military, she was devastated. Being in the military was something she loved, and the injury forcibly removed her from active participation. Conner felt as if she was slowly spiraling out of control and had lost her direction. She eventually turned to restricting her food intake in order to regain that sense of command over her life.
“I would purposely restrict how much I was eating in order to regain control. I felt so out of control with having to leave the army–it was what I thought I was going to do [for the foreseeable future], so I didn’t know what to do,” Conner said.
Eventually, Conner got professional help when, during a routine weight check, one of the military doctors noticed how dangerously low she measured. As a result, the military provided her with counseling to talk through her disorder. However, this did not help much.
“Because the counseling was provided by the military, they didn’t really care much. It was more because they had to,” Conner said.
While this was years ago, and Conner is much more comfortable with her body but she still does not consider herself recovered.
“An eating disorder isn’t something you ‘recover’ from. There’s always a chance of a relapse. Sometimes I’m scared that I will relapse again,” Conner said.
As a teacher who has gone through an eating disorder herself, Conner sees the same signs that she exhibited with some of her students now–even those who are only in seventh grade. She sees young children discuss their weight and count their calories in an extremely damaging way. She strongly believes in the importance of recognizing if someone has an issue and the importance of reaching out for help.
“If you have a problem, reach out for help. It is so important for you to get help because an eating disorder can ruin your life. I know it can be hard, but it needs to be done,” Conner said.

media and misconceptions.

One of the primary contributors to negative body image is the unrealistic portrayal of bodies in the media. Commercials, TV shows, movies and magazines all advertise the ideal figure, often heavily edited and posed. As these misleading images do not reflect reality, impossible standards are set.
In more recent years, social media has amplified this issue. Every day, users are bombarded by hundreds of airbrushed images of models and celebrities. Additionally, restrictive diets and unhealthy cleanses, such as FitTea, gain momentum on platforms such as Instagram and Snapchat.
“[Social media is] not really how you feel or what skills you have, how interesting you are. It is about … how many likes you get,” said Rebecca Lester, Associate Professor of Anthropology at Washington University of St. Louis.
Social media is not the only form of media that fosters unhealthy habits. Big-picture media, such as movies and television shows, can also enhance the danger of comparison, with many love interests and “beautiful” characters synonymous with skinny characters.
Media also holds the power to push misconceptions of eating disorders onto viewers. Many portrayals of eating disorders on major media outlets focus on skinny female characters, which is not always the case in real life, according to Intensive Outpatient Coordinator for St Louis Behavioural Medicine Institute, Eileen Vollmer.
“A common misconception is that you have to be extremely visibly underweight to have an eating disorder. Number two, that boys don’t get eating disorders, but they do,” Vollmer said.
The media also often portrays eating disorders as a struggle that individuals can fully recover from, but this is, unfortunately, not always the case. Eating disorders always pose the possibility of relapse.
“About a year to 18 months point [into recovery] is the time when people are [most] at a risk for relapse,” said Vollmer.

Furthermore, a common misconception that media can perpetuate is that eating disorders can just be “switched off” merely through willpower, which is simply not true, according to Vollmer.
“[People] have a hard time understanding why you can’t just eat a sandwich, just stop exercising, just stop purging. They don’t really understand that it’s not as simple as that,” Vollmer said.
However, while media can promote “comparison culture” and misconceptions of eating disorders, it can also make change positively. Recently, the body positivity movement has picked up on social media and led to a wider acceptance of different body types and sizes. For example, actress Jameela Jamil created her “I Weigh” account to highlight women’s accomplishments, rather than focus on their weight.
Despite its negative impacts on body-image, recent trends prove that social media is moving towards being an effective vehicle to spread acceptance.

resources.

Eating disorders are extremely difficult to deal with, especially for teenagers. The intense academic and social pressure found within schools coupled with unrealistic body-image can be large contributing factors to eating disorders.
While eating disorders can be life-threatening, unfortunately, most teenagers with eating disorders keep them hidden. According to the National Eating Disorder Association, signs of eating disorders may include preoccupation with food, extreme concern with body size/shape, withdrawal from friends/activities and extreme mood swings.
However, many of these signs can be difficult to notice, especially within a school setting. For example, it is easy for students to skip meals by doing homework during lunch, or creating excuses such as leaving their lunch at home. If you notice these patterns and think that someone may have an eating disorder, there are certain actions you can take.
When approaching someone who you suspect is struggling with an eating disorder, remember that people with eating disorders have a mental disorder and hearing what they are doing is dangerous will not cause them to stop. It is important to help them get professional help from a counselor, doctor or other trusted adult. If you plan to confront them, rehearse what you are going to say to them and set a private time and a safe place you can talk. Remain calm and be caring but firm. Tell them about your concerns and urge them to seek professional help. Make sure to emphasize that there is absolutely no shame in receiving help.
However, an intervention may not succeed. If you reach out and they refuse your help, tell someone. Do not wait as the situation gets worse. Although your loved one may not be happy with you, it is better for them to be angry at you as opposed to them getting hurt due to their disorder.
Above all, it is essential that you educate yourself on eating disorders. Learn what healthy nutrition and exercise look like, and how they vary between different people. Try to be aware of the comments you make regarding people’s appearances. Commenting on someone’s body size can have unintended dangerous consequences. Knowing more will provide you with the resources to aid those who need help.

If you or a loved one may be struggling with an eating
disorder, here are some resources:

National Eating Disorder Association (NEDA):
Website- https://www.nationaleatingdisorders.org
Helpline – (800) 931-2237

Families Empowered and Supporting Treatment of Eating Disorders (FEAST):
Website – https://www.feast-ed.org/

National Association of Anorexia Nervosa and Associated Disorders (ANAD):
Website – https://anad.org/
Helpline – (630) 577-1330

Eating Disorders Recovery System:
Website – https://www.eatingrecoverycenter.com/
Contact Information – (877) 711-1690

McCallum Place Eating Disorder Centers:
Website – https://www.mccallumplace.com/
Contact Information (24/7) – (878) 648-6244
Location (STL) – 231 W. Lockwood Ave., Suite 201, St. Louis, MO 63119