"You're not sick enough": Eating disorder misconceptions

Common misconceptions about eating disorders

The idea that someone needs to be “sick enough” in order to have an eating disorder is one misconception, among many, that may discourage people from seeking out professional care for an eating disorder. 

Below are a few common misconceptions about eating disorders that we have debunked.¹

Misconception #1: "You can tell someone has an eating disorder by looking at them"

You cannot tell someone has an eating disorder simply by looking at them. 

Eating disorders are physical and mental health conditions, which means that although there are physical side effects of the disorder, large portions of the condition exist internally and cannot be perceived from the outside. Some people believe that a person with an eating disorder must be extremely thin or extremely fat in order to be “sick enough” for it to be a medical condition. But this isn’t true. The reality is that eating disorders affect people of all body weights, shapes, and sizes. 

Misconception #2: "Only skinny white girls and women have eating disorders"

The truth is that anyone can be affected by eating disorders.

People of all different races, ages, genders, and sexualities are affected every day by eating disorders. Eating disorders do not discriminate, and it’s estimated that 30 million Americans will struggle with an eating disorder at some point in their life.⁴ 

Misconception #3: "Eating disorders are a normal part of being a teenager"

Eating disorders are serious mental health conditions and are not a normal part of adolescence.

While it is true that many eating disorders first present themselves in adolescence, eating disorders don’t go away without treatment.⁵ Eating disorders aren’t a normal phase of being a teenager that someone can “grow out of” without intervention. In fact, early intervention is hugely beneficial in recovering from an eating disorder, so if you suspect your child or teen is struggling with an ED, getting them professional help as soon as possible is a great option. 

Misconception #4: "Eating disorders are a choice"

People do not choose to have an eating disorder. 

Assuming people are opting into having an eating disorder or avoiding eating as a form of attention-seeking behavior is a damaging misconception that can add a great deal of shame to the situation. If you have an eating disorder, know that it’s a result of many interacting genetic, environmental, and social risk factors (also known as the biopsychosocial model), and it was not your choice. But getting help can be your choice. 

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Misconceptions act as a barrier to getting eating disorder treatment 

Most of the misconceptions listed above have likely been a barrier at one point or another to someone trying to receive eating disorder treatment. These misconceptions are harmful and insidious, as they create invalidating thoughts in the individual about their own eating experiences, which may include thinking things like: 

• I’m not “sick enough” to attend treatment
• I’m not “sick enough” to have an eating disorder
• My eating disorder isn’t “bad enough” to be a problem
• I don’t deserve treatment 

To be clear, if you feel like you are struggling with eating, your body image, or exercising, know that help is always available to you at Within. You deserve to live joyfully and healthily, and you don’t have to struggle with your eating disorder alone. 

How people reinforce these misconceptions about eating disorders

Some people are uninformed about eating disorders and incorrectly equate body weight to health, assuming that thin people are “healthy” and fat people are “unhealthy.” Equally harmful is the impact diet culture and our society’s fixation on health and fitness have on our beliefs about what constitutes “healthy” and “unhealthy” food, eating habits, and physical activity levels. 

Because of these beliefs, people may inadvertently reinforce these misconceptions about eating disorders by:

• Praising you for dieting or engaging in excessive exercise
• Praising you for losing weight or telling you how good you look
• Not believing you when you express concerns or ask for help
• Making stigmatizing comments about people with eating disorders

In this way, those around you, including friends and family, may consciously or subconsciously invalidate your eating disorder and make it harder for you to believe that you need help.

How the DSM-5 can invalidate those with eating disorders

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is a diagnostic tool published by the American Psychiatric Association. It contains a comprehensive list of mental health disorders, as well as the diagnostic criteria for each one. 

Unfortunately, the DSM-5 is not perfect. It tends to base the severity of an eating disorder on physical attributes, such as weight. This is especially true of anorexia nervosa (AN). The very first criterion involves food restriction that leads to a significantly low body weight.² The severity of anorexia is based on a person’s body mass index (BMI), which is already an inaccurate measurement of body weight and health.²

This is problematic, especially given that many people with eating disorders are of an “average” or “above average” weight. If you don’t meet the weight criteria for an eating disorder like AN, then you might falsely believe you don’t have an eating disorder. Leaving AN untreated can have detrimental effects on a person’s health and can even be fatal.

The consequences of feeling “not sick enough” to have an eating disorder

One of the most severe consequences of not feeling sick enough to have an eating disorder is not receiving adequate treatment for your condition. Eating disorders tend to progress and worsen with time, so the longer your eating disorder goes untreated, the more severe it may become. And with greater severity, the more likely you are to experience harmful health consequences, such as:³

• Osteoporosis and brittle bones
• Muscle loss and weakness
• Abnormal organ functions leading to heart, kidney, or liver failure
• Low blood pressure
• Abnormally slow heart rate
• Severe dehydration
• Electrolyte imbalances
• Fatigue and fainting
• Hair loss or brittle hair
• Gastric rupture
• Tooth decay
• Constipation
• Pancreatitis
• Sudden death

The longer you engage in disordered eating behaviors and avoid treatment, the more difficult it may be to treat your condition. Earlier detection and treatment tend to be associated with more positive treatment outcomes. However, that doesn’t mean you shouldn’t seek treatment if you suspect you’ve had an eating disorder for years. It’s never too late to seek help.

What to say when you are feeling invalidated about your eating disorder

Whether you’ve received treatment or not, there are some things you can say when you are feeling like you aren’t sick enough or like you don’t have a “real” eating disorder. These include:

• “I am deserving of treatment, recovery, and care.”
• “I don’t need a diagnosis to have an eating disorder.”
• “Many people with eating disorders are undiagnosed or underdiagnosed.”
• “Regardless of my formal diagnosis, my eating disorder is dangerous and requires treatment.”
• “Eating disorders are mental health conditions—not physical health conditions. My appearance doesn’t reflect my mental health.”

Although it may be difficult, you are going to want to advocate for yourself in a healthcare setting, even if your provider is not taking your disorder seriously or refuses to diagnose you. You may need to seek treatment on your own or advocate for a higher level of care than you’ve been referred to. Remember, you know yourself, your needs, and your situation better than anyone else. Don’t let eating disorder specialists or other treatment professionals invalidate you.