‘You Don’t Look Sick’: What is an Eating Disorder?

By Cadence Beck

I didn’t look sick. At least, not to anyone who didn’t know me well. My weight hadn’t plummeted to dangerous lows; my skin wasn’t pale; my hair wasn’t falling out in chunks. I didn’t ‘look’ sick, so I convinced myself that I wasn’t.

My parents tell a different story. When I ask them about how I was back then, they tell me that I was shaky and unfocused. They tell me that the doctor said I was a week away from having a heart attack. They tell me that I was dying. It was the fall of my freshman year in high school, and I was making myself throw up seven times a day, minimum. 

Months later, after I’d clawed my way out of the hospital and regained some of the life that I’d lost to bulimia, I explained to a football player that I was recovering from an eating disorder. His response? “But you look well-fed.”

The aftermath of the destruction has left me with a few realisations. One of them is that the way we look at eating disorders seriously needs to change. The image of the thin, white, middle-class girl nervously pushing potatoes around her plate cannot be the only one we bring to the table when a friend tells us that they are struggling. An eating disorder is not just a physical ailment. It is not a diet, or a cool trick, or a phase. It is not a quirky behaviour, or just something women do. 

So then, what is an eating disorder?

Friends I made at residential and outpatient treatment offered their thoughts on the matter. One, whom we will call Cam, said: “An eating disorder is just as the word implies – a disordered pattern of eating. Notice that it isn’t called a weight disorder, a malnourishment disorder, or anything pertaining to physical aspects. I knew I had an eating disorder when I no longer viewed food as something necessary to thrive but as an obstacle to achieving my ideal body. For those without body-image centred eating disorders, it can be even more invalidating when the requirements for diagnosis and treatment contain specific health issues.” 

For many, eating disorders are a manifestation of the human need for control. Those on the outside of this disease will point to the afflicted and say, “I could never do that. How do they do that to themselves?” They will not see that they do it to themselves every day, that it shows up in their lives when they work and when they organise. It is a way of coping with the world. The difference, of course, is that some ways of coping are harmless, possibly healthy, and others kill over ten thousand people each year (anad.org).

So, how do we fight these disorders?

A good step would be to re-examine how we treat them, especially the ones that fall outside of the characteristics we expect to see. Cam writes, “Treatment centres focus on the medical and weight aspects of eating disorders. I was not provided with the tools to maintain recovery…” 

Most residential treatment centers are focused on making a profit. This is not an inherent evil: without money, they would not be able to provide life-saving care. But the issue sets in when treatment becomes about the body and not the mind controlling it. Many patients relapse as soon as they leave the hospital simply because they are no longer being forced to eat normally. There is only so much the psych ward can do.

“I eat because I am afraid to go back into treatment,” writes an anonymous sufferer of ARFID (Avoidant Restrictive Food Intake Disorder). This sentiment is shared with many patients discharging from various levels of care. Their minds remain sick, their views of food don’t change, and it’s up to them entirely to learn how to become who they once were (in many cases, however, the disorder was present in early childhood. I imagine it would be quite difficult to figure out your place in the world when all you have ever known proves to be unsustainable). 

What are we to do when our loved ones are in danger? One young woman came up with this: “…have patience for them. Know that while you may know a tremendous amount of their struggle, you will never know what it truly feels like.” Check on your recovering friends. Reassure them. Hold them accountable. Remember that your support could save their lives.

For my fellow recovery warriors, know this: you can survive. “I’m not 100%…” writes Ella Bull, a recovering anorexic, “heck, maybe I never will be. But at least I have my smile back.” Recovery is a constant struggle, but it is one that gets easier. That voice will become quiet. Your life will return to the very tips of your fingers. You will, in your own, lovely way, heal.