Movies, TV shows and social media all pictured similar scenes: the girl casually going to the bathroom in hopes of losing her last meal; the boy spending hours on end in the gym to satisfy societies definition of “masculine;”or the teenager who eats once a week for years and then miraculously recovers from her illness. However, these situations should never be normalized, or accepted as the sole true scenarios because they stem from assumptions and stereotypes about eating disorders.

The main stereotype  depicts an anorexic or bulimic high school girl, either extremely social and outgoing or very anti-social and introverted. But there are so many more types, elements, and factors surrounding and contributing to eating disorders. “It certainly isn’t a public school or white thing anymore…[a while back] it focused in white upper class girls but that’s [changed],” Upper School Counselor Susanna Short said.

Short states that there are four main types of eating disorders: anorexia-nervosa (AN), bulimia-nervosa (BN), binge eating disorder (BED), and eating disorder not otherwise specified (EDNOS). According to the National Eating Disorder Association, the health risks range from excess hair growth or low blood pressure and heart rate due to prolonged self-starvation, to electrolyte imbalances which lead to irregular heart beats from constant purging.

Fluctuating weight loss and gain, anxiety and depression, and hyper-vigilance about one’s own weight, appearance and food consumption constitute EDNOS. EDNOS is a dangerous disorder, and is also the most common. But lack of awareness and informative discussions about it simply tell people who suffer from EDNOS or other less well known disorders that they don’t fit into the category of anorexic or bulimic.

Another misconception that only young adolescent girls having eating disorders leads to an extremely low rate of males seeking help for their illness. Short states that “in boys, eating disorder [rates] look pretty similar to girls.” According NEDA, 10 million American males will suffer from an eating disorder at some point in their life, and they are the gender which is the least likely to ask for help. There’s nothing feminine about having an eating disorder. While getting help is always difficult, encouraging an all-gender-encompassing view of eating disorders will help make it easier for guys to reach out for assistance.

Also, people of color, and those from all socioeconomic statuses, are just as susceptible to eating disorders. Assuming that rich white American girls are the only ones who are susceptible to an eating disorder has a similar effect on people of color as the feminine stereotype does on men. People of color, though, can be reluctant to acknowledge their disorder and avoid getting help.

There are so many different types and combinations of disorders, other illnesses which accompany them, and an enormous number of genetic and environmental factors. Short states that, “I don’t think people understand it is both a mental and medical health issue, with significant and serious implications.”  Eating disorders are biopsychosocial, meaning there are biological (physical), social and psychological influences and implications. It is not something people choose — they  do not choose to be anorexic, bulimic or anything of the sort.

Biological factors include a family history of obesity, body image issues and eating problems. And after eating disorders have progressed to a certain point, the body is subject to leptin resistance where the stomach does not properly recognize the chemical leptin. Leptin is used by the body to control and signal hunger or when it is full. This signal is leptin from their fat cells essentially requesting more fats and other nutrients or indicating that there are enough of those nutrients.

Usually, bulimics will begin to stop feeling full, while anorexics will end up going numb to hunger pains. This numbness is due to spikes and lows of leptin levels in the body. The spikes occur before or after purging, and during feelings of hunger.

Psychological factors, most of which develop as the disorder progresses, can include, but is not limited to, anxiety, depression, loss of control, and skewed or distorted body image. To manage all or a few of these things, a person may begin restricting calories, purging, over-exercising, or any other eating disorder related symptom in order to gain some sort of control. Eating disorders are coping mechanisms which have room to take hold over other non-eating related coping mechanisms due to concerns about weight or image. AN, BN, BED, and EDNOS all contain symptoms which involve something being forced or controlled, which can give the person with this disorder a dependance on purging, or over-exercising or restricting food.

Similar to alcohol and drug addictions, the brain associates a “good” feeling after following through with these harmful actions because it feels in control. This is extremely unhealthy and dangerous, but people with eating disorders do not make a true conscious choice to put their bodies in harms way and suffer from one of many eating-related illnesses.

Another sphere of influence is the social atmosphere a person is surrounded by. An example would be social media. From Facebook, to Instagram, to movies and TV shows, and to celebrities in the news, almost everyone is touched by social media’s fat shaming, skinny shamming, body and beauty centered world. And, when other biological and psychological factors are present or have the potential of presenting themselves, this harmful media concoction can negatively affect a person’s own body image.

Family, friends, school, and other people or activities are also extremely influential on one’s mental health. Issues in these areas, especially in cases of abuse, pressure, high standards or bullying, can contribute to the use of a control or coping mechanism such as purging or starvation. An article by Caitlyn Hamilton for NEDA on trauma and eating disorders  states that “Traumatic experiences, especially those involving interpersonal violence, have been found to be a significant risk factor for [eating disorders], particularly those characterized by bulimic symptoms…” For more information on trauma and its relationship with eating disorders, read this article titled “Trauma, Sexual Assault and Eating Disorders” on the NEDA website.

At St. Paul Academy and Summit School, eating disorders are discussed in Middle School Wellness and in Upper School Fitness for Life and Wellness. There are many resources, such as the Upper School counselor, Susanna Short, or any of the other SPA counselors and teachers, for students who want more information, support for friends struggling with eating disorders, or support for people with an eating disorder who wish to seek assistance. “When students have significant medical needs, whatever they are, the school works very hard and very close with them and their families,” Short said.

For more information about eating disorders, visit NEDAwareness.org or nationaleatingdisorders.org