I want to start by telling the story of Valeria Levitin (Russia, 1973), a beautiful and talented woman whose Eating Disorder foreshadowed a tragic life.
I first heard about Valeria in 2012, during my Psychology 101 class; she was 39 years old. Her pictures were disturbing to me. I could not help my brain from repeating her images in my head, which spurred me to research her personal life.
I was in awe at how someone could achieve such a deteriorated physical state and still be alive.
Valeria battled her ED (Anorexia Nervosa) for most of her life. Valeria stated that her mother ingrained in her a noxious fear of weight gain. There were some obese individuals in her family whom her mother deprecated. For this reason, Valeria’s mother would weigh her consistently to make sure she was not putting on any weight. Her mother’s drive for perfection and her lack of peer acceptance (suspected bullying) led to her ED’s onset.
Valeria began to restrict her food intake in her early teens, with undeniable intentions to lose weight. Although by age 23, she was already considerably thin, she wanted to lose more weight to be a model.
When her family began to worry that she might die from this illness, she reached out for help. Doctors and specialists had a hard time helping her; her symptoms and behaviors were inexorable. Valeria reported that most foods did not sit well in her body; her ED had damaged her GI system’s functioning. She also presented other physical symptoms, not excluding dizziness with the risk of fainting/falls, bruising, and infertility.
Valeria gained popularity around 2012 when she won the record of the “thinnest woman in the world.” For moral and ethical reasons, the Guinness Book of Records did not register her. She became a leader of an international campaign against eating disorders. During this time, she received letters from young girls who saw her as an inspiration, seeking advice to be like her.
Valeria remarked, “I’m not going to teach young girls how to die.” Despite her fame, she ironically stated, “Anorexia has made me lonely, unattractive and repulsive for the people around me.” Anorexia took her life away in December 2013.
Anorexia Nervosa (AN)
It is delineated by significant low body index mass (BMI) due to restrictive dieting and an obsessive preoccupation with weight (Forbush & Hunt, 2014). The most typical physical symptoms reported include low heart rate, dehydration, night sweats, hair loss, lanugo, GI problems, dizziness, fainting, inability to concentrate, black/blurred vision, fatigue, muscle weakness, cold intolerance, bruising, blue hands/feet.
There are different ways to restrict food intake. Some clients decrease (and micromanage) their calorie consumption, some skip meals, others eliminate foods, and food groups from their diet. In contrast, others fixate only eating healthy or “clean” foods (i.e., orthorexia). Aside from the disordered behaviors and strict rules around food, individuals with Anorexia Nervosa endorse body distortion with fear of gaining weight. They report intrusive thoughts from “The Eating Disorder Voice,” which ultimately rules their lives. Several individuals with Anorexia Nervosa use compensatory behaviors such as purging via exercise, vomiting, laxatives, diet pills, water loading, or diuretics. These people fall into the category of Anorexia Nervosa purging type.
Through my experience with this population, I have found that many clients with anorexia display an (irrational) desire to become/stay ill. Various personal factors can lead to this rationale. However, it is crucial to remain attentive to this underlying intention as Anorexia Nervosa has high mortality rates, risk of sudden death, and refeeding syndrome.
Bulimia Nervosa (BN)
It involves the presence of binge episodes (i.e., ingesting large amounts of food in one sitting) followed by one or more compensatory behaviors, such as excessive exercise, purging, fasting, abuse of laxative/diuretics/diet pills, or caffeine (Selby & Reel, 2011). Individuals struggling with Bulimia Nervosa endure maladaptive eating cycles that are detrimental to their overall health. Several clients express that their bulimic behaviors are, in a way, “addicting and satisfying.” Others report that they dissociate during their episodes and somehow feel as if they are not in control of what is happening. On the other hand, some groups endorse using bulimia as self-harm. Notwithstanding, they all have a difficult time abstaining from disordered behaviors without proper support and monitoring.
- Did you know that by purging (via self-induced vomiting) you are discharging no more than 50% of the calories you ate? (No matter how fast you get to it)
- Laxatives and diuretics only get rid of 10% of the calories.
- Excessive exercise comes with side effects to your physical/medical health.
Binge Eating Disorder (BED)
It is characterized by the act of eating large amounts of food without engaging in compensatory behaviors (Forbush & Hunt, 2014). People with binge eating disorder tend to report a lack of control around food and the eating process. For this reason, they continue to indulge even when they have exceeded their comfort fullness level. The majority of clients with binge eating disorder identify themselves as “emotional eaters.” It is common for these individuals to struggle with obesity. Equally important, individuals with binge eating disorder experience extreme shame and guilt regarding their behaviors. Thus, a lot of them prefer to eat in secret. They present severe dissatisfaction with their body image, for that they make efforts to hide their bodies from others. This issue contributes to their resistance to exercise. Clients often claim, “I do not exercise because I do not want others to see me at the gym” or “I do not like how I look in workout clothes.”
In many cases, their cycle looks like this:
- Binge episode/s
- Feelings of guilt and remorse
- “Control phase,” which happens when the person tries to diet or restrain themselves from eating.
- “Tension phase”: individuals feels unable to maintain involvement in the diet culture
- Physical and emotional needs lead to the inability to continue the diet; the client resolves to binge.
Other Eating Disorders
Other Specified Feeding or Eating Disorder (OSFED). This category includes all other maladaptive eating behaviors that do not meet the criteria for anorexia or bulimia nervosa (Smink, Hoeken, Oldehinkel, Hoek, 2014). Based on research, and my direct experience with this population, OSFED is one of the most common diagnoses in EDs. Less common diagnosable eating disorders include Pica, rumination disorder, and avoidant/restrictive food intake disorder.
For more information on ED diagnoses please visit The National Eating Disorder Association.
Helpful Tips To Keep In Mind:
✅ Say no to the diet culture
✅ Focus on reducing ‘perfectionist’ habits
✅ Get rid of the scale
Please note that there are different levels of care offered to clients with Eating Disorders. If the ED is taking over the person’s life by negatively impacting daily living and causing any medical or physical concerns, please speak with your Primary Care Physician and research medical criteria for therapeutic services.