AUSTIN, Texas — Mental illnesses can be life-threatening, but some are quieter than others and harder to detect.
Eating disorders affect people of every age, race, size, gender identity, sexual orientation and background. The combined mental and physical assault on the body from an eating disorder boosts the mortality rate from death by sudden heart attack, multiple organ failure and other deadly consequences of prolonged malnutrition.
Eating disorders – including anorexia nervosa, bulimia and binge eating – are the most lethal mental health conditions. Every 52 minutes, someone dies due to an eating disorder in the U.S.
A challenge faced with the illness is that it often goes undetected, and people may struggle for years before receiving a diagnosis and specialty treatment. Part of this is due to longstanding stereotypes about what someone with an eating disorder “looks like.” Many people with an eating disorder may also not have obvious signs or symptoms that indicate there is a problem.
Cases are rising
Studies show there has been a significant rise in eating disorder cases – specifically among teens and young adults – since 2019. Early 2022 data shows no improvement. Common symptoms are listed as unusual weight fluctuation, food restriction, and an increased irritability, fatigue, anxiousness or depression.
Abby Christiansen is one of those cases.
“It’s like this voice in my head,” Christiansen said. “It was just, 'You need to lose this weight. You need to exercise this much. You need to burn this many calories.' And then whenever I did, it just never was enough.”
The 16-year-old junior in high school loves to learn. She’s in marching band and stays active by doing karate. But these things she loves were stripped from her when, at 14 years old, disordered eating behaviors crept into her everyday life.
Christiansen, a self-described perfectionist who has struggled with anxiety, said when the pandemic kept her home and away from music and exercise, things started to go downhill.
“I started seeing all this stuff online like, you have to become a better version of yourself through COVID. And the main way they were talking about that was, like, changing your body,” Christiansen said.
The climbing number of eating disorders are due, in part, to diet and exercise culture during a time places like gyms were shut down. The problem became so widely apparent during this time that even social media platforms like Instagram stepped in to create a more body-positive environment, offering users the option to block weight-related ads.
Still, it wasn’t enough to keep the teen from becoming sick.
“It felt like I was never really present in any moment because I was always thinking about food, I was always thinking about my body. I was thinking of what others thought of my body,” Christiansen explained. “I was described as looking like I was dying. I lost the sparkle in my eyes. That was one of the huge things. People were always like, 'You lost the sparkle in your eyes.'”
Across the country, the yearly economic cost of eating disorders, due to emergency room visits and inpatient hospitalizations, is in the billions. The illness effects all genders, but women are two times more likely to have an eating disorder. And while it affects people of all races, studies show people of color with eating disorders are half as likely to be diagnosed or to receive treatment.
Christiansen credits her doctor, whom she also lovingly calls her friend, for pushing her to seek the help she needed. First, Christiansen was treated at Dell Children’s Hospital in Austin. From there, she spent nearly seven weeks in in-patient and residential treatment program at a facility in Plano. Following that, she was an intensive outpatient. Now, Christiansen has regularly scheduled therapy appointments.
“I had to do it for myself if I was going to survive,” Christiansen said. “It was going to be fatal if I didn’t get the help I needed.”
Christiansen has taken her experiences and used them to educate the public through her Instagram account and eating disorder awareness organizations, such as the National Eating Disorder Association. In November, Christiansen coordinated a NEDA Walk at the Austin Zoo with her mother, Sheri.
Still, Christiansen admits that even with the progress she has made in her recovery, she still struggles to “let go” of eating disordered behaviors.
“Your eating disorder convinces you that it makes you feel so good about yourself. But whenever you go against what it says, it tells you, 'Oh, you’re going to look like ‘this’ and everyone’s going to hate you because of it,' sort of thing,” Christiansen said. “And I’m still realizing that’s not true.”
Diana Anzaldua is a licensed counselor and the founder of Austin Trauma Therapy Center in Austin. Her caseload consists of clients with chronic illnesses and mental disorders, including eating disorders.
Anzaldua said she and other counselors have seen an uptick in young patients with eating disorders.
“It might be, like, obsessing about their body weight or their size, obsessing about calories,” Anzaldua said. “That anxiety and obsession about, 'Oh, I can't eat this, I can’t eat that.'”
Anzaldua explained that eating disorders, while they can be influenced by our surroundings, can also be brought on by past trauma and even our family genes.
“We don't know other people's stories,” Anzaldua said. “We don't know where they've come from, what they've gone through, how trauma has impacted them and their gender, their family and then generations before them.”
Annabelle Osowski is a dietician nutritionist. She often works with patients with disordered eating.
Osowski said not every patient is immediately ready to remedy their relationship with food, but learning the connection between food and mental health is a good place to start.
“Oftentimes nutrition and food aren't necessarily how traditional medicine approaches mental health or any kind of issues around depression or psychological disorders,” Osowski said. “But nutrition can be a huge benefit.”
Osowski said a healthy relationship with food means to approach, think and consume food confidently and well.
“[A healthy relationship with food] is being able to be involved with it – whether that's at an event or at home … To be around food and to not struggle with the type of food or the amount of food, to be able to approach freed from a mindful place and to be able to not focus on outward appearance or how that food is going to affect their weight, but instead just how it's going to be beneficial to their body,” Osowski explained.
Recovering is possible
Anzaldua and Osowski agree that recovery from an eating disorder is possible.
“I think with tools, both psychotherapy and nutrition counseling, and other approaches that might be more centered or holistic can offer opportunities for healing and recovery for anyone suffering from an eating disorder,” Osowski said.
Christiansen said receiving help is a privilege she is fortunate to have. She also said it isn’t just her who needs recovery from disordered eating, but society does.
“I feel like almost everybody in society has engaged in disordered eating or thoughts of disordered eating. So I feel like the point I’m at now is making people aware. I’m obviously still working on it myself, but it’s what I want to do with my life,” Christiansen said. “I want to do anything I can to help other people.”
If you would like to get involved with the National Eating Disorder Association, click here.
If you are struggling with disordered eating, the National Disorder Association has created a guide on how to navigate the holidays, which can be viewed here.
If you are seeking help for you or a loved one who may have an eating disorder, click here.