Alone in the bathroom, I came face-to-face with my naked body. Illuminated by the harsh light, I studied my reflection in the mirror, scrutinizing the dark shadows tainting the space around my collarbones and across the undulations of my spine. I deliberately stepped on and off the scale, sure of an error, but I repeatedly confronted the same number. Lower than ever, each flash confirmed that this unrecognizable body was mine.
Three days after this encounter, I reclined on the doctor’s table. Scheduled for an overdue physical, our casual conversation pivoted as she moved her stethoscope up my chest and revealed the sharpness of my ribs.
“You’ve lost some weight since I last saw you,” she commented, a hint of concern noticeable in her tone. “How many meals are you eating per day? Are you exercising?”
“Breakfast, lunch, and dinner,” I answered. “I walk almost every day, usually for an hour and a half.”
“Add a snack between meals and no more than one hour of walking per day. Before addressing your anorexia, I want to see some weight gain.”
I straightened up, crinkling the paper beneath me. The harshness of that word lingered. If she registered my shock, she didn’t show it as she dove into a discussion of the physical and mental signs of an eating disorder, connecting each to the behaviors I had revealed during our dialogue.
Was it then that my eating disorder began? A diagnosis from a qualified physician may seem like an uncontested point of origin, but in the days following our exchange, her observations incited reflection. Truth is, my story extends back father in time, though to when exactly remains unclear.
As I proceeded with treatment for my anorexia, I found myself obsessed with deciphering when it began. I analyzed and re-analyzed every moment of my childhood, desperately trying to discern which one triggered the behavior that brought me to my breaking point. Aware that such rumination bordered on self-destruction, I let the memories flood in nonetheless, each a possible explanation.
Age 10, a day at the lake, the first time feeling shame about my body. I removed my cover-up to show off my new pink swimsuit. My brother ran over, cruelly pinching the fat on my prepubescent hips: “When are you going to lose those love handles?!” I held back tears, and later, dabbed the oil off of my pizza and left the crust uneaten.
Age 12, Mom’s birthday dinner, Dad skipping me as he distributed narrow slices of chocolate cake. “You’ve had enough to eat,” he announced to all with a chuckle. Heat consumed my cheeks and I spent the night tallying up the calories from dinner. The next morning, I woke early to run before eating a light breakfast.
Age 16, the universal age of insecurity. I downloaded a calorie-counting app and logged every morsel of intake, down to a single grape. There was no limit as to what I could withhold from myself. I eliminated all wheat products and religiously logged 12,000 steps per day. I avoided parties, fearing the snacks involved, and exercised outdoors despite brutal temperatures and a body that ached for rest. Friends and family expressed admiration for the perceived dedication to my goals.
Met with endless praise, I never questioned the impact of my actions. I unearthed a new obsession, external validation, and my thirst for it became unquenchable. Eating disorders are an addiction, and I was hooked on the high of reverence.
Back on the examination table, I half-listened to the doctor rattle off symptoms of anorexia. Though my behavior matched the diagnostic criteria, I struggled to comprehend how the same habits that once solicited praise were suddenly labeled as disordered. Developed long ago, my “admirable willpower” transformed into “harmful restriction.” What changed?
Finally it clicked: I changed, physically. I recalled the hollowness reflected in the mirror, the way my pants hung on my protruding hips. Newly shrunken, my appearance matched the diagnosis, turning age-old tendencies into causes for concern. Aligning with the socially-accepted definition, others came to recognize my condition for what it had been all along: an eating disorder.
How infuriating this is, I think as I reflect on the years spent at war with my own body, on the energy expended on self-loathing. Had someone, anyone, seen past my size and noticed my actions, intervention could have occurred sooner: before I hurt my body, missed moments of joy with loved ones, and felt trapped by the darkness of my psyche. No matter how hard I try, reversing the harm done during that time remains impossible.
This narrative is not uncommon. For a multitude of reasons, eating disorder victims experience a lag between the onset and recognition of their illnesses. Latching onto the stereotypical image of the paper-thin anorexic teenage girl dangerously excludes people of color, older people, men, the LGBTQ+ community, and other marginalized groups from accessing the help they deserve.
I feel obligated to recognize my own twisted privilege; by achieving the anorexic stereotype – thin, white, upper-middle class, teenage girl – I received the help I needed. However, most do not enjoy that fortune.
Specifically, I think of cis men, prepubescent girls, postmenopausal women, and women using hormonal replacements who cannot meet the pre-requisite condition of amenorrhea in the diagnosis of anorexia. I think of bulimia sufferers, many of whom exist at Body Mass Index (BMI) levels deemed “normal.” I think of the victims exhibiting disordered tendencies but whose bodies do not satisfy the DSM-IV definition of weighing 15% less than their expected weight relative to height. I think of those struggling with eating disorders not recognized: orthorexia, an obsession with “healthful” eating, representing one of many.
These victims, whose bodies do not reflect society’s expectations of their mental condition, deserve support as much as the stereotypical victim does. How long must these individuals suffer, and at what greater cost?
Marginalized voices have joined the conversation in recent years: through her own story, Roxane Gay demonstrates how eating disorders develop in response to trauma; Kiese Laymon brings weight into a racial context; and Portia de Rossi recounts using her eating disorder to conceal her sexuality.
But to fully grasp the reach of eating disorders and their potential damage, and to support people of all backgrounds, this message must reach the medical community. Retaining a limited view of eating disorders that revolves around weight threatens the victims of body image disorders that do not meet this conception, rendering it impossible for people to receive help for their mental illnesses. Healing people after they become sick is one of the greatest flaws of our healthcare system, and the mental health sector commits this same fault. The medical system holds an obligation to keep people in balanced states of health, rather than permit the formation of preventable conditions arising from a lack thereof.
In the period of time between onset and recognition, eating disorder victims risk enacting irreversible damage to their bodies: infertility as a consequence of malnourishment; damage to the digestive system; comorbidities like anxiety and depression. In fact, anorexia nervosa demonstrates the highest mortality rate of any mental illness.
As I progress through treatment, I have witnessed how the medical and public perception of eating disorders fails those attempting to recover. Eating disorders do not discriminate on the basis of size, race, gender, ethnicity, or sexuality. So why do we?
In an ideal world, there should be no minimum level of sickness required to qualify individuals for aid. An effective system must grant all individuals equal access to treatment, regardless of race, gender, or class. Practitioners must expand their diagnostic criteria to account for age, ethnicity, trauma, and other factors that contribute to the onset of eating disorders. Finally, the medical community must recognize that eating disorders, at their core, are not physical; they are multidimensional disorders influenced by biological vulnerability, psychological predisposition, social environment, and family.
Given these complexities, diagnosis based on physical attributes must end. So does abiding by the belief that eating disorders exclusively spawn from attempts to adhere to societal beauty standards. This stance disregards the victims that turn to disordered eating as a means of coping with trauma and discrimination. Trauma-informed care has gained traction throughout the medical community, and eating disorder victims will gain from that same approach.
The medical conception of eating disorders as physical pathologies, defined by being underweight, trickles into society and into the ways we perceive our bodies and our suffering. Earning praise for my disordered eating and exercise habits harmed me and my relationships, before and after my diagnosis.
What if, as a society, we recognized these habits as symptoms of a mental illness – without regard for size, race, or sex of the individual in question? What if we stopped romanticizing weight loss, or better yet, stopped commenting on it entirely? What if we gave all those suffering from eating and body image disorders a real chance to heal?
Three years later, my body looks back at me in the same mirror. In her, I see softened hips, a belly full of enjoyment. I see round cheeks, pink after a day spent in the sun. I see tall shoulders, a sign of heightened self-esteem.
I recognize this body, but I also recognize what more reflects back at me: an earnest woman, a daughter and a sister, a loyal friend, an avid learner, a world traveler, and more. Though I will always grieve the moments lost to my eating disorder, all I can do now is move forward and be present in the moments to come. Healing permits this, and I am grateful for signs of its occurrence daily, but I continue to fight for a world in which this becomes a reality for all.
Emma is a third-year undergraduate student at The Johns Hopkins University, where she double-majors in International Studies and Sociology. Her first-person piece integrates reflections on her own experience confronting disordered eating with a sociological critique of its diagnosis in the United States.
Specifically, she addresses the way disordered eating is glorified in society yet pathologized in medicine; the current exclusion of many victims by a limited diagnostic criteria; and the inaccessibility of treatment. A survivor of anorexia herself, she argues that the medical community and society at large must expand the current practical and cultural understanding of eating disorders in order to help the growing number of people struggling with these diseases.