Those who have not been directly or indirectly affected by an eating disorder may find it easy to dismiss behaviors associated with these conditions. They may not understand that it’s more than an obsessive diet or a desire to lose weight. But the truth is that eating disorders are serious medical and mental illnesses that are incredibly complex and risky — not merely a phase or a lifestyle choice.

Eating Disorders and Mental Health

Unfortunately, insurance companies and other organizations often fail to recognize eating disorders as the mental health problems they are. This can make it extremely difficult for those suffering from these conditions to seek treatment and for their families to gain a true understanding of their disorders.

But according to the Academy for Eating Disorders, research shows that eating disorders are, in fact, serious mental health conditions that pose serious risks such as mortality. Scientific and medical evidence supports the position that eating disorders such as anorexia nervosa and bulimia nervosa are actually biologically based and can be considered as heritable as conditions like depression, bipolar disorder, and schizophrenia. The behaviors associated with eating disorders — such as bingeing, purging, and restricting food consumption — have been shown to change an individual’s metabolism, neurochemistry, and brain structure in ways that make it extremely difficult for the person to stop these behaviors (much like addictions). In addition, eating disorders are associated with countless medical complications, cognitive and emotional impairment, and the highest rates of mortality among any other psychiatric disorder. In fact, those who suffer from eating disorders have a 10-15% mortality rate and a 25% suicide rate.

Who Suffers?

Mental Health America reports that 20 million women and 10 million men suffer from a clinically significant eating disorder at some point during their lives in the United States. While some people may be more likely to develop an eating disorder, the reality is that anyone — regardless of age, race, gender, ethnicity, sexual orientation, or size — can be at risk. And like with many other mental health issues, it’s not always obvious who may be suffering from an eating disorder. A person may appear to be healthy in many respects but may actually be extremely ill.

Eating disorders have more than one root cause, but there may often be issues related to mental health that contribute to their development. According to Mental Health America, contributing psychological and sociocultural factors may include low self-esteem, a rigid way of thinking, cultural pressure to be thin, or a history of sexual abuse. Those who have a genetic predisposition to depression or anxiety (including obsessive-compulsive disorder) may also be at a higher risk for eating disorder development. Those with eating disorders may also have co-occurring mental health conditions such as anxiety disorders (OCD, social anxiety, generalized anxiety), depression, post-traumatic stress disorder, mood disorders, and substance abuse disorders.

Are There Treatment Options?

Although many mental health disorders are not completely curable, they’re typically treatable. Eating disorders are no exception. Typically, treatment for eating disorders may include psychotherapy, medical care, or medications (or a combination) — just like countless other mental health issues. Eating disorder treatment may also include nutritional counseling. The National Institute of Mental Health stresses the importance of researching the root causes and risk factors associated with eating disorders to develop new ways to diagnose and treat these issues.

Eating disorders certainly impact the physical body, but they really get their start in the mind. That’s why they are classified as mental health disorders; despite the fact that we can’t see how an eating disorder affects the brain of someone we love, it’s imperative to focus treatment on thought processes and learned behaviors in order to facilitate recovery.

Starting a grassroots mental health organization is kind of like creating your own puzzle. One of the most challenging pieces is managing your own mental health in the process. “I think I am doing well,” I told my therapist as I was leaving his office. “Much improved from last month!” he replied. As I dodge raindrops on my way out to my car, I know we are both right. I have been battling medication adjustments for the last year. However, the recent medication changes my psychiatrist made seem to be working. I still have some anxiety, but as my therapist said, “Some anxiety keeps you on your toes”. I am comforted by the fact that my boss recognizes that living with a mental illness is a daily struggle. In one presentation we did together she said, “Living with mental illness is a full-time job.”

Puzzle Pieces

Another piece of the puzzle is a lack of competition when it comes to resources in a rural county. As I plug in my phone at home, I see that we don’t have any internet access. “Still?” I say to my husband. “Why does this happen every time it rains?” As an affiliate, we are not big enough to have a formal office yet.

I can’t help but think about the bookmarks that my sister and I are working on. Rats, I think to myself. Will we get them completed in time for the Health Fair? You don’t have the infrastructure of an affiliate in a larger county. You only have a handful of people. You have yet to start fundraising. You see so many needs, but you don’t have the resources to fill them yet. Lack of infrastructure missing piece in the puzzle.

Two hours before the support group meeting tonight, I think to myself. I have got to remember to give the key to Vera* so she can cover for me on Thursday. Because of how the calendar falls, we have two support group meetings in the same week! I have to go speak at a local organization. Vera will have to cover for me on Thursday night for the Connection Support Group meeting. I have to find out how Brittany* is doing from Vera, I think to myself. She has been going through a rough time.

When Some are Missing

Because income levels and resources are more limited in a rural county, people can fall through the cracks. Some of the attendees would like for us to offer more of the advanced National Alliance on Mental Illness classes. We simply don’t have the people to do so. “It’s not about where you see a need,” one NAMI Program Director told me once, “It’s where you have the volunteers who are excited about meeting that need.” It’s the “grassroots puzzle piece” in a grassroots mental health organization.

At least we have people coming, I think to myself. I remember in the beginning when it was just me and one other woman. I thought she stopped coming because she was so tired of just seeing me! Then I got a text from her after I sent her a reminder, “I miss you! I’ve just been crazy busy.”

As I look around the table at the three other faces as we begin the support group meeting, it hits me. If I hadn’t worked to get this NAMI affiliate started, none of us would be here. We may still be small. We may have our daily challenges. Some people may want us to do more than we can. And yes, I will have to struggle daily with my own mental illness, but we are making a difference in people’s lives. People are the most important pieces of the puzzle. That’s what really matters.

* Names have been changed to protect identities.