7 The Silent Battle: The Complex World of Eating Disorders

This chapter is based on the Social Ecological Model.

Eating disorders are defined as “behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions” (Guarda, 2023, para 1). Eating disorders fall under the broader umbrella of disordered eating, which encompasses a wide range of irregular eating behaviors that may or may not meet the criteria for a clinical diagnosis. Anyone can develop an eating disorder; however, they are most prevalent in women ages 12-35 (Guarda, 2023). These disorders can lead to long-term mental, emotional, and physical issues. People with eating disorders often struggle to maintain relationships, in part because they tend to seclude themselves from others as they hide or deny the reality of their condition. Additionally, many physical symptoms, such as higher or lower body mass index (BMI), dizziness/fainting, loss of muscle tone, osteoporosis, organ failure, and even death, are associated with eating disorders (Guarda, 2023).

Numerous factors contribute to the risk of developing eating disorders. According to Hazzard et al. (2020), at-risk children and families often have a higher risk of developing an eating disorder. Families of lower socioeconomic status often face food insecurity, which can contribute to disordered eating habits (Hazzard et al., 2020). If someone in the family, such as a parent or sibling, has an eating disorder, other family members are more likely to develop similar issues (Mayo Clinic, 2023). Additionally, having a diagnosed mental health disorder like depression, anxiety, and obsessive-compulsive disorder (OCD) can increase this disease risk (Mayo Clinic, 2023). Periods of intense stress contribute to a heightened vulnerability, as individuals may seek control in certain areas of their lives (Mayo Clinic, 2023). Another risk factor is frequent dieting. Dieting increases the risk of eating disorders, as inconsistent weight loss may drive individuals to seek “better” results through harmful behaviors (Mayo Clinic, 2023). Many resources are available for family and friends to help those who suffer from any type of disordered eating.

Individual

The first step toward healing from disordered eating is recognizing that you are struggling and need help. Many resources, such as self-tests, can help identify disordered thoughts and/or actions associated with someone’s eating. The National Eating Disorders Association (NEDA) (n.d.a) offers a screening tool for individuals aged 13 and older, designed to help individuals realize whether they are experiencing eating disorders. If the screening tool finds high-risk behaviors, NEDA (n.d.a) can help connect people with different treatment options if/when they decide that they are ready to receive help.

Another helpful approach is to begin incorporating self-help or self-care strategies. Online resources teach people how to practice self-care if they are not ready to talk to someone about their struggles (The Renfrew Center [TRC], n.d.). These practices include meditation, breathing techniques, getting enough sleep, and spending time with family and friends (TRC, n.d.). If a person works on better mental and psychological health, symptoms can decrease and a better chance for recovery (TRC, n.d.).

Relationship

People with eating disorders tend to deny having any issues with their relationship with food and will hide as much as they can about their disorder. The nature of these disorders can make it difficult for people around them to see that they are struggling (Guarda, 2023).  The National Eating Disorder Association, the nation’s largest nonprofit organization, supports individuals affected by all forms of eating disorders. NEDA‘s resources highlight the different types of eating disorder treatments. Treatment can range from different forms of therapy visits to complete inpatient treatment (NEDA, n.d.c). Friends and family can be a first step to helping a high-risk person contact medical professionals to start an appropriate treatment plan.

Family and friends’ support plays a vital role in these individuals’ recovery process. Research shows that when loved ones are informed about the disorder and have access to external support, they are better prepared to offer effective and meaningful help (Hannah et al., 2022). The carer interventions that were studied utilized therapy and teaching models to teach carers how to communicate without judgment, recognize warning signs, and create a supportive, low-pressure environment that encourages the person to seek help. Hannah et al. (2022) reviewed the effectiveness of seven different studies and found that interventions that adopted the Experienced Carers Helping Others (ECHO) model resulted in “long-term positive outcomes.” The ECHO intervention provides families and caregivers with resources such as books and online coaching to help carers determine if their behaviors support or enable their loved ones’ disorder (Hannah et al., 2022). While professional treatment is crucial, fostering carer relationships that provide encouragement and emotional stability can significantly affect a person’s ability to recover (Hannah et al., 2022).

The Emily Program is another resource available that provides information to families on how to get help for a loved one. The Emily Program’s comprehensive website offers assessment quizzes for individuals or families who think someone they know might be struggling (The Emily Program, n.d.). The Emily Program has several locations across the country, including Georgia, Minnesota, NC, Ohio, Penn, and Washington, all with inpatient, outpatient, and virtual treatment options. The Emily Program is just one of many different programs available to help those struggling with an eating disorder.

Community

Some children with eating disorders may not feel safe confiding in anyone at home or school. School staff and coaches can help spot, prevent, and intervene when symptoms arise (American Academy of Pediatrics, 2022). School-based advocates can consider implementing the Multi-Tiered Systems of Support (MTSS) lens, which lays out three levels of intervention and treatment options for mental issues (Macheca et al., 2024). Tier one focuses on educating teachers and school staff on how to identify disorders and conduct screenings or reports. The second tier allows students to form small groups “who are at-risk using evidence-based practice” and discuss their feelings (Institute of Educational Sciences, 2024). The third tier assists teachers (with parent permission) in recommending students to specialists and facilitating communication between outside teams (Institute of Educational Sciences, 2024). The MTSS facilitates the early identification of at-risk students through its multi-step approach, enabling timely intervention and increasing the chances of treatment for any mental illness, including disordered eating. School counselors should be properly trained on how to help and refer these students to help them get on the road to recovery (Institute of Educational Sciences, 2024).

Disordered eating occurs in adolescent athletes, with a greater percentage being females (Sundgot-Borgen et al., 2025). Therefore, coaches need to be able to identify the signs and help provide resources for treatment. Coaches can help their athletes see food as fuel rather than a factor for weight regulation (Children’s Health, 2024). If a coach suspects an athlete is suffering from an eating disorder, he/she should encourage the athlete to seek professional help before the condition causes lifelong harm. While local resources are often available through mental health services, some national resources include the ANAD Support and Project HEAL (both programs support online group sessions to help work through eating disorder challenges).

Societal

Experts recognize the growing use of social media platforms as a significant risk factor in the development of an eating disorder (Au & Cosh, 2022). However, various organizations are implementing new measures to help with the early detection and prevention of eating disorders. Instagram highlights expert-backed resources to appear when someone searches for self-harm-related content (Instagram, 2021). Instagram partnered with NEDA to develop resources such as eating disorder hotlines and advice on building body confidence (Instagram, 2021). According to Instagram’s webpage, community leaders can share Reels to “encourage positive body image, push back against weight stigma and harmful stereotypes, and show that all bodies are worthy and deserve to be celebrated” (Instagram, 2021). Au and Cosh (2022) found that recovery communities on social media platforms can positively impact users. According to their study, people use Instagram recovery communities to connect with others like themselves, find motivation, share coping mechanisms, provide encouragement, explore alternatives to professional help, and share their experiences in a safe space. When individuals lack access to providers, the recovery communities are a means of social support; however, in some cases, it may impact recovery (Au & Cosh, 2022).

Although eating disorders are a personal battle, there are publicly funded organizations that can help provide coping methods, mental exercises, and people to contact for support.  As previously stated, NEDA helps those find screening tools and treatment options, but it is also the nation’s largest supportive nonprofit organization. This program allows those to sort through various treatment options such as nutrition counseling, treatment providers, and various helplines available to text or call (NEDA, n.d.b). Another program that can help those suffering from disordered eating is the National Alliance for Eating Disorders. This organization’s helpline encourages individuals to call or email for assistance. Their advocates can assist concerned family and friends on how to be supportive and deal with the challenges (National Alliance for Eating Disorders, 2023).

References

American Academy of Pediatrics. (2022, November 15). Eating disorders and the school setting. https://www.aap.org/en/patient-care/school-health/mental-health-in-schools/eating-disorders-and-the-school-setting/

Au, E. S., & Cosh, S. M. (2022). Social media and eating disorder recovery: An exploration of instagram recovery community users and their reasons for engagement. Eating Behaviors, 46. https://doi.org/10.1016/j.eatbeh.2022.101651 

Children’s Health (2024). Eating disorders in athletes.  https://www.childrens.com/health-wellness/athletes-and-eating-disorders

Guarda, A. (2023, February). What are eating disorders? American Psychiatric Association.  https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders

Hannah, L., Cross, M., Baily, H., Grimwade, K., Clarke, T., & Allan, S. (2022). A systematic review of the impact of carer interventions on outcomes for patients with eating disorders. Eating and Weight Disorders, 27, 1953–1962. https://doi.org/10.1007/s40519-021-01338-7

Hazzard, V. M., Loth, K. A., Hooper, L., & Becker, C. B. (2020). Food insecurity and eating disorders: A review of emerging evidence. Current Psychiatry Reports, 22(74). https://doi.org/10.1007/s11920-020-01200-0

Instagram. (2021, February 23). Supporting users affected by eating disorders. https://about.instagram.com/blog/announcements/how-were-supporting-people-affected-by-eating-disorders-and-negative-body-image

Institute of Educational Sciences. (2024, April). Meeting the social, emotional, and mental health needs of all students. https://ies.ed.gov/sites/default/files/migrated/rel/regions/northeast/pdf/Meeting_Social_Emotional_MH_Factsheet.pdf

Macheca, E., Fuxman, S., & Lipton, B. (2024, November 8). Using MTSS to support student well-being: New fact sheets for schools. Institute of Education Sciences. https://ies.ed.gov/learn/blog/using-mtss-support-student-well-being-new-fact-sheets-schools

Mayo Clinic. (2023, March 28). Eating disorders. https://www.mayoclinic.org/diseases-conditions/eating-disorders/symptoms-causes/syc-20353603#:~:text=Trauma%2C%20anxiety%2C%20depression%2C%20obsessive,on%20and%20off%20new%20diets.

National Alliance for Eating Disorders. (2024, May 4). Eating disorder statistics: an updated view for 2024. https://www.allianceforeatingdisorders.com/eating-disorder-statistics-an-updated-view-for-2024/?gad_source=1&gclid=Cj0KCQjwm7q-BhDRARIsACD6-fXlH-Js2Tu_fLsSJjYAWF8vKhdeFlr8PobdTQfpF41lmAcBFRh71cgaAmseEALw_wcB 

National Alliance for Eating Disorders. (2023, April 14). What is an eating disorder helpline? https://www.allianceforeatingdisorders.com/what-is-an-eating-disorder-helpline/#:~:text=To%20reach%20the%20helpline%20for,00%20pm%20EST%20on%20weekdays.

National Association of Anorexia Nervosa and Associated Disorders. (2025, January 27). ANAD Home. https://anad.org/

National Eating Disorders Association. (n.d.a). Eating disorder screening tool. https://www.nationaleatingdisorders.org/screening-tool/

National Eating Disorders Association. (n.d.b). Get help. https://www.nationaleatingdisorders.org/get-help/

National Eating Disorders Association. (n.d.c). Levels of care for eating disorders. https://www.nationaleatingdisorders.org/levels-of-care/

Project HEAL. (2025). What are eating disorders? https://www.theprojectheal.org/what-are-eating-disorders

Sundgot-Borgen, C., Sundgot-Borgen, J., Sølvberg, N., Torstveit, M. K, Mountjoy, M., & Mathisen, T. F. (2025, March 17). Factors predicting disordered eating and the prevalence of eating disorders in adolescent elite athletes, trained athletes and a reference group: A prospective controlled two-step study. British Journal of Sports Medicine. 0, 1-12 https://doi.org/10.1136/bjsports-2024-108808

The Renfrew Center. (n.d.). What is self-care & why is it important in eating disorder recovery? https://renfrewcenter.com/what-is-self-care-why-is-it-important-in-eating-disorder-recovery/