7 myth-busting facts about the risk of eating disorders

When eating disorders were first added to the Diagnostic and Statistical Manual of Mental Disorders, they were considered a disorder affecting young, thin and affluent White girls and women.

Forty years later, this myth and many others persist, with misinformation that puts people at risk. KU Life Span Institute researchers and other mental health experts reveal the truth in these seven myth-busting facts about eating disorders.

FACT 1: Most screening tools don't account for the diversity of populations affected.

Kelsie Forbush, senior scientist at the KU Life Span Institute, professor of clinical child psychology and clinical science and director of the University of Kansas Center for the Advancement of Research on Eating Behaviors, said screening tools are essential to identify people with eating disorders.
"If you’re just asking somebody, ‘Do have you had an eating disorder?’ very few people would say ‘yes,’” Forbush said.

However, most of the surveys and other tools were developed to target cisgender, White female populations and were not tested for accuracy among other genders, racial groups or ethnicities. The failure to diagnose eating disorders makes treatment difficult, if not impossible, which makes early detection important to recovery, explains the National Institute of Mental Health.

"Screening is a critical first step for providing intervention,” Forbush added. “We wouldn't be able to do any kind of intervention without screening.”

FACT 2: Eating disorders impact people from all racial groups.

While research initially pointed to case studies of White girls and women as at risk for eating disorders, we now know this mental-health condition impacts people beyond this narrow demographic. Studies, such as one published in Eating Behaviors in January 2019, have found no ethnic differences in the prevalence of eating disorders. Old ideas, however, can impede diagnosis.

Research published in the journal Behavior Therapy in December 2006 found clinicians are less likely to diagnose a person of color — even with the same list of symptoms, which can put these individuals at higher health risk due to late or missed diagnoses. Consequently, people of color are half as likely to be diagnosed with and receive treatment for eating disorders, the Eating Disorders Coalition reports.

FACT 3: Eating disorders impact people from all socioeconomic statuses, but especially people from marginalized economic groups.

In fact, explained Forbush, recent research has found eating disorders are significantly more common in marginalized and lower socio-economic groups.

Forbush co-authored a study published in April 2021 in the International Journal of Eating Disorders that surveyed 579 college students and found those with food insecurity — a lack of consistent access to food — reported “significantly greater frequency” of binge eating, fasting and other eating disorder symptoms. According to researchers who authored a March 2023 article in the journal Public Health Nutrition, food deprivation due to dieting or food insecurity seems to trigger a combination of neurobiological, psychological and behavioral responses that increased the likelihood of binge eating, which can trigger other disordered eating symptoms or lead to an eating disorder.

FACT 4: Men who develop eating disorders face double the risk of death.

Although the risks of developing an eating disorder are higher in women and girls, the mortality risk for males is more than twice that of females, as explained in a January 2020 journal article in “BMC Psychiatry.”

According to Forbush, "Rates of eating disorders in boys and men vary based on the specific eating disorder.” She said about 9% of people with anorexia nervosa and bulimia nervosa and about a third of people with binge eating disorder are males. This represents thousands of people who are more likely to be overlooked by screening tools that focus on female representations of what it looks like to have an eating disorder — as well as in treatment options that tend to be tested on female populations. For example, men and boys may be more concerned with low body fat and muscular definition than thinness.

“If a screening tool is highly gendered, then we might miss someone with an eating disorder,” Forbush said. For example, "Asking about dissatisfaction with hips and thighs or a desire to avoid weight gain may miss people with eating disorders who want high muscularity and low body fat.”

Due to stigma, males may also be less likely to seek treatment even if they recognize they have a problem, contributing to the higher mortality rate.

“There are so many men who have eating disorders,” Forbush said, “yet many men avoid seeking help due to the shame and stigma associated with having what society often falsely perceives as a ‘female’ illness.”

FACT 5: Sexual and gender minorities face higher risk of developing eating disorders.

People who are LGBTQIA experience higher rates of eating disorders compared to individuals who are heterosexual or cisgender. As reported by the Bulimia Project, gay men comprise about 42% of men who have eating disorders, while only being about 5% of the total male population.

Transgender or nonbinary people are four times as likely than their cisgender peers to have an eating disorder, according to the National Eating Disorders Association. Janine Averbach, senior primary therapist at Princeton Center for Eating Disorders, explained this in a 2019 article from Penn Medicine News. She said transgender teens have been known to use restricting, purging or exercising in place of hormone therapy as method to suppress menstruation and the development secondary sexual characteristics or to achieve a more feminine appearance.

FACT 6: People with autism may be at increased risk for developing eating disorders.

Researchers have recently discovered people with anorexia nervosa are at a higher risk of also having autism, a 2022 article in the journal Frontiers in Psychology explained. In clinical settings, they found high levels of autistic features linked to “more complex, highly comorbid illness presentation and poorer treatment outcome.” Other studies have reported more than 20% of people with anorexia nervosa have autism as well, compared to an estimated 2-3% (1 in 36) of the general population.

Experts suspect the propensity of people with autism to engage in restrictive and repetitive behaviors, which can be connected to the development of eating disorders. A condition called ARFID (avoidant/restrictive food intake disorder) is known to occur with autism and contributes to food avoidance without the focus on weight and body image.

As science in this area is still developing, treatment for anorexia among people who have autism has worse outcomes, according to several studies, including one published in the Journal of Eating Disorders in 2023, highlighting the need for treatment plans tailored to people with autism.

FACT 7: Military service can increase the risk of developing eating disorders.

According to Forbush, who in 2023 developed the first screening tool for eating disorders in veterans, the focus on weight and physical appearance through enforcement of strict body composition standards, in addition to food restriction during missions, can contribute to binge-eating, purging, and other unhealthy eating behaviors.

Military members, including veterans, may face higher risks for eating disorders than civilians. While some studies have found comparable rates among civilians and people with a history of military service, a Government Accountability Office report in 2020 said survey responses suggest a higher rate of eating disorders than have been clinically diagnosed. One reason is that the military has a larger male population that may not identify with stereotypical eating disorder screening, which tends to focus on a female perspective.