Ask an Expert: Questions About Eating Disorders and Recovery

Can you be born with an eating disorder?

While research does show a strong genetic component to these mental illnesses, there is not a single “eating disorder gene” detectable at birth or otherwise. Instead, it is believed that some people are born with a genetic predisposition to eating disorder development. That is, they are born with specific personality and psychological traits that make them particularly vulnerable to developing an eating disorder at some point in their lives. Perfectionism, rigidity, neuroticism, and cautiousness are among the aspects of personality that have been associated with a higher risk of eating disorders. The presence of these traits doesn’t necessarily cause an eating disorder, however; they can and do exist in people without these disorders as well.

There is more to these biopsychosocial illnesses than biology and psychology. A saying used in many illness contexts, “genetics loads the gun, and environment pulls the trigger,” is also sometimes used to describe the etiological role of social factors in eating disorders. Sociocultural influences including family, peers, and media interact with genetics in complex ways to trigger the onset of an eating disorder. Though we cannot change the genetic component, we can challenge our culture’s obsession with diet, weight, and appearance to offset these social risk factors.

Can I have an eating disorder if my weight is normal?

Absolutely. While some people with eating disorders do experience significant weight loss or gain as part of their illness, weight is far from the only criterion used to make a diagnosis. Eating disorders come in all body shapes and sizes—and, contrary to stereotypical depictions, most people with these illnesses do not “look” like they have one. Eating disorders are complex mental illnesses that cannot be reduced to weight conditions.

Similarly, weight cannot communicate the specific eating disorder someone has. It is inaccurate to assume that those with eating disorders in smaller bodies must have anorexia, while those in larger ones must have binge eating disorder (BED). Restricting, bingeing, and purging are all behaviors that may or may not influence the number on the scale. Each disordered behavior presents in people across weight categories.

Can you ever really recover from an eating disorder?

Often people in recovery want to know: Does an eating disorder ever go away completely? Will food forever be a struggle, the thoughts and behaviors around it a lifelong practice? Can you ever be “recovered”—or is “in recovery” the best you can hope for?

Because recovery from an eating disorder includes both behavioral and cognitive changes—and because eating disorders differ from person to person—the experience of full recovery is hard to define. It’s relatively straightforward to evaluate physical symptoms and the frequency of behavioral ones, but measuring psychological symptoms is a more subjective task. How much fear, worry, or distress is the disorder still causing? To what degree does the preoccupation with food or body remain? These indicators of recovery are harder to evaluate than electrolyte levels or blood pressure, for example, and they’re not as black-and-white as the absence or presence of disordered behaviors. What’s more, some degree of food and body concern is normative in our diet-obsessed culture. Must people rid themselves of all traces of this to call themselves recovered?

In research, at treatment centers, and among individuals in the eating disorder community, there is no one definition of recovery. For some, the difference between “recovered” and “in recovery” is merely semantic, and for others, one term resonates more. Some may find that “in recovery” is a helpful reminder of the everyday practice of living fully and authentically—whatever that means to them in regards to food and beyond. Some may find that “recovered” helps them close the chapter on their illness in a way the in-progress definition does not. 

No matter which words are used to describe full recovery, it is clear that it is possible to recover to the extent that the eating disorder no longer impacts your life. Not only can you stop restricting, bingeing, and/or purging, you can live a full life undeterred by food or body concerns. As Johanna Kandel mentioned in a recent Peace Meal episode, when people ask about the possibility of recovery, they’re often asking one fundamental question: Can it get better? And the answer to that is an unequivocal “yes,” in behavioral, physical, and psychological ways.   

If you have a question about eating disorder education, treatment, or recovery, please email AskEmily@emilyprogram.com. For eating disorder support for yourself or a loved one, call 1-888-364-5977 or complete our online form today.