In psychology the analogy of an iceberg is often useful and I can think of no instance more appropriate to use it than the in case of eating disorders. Family members (and even therapists are sometimes guilty) express a level of concern for someone with eating issues based on what they see or don’t see. If someone lost or gained 20 pounds in a month or stopped eating dinner for 2 weeks it would raise a red flag for most. The truth is that most people who are struggling with food or eating appear to be “normal” in their habits. It’s not surprising then that when someone comes out to family or friends that they are struggling with food they may not always get the level or empathy of compassion they deserve. So why is that? What you SEE does not necessarily correlate with the amount of suffering a person is experiencing. There are two things to consider when it comes to eating issues. First, BEHAVIORS (eating, not eating), which are the tip of the iceberg. Second, the AMOUNT OF MENTAL SPACE that is taken up in a person’s mind. The time that someone spends thinking about food, body image, eating, and not eating is strongly correlated with a person’s level of suffering. Unfortunately, you can’t always see suffering.
You may be talking with your best friend about what happened on your date last night and they can be completely engaged in the conversation. However, you would have no clue that the entire time they were speaking with you they had their attention on a constant stream of negative thoughts (or images) and fears related to eating and/or their bodies. That’s why I always try to get a sense of how much time someone spends thinking about things related to eating and their physical appearance. Someone may not be engaging in behaviors that would get them a diagnosis of an eating disorder but their brains, emotions, and suffering are congruent with a person who has a diagnosable eating disorder and they deserve the same attention and help.