(CNN)– Emily Boring was diagnosed with an eating disorder by chance.
She went to her university’s mental health office to discuss the anxiety she was experiencing and learned through conversations that her eating behaviors were classified as an eating disorder, she said.
Now 27, she is a graduate student at Yale Divinity School in New Haven, Connecticut, and her journey of recovery and relapse has taught her much about caring for herself and others.
During Eating Disorders Awareness Week in late February, Boring spoke to CNN about the misunderstanding, shame and stigma surrounding eating disorders to help increase their understanding.
This conversation has been edited and condensed for clarity.
CNN: What do you want people to know about eating disorders?
Emily Boring: I would like people to know that they are everywhere. The vast majority of people will experience some sort of disordered relationship with food in their body, simply because of the culture in which we live.
What I would say first and foremost is that disordered eating, and this also applies to formal eating disorders, is not seen in a specific way. They affect everyone, regardless of gender, race, ethnicity, age, or socioeconomic status. Disordered eating and eating disorders do not come with a “thin” or underweight body.
CNN: How do you understand eating disorders and their treatment?
Boring: Eating disorders are now classified as metabo-psychiatric diseases: metabolism refers to the way the body processes energy, and then the psychiatric part related to the brain and behavior.
This confirms the experience of people with eating disorders. For decades we, and clinicians alike, have observed that eating disorders tend to be triggered when someone falls into an energy deficit or does not eat enough calories to sustain their body.
Since her experience, Emily Boring has been a mentor to other patients recovering from eating disorders. Credit: Wendy Petersen Boring
Eating disorders are not something to be ashamed of. They are not a choice or a failure. There is still some stigma around the idea that eating disorders are something you choose. I would add something else: if someone is about to find out they have an eating disorder or receive that diagnosis from someone else, I would stress the importance of early intervention. And I would say that the first step to recovery is finding a good treatment team that includes a therapist, a nutritionist, and a doctor.
CNN: How should loved ones talk to people recovering from an eating disorder?
Boring: I speak mostly from my own experience, but I have also mentored quite a few teens through this process. I’ve learned the hard way what isn’t helpful to tell you and I’ve also received (unhelpful feedback).
As much as possible, avoid comments and actions that we associate with “diet culture.”
In this country especially, the way we privilege fitness in popular culture is antithetical to recovery. “Diet culture” often hides under the banner of “healthism,” which is basically the belief that there is a standard of fitness and body capacity that everyone can achieve if they work hard.
There is a whole scientific literature that shows that health and weight do not have a causal relationship. So a higher weight does not necessarily equate to a worse state of health.
CNN: What do you mean when you say not to use “the eating disorder’s own voice” to answer him?
Boring: Let’s say I show up at a doctor’s office and I’m afraid of what’s happening to my body. I’m afraid of getting fat. And a well-intentioned doctor might tell me, “Don’t worry, your body isn’t going to change that much. Your weight doesn’t have to go up.”
Regardless of the truth of that statement or not, that is falling into the eating disorder belief game. It’s so easy to try to reassure (the loved one) using eating disorder language, and I’ve found that doesn’t work in the long run.
CNN: What are ways to talk to people while avoiding using “the eating disorder voice”?
Boring: Some questions I encourage people to ask are things like, “Does what I’m going to say imply that some bodies are better than others? Or that some foods have more or less moral value?” Also try to avoid mentioning anything with numbers, whether it’s weight or calories or the number of hours you exercise per week.
Don’t assume someone’s inner state based on how they are on the outside. Whenever possible, step back and ask questions, rather than making assumptions.
An example: “I see that you are improving in these behaviors, as we proposed last week. How are you feeling? How did your mind react?” That gentle inquiry process rather than assertions and assumptions is really key.
CNN: What do people need to know about relapse?
Boring: That it is not a failure, and that it does not have to lead you back to the worst disease you have ever experienced. You can detect it in time and turn the situation around.
What I wish I had known about relapse is that it happens faster, more suddenly, and intensely than I thought.
If you have the genes for an eating disorder (whether it’s anorexia, bulimia, binge eating disorder, or any other disorder on the spectrum), you may always need to be careful and vigilant about maintaining nutrition, eating plenty and variety, and isolating yourself from the “culture of diets”. Because it can happen quickly: a few days of restriction, a few pounds lost, and suddenly you’re right back in the eating disorder.
And I would also say that relapse is a learning opportunity. I don’t always feel that way in the moment, but the times I have relapsed, I look back and realize that in each case I discovered something about what recovery means to me.
I guess that’s just a way of saying, be kind to yourself and be open-minded that yes, relapse is a crisis and you need to do everything you can to get out of it. But also, it’s not a failure and it’s not a sign that you’re going to be struggling with this forever.
CNN: What have you learned about recovery?
Boring: When I first started recovering, people — mostly doctors, but also in some of the books and blogs I’ve read about people who have recovered — framed recovery, mostly in terms of absence. When you have recovered, you will no longer have these annoying symptoms, or you will not spend as much time thinking about food in your body.
Actually, what it feels like to be recovered is all about presence. It is the ability to be present in the relationships that surround you and in the things that interest you. It is also the physical presence of awareness of your own body, the ability to perceive sensations, the ability to listen to your body’s hunger and satiety signals.
The eating disorder is completely gray and I feel like it is dragging me through the days. When I recover, the world has color again.
