Not "Sick Enough" to Have an Eating Disorder: What to Do When You Feel Invalidated About Your Eating Disorder
Written by CCTC Staff Writer
It doesn’t matter what stage of an eating disorder you’re in — whether you’ve never been formally diagnosed with an eating disorder, are currently in eating disorder treatment, or if you’ve been in recovery for years — at some point, you have probably said at least one of these to yourself:
“I’m not really sick enough to have an eating disorder.”
“My eating disorder isn’t severe enough to be a problem.”
“I’m not sick enough to get better.”
“I am not deserving of treatment because I’m not ___ .”
This is known as feeling invalid about your eating disorder. Read on to learn why people you may feel invalidated when it comes to your eating disorder, and some of the consequences of feeling invalid. We’ll also talk about what to do during those times when you don’t feel “sick enough” to really have a problem, or that your eating disorder is not “severe enough” for you to need recovery.
But first: No matter what anyone says or thinks, whether you have a formal eating disorder diagnosis, or your physical state, your eating disorder is a serious, life-threatening mental illness. You are valid, and you deserve recovery.
The real reason behind feeling invalid: It’s about “the look.” One of the biggest barriers of admitting to and receiving treatment for an eating disorder is the idea that eating disorders have a “look” — specifically the young, white, emaciated girl that the media has painted as the eating disorder “standard.” This “standard” exists in all areas of life.
How the Eating Disorder “Look” is Invalidating in Daily Life
When a person with an eating disorder does not look severely underweight (and the majority of those with eating disorders present as normal weight or even overweight), then it’s easy to assume that their eating disorder isn’t “real.”
And so many people who developed an eating disorder at a normal or above average weight have shared these kinds of experiences:
If your eating disorder results in weight loss, you are praised for losing weight. Despite the dangerous methods you have used to lose weight, you are still rewarded.
If you try to ask for help, others might not believe you.
If you speak out about disordered behaviors, and there is fatphobia involved, you might be praised for using dangerous methods to lose weight, even if it’s a known fact that you’re showing signs of a serious mental illness.
If others don’t recognize that you have a problem, then it’s really hard to believe you actually have one.
How the Diagnostic Criteria of Eating Disorders is Invalidating
Anyone, no matter your shape, size, or background, can develop an eating disorder. It would make sense to assume that the DSM-5, the handbook listing what “qualifies” or can be identified as an eating disorder, would reflect this fact.
However, the DSM-5 largely bases the severity of an eating disorder — which is a mental illness that may result in physical illness — on physical features. Specifically, the DSM focuses on weight.
If you do not reach a low weight criteria for an eating disorder (specifically anorexia, as this type of disorder very much focuses on weight as an important factor) then you are diagnosed with “atypical anorexia,” or “eating disorder not otherwise specified.”
Because you might not fit neatly into one single diagnosis, or don’t have a definitive label attached to your medical records, you may not believe that you are worthy of the same treatment as others. You may not recognize yourself as having an eating disorder at all.
How the Treatment Setting Can Make You Feel “Not Sick Enough”
Insurance coverage, which affects how long patients are in a certain level of care, is also heavily focused on physical factors like weight and vital signs. It is common practice for insurance companies to discontinue coverage for residential and partial hospitalization programs (PHP) when you reach a certain weight. They do this even when you still need a high level of support.
When you only spend a few weeks in a residential or day program, and others spend much longer in the same setting, it’s easy to feel like you are not as sick as everyone around you. Even though you may be struggling just as much as others, you are kicked out of a program earlier than them because of your weight.
Related: There are so many consequences of weight stigma, both in the treatment setting and in daily life. Read about them, and about what to do if you are faced with weight stigma, here.
How the Competitive Nature of Eating Disorders is Invalidating in the Treatment Setting
Many people with eating disorders know that they’re dealing with a mental illness. But they still seek validation through the physical body. When everyone around you is dealing with an eating disorder, almost everyone is comparing. It’s common to base the severity of your eating disorder on those around you — if you are thinner than someone else, then you are “sicker than them.” If you are not, then you are “not sick enough.”
And while staff know that eating disorders are mental illnesses, many therapists and dieticians take some individuals more or less seriously than others. Dieticians, in particular, focus on the physical side of eating disorders, and may prescribe smaller meal plans to people in larger bodies.
In these situations, even if you have gone to extreme lengths to reach your current weight, you are not given a weight restoration meal plan. You are not seen as someone “sick enough” to need to gain weight.
And if you are on a smaller meal plan than everyone else, the comparison happens again during mealtimes. In those moments, you start to wonder whether you’re supposed to be in treatment at all.
The Consequences of Feeling Invalidated About an Eating Disorder
When you don’t see your eating disorder as a valid problem, or think you’re not “sick enough” to need help, you may not ask for it. This is a very common thing that happens to a lot of people, so know that you’re not alone if you don’t immediately seek help for your eating disorder.
But waiting to fit “the look” of an eating disorder has dangerous consequences:
You continue engaging in behaviors to achieve “the look” of an eating disorder. In many cases, people do this just to be seen as someone with problems surrounding food.
Eating disorders of all kinds adversely affect the body, and it becomes more damaged the longer you engage in eating disorder behaviors.
The longer you engage in behaviors, the harder it will be to stop.
As your eating disorder takes over your life, there’s no space in it for other things. Many people eventually need to leave school, work, and special events like vacations, to seek a higher level of care, and end up in a higher level of care for a longer period of time.
The eating disorder voice, over time, will take over, and your voice will grow smaller.
What to Do When You Feel You’re “Not Sick Enough”
Say these things to yourself when you feel invalidated:
“Eating disorders are a mental illness, not a physical one. How I look does not reflect my mental state.”
“No matter my formal diagnosis, any eating disorder is severe, dangerous, and life-threatening.”
“I don’t need a formal diagnosis to have an eating disorder. In fact, many people with eating disorders don’t have a formal diagnosis, go through treatment, or have a dramatic ‘eating disorder story.’”
“I deserve recovery as much as anyone else.”
Take these actions when you feel “not sick enough”:
Find someone who believes you when you tell them about your eating disorder. Lean on them when you need to.
Speak to your treatment team, if you have one.
Seek help from a therapist if you do not have an established treatment team.
Advocate for yourself when you feel like you are not being taken seriously in a treatment setting. If you know that you need more time at a higher level of care, work with your treatment team to speak with your insurance company.
Write down on sticky notes all the reasons you want to recover. Hang them somewhere you can see.
Read stories about others who have recovered from an eating disorder at a normal/above average weight. Remember that you are not the only one who has ever felt this way.
No matter what you look like, or what anyone else around you believes — if you consistently have disordered thoughts/behaviors when it comes to food, you have an eating disorder. And you deserve recovery as much as anyone else.
If you or a loved one is suffering from an eating disorder, take the first step today and talk to someone about recovery or simply learn more about the holistic eating disorder recovery programs we offer.