Pause for a second, close your eyes, and conjure up an image of someone with anorexia. What do they look like?

If you’re like most people, they’re probably female with a waist you could cold hold in a single fist, skeletal limbs, a visible rib cage, and sharp joints that cut through the air like a razor. This person probably hasn’t had breakfast or lunch or dinner the night before. She probably spends a lot of time on the treadmill, and maybe she chews gum to keep her hunger at bay.

Why is she like this? Because she wants to be beautiful, and our culture– with its magazine covers and runway models and crash diets– told her the only way to beautiful was to be skinny. Absurdly skinny. Dangerously skinny.

What should she do? Realize all those messages are bullshit, of course. Give the fashion and diet industry the middle finger and eat. Eat until her hips are round again and her chest fills back out and, you know, until she’s cured. Right?

I’m here to implore you to expand your image of anorexia because there is so much about this illness that goes unseen– even by those who suffer from it. I’ve struggled with the eating disorder for more than six years now, and there’s a great deal I didn’t know influenced it or came with it until a number of years in. Since then, I’ve been wanting to share my experience and help broaden the conversation around anorexia by busting through some of the common misconceptions surrounding it.

It should go without saying that I am not a doctor or a psychologist. I have no professional knowledge of eating disorders, so nothing I say should be taken as absolute fact or professional medical advice. This is simply what I have collected through my personal experience living with anorexia, working with a therapist for several years, and working with many doctors. I hope my words can just provide a little insight into a complex condition and help you approach conversations around it with more understanding and compassion.

1. It’s not just about food or weight

Some of the most grating things repeated to me over and over during my struggle with anorexia were comments along the lines of “You look great, you don’t need to lose weight.” Those comments drove (and continue to drive) me insane not because they are wrong, but because they were barely scratching the surface of what I was going through. Because, yes, I was dealing with body dysmorphic thoughts, self-consciousness about my weight, and a desperate desire to change my body since around the age of 5 or 6, but my body was also holding a whole other universe of stress and trauma that had nothing to do with my weight or appearance.

For instance, individuals with anorexia are also often found to be perfectionists and overachievers who perform well in school and take an active role in their communities. These individuals are prone to taking on a lot of stress, and food restriction and weight loss may be one of the ways to deal with the pressure. Additionally, some researchers believe that anorexia is part of an unconscious attempt to deal with unresolved conflicts and childhood traumas.

As I said, my discontent with my body started around the age of 6, but it took a decade for me to begin restricting. What pushed me over the edge was intense personal stress, discomfort at home, and a smattering of other mental illness I was addressing. I felt like I was spiraling out of control, so I began doing everything in my power to take ownership over my life. This meant getting straight A’s in school, being very careful with the things I said in public, and, yes, starving myself.

Yes, anorexia is characterized by an intense fear of gaining weight that leads to food restriction and there are certainly environmental pressures (such as bullying and culture beliefs) related to thinness that propel anorexia, but many people fail to realize that there is so much beyond those fears and obsessions.

2. Anorexia resembles an addiction

I don’t drink or do drugs because I know that, what with my mental health history and all, the second I start on something, I’d never stop. It never occurred to me, however, that my addictive personality might be getting its “fix” from anorexia. It was mentioned by my therapist, of course, for the 6 plus years I’ve struggled with my ED, but I didn’t understand how that could be until a particular anxious commute home when I caught myself in a cold sweat at the bottom of a particularly concentric thought spiral around food.

Now, there’s not enough scientific evidence (that I could dig up, at least) to suggest anorexia is an addiction, but it has been shown to resemble an addiction. Individuals with anorexia narrow their behaviors so that restricting food intake, weight loss, and excessive exercise interferes with their lives in a similar manner to substance abuse.

In other words, weight loss and food restriction become your life, just as getting a “fix” of a drug controls the life of an addict. I had thought spirals  about food that would absolutely block out all other thoughts, I backed out and avoided social obligations so I could avoid eating or make elaborate excuses as to why I was not eating, and I failed to stop my restrictive behavior long after I knew it was hurting me and had decided I wanted to heal. All of these activities are paralleled by the symptoms of substance abuse.

Additionally, there’s a theory floating around that food restriction may activate the same parts of the brain that are activated with addiction, but I couldn’t find much evidence supporting that. What I will say is that I did experience a feeling of pride and elation whenever I successfully avoided eating that I imagine is comparable to some sort of high.

3. People notice your behavior

I definitely wanted people to notice the change of my body when I started losing weight. I wanted them to see that I was “healthy,” beautiful, perfect. What I did not want, or even expect, them to notice was what I was doing to my body. I thought I had crafted an eating and exercise routine that would appear “normal,” developed convincing explanations to my strange dietary habits, and showcased a dedication and conscientiousness to my health that others would find admirable.

But they weren’t fooled and they weren’t impressed. They were worried.

The first person to approach me was a high school friend who consulted with another friend of ours and then held a sort of “intervention” for me when we were hanging out that weekend. I came home in tears, absolutely in denial that their concern was legitimate. Then came the whispers at lunch that reached me in a sort of game of telephone that one person or another noticed I barely touched my meal. Soon after it was a karate instructor, then another friend who approached me in the hallway, then the school guidance counselor who reached out to me on behalf of an anonymous party. Finally, my mother, who had tried to be patient and understanding while biting her nails in silence, told me things were going to change. Although I tried to play along as best as I could, my first attempt at recovery was not my decision. It was that of a perceptive world that watched me throw away the bulk of my lunch and saw how I had to pin back several inches of fabric to get my clothes to fit right.

4. Anorexia f*cks up your body

You probably know this, but there’s a reason you eat. It’s so that your body— literally every part of it— can function. Stop eating and your body stops functioning.

The starvation characteristic of anorexia hits the body hard. If you’re a female, one of the most obvious effects is the cessation of your menstrual cycle, known as amenorrhea. This occurs because, when in starvation mode, your body picks and chooses what processes are most important to divert energy to, and reproduction is one of the last on the list. I’ve experienced amenorrhea twice– once in high school before my first attempt at recovery and again in college after my first attempt at recovery failed– so allow me to tell you how disconcerting it is to witness such an obvious change in your biology and connect the dots of causation back to your own actions. Let me also tell you what absolute hell it is to develop a regular period all over again. I went through several years of sickening PMS, rock bottom moods, and unpredictable bleeding before I return to a relatively regular, relatively painless menstrual cycle.

But, of course, anorexia torments your body in many other ways, with the bones and heart being most at risk. Starvation can prevent the development of bone mass, especially in adolescents who are in the critical period of building bone mass. Once gone, bone mass can’t be recovered, making it one of the longest lasting symptoms of anorexia. Heart damage due to loss of muscle mass, however, is the most deadly symptom and common cause of hospitalization for those with anorexia.

Another effect of anorexia I experienced was poor circulation which led to chronic chills and the near-daily loss of feeling in my hands and feet. I couldn’t stand to be in air conditioning and the slightest breeze brought my body to collapse in on itself for warmth. I was only ever comfortable when lying directly in the summer sun, but, even then, I often wore a sweater in August.

My first attempt at recovery also revealed that I had developed brutal digestive issues that took nearly a decade to even begin to heal. During that time, absolutely everything — even drinking water — caused my stomach to become upset which made it all the more difficult to recover from anorexia. Several blood tests done to explore my digestive issues revealed that I had an abnormally low white blood cell count for many years, which I later learned is a common symptom of anorexia.

And that’s just scratching the surface of what starvation does to your body. It’s downright shocking what harm I was doing to my body without realizing it, and it’s miraculous how many fail-safe systems our body can revert to before we begin to feel the full force of our own deterioration.

5. It never just “goes away”

I was recently at an expo for work were I struck up a conversation with a fellow attendee that, one way or another, led to me mentioning my history with anorexia (I’m a very open person and tend to get to hard-hitting topics fast). He asked me if I was “healed” and was confused by the response that I was “in recovery.” “What does that mean?” he asked, “You eat, now, right? So you must be healed.” If only that’s how it worked.

You see, anorexia was not just a “phase in my life.” It’s not something that I “healed from,” and I won’t ever forget about it. Anorexia is something I have, it’s something that I’m in active recovery from, and I will have to work to avoid for the rest of my life.

I don’t know why it is that way, but it just is. No matter how long I eat normally or what healthy weight I maintain, the temptation of restriction and starvation will call my name. Not every day, but not never again, either.

I’ve found it’s often a reaction to stress or feelings of imperfection, and that I’ll often restrict as a show of control when I’m around people that cause me stress. I’m still very new to the “recovery game,” so perhaps things will get easier one day, but I’ve had to take a break from cooking for myself because the act of food preparation makes me panic. And, even when eating out, I often must kindly remind myself not to calculate the calories of menu items. I’m also on a long hiatus from working out because, when I’ve tried to start a regular exercise routine in the past, I become very hard on myself and will tempt myself to overwork.

As for feelings towards my body and appearance, I’m in a state of love and appreciation most of the time, but I won’t lie and say it was easy to watch myself put on 30 pounds or have to replace more than half my closet with items a size or two up. And I do know to stay away from fitting rooms, as there’s something about the mirrors in them that make me see the worst in myself.

Truth be told, I could easily write a list of 5, 10, or 15 more things no one told me about having anorexia, and, truth be told, I eventually will. But these 5 points have always struck me as some of the most crucial yet under-recognized aspects of the illness. I hope you take a little time to digest them (bad choice of words?.) and use them to bring a little bit more knowledge and compassion to your perceptions of anorexia and other eating disorders. As we’ve addressed, there’s so much more to it than meets the eye, and it’s too serious of an illness for us to continue to walk around blind.