Chances are, you know somebody who has struggled with an eating disorder. According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), approximately 30 million people in the United States suffer from this affliction–that’s almost 11 percent of the country’s population! With body image pressures more acute than ever (for both men and women), it’s no wonder that the illness is more prolific than it used to be.

The most well-known forms of disordered eating are anorexia nervosa and bulimia nervosa (the first being extremely restrictive diet or outright refusal to eat, the second a disorder characterized by binging and purging).  However, there are more insidious iterations of food restriction and extreme dieting that go under the radar.

One of these offenders is orthorexia: a set of behaviors which the individual believes help them achieve a “healthy” diet. The problem is that extreme levels of restriction and anxiety associated with this pursuit leave people affected by it both emotionally fraught and physically  malnourished. The obsessive behavior compartmentalizes some foods into the “good, clean, healthy” category, and others into the “bad, dirty, and impure” category.

Furthermore, those suffering from orthorexia integrate their own theories about health and acceptability, meaning that personal theories about which foods are acceptable and which aren’t overshadow actual trends of a healthy, well-balanced diet. This can leave those afflicted feeling anxious, depressed, underweight, or malnourished–which can result in additional symptoms like hair loss and skin problems.

“It’s no secret that increasingly unrealistic body image ideals are portrayed in the media today. We are constantly bombarded by photoshopped images, promoting unhealthy and unattainable standards. The psychological effects of this are far-reaching and real.”

Recently, Broadly.com published an article entitled “The Diabetic Women Who Skip Insulin To Lose Weight” in which they outlined the little-known and overwhelmingly under-diagnosed disorder called diabulimia.

Those with type 1 diabetes (an autoimmune disease, as opposed to type 2 which is adult onset, resulting from genes or poor diet), must regularly inject themselves with insulin. They become dependent on externally acquired insulin in order to stay alive. As the title of the Broadly piece suggests, diabulimia is when people with type 1 diabetes intentionally restrict their insulin intake (a process vital to their body’s ability to regulate and digest sugar), in order to lose weight.

This risky process can result in limb loss, blindness, as well as countless other physical ramifications. Broadly interviewed Rebecca Ryan, a young woman who deliberately denied herself crucial injections of insulin, all the while keeping it a secret from friends and loved ones, and ended up in the hospital as a result.

Ryan told Broadly, “It got to the point that when I was injecting insulin, I felt like I was injecting fat.” She continued, “It was just the most horrible feeling. So then I just fell into a cycle of restricting insulin, losing weight, and feeling awful and guilty.”

Overtime, repeatedly withholding insulin can result in early death. Diabulimia often goes undiagnosed; it falls under the radar and is masked by a carefully crafted fallacy that the individual is simply bad at managing their diabetes. It is estimated that approximately 40 percent of women with type 1 diabetes between the ages of 15 and 30 suffer from it—a staggering and tragic statistic.

It’s no secret that increasingly unrealistic body image ideals are portrayed in the media today. We are constantly bombarded by photoshopped images, promoting unhealthy and unattainable standards. The psychological effects of this are far-reaching and real.

Unfortunately, eating disorders are routinely ignored and mis-categorized. Like many mental illnesses, eating disorders are often treated as phases or a choice that the afflicted is making. This couldn’t be further from the truth: often those engaging in these behaviors also suffer from body dysmorphic disorder, a condition which causes them to disassociate from the way that their body actually looks, and instead see themselves in a highly distorted manner.

Recently, though, historic strides have been made in the direction of recognition and treatment for eating disorders. In December, the United States Senate passed a comprehensive piece of health legislation, entitled the 21st Century Care Act. If signed into law, the Bill will be the first piece of eating disorder legislation to be legally recognized.

Along with initiatives specifically designed to recognize, combat, and treat eating disorders, the bill also looks to prevent suicide, and more inclusively recognize the myriad mental health concerns that face citizens all over the country.

This doesn’t mean that the struggle is over, though. In order to lessen the amount of people affected by eating disorders, it’s necessary for initiatives on every level: from body positivity, to food accessibility, to nutrition education. The 21st Century Care Act, and other legislation like it, could work towards legitimizing eating disorders and other mental health concerns under the eyes of the law, and therefore inspire more effective and affordable approaches to understanding and treating the root causes which plague those who are suffering.