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Health Advisor is a regular column where contributors share their knowledge in fields ranging from fitness to psychology, pediatrics to aging. Follow us @Globe_Health.

'You're a lazy, fat ass. Your partner dumped you. Your parents divorced because of you. You didn't get into school because you're stupid. And lazy. And fat."

Noise doesn't start this way. It starts off innocently. Meet Girl: Girl feels badly about herself and her life. Her partner left her, parents are divorcing and she wasn't accepted into the university of her choice. Feeling ashamed and embarrassed, she keeps her feelings inside and hopes they will just disappear. She decides that losing a few pounds would make her feel better and act as a good distraction.

Enter Noise, the eating disorder. It's friendly at first. Noise provides helpful tips and suggestions about what to cut out of her diet, how to amp up her exercise regime. Girl likes Noise: She feels heard by Noise, and decides to trust it.

Before long she starts to get feedback from those around her about how good she looks, how fit and strong and beautiful. People stop asking about her breakup, her parents, where she's going to school in the fall, and instead just comment on her body. Girl feels safer in the world this way. Noise has protected her. Noise has allowed her to avoid those difficult feelings. Noise is her friend.

Do you think eating disorders are about food and the body? They're not. They're the about intrusive, pervasive, abusive Noise. How do I know this?

As an eating-disorder therapist for the past decade, and as a survivor of both anorexia and an overexercise disorder, I've come to know Noise quite well. Eating disorders are severe and debilitating mental-health issues that manifest themselves through food and the body. Initially, manipulating food and the body serves as a necessary distraction from deep-rooted, seemingly out-of-control emotions and life circumstances. It is this reprieve – not the goal of being skinny – that is enticing.

Noise and Girl have been hanging out for a few months, and they're getting closer. Girl's friends have partners, parents who are still married and acceptances into schools. Girl has Noise. Without Noise, she has nothing. One morning she sleeps in. Many months of hanging with Noise (eating marginally and exercising intensely) have worn on her. Noise is angry. "You're lazy and fat," Noise screams. "Sleeping in? What are you doing? Who's ever gonna want to be with someone so lazy? Get up. You're gonna eat less and work out more all week because of how lazy you are. Get up."

Noise announces a new plan: "Starting today you will miss breakfast and lunch and you will exercise more – a new standard you must follow or you'll just end up worthless." Girl accepts the new rules. She agrees that she is lazy and fat. Noise knows best. Noise is protecting her. Noise cares. Girl hates that she is lazy and fat. Girl needs to up the ante. Noise is right.

This is what is happening to Girl: As she gets closer to the eating disorder, she gets farther from those painful emotions and life circumstances. This makes the thought of facing her feelings even more frightening – seemingly impossible even – and leads her to seclude herself from parents and friends. Her life becomes smaller, more disconnected, depressing and dependent on the eating disorder. Life is too overwhelming, and she believes she is safer with Noise. This is an illusion. After all this time together Noise has effectively become her world. To imagine otherwise isn't fathomable to her; it has become all-consuming. She has lost herself. She is fully enmeshed in Noise.

By now, a shift has typically taken place by those around her. The feedback about her body is of concern, not flattery. Family members and friends share in their worry and acknowledge her avoidance, asking how they can help her. Girl wants this help and care, but Noise only gets louder and more abusive, and overrides the concern of those who love her.

Noise says, "Girl, you can't listen to them. Where have they been all this time? I've taken care of you. Remember they left you because you were lazy and fat – and now they're just jealous of you.

Also, your parents aren't even together any more. They love others now, and you think they want to help you? I'm protecting you." Girl knows. She cannot believe otherwise. She trusts Noise. She won't let go. She does not want to face her feelings or her life.

We have a responsibility to better understand eating disorders in our culture. When Girl can begin to separate herself from Noise, her recovery will begin. To help, we must begin to listen to what only Girl can hear, and help her to confront what Noise has protected her from.

Health Advisor contributors share their knowledge in fields ranging from fitness to psychology, pediatrics to aging. Kyla Fox is the founder of The Kyla Fox Therapy Centre, an eating disorder recovery centre in Toronto. She has been a clinical therapist in the field of eating disorders for the last decade, and is also a public speaker, writer and advocate for eating disorder awareness and prevention. You can find her at and follow her on Twitter @Kylafoxtherapy.