Writer: Jessica A. Dennehy
Editor: Isabella Io
The 1920s marked the development of two interconnected events: the expansion of modern-day media, which quickly transitioned to the newest medium to propagate the new ‘ideal physique,’ and the rising prevalence of eating disorders. This historical phenomenon underscores the delicate and complex relationship between societal influences and the general population’s mental and physical well-being. With the evolution of modern media, the portrayal of the ‘ideal body,’ popular dieting fads, and cultural beauty standards have also evolved. These have all contributed to the creation of new cultural norms laden with unrealistic and unhealthy expectations regarding one's physical appearance and relationship with food. Alongside this societal shift, younger generations have become increasingly susceptible to developing mental illnesses, especially eating disorders. [8]
What is an Eating Disorder?
Eating Disorders (EDs) serve as an umbrella term encompassing the various mental illnesses that detrimentally affect an individual's diet and/or eating behavior. Beyond influencing one's relationship with food, EDs significantly impact physical and emotional well-being, as well as one’s ability to function in society. They are typically characterized by a fixation on food, body weight, and/or physical appearance. [2] EDs possess incredibly high fatality rates. They have, unfortunately, been glamorized by major celebrities, especially high fashion models and professional athletes. An estimated 9% of the American population is expected to develop an eating disorder in their lifetime, with numbers continuously rising. [12] This research aims to provide an accurate yet palatable overview of the psychological and physical complexities of EDs.
Causes of Eating Disorders
The causes of EDs, like those of many other mental health conditions, are not fully understood. However, several risk factors have been determined that contribute to their development, including genetics, biology, and environmental influences. [4] Research has determined a correlation between certain genes, particularly those on chromosomes 1 and 10, that have an increased risk of developing certain EDs. [11] Additionally, individuals with a family history of EDs are more likely to develop one themselves. From a biological perspective, hormonal and biochemical shifts in the body have been determined to lead to increased amounts of mood swings, rigid thinking, anxiety, and/or reduced appetite, which may either directly precipitate an ED or indirectly contribute to its development via excessive dieting and borderline starvation. [6]
Environmental influences can also contribute significantly to the manifestation of EDs, and stress and other mental health concerns, such as anxiety or depression, are believed to play a significant role in ED development. [4] Moreover, individuals who have experienced weight-targeted bullying are at a considerably higher risk of developing an ED, as there is a great probability that they have already developed self-esteem issues relating to their weight and body image. [6] Other environmental risk factors may include exposure to competitive environments that prioritize appearance and/or weight, such as professional athletics and modeling, where individuals may feel compelled to resort to behaviors that precede EDs to achieve success. [4] Despite the unfortunate modern glamorization of EDs by society, the reality behind the scenes, whether famous or not, is far from glamorous.
The Psychology of Eating Disorders
Recent medical studies have revealed a direct correlation between EDs and other mood disorders, and the medical community continues to study the exact relationship between these mental disorders. [6][7] Currently, the prevailing consensus is that mental illnesses and mood disorders can both contribute to and result from EDs. [4] Researchers have previously utilized brain imaging technologies and observed distinct differences in brain activity between individuals with EDs and those in good health. This is optimistically thought to play a key role in later improvements in diagnosis and treatments. [5] The mood disorders that EDs are most commonly associated with include major depressive disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and various anxiety disorders. Additionally, individuals with EDs can often engage in self-harm and exhibit suicidal thoughts and behaviors. Further studies indicate that 56-85% of individuals diagnosed with EDs also exhibit symptoms of at least one other physical or mental health condition. [7]
It is also true, however, that EDs significantly increase an individual's risk of developing additional mental disorders, particularly anxiety and depression. The second highest cause of death in individuals diagnosed with anorexia nervosa - one of various mental illnesses that fall under the category of EDs - is suicide. Among all mental health conditions, an ED has the second-highest crude death rate, indicating the severity of the issue beyond the direct effects of the disorder. [12]
There exists a misconception that EDs are solely about food and are viewed as a lifestyle choice for the affluent and the ‘white women of high society'. [2] In reality, individuals with EDs can have awful relationships with both food and their body, to the extent that the number on the scale often dictates whether they will eat dinner that night, have breakfast the next morning, or even dinner the following night. For these individuals, the battle extends beyond their physical bodies; it encompasses their entire sense of self-worth, their state of being, and their identity, all of which have become entangled with what they do or do not eat. [4] EDs are complex, multifaceted coping mechanisms that often stem from further underlying concerns.
Anorexia Nervosa
Individuals with anorexia nervosa, often referred to as anorexics, typically exhibit behaviors such as avoiding food, severely restricting their food intake, or consuming minuscule amounts of certain foods. Despite commonly being dangerously underweight, those with the condition almost always perceive themselves as overweight, or even obese. [2] This distorted self-perception drives the afflicted to relentlessly pursue thinness, often at the expense of maintaining a healthy weight. The intense fear of weight gain further fuels their avoidance of food and rigid dietary restrictions. This distorted body image and corresponding low self-esteem stem from their ongoing struggles to accurately perceive their bodies. Anorexia nervosa can be further categorized into two subtypes: “restrictive” and “binge-purge”. [5]
Restrictive Anorexia: Individuals severely limit the quantity and variety of food intake in this subtype.
Binge-Purge Anorexia: Following a period of greatly restricting food intake, individuals experience a binging episode, characterized by consuming large amounts of food in a relatively short period. This is then followed by a purging session, during which individuals remove large quantities of food from their bodies in a relatively short period. This purging session typically involves the use of diuretics, laxatives, or self-induced vomiting. There is a large overlap between binge-purge anorexia and bulimia nervosa, another common eating disorder. [5]
Long-term developments from anorexia can include physical complications such as osteopenia or osteoporosis (thinning of the bones), muscle wasting and weakness, structural damage to the brain and heart, multi-organ failure, and infertility. The majority of these associated conditions arise from the near-lack of fat supply in the body. [5] Fat serves as an important source of cushioning for the internal organs. This particular fat is known as adipose tissue; in its absence, organs become more vulnerable to external damage. Additionally, fat serves as a long-term energy storage source for the body. With minimal fat reserves, the body may turn to converting muscle tissue, including the muscles of the heart, as a resource for cellular respiration. Anorexia nervosa has the highest case mortality rate, reflecting the rate of death within the affected population from factors related to their condition. Individuals with anorexia most often die from causes related to starvation. However, anorexia nervosa also ranks second among all mental disorders in terms of crude mortality rate, with affected individuals being 18 times more likely to attempt suicide than those without the disorder. [12]
Bulimia Nervosa
Individuals with bulimia nervosa, often referred to as bulimics, experience recurrent episodes of binge eating, characterized by the consumption of large amounts of food in a short period. These episodes are almost always followed by compensatory behaviors to counteract the effects of the binge episode. These compensatory behaviors can be categorized into purging or non-purging behaviors. [3]
Purging | Non-Purging |
After the initial binging episode, a purging bulimic will secretly purge their ingested food before it is absorbed by the body, through methods including:
The main purpose of these methods is to clear the digestive system as quickly as possible. | After the initial binging episode, a non-purging bulimic will utilize alternative methods to mitigate the effects of their previous binging episode, such as:
The main purpose of these methods is to “cancel” out their previous binging episode’s caloric intake. |
Individuals with bulimia nervosa typically maintain a normal or above-average body weight while often experiencing significant insecurity regarding their bodies. In the United States alone, 4.7 million women and 1.5 million men have been diagnosed with the condition. [1] Bulimia's prevalence can be in part due to its secretive and easily disguisable nature. One of the challenges in detecting bulimia is its discreteness, as purging behaviors, such as self-induced vomiting or the misuse of laxatives, can be easily hidden. This is particularly an issue in cultures where bathroom usage following meals is common and considered socially acceptable. This clandestine behavior allows undiagnosed individuals to engage in purging after meals without the knowledge of those around them. Awareness plays a crucial role in addressing eating disorders like bulimia nervosa; by educating individuals about the symptoms and behaviors associated with these disorders, we can empower communities to recognize the signs that may have previously been hidden or ignored and provide support to those who may be struggling, even if they are not yet ready themselves to seek professional help.
Individuals with bulimia nervosa who engage in self-induced vomiting commonly experience symptoms such as a chronically inflamed and sore throat, swollen salivary glands in the neck and jaw, and worn tooth enamel with sensitive, decaying teeth. [5] These side effects are mostly due to the repeated exposure of soft oral and esophageal tissues to stomach acid regurgitated during the act of vomiting. The frequent purging can also lead to acid reflux disorders, commonly known as heartburn, where stomach bile and acid reflux into the esophagus. This causes significant discomfort, potentially leading to erosion of the esophagus lining. [2] Repeated self-induced vomiting can result in the erosion of various layers of the digestive tract, including the linings of the stomach and esophagus, as well as damage to teeth and surrounding tissues. Moreover, bulimics who abuse diuretics and/or laxatives may experience similar symptoms, but also can further experience severe intestinal distress, irritation, and ultimately, severe dehydration due to the constant purging of fluids. [3] Furthermore, individuals, especially those using diuretics, may develop electrolyte imbalances from excessive urine excretion, which can lead to serious medical complications such as strokes and heart attacks. [2] Despite the plethora of medical conditions associated with bulimia nervosa, suicide remains the most common cause of death among individuals with the disorder.
Binge Eating Disorder (BED)
Individuals with binge eating disorder (BED) make up the largest population among those with eating disorders, also being the most prevalent ED in America. [5] BED is characterized by a loss of control over eating habits, leading to recurrent episodes of binge eating, during which individuals consume unusually large amounts of food. [9] Unlike bulimia, binge episodes in BED are not followed by purging behaviors, but rather by periods of somewhat restricted eating or dieting. [5] Even when uncomfortably full, individuals with BED will continue to consume large amounts of food, perpetuating a cycle of binge eating episodes and subsequent restrictive behaviors. [7] Often feeling embarrassed or ashamed of their eating habits, individuals with BED, even when not binging, will typically eat by themselves in private. Research has explored the connection between dieting and BED and has revealed an established relationship. [9]
While there is some debate regarding the average weight of individuals diagnosed with BED and whether they fall within the normal weight range or are overweight/obese, studies have consistently found that individuals with BED can experience conditions commonly associated with obesity, even when said individuals are not clinically obese. [9] These conditions may include, but are not limited to:
Joint Problems
Heart Disease
Type 2 Diabetes
Gastroesophageal Reflux Disease (GERD)
Poor Nutrition
Sleep-Related Breathing Disorders
These health complications underscore the significant impact of BED on overall health and well-being, irrespective of body weight status. In addition to the physical health-related complications, BED can severely affect an individual's social life and interpersonal abilities. Feelings of isolation, difficulty communicating, and a pervasive sense of discomfort in all aspects of daily life are commonly experienced by those with BED. [9] It is disheartening to know that so much of the population feels alone and must suffer in silence. There is help, there is support, there is acceptance, and there is recovery, if and when you or your loved ones feel ready to pursue it.
Treatments: Psychotherapy
Psychotherapy, also known as talk therapy, encompasses treatments aimed at assisting individuals in identifying and addressing emotional, psychological, and behavioral concerns. This assists EDs through the notion that many are based on or relate to other mental health concerns. To address the root issue that manifests as the ED, psychotherapy is designed to provide a mental pathway to recovery. These therapies can be conducted in one-on-one sessions between an individual and a licensed professional, or a group and/or family setting. [10]
Family-Based Therapy (FBT): This approach is commonly used in cases of adolescent anorexia nervosa, where parents of adolescents with the disorder take responsibility for feeding their child. FBT effectively promotes weight gain and improves eating habits in these instances. [10]
Cognitive Behavioral Therapy (CBT): CBT is frequently used for individuals with binge eating and/or purging behaviors. [3] This therapy helps individuals recognize and challenge distorted and harmful thought patterns, enabling them to disrupt the binge-purge cycle often experienced in bulimia nervosa and binge eating disorder (BED). [10]
Treatments: Medication and Nutritional Counseling
In addition to psychotherapy, medication such as antidepressants, antipsychotics, and mood stabilizers have been used effectively in treating EDs and co-morbid mental illnesses. Nutritional counseling and therapy are also integral components of rehabilitation programs, which are targeted to address the nutritional deficiencies commonly seen in individuals with EDs. Depending on the severity and stage of the ED, medical care and monitoring may also be necessary. [4] It is important to note that the various subgroups of therapy can be combined and customized to better suit the needs of individuals affected by EDs. [2]
How to Access Treatment and Related Challenges
Unfortunately, only one out of every ten individuals struggling with an ED will receive treatment. This discrepancy may stem from financial barriers, the societal stigma surrounding EDs, and mental illness. However, research has shown that individuals who seek professional help have a 60% chance of making a full recovery. [2] If you or someone close to you is seeking discreet help, there are a variety of resources online, along with assistance embedded in your local community, including confiding in trusted individuals, school psychologists and/or counselors, and professional psychologists and therapists. If you or someone you know has an ED, it is important to understand that help is available. Regardless of the magnitude or medium, if there is one thing to take away from this research, it is that support, awareness, and treatment are possible for those who seek it.
Sources & Works Cited
(1) American Addiction Centers. “Finding a Bulimia Treatment Center.” American Addiction Centers, 29 June 2023, https://americanaddictioncenters.org/bulimia-treatment. Accessed 12 June 2024.
(2) Behavioral Health Centers. “How to Cope With An Eating Disorder.” https://behavioralhealth-centers.com/blog/how-to-cope-with-an-eating-disorder/?cq_src=google_ads&cq_cmp=19729676341&cq_con=&cq_term=&cq_med=&cq_plac=&cq_net=x&cq_pos=&cq_plt=gp&gclid=Cj0KCQjwu8uyBhC6ARIsAKwBGpQZ_X4yxxK4POVv4BrMkSAzeE491uDUiNsupvuxBv-CcSXD. Accessed 26 May 2024.
(3) “Bulimia Nervosa.” Johns Hopkins Medicine, https://www.hopkinsmedicine.org/health/conditions-and-diseases/eating-disorders/bulimia-nervosa. Accessed 26 May 2024.
(4) “Eating Disorders Help: Support for Eating Disorders | UKAT.” UK Addiction Treatment Centres, 9 January 2024, https://www.ukat.co.uk/eating-disorders/. Accessed 26 May 2024.
(5) “Eating Disorders - National Institute of Mental Health (NIMH).” National Institute of Mental Health, https://www.nimh.nih.gov/health/topics/eating-disorders. Accessed 26 May 2024.
(6) “Eating disorders - Symptoms and causes.” Mayo Clinic, 28 March 2023, https://www.mayoclinic.org/diseases-conditions/eating-disorders/symptoms-causes/syc-20353603. Accessed 26 May 2024.
(7) Garnham, Chloe. “What Is Disordered Eating? Signs, Symptoms, And Support.” HealthMatch, 19 May 2022, https://healthmatch.io/blog/what-is-disordered-eating-signs-symptoms-and-support. Accessed 26 May 2024.
(8) Howard, Jacqueline. “How the ‘ideal’ woman’s body shape has changed throughout history.” CNN, 7 March 2018, https://www.cnn.com/2018/03/07/health/body-image-history-of-beauty-explainer-intl/index.html. Accessed 26 May 2024.
(9) Mayo Clinic Staff. “Binge-eating disorder - Symptoms and causes.” Mayo Clinic, 23 February 2024, https://www.mayoclinic.org/diseases-conditions/binge-eating-disorder/symptoms-causes/syc-20353627. Accessed 26 May 2024.
(10) “Psychotherapies - National Institute of Mental Health (NIMH).” National Institute of Mental Health, https://www.nimh.nih.gov/health/topics/psychotherapies. Accessed 26 May 2024.
(11) Shaw, Gina. “Anorexia and Bulimia: Cracking the Genetic Code.” WebMD, https://www.webmd.com/mental-health/eating-disorders/anorexia-nervosa/features/anorexia-bulimia-genetic-code. Accessed 26 May 2024.
(12) Sommerfeld, DH. “Eating Disorder Statistics.” ANAD, https://anad.org/eating-disorder-statistic/. Accessed 26 May 2024.
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