Eating is a natural and necessary part of everyday life, so how does it become disordered? The answer to that question may be as individual as the person diagnosed with an eating disorder. While a preoccupation with food may be the most commonly identifiable trait of eating disorders, this is not the whole story. Sheila Thomas, a clinical director from Focus Healthcare, says that people with eating disorders use food, either refusing it or overindulging, as a method of control, compensation, or coping. Ultimately, the behaviors involved with eating disorders are associated with a person’s mental health.
Mental Health & the Body
By Pamela Boaz
Eating disorders include anorexia nervosa, bulimia nervosa and binge eating, as well as other manifestations of these. While anorexia nervosa and bulimia nervosa are the most familiar of the eating disorders, the National Eating Disorders Association recognizes the full range of issues relating to weight and food.
Anorexia nervosa is characterized by selfstarvation and excessive weight loss. It is a potentially life-threatening disorder. Those with anorexia nervosa display extreme thinness, an intense fear of gaining weight, and a distorted self image. Females may lack normal menstruation.
Bulimia nervosa similarly carries lifethreatening results. Bulimia is characterized by a cycle of binge eating, or eating to excess, followed by purging through self-induced vomiting, excessive use of laxatives, extended episodes of intense exercise, or some combination of these. There may be no noticeable weight gain or weight loss with bulimia, but health issues related to it such as dental problems or gastrointestinal problems usually become apparent.
Binge-eating disorder (BED), is a loss of control over food intake. With BED there is no attempt to purge or to reduce the effects of overeating. Binge eaters are often overweight or obese and are at risk for cardiovascular disease and high blood pressure. In addition, they may feel guilt or shame associated with their behaviors.
According to Jenny Johnston, executive director of the Mary Cameron Robinson (MCR) Foundation in Chattanooga, eating disorders are essentially a mental health issue. While all eating disorders center on a person’s relationship to food, the underlying causes relate to emotions, attitudes, and behaviors.
Although people commonly think that an eating disorder is just about food or that the person wants attention, getting an anorexic to eat is not the solution. The idea that an eating disorder can be cured with self-discipline ignores the mental issues that accompany the illness. Thomas explains that an eating disorder can even be understood as a psychological addiction to a behavior.
Among psychological issues causing a preoccupation with weight are depression, anxiety, and obsessive-compulsive disorder. Thomas adds that perfectionism, low self-esteem, feelings of inadequacy, and obsession with control are also common denominators among people with eating disorders. For example, a student who insists on earning straight A’s or has a high IQ may have a higher risk for developing an eating disorder.
Ultimately, negative emotions, attitudes and behaviors result in an inaccurate selfimage or sense of self-worth, causing an unhealthy relationship with food. When thinking becomes rigid or skewed, a desire to be or look a certain way becomes self-punishing.
Anyone can have an eating disorder, but girls are ten times more likely to be at risk than boys. In general, eating disorders occur during teen and young adult years. However, an article in the August 2011 issue of Parenting magazine sites an increasing number of preteens being diagnosed. According to Thomas, 95 percent of eating disorders are diagnosed in people between the ages of 12 and 25.
The influence of the media in body image cannot be ignored. Teens and young adults are bombarded with images of super-thin celebrities depicted in digitally enhanced photographs, creating unrealistic expectations of one’s own appearance. Airbrushed photographs of Julia Roberts and Christy Turlington in advertisements for skin care lines were recently banned in the United Kingdom after critics stated that the photographs were misleading and did not reflect reality. The countless advertisements and products emphasizing weight loss and praising thin bodies clearly contribute to body image issues.
In addition, the United States supports a $30 billion dollar diet industry, and the constant message of thinness is indisputable. In households where parents are concerned with their own weight, talk about dieting often influences children. “Words have power,” cautions Johnston, “and parents need to know that what they say can alter a child’s selfimage.” While the media plays a role in the obsession to be thin, parents can mitigate the impact of what children see and hear on television and in print by limiting their exposure and by talking to them about realistic images and words.
Thomas says that those who are bullied at school or who experience stress at home may use eating as a maladaptive way of coping with emotions or as a way of self-medicating feelings. When everything else is out of control, eating is seen as something that can be controlled. The paradox is that this thinking and this behavior are out of control too.
Certain physical activities have also been associated with eating disorders. A Vanderbilt study by Ana Cintado listed gymnastics, longdistance running, diving and figure skating as sports with high incidences of eating disorders. Those who study dance — especially ballet — are also at risk. Being lean is clearly an advantage in each of these activities, and a desire to excel can put young participants at risk. One image of a perfect gymnast, for example, comes from Olympic gold medalist Shawn Johnson at 4’9” and weighing 90 pounds.
A lack of control in one’s life, difficulty in relationships, or an inability to express emotions are also associated with eating disorders, as is a history of being ridiculed about weight or a history of physical or sexual abuse.
While the pressure to be thin and to have a perfect body may come from the outside, biological factors may also be present. During puberty, when there is an increased risk for developing eating disorders, almost 50 percent of that risk can be attributed to genetics, according to research out of Michigan State University. Other studies indicate that certain brain chemicals such as serotonin may be abnormal in eating disordered individuals. Research is being done to identify biochemical imbalances that affect hunger, appetite and digestion.
Eating disorders have the highest mortality rate of any mental illness. For those with anorexia nervosa, a slow heart rate and low blood pressure may occur, raising the risk for heart failure. There is often a loss of bone density that results in young females developing osteoporosis. Anorexia nervosa can also cause muscle loss and weakness. Refusing food can create severe dehydration which is a factor in kidney failure. Fainting and fatigue are common as is hair loss and dry skin.
The bingeing part of the bulimia nervosa cycle can result in an irregular heartbeat and even heart failure, while purging behaviors may create electrolyte imbalances because of dehydration and the loss of potassium, sodium and chloride. Those who have bulimia nervosa risk their oral health because of the acid associated with constant regurgitation. Frequent vomiting can cause inflammation or even rupture of the esophagus. Some studies indicate that as many as 89 percent of those with bulimia nervosa have tooth erosion. Laxative abuse during purging can result in irregular bowel movements and constipation. Peptic ulcers and pancreatitis are also associated with bulimia nervosa.
Binge eating and obesity carry with them the likelihood of high blood pressure and high cholesterol levels. In addition, heart disease, Type II diabetes, and gallbladder disease are associated with BED and obesity.
As the causes of eating disorders are complex, long-lasting treatment must address all facets of the illness. As well as attending to the symptoms of eating disorders, treatment should address psychological, biological, interpersonal and cultural forces that cause or contribute to the illness. Therefore, the most effective and long-lasting treatment for an eating disorder is some form of psychotherapy or counseling coupled with careful attention to medical and nutritional needs.
Thomas says that treatment requires a wholistic approach that addresses the mind, body and spirit. At Focus Healthcare, programs span individual therapy, group therapy, family education, after care planning, lifestyle management classes, nutrition education classes, dialectical behavior therapy, and relapse prevention. Each person’s illness must be addressed in ways that fit that specific case.
The treatment of anorexia nervosa often includes the use of medications such as antidepressants or antipsychotics in order to stabilize the symptoms of anxiety. The same approach also holds true for the treatment of bulimia nervosa. Among effective treatments for binge-eating are cognitive behavioral therapies. As with many other illnesses, research is being done to determine the role that genetics play in eating disorders.
Help and hope are everywhere, including through agencies like the MCR Foundation, Focus Healthcare and the National Eating Disorders Association. Thomas says that it is vital for individuals and organizations to begin promoting healthy, realistic images of the body. Awareness on the part of parents can enable children and young adults to counteract the unrealistic messages of society. Schools can help students learn healthy attitude toward food and build positive self-images. All of these efforts are critical components in preventing and treating this growing illness.
Pamela Boaz, a writer and editor, earned a B.S. degree from the University of North Florida and an M. Ed. from UTC. During her more than 30-year career in education, she has served as faculty advisor for student publications and written curricula for a variety of courses.