Did you know?
- The rate of development of new cases of eating disorders has been increasing since 1950 (Hudson et al., 2007; Streigel-Moore &Franko, 2003; Wade et al., 2011).
- There has been a rise in incidence of anorexia in young women 15-19 in each decade since 1930 (Hoek& van Hoeken, 2003).
- The incidence of bulimia in 10-39 year old women TRIPLED between 1988 and 1993 (Hoek& van Hoeken, 2003).
- The prevalence of eating disorders is similar among Non-Hispanic Whites, Hispanics, African-Americans, and Asians in the United States, with the exception that anorexia nervosa is more common among Non-Hispanic Whites (Hudson et al., 2007; Wade et al., 2011).
It is common for eating disorders to occur with one or more other psychiatric disorders, which can complicate treatment and make recovery more difficult. Among those who suffer from eating disorders:
- Alcohol and other substance abuse disorders are 4 times more common than in the general populations (Harrop&Marlatt, 2010).
- Depression and other mood disorders co-occur quite frequently (Mangweth et al., 2003; McElroy, Kotwal, & Keck, 2006).
- There is a markedly elevated risk for obsessive-compulsive disorder (Altman &Shankman, 2009).
Dieting and the Drive for Thinness
Dieting and weight control strategies reflect how dissatisfied a person is with her or his own body size and shape. Besides being associated with the onset of eating disorders, these behaviors alone can be dangerous to health.
- 42% of 1st-3rd grade girls want to be thinner (Collins, 1991).
- In elementary school fewer than 25% of girls diet regularly. Yet those who do know what dieting involves and can talk about calorie restriction and food choices for weight loss fairly effectively (Smolak, 2011; Wertheim et al., 2009).
- 81% of 10 year olds are afraid of being fat (Mellin et al., 1991).
- 46% of 9-11 year-olds are “sometimes” or “very often” on diets, and 82% of their families are “sometimes” or “very often” on diets (Gustafson-Larson & Terry, 1992).
- Over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives (Neumark-Sztainer, 2005).
- 35-57% of adolescent girls engage in crash dieting, fasting, self-induced vomiting, diet pills, or laxatives. Overweight girls are more likely than normal weight girls to engage in such extreme dieting (Boutelle, Neumark-Sztainer, Story, &Resnick, 2002; Neumark-Sztainer&Hannan, 2001; Wertheim et al., 2009).
- Even among clearly non-overweight girls, over 1/3 report dieting (Wertheim et al., 2009).
- Girls who diet frequently are 12 times as likely to binge as girls who don’t diet (Neumark-Sztainer, 2005).
- The average American woman is 5’4” tall and weighs 165 pounds. The average Miss America winner is 5’7” and weighs 121 pounds (Martin, 2010).
- The average BMI of Miss America winners has decreased from around 22 in the 1920s to 16.9 in the 2000s. The World Health Organization classifies a normal BMI as falling between 18.5 and 24.9 (Martin, 2010).
- 95% of all dieters will regain their lost weight in 1-5 years (Grodstein, Levine, Spencer, Colditz, &Stampfer, 1996; Neumark-Sztainer, Haines, Wall, & Eisenberg, 2007).
- 35% of “normal dieters” progress to pathological dieting. Of those, 20-25% progress to partial or full-syndrome eating disorders (Shisslak, Crago, & Estes, 1995).
- Of American, elementary school girls who read magazines, 69% say that the pictures influence their concept of the ideal body shape. 47% say the pictures make them want to lose weight (Martin, 2010).
What are the Major Types of Eating Disorders?
In a society that still idealizes thinness even as Americans become heavier than ever before, almost everyone has some concern about their weight at least occasionally. People with eating disorders take such concerns to extremes, developing abnormal eating habits that threaten their well-being and even their lives. This question-and-answer fact sheet explains how psychotherapy can help people recover from these dangerous disorders.
There are three major types of eating disorders:
- People with anorexia nervosa have a distorted body image that causes them to see themselves as overweight even when they’re dangerously thin. Often refusing to eat, exercising compulsively, and developing unusual habits such as refusing to eat in front of others, they lose large amounts of weight and may even starve to death.
- Individuals with bulimia nervosa eat excessive quantities, then purge their bodies of the food and calories they fear by using laxatives, enemas, or diuretics; vomiting; or exercising. Often acting in secrecy, they feel disgusted and ashamed as they binge, yet relieved of tension and negative emotions once their stomachs are empty again.
- Like people with bulimia, those with binge eating disorder experience frequent episodes of out-of-control eating. The difference is that binge eaters don’t purge their bodies of excess calories.
- Another category of eating disorders is eating disorder not otherwise specified, or ednos, in which individuals have eating-related problems but don’t meet the official criteria for anorexia, bulimia or binge eating.
It’s important to prevent problematic behaviors from evolving into full-fledged eating disorders. Anorexia and bulimia, for example, usually are preceded by very strict dieting and weight loss. Binge eating disorder can begin with occasional bingeing. Whenever eating behaviors start having a destructive impact on someone’s functioning or self-image, it’s time to see a highly trained mental health professional, such as a licensed psychologist experienced in treating people with eating disorders.
Who Suffers From Eating Disorders
According to the National Institute of Mental Health, eating disorders primarily affect girls and women.1 But eating disorders aren’t just a problem for the teenage women so often depicted in the media. Men and boys can also be vulnerable. About a quarter of preadolescent cases of anorexia occur in boys, for example. And binge eating disorder strikes males and females about equally. People sometimes have eating disorders without their families or friends ever suspecting that they have a problem. Aware that their behavior is abnormal, people with eating disorders may withdraw from social contact, hide their behavior, and deny that their eating patterns are problematic.
What Causes Eating Disorders?
Certain psychological factors and personality traits may predispose people to developing eating disorders. Many people with eating disorders suffer from low self-esteem, feelings of helplessness, and intense dissatisfaction with the way they look.
Specific traits are linked to each of the disorders. People with anorexia tend to be perfectionistic, for instance, while people with bulimia are often impulsive. Physical factors such as genetics also may play a role in putting people at risk.
A wide range of situations can precipitate eating disorders in susceptible individuals. Family members or friends may repeatedly tease people about their bodies. Individuals may be participating in gymnastics or other sports that emphasize low weight or a certain body image. Negative emotions or traumas can also trigger disorders. Even a happy event, such as giving birth, can lead to disorders because of the stressful impact of the event on an individual’s new role and body image.
Once people start engaging in abnormal eating behaviors, the problem can perpetuate itself. Bingeing can set a vicious cycle in motion, for instance, as individuals purge to rid themselves of excess calories and psychic pain, then binge again to escape problems in their day-to-day lives.
Why is it Important to Seek Treatment for these Disorders?
Research indicates that eating disorders very often go untreated. About 86% of people report the onset of their eating disorder by the age of 20, making treatment and recovery more likely.
Leaving eating disorders untreated can have serious consequences. Research has found that individuals with anorexia have a mortality rate 18 times higher than peers who don’t have eating disorders, for example. Also, eating disorders can devastate the body. Physical problems associated with anorexia, for instance, include anemia, constipation, osteoporosis, even damage to the heart and brain. Bulimia can result in a sore throat, worn-away tooth enamel, acid re-flux, and heart attacks.. People with binge eating disorder may develop high blood pressure, cardiovascular disease, diabetes, and other problems associated with obesity.
Eating disorders are also associated with other mental disorders like depression. Researchers don’t yet know whether eating disorders are symptoms of such problems or whether the problems develop because of the isolation, stigma, and physiological changes wrought by the eating disorders themselves. What is clear from research is that people with eating disorders suffer higher rates of other mental disorders – including depression, anxiety disorders, and substance abuse – than other people.4
How Can a Psychologist Help Someone Recover?
Psychologists play a vital role in the successful treatment of eating disorders and are integral members of the multidisciplinary team that may be required to provide patient care. As part of this treatment, a physician may be called on to rule out medical illnesses and determine that the patient is not in immediate physical danger. A nutritionist may be asked to help assess and improve nutritional intake.
Once the psychologist has identified important issues that need attention and developed a treatment plan, he or she helps the patient replace destructive thoughts and behaviors with more positive ones. Simply changing patients’ thoughts and behaviors is not enough, however. To ensure lasting improvement, patients and psychologists must work together to explore the psychological issues underlying the eating disorder. Psychotherapy may need to focus on improving patients’ personal relationships. And it may involve helping patients get beyond an event or situation that triggered the disorder in the first place.
Some patients, especially those with bulimia, may benefit from medication. It’s important to remember, however, that medication should be used in combination with psycho-therapy, not as a replacement for it.
Does Treatment Really Work?
I EMPHASIZE TO EACH OF MY PATIENTS THAT FULL RECOVERY IS POSSIBLE! Many people, with and without an eating disorder, believe that once a person has an eating disorder, that person will always have an eating disorder. This is not true, especially with treatment. Most cases of eating disorder can be treated successfully by appropriately trained health and mental health care professionals. But treatments do not work instantly.
Incorporating family or marital therapy into patient care may help prevent relapses by resolving interpersonal issues related to the eating disorder. Therapists can guide family members in understanding the patient’s disorder and learning new techniques for coping with problems. Support groups can also help.
Remember: The sooner treatment starts, the better. The longer abnormal eating patterns continue, the more deeply ingrained they become and the more difficult they are to treat.
Eating disorders can severely impair people’s functioning and health. But the prospects for long-term recovery are good for most people who seek help from appropriate professionals.
1 National Institute of Mental Health. (2007). “Eating disorders.”
National Eating Disorder Association
By Karin Kratina, PhD, RD, LD/N, modified by Elayne Daniels, PhD
Research has demonstrated a correlation between individuals who have had traumatic experiences who later develop eating disorders.
Post-Traumatic Stress Disorder (PTSD) is often a co-occurrence with persons who suffer from an eating disorder. Those who have experienced traumatic events may engage in an eating disorder to self-manage the feelings and experiences related to PTSD.
Particularly with child sexual abuse (CSA), there has been a large amount of research related to the effect of CSA on body image. It is believed that 30% of individuals with an eating disorder have been sexually abused. Some researchers connect the large association of self-harm with victims of CSA and other traumas to those with eating disorders. There tends to be a strong view that body shame sparks a large amount of eating disorders related to CSA. The body shame might trigger habits geared toward destroying the body of which the victim is so ashamed, resulting in starvation, purging, or binge eating, depending on the manifestation of the eating disorder. Eating disorders related to sexual abuse are also viewed as a coping mechanism similar to those who engage in other self-harming activities.
Bulimia, in particular has been connected to trauma as a means of self-protection, because the binge/purge cycle of behaviors seem to reduce awareness of thoughts and emotions as a means of escape for several of the emotions that may accompany traumatic experiences such as anger, guilt, need to cleanse oneself of the experience and refocus, stress, need for control and predictability, and need for personal space.
Treatment of individuals suffering from an eating disorder should receive care for both his/her eating disorder as well as his/her traumatic experiences. If the trauma is not addressed during the treatment of an eating disorder, successful recovery will be extremely difficult, since the eating disorder may have developed as a method of self-defense for the victim. Important factors contributing to the success of treatment can include positive reactions to disclosure about a traumatic event, as well as strong support from family and friends.
Helpful link for parents: http://www.nationaleatingdisorders.org/sites/default/files/Toolkits/ParentToolkit.pdf
Helpful link for educators: http://www.nationaleatingdisorders.org/sites/default/files/Toolkits/EducatorToolkit.pdf