Eating Disorders
Our bodies are naturally disposed to maintain a steady weight, including storing energy for times when food becomes unavailable. But sometimes psychological influences overwhelm biological wisdom. This becomes painfully clear in three eating disorders.
- Anorexia nervosa typically begins as a weight-loss diet. People with anorexia—usually female adolescents, but some women, men, and boys as well—drop significantly below normal weight. Yet they feel fat, fear being fat, diet obsessively, and sometimes exercise excessively. About half of those with anorexia display a binge-purge-depression cycle.
- Bulimia nervosa, unlike anorexia, is marked by weight fluctuations within or above normal ranges, making the condition easier to hide. Bulimia may also be triggered by a weight-loss diet, broken by gorging on forbidden foods. People with this disorder—mostly women in their late teens or early twenties (but also some men)—eat in spurts, sometimes influenced by negative emotion or by friends who are bingeing (Crandall, 1988; Haedt-Matt & Keel, 2011). In a cycle of repeating episodes, overeating is followed by compensatory vomiting, laxative use, fasting, or excessive exercise (Wonderlich et al., 2007). Preoccupied with food (craving sweet and high-fat foods), and fearful of becoming overweight, binge-purge eaters experience bouts of depression, guilt, and anxiety during and following binges (Hinz & Williamson, 1987; Johnson et al., 2002).
- Those with binge-eating disorder engage in significant bouts of overeating, followed by remorse. But they do not purge, fast, or exercise excessively and thus may be overweight.
A U.S. National Institute of Mental Health-funded study reported that, at some point during their lifetime, 0.6 percent of Americans met the criteria for anorexia, 1 percent for bulimia, and 2.8 percent for binge-eating disorder (Hudson et al., 2007). Anorexia and bulimia can be deadly. They harm the body and mind, resulting in shorter life expectancy and greater risk of suicide and nonsuicidal self-injury (Cucchi et al., 2016; Fichter & Quadflieg, 2016; Smith et al., 2016).
Sibling rivalry gone awry Twins Maria and Katy Campbell have anorexia nervosa. As children they competed to see who could be thinner. Now, says Maria, her anorexia nervosa is “like a ball and chain around my ankle that I can’t throw off” (Foster, 2011).
“Gee, I had no idea you were married to a supermodel.”
Understanding Eating Disorders
Eating disorders are not (as some have speculated) a telltale sign of childhood sexual abuse (Smolak & Murnen, 2002; Stice, 2002). The family environment may influence eating disorders in other ways, however. For example, the families of those with anorexia tend to be competitive, high-achieving, and protective (Ahrén et al., 2013; Berg et al., 2014; Yates, 1989, 1990).
Those with eating disorders often have low self-evaluations, set perfectionist standards, fret about falling short of expectations, and are intensely concerned with how others perceive them (Culbert et al., 2015; Farstad et al., 2016; Yiend et al., 2014). Some of these factors also predict teen boys’ pursuit of unrealistic muscularity (Ricciardelli & McCabe, 2004).
Heredity also matters. Identical twins share these disorders more often than fraternal twins do (Culbert et al., 2009; Klump et al., 2009; Root et al., 2010). Scientists are searching for culprit genes, which may influence the body’s available serotonin and estrogen (Klump & Culbert, 2007). Data from 15 studies indicate that having a gene that reduces available serotonin adds 30 percent to a person’s risk of anorexia or bulimia (Calati et al., 2011).
A distorted body image underlies anorexia.
But eating disorders also have cultural and gender components. Ideal shapes vary across culture and time. In countries with high rates of poverty—where plump means prosperous and thin can signal poverty or illness—bigger often seems better (Knickmeyer, 2001; Swami et al., 2010). Bigger less often seems better in Western cultures, where, according to 222 studies of 141,000 people, the rise in eating disorders in the last half of the twentieth century coincided with a dramatic increase in women having a poor body image (Feingold & Mazzella, 1998).
Those most vulnerable to eating disorders are also those (usually women or gay men) who most idealize thinness and have the greatest body dissatisfaction (Feldman & Meyer, 2010; Kane, 2010; Stice et al., 2010). Should it surprise us, then, that women who view real and doctored images of unnaturally thin models and celebrities often feel ashamed, depressed, and dissatisfied with their own bodies—the very attitudes that predispose eating disorders (Grabe et al., 2008; Myers & Crowther, 2009; Tiggemann & Miller, 2010)? Researchers tested this modeling idea by giving some adolescent girls (but not others) a 15-month subscription to an American teen-fashion magazine (Stice et al., 2001). Compared with those who had not received the magazine, vulnerable girls—defined as those who were already dissatisfied, idealizing thinness, and lacking social support—exhibited increased body dissatisfaction and eating disorder tendencies. Even ultra-thin models do not reflect the impossible standard of the old classic Barbie doll, who had, when adjusted to a height of 5 feet 7 inches, a 32–16–29 figure (in centimeters, 81–41–74) (Norton et al., 1996).
“ Why do women have such low self-esteem? There are many complex psychological and societal reasons, by which I mean Barbie.”
Dave Barry, 1999
There is, however, more to body dissatisfaction and anorexia than media effects (Ferguson et al., 2011). Peer influences, such as teasing, also matter. Nevertheless, the sickness of today’s eating disorders stems in part from today’s weight-obsessed culture—a culture that says “fat is bad” in countless ways, that motivates millions of women to diet constantly, and that invites eating binges by pressuring women to live in a constant state of semistarvation. One former model recalled walking into a meeting with her agent, starving and with her organs failing due to anorexia (Caroll, 2013). Her agent’s greeting: “Whatever you are doing, keep doing it.”
“Up until that point, Bernice had never once had a problem with low self-esteem.”
Too thin? Anorexia was identified and named in the 1870s, when it appeared among affluent adolescent girls (Brumberg, 2000). Many worry that today’s superthin models make self-starvation seem fashionable. In response to this concern, British advertising regulators banned this advertisement because the female model appeared “unhealthily thin.”
Most people diagnosed with an eating disorder do improve. In one 22-year study, 2 in 3 women with anorexia nervosa or bulimia nervosa had recovered (Eddy et al., 2017). It’s also possible to prevent people from developing these disorders. Interactive programs that teach people (especially girls over age 15) to accept their bodies reduce the likelihood of an eating disorder (Beintner et al., 2012; Melioli et al., 2016; Vocks et al., 2010). By combating cultural learning, those at risk for eating disorders may instead live long and healthy lives.
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The bewilderment, fear, and sorrow caused by psychological disorders are real. But, as our next topic—therapy—shows, hope, too, is real.