What’s eating you?

Eating disorders are overwhelmingly misunderstood by the general population, and even many medical professionals.  The American Psychiatric Association has established criteria for three separate eating disorders as of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders: Anorexia Nervosa, Bulimia Nervosa, and Eating Disorders Not Otherwise Specified (EDNOS) (DSM-IV-TR, 2000).  Each disease is characterized by specific behaviors, but they all include an intense desire for thinness and a fear of becoming fat (Hinton & Chapman, 2009).  The media is often blamed for the recent rise in patients diagnosed with eating disorders; however, media influence only plays a very small role in the development of most eating disorders (MacDonald, 2001).  There are numerous factors behind complicated mental illnesses like eating disorders, and underweight, emaciated females certainly are not the only victims.

Many people are quick to dismiss these deadly diseases as sheer vanity, and blame superficial sources like celebrities and advertising campaigns for behaviors and thoughts that are actually rooted in very deep issues of self-concept and identity (Hinton & Chapman, 2009).  Although the media may play a role in some patients’ eating disorders and advertisers have capitalized on society’s obsession with body image, they cannot be blamed as the cause of eating disorders (MacDonald, 2001).  Melanie Katzman, a consultant psychologist from New York, argued that the media was to blame for eating disorders and stated, “You don’t get eating disorders without dissatisfaction” (as cited in MacDonald, 2001, p. 1002).  Although she was not entirely incorrect in that statement, dissatisfaction can come from several external factors, as well as from within, without any influence from the media.  Family environment, social circle and peers, and negative life events are just a few of the external factors that can influence eating behaviors.  Genetic factors, personality traits, and unsuccessful resolution of developmental milestones are often triggers for disordered eating, and comorbid psychiatric conditions significantly quantify the severity, development, and course of eating disorders (Hinton & Chapman, 2009).

It has been theorized that personality traits such as perfectionism, compliance, and self-sacrifice and an inability to achieve autonomy may predispose an individual to developing an eating disorder (Wechselblatt, Gurnick, & Simon, 2000).  Feelings of powerlessness and lack of control in one’s life are also correlated to disordered eating (Hinton & Chapman, 2009); patients often measure their feelings of self-worth and esteem by their ability to control their eating behaviors, not by the actual amount of weight lost, although weight loss may be used as a measure of this ability.  Control over one’s thoughts and behaviors related to food become central to the patient’s self-concept and loss of this control results in feelings of shame, disgust, and guilt (Hinton & Chapman, 2009).

Although the APA only recognizes eating disorders that lead to or endeavor for abnormally low body weight, many overweight and obese individuals also suffer from disordered eating.  Binge eating and chronic overeating leading to above average BMI are both disordered eating behaviors that are currently being researched for possible inclusion as eating disorders in future revisions of the DSM (DSM-IV-TR, 2000, Hinton & Chapman, 2009).  The current criteria for eating disorders elude to a stark contrast between obesity and eating disorders, however the concomitant rise at both ends of the BMI scale suggest that these diseases may not be as different as is currently believed.

Statistics show that 90% of patients with Anorexia Nervosa, Bulimia Nervosa, and Eating Disorders Not Otherwise Specified are female, however the incidence of eating disorders in young males has been increasing over the past few decades.  This statistical increase may be partially due to more males now seeking treatment than in previous generations; however, males are just as susceptible to societal demands as females and may develop disordered eating or exercise behaviors in response to society’s current focus on the benefits of nutrition and fitness.  Males are also at risk for the same feelings of powerlessness and lack of control as females and may use disordered behaviors to compensate for feelings of inadequacy in the same manner as females.

Eating disorders are highly complex illnesses that are vastly misunderstood by the majority of society.  The numerous and various contributing factors, and resulting thoughts and behaviors, complicate not only the treatment and recovery of individuals afflicted, but also the education of the general public, and medical community alike, about these life-threatening illnesses.  As further research is conducted on the incidence and causes of currently recognized eating disorders, new information is likely to clarify some of what is already known about these disorders while simultaneously raising many new questions such as, should there be a classification within the eating disorders for overweight and obese individuals?

References

American Psychiatric Association.  (2000).  Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR).  Retrieved from http://behavenet.com/apa-diagnostic-classification-dsm-iv-tr

Hinton, P.S., & Chapman-Novakofski, K.. (2009).  Special topics in preadolescence and adolescent nutrition: dietary guidelines for athletes, pediatric diabetes, and disordered eating. In S. Edelstein & J. Sharlin (Eds.), Life cycle nutrition: An evidence-based approach (83-102). Sudbury, MA: Jones and Bartlett.

MacDonald, R.. (2001).  To Diet For.  British Medical Journal, 322(21 April), 1002.

Wechselblatt, T., Gurnick, G., & Simon, R. (2000). Autonomy and relatedness in the development of anorexia nervosa: a clinical case series using grounded theory. Bulletin Of The Menninger Clinic, 64(1), 91-123.

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