Eating Disorders Do Not Discriminate
It is a week away from the high school wrestling tournament and, once again, your son is refusing to eat dinner. You worry, but shrug it off, deciding that it is just stress about the wrestling tournament that has affected his appetite. Or maybe, you believe that his tendency to not eat can't possibly be a problem because he is a boy. Like many people, you may believe that eating disorders are a problem reserved for white, middle class, females. This erroneous thinking is a recipe for disaster! The fact is, eating disorders do not discriminate based upon gender, race, or income level. Although there are groups who are statistically more likely to suffer from an eating disorder, the bottom line is that anyone can become ensnared by an eating disorder.
Obtaining accurate statistics for eating disorders is difficult because health care providers are not required to report eating disorders. Additionally, most people who suffer with eating disorders do so secretively and often even family members and close friends are not sure that there is an eating disorder. A report done in 2003 in the journal 'Clinician Reviews' estimated that about five million Americans per year are affected by an eating disorder. However according to the National Association of Anorexia and Nervosa and Associated Disorders, that number is close to eight million people or 3% of the population. This essentially means that about three out of every 100 people in the United States has some form of an eating disorder.
Eating disorders, historically, have been linked to intelligent, attractive, young women between the ages of 12 and 25. The general assumption has been that if you don't fall into this category, you can't possibly have an eating disorder, regardless of how unusual your eating patterns. However research has shown that the previously assumed profile is not completely accurate. Boys now account for at least 10% of reported eating disorders.
There are some character traits that seem to be present in the majority of those who suffer from Anorexia Nervosa. People with Anorexia Nervosa are generally hardworking, eager to please, and conscientious. They tend to be good students and strive for perfection in their pursuits. They want to rise above mediocrity. Typically they will avoid conflict and try to please the people in their lives. People who develop Anorexia generally do not deal well with change. They will set unrealistic goals for themselves and feel that controlling their hunger and need to eat indicates control over other aspects of their lives.
Those who develop Bulimia are generally anxious and often depressed. They may lack the ability to control impulses and, because of this, may find themselves in trouble with alcohol or drug abuse, casual sex, and other self destructive behaviors. They will claim to be completely in control of their lives and independent, when in actuality they are very dependent on their families for a sense of stability. They will often struggle to form close friendships and are not prone to trusting easily. Similar to those who suffer from Anorexia, they may begin strict dieting to gain a sense of control over their lives. The hunger, however, eventually leads to intense cravings and binge eating. This binge eating is immediately followed by a suffocating sense of guilt and the need to eliminate the calories from their bodies. The resultant purging is done through vomiting, laxative abuse, or intensified efforts at fasting
Common in all eating disorders is a tendency for the families of those affected to be stand-offish, unsupportive and critical. They may overly emphasize appearance and be particularly concerned about what others think. The parents are often physically restrained and don't show affection easily. Children learn that being thin is the ultimate goal, and begin to believe that the thinner the better, as they watch their mother's constantly strive to lose a few pounds or stick to a diet. Using food as a punishment or reward can also instigate detrimental eating patterns. Some parents will attempt to limit their child's consumption of 'junk' food and, by restricting it, make it more desirable. This, of course, being opposite of the desired effect.
Western society, in particular, inadvertently aggravates the development of eating disorders. The demand for wrestlers, dancers, gymnasts, models, actresses, and athletes to be thin is overwhelming. Fast and drastic weight loss is often recommended by coaches and career counselors to fit into a specific, desired mold for a particular role. Furthermore, we are constantly bombarded with messages on television, in magazines, and in books telling us that we just need to be beautiful or lose those 'stubborn last few pounds' to be happy. People are seeking solace for emotions such as anxiety, fear, frustration, and insecurity. They begin to believe that if they can just control their diet and, consequently, their weight they will be happy. We are told that if we just improve our outward appearance that, voila, we will have a whole new, happy life. On a biological level, some research has shown that foods which are high in fat, sugar, and calories seem to have a calming effect on the body. In a society where life is very fast-paced and demanding, over-eating these 'comfort' foods can be hard to avoid. In a person prone to an eating disorder, this can lead to a binge/purge cycle. According to a report by TV-turnoff Network in 2005, the average child sees more than 30,000 commercials each year. The vast majority of those commercials show ultra-thin, ultra-beautiful people gushing about how perfect life is for them. The child may not notice the product that the model is selling, but they will internalize the belief that thin and beautiful are desirable and, not only that, a prerequisite for success. While the prevalence of eating disorders in Western society is greater than in other, non-Western societies, the incidence of eating disorders in other countries is rising. This may be due to the influx of television shows, movies, and magazines feature Western values and ideals.
An unfortunate truth is that eating disorders often present at a critical stage of life and, due to the disruption of electrolytes and other essential chemical processes, the very part of the brain necessary to overcome eating disorders is often impaired. Studies have been done that have included magnetic resonance imaging which have shown that the brain is not fully developed until well into the 20's. Therefore, an individual who begins to starve herself as a young adolescent is not providing the nourishment that the brain needs to make mature, rational choices. Altering brain chemistry can result in feelings of euphoria or satisfaction. This quells feelings of anxiety or depression and may be a method of self medicating for some people.
A recent report in the Archives of General Psychiatry reported that genetic factors account for 56% of the risk of developing Anorexia Nervosa. It is believed that temperament is, at least somewhat, genetically determined. Some personality types, i.e. obsessive/compulsive, have been linked to an increase in eating disorders. These links would also suggest that the same genetic factors that predispose an individual to anxiety, perfectionism, etc. may predispose them to eating disorders as well. At the International Conference on Eating Disorders in 2004 a list was compiled of risk factors for development of an eating disorder. The more risk factors a person has, the greater their risk. These risks include:
- High level of perceived stress.
- Behavioral problems at an early age (before age 14).
- Weight concerns before the age of 14.
- A history of dieting.
- A mother who diets or is overly concerned about physical appearance.
- Siblings or peers who diet or are concerned about physical appearance.
- Negative feelings toward themselves.
- Perfectionism.
- Few if any male friends.
- Controlling parents.
- Sibling rivalry and/or competitiveness with siblings over weight or appearance.
- Anxiety or shyness.
- Excessive distress about family conflicts.
- Criticism from friends or family regarding weight or body type.
- Distressing life events.
- Being fat or overweight as a child.
- Dieting. (Dieting is felt to be a powerful trigger for eating disorders.)
- Participation in a sport that demands thinness, i.e. wrestling, gymnastics, swimming, etc.
- A career that demands thinness, i.e. jockeys, models, entertainers.
It was traditionally felt that eating disorders were a cause for concern only for women. That belief is rapidly changing, however, as the number of males who have diagnosed eating disorders increases. Twenty years ago the belief was that approximately one in every ten to fifteen patients with an eating disorder would be male. Now that number has risen to as high as one in every five for anorexia and one for every ten or so patients with bulimia. Generally health practitioners see many more females than males with eating disorders, however that could stem from the belief that eating disorders are strictly a female problem and, therefore, they go undiagnosed in males. Recent research released from Harvard University Medical School this past February cited data indicating that up to 25% of adults with eating disorders are male. It is unknown whether the increase in male patients is due to the fact that more men are developing eating disorders or whether it is because diagnosis in men is becoming more common. It may be that men are becoming more concerned about their body image than they were in the past.
Following are some final thoughts to consider with eating disorders:
- It is estimated that 10% of female college students suffer from a borderline eating disorder or a clinically diagnosed eating disorder. Over half of these are believed to suffer from bulimia.
- Approximately 5% of the female population suffers from clinical eating disorders, either Anorexia Nervosa, Bulimia Nervosa, or Binge Eating Disorder. Meanwhile, another 15% are believed to have disordered eating behaviors and attitudes.
- An estimated 1% of men suffer from eating disorders.
- It is estimated that as many as 300,000 Canadian women between the ages of 13 and 40 suffer from Anorexia nervosa.
- Approximately one in three compulsive dieters will develop full or partial eating disorders.
- It is estimated that 2% of secondary school girls in the UK suffer from eating disorders.
- Although it is difficult to determine due to coincidental medical conditions, it is estimated that as many as 15-20% of those suffering from eating disorders will die from eating disorder related complications if left untreated. With treatment, that number decreases to roughly 2-3%.
- As many as 8 million people in the United States suffer from eating disorders.
- Eating disorders are believed to have the highest mortality rate of any psychological disease.
- The age of development for eating disorders is getting increasingly younger, sometimes in children as young as seven years old.
- Eating disorders are becoming increasingly prevalent in a diverse array of ethic and socioeconomic groups.
- Up to 50% of high school age girls diet and of those, 13% purge. 30-40% of junior high school age girls worry about their weight. Up to 40% of 9 year old girls have already started dieting.
- With proper treatment, up to 60% of those suffering from eating disorders make a full recovery and go on to live full, productive lives. Unfortunately, even with treatment, up to 20% of those treated will maintain characteristics of disordered eating, only making a partial recovery. The remaining 20% do not recover, even with treatment.
Sources: American Journal of Psychiatry 2001, Randomhouse.com, APA Work Group on Eating Disorders, 2000, AEDweb.org, Medscape's General Medicine 2004
