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What is an Eating Disorder?

by Jeanne Rust, PhD

An eating disorder is many things to different people.  When I attended a meeting last spring with the on-staff nutritionists at the University of Arizona Student Health Center, I heard one of the most interesting explanations of “What Is an Eating Disorder.”  The woman who was speaking talked about a continuum where at one end was the normal eater and at the other end of the continuum was a clinical eating disorder.  She drew a straight line on the board with normal eating at one end and the eating disorder at the other.  In the middle there was a huge range of possibilities for people who had food issues or any kind of difficulties. 

According to Wikipedia, “an eating disorder is to eat, or avoid eating, which negatively affects both one’s physical and mental health.  An eating disorder is all encompassing.  They affect every part of the person’s life.”  According to the authors of Surviving an Eating Disorder: Strategies for Families and Friends, “feelings about work, school, relationships, day-to-day activities and one’s experience of emotional well being are determined by what has or has not been eaten or by a number on a scale.” 

Anorexia nervosa is an eating disorder.
Bulimia nervosa is an eating disorder.
Binge eating disorder is an eating disorder (we’ll discuss obesity in a bit).
Rumination is an eating disorder.
Pica is an eating disorder.
EDNOS (Eating Disorder Not Otherwise Specified) is an eating disorder.
An eating disorder is a serious, life-threatening condition. 
Let me repeat that one more time:
An eating disorder is a serious, life-threatening condition.

An eating disorder is extremely complex and an eating disorder is about so much more than a teenager girl just wanting to be thin so she can look cute in her clothes!

10%-25% of all those battling anorexia will die as a direct result of the eating disorder. Eating disorders have one of the highest mortality rates of any psychiatric diagnosis.  An adolescent who has an eating disorder much more likely to die from the eating disorder than from any other psychiatric condition or from an accident.

Overall, the eating disorder spectrum includes anorexia nervosa, bulimia nervosa, binge eating disorder, pica, rumination disorder of infancy, and eating disorder not otherwise specified.  The eating disorder, Pica, which is persistent eating of nonnutritivesubstances, is commonly seen in children with low socio-economic status and/or developmental delays. Rumination disorder is an eating disorder characterized by repeated regurgitation of food that has been eaten and significant weight loss in infancy. These two eating disorders are commonly seen in early childhood and are not related to anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified or binge-eating disorder, the primary emphases of this study.  However rumination as an eating disorder in adults is becoming more and more common.

 Anorexia

The primary concern of people with the eating disorder, anorexia, or the eating disorder, bulimia, is fear of gaining weight, while the term anorexia literally means “loss of appetite.”  The main problem in anorexia does not result from appetite loss, but from self-starvation. Bulimics, in contrast, tend to maintain normal weight, but do it by binge eating, followed by inappropriate and often harmful compensatory behaviors, such as laxatives, vomiting, diuretics, and excessive exercise.

 Binge Eating

Individuals who binge-eat without bulimic-type behaviors tend to eat large amounts of food without feeling hungry, which results in weight gain. It is therefore important that one understand the underlying reasons that cause the person to make the choice to engage in such extreme behaviors, which are largely the result of the perception of “fatness.”Obesity, another eating problem, is not considered an eating disorder, according to the DSM-IV, since it has been shown to be influenced by genetic, psychosocial and nutritional factors. 

 Obesity

When Robert Spitzer prepared the Diagnostic and Statistical Manual III in 1980, he concluded that obesity should be classified as a somatic disorder and not a psychiatric diagnosis; hence, obesity is not included in the DSM.  However, Kelly Brownell, a world-class researcher at Yale, states that with the focus on medical risk, other important facets of a person’s life are ignored with the result being nearly all treatment programs for obesity do not attempt to assess or intervene with psychological and social issues.

Eating Disorder Characterisctics

Certain psychological characteristics are more prevalent in a person with an eating disorder, including impulsivity, feelings of ineffectiveness, manipulativeness, alienation, chronic low self-esteem, perfectionism, and over-compliance (particularly in anorexia nervosa. Two recent studies found an increased risk in a patient with eating disorder for anxiety disorders, cardiovascular symptoms, chronic fatigue and pain, depressive disorders, infectious diseases, insomnia, neurological symptoms, and suicide attempts during early adulthood.  These symptoms have likewise been implicated as potential risk factors for eating disorders.

Family Studies with an Eating Disoder

An eating disorder occurs more frequently in biological relatives of patients who present  the disorder. Researchers have found that first degree relatives of a person with an eating disorder are three times more likely to develop an eating disorder in their lifetime. Evidence from family studies shows that there is a significantly greater occurrence of affective disorders and that there is a high rate of substance abuse as well.

 Mood Disorders

Several family studies have examined psychiatric conditions that co-occur with anorexia nervosa (AN), bulimia nervosa (BN), or binge-eating disorder (BED). With regard to major mood disorders, studies of anorexic patients have found that there is a risk in the range of 7% to 25% that a family member will either have or develop a mood disorder in his or her lifetime. In control groups this risk is only a range from 2.1 to 3.4% Studies of bulimic patients have shown that their first degree relatives are several times more likely to have mood disorders than are relatives of control groups.

 Substance Abuse

Some studies have also found a familial connection between substance abuse and an eating disorder. Researchers have reported an increased risk for alcohol abuse among first-degree as well as second-degree relatives of bulimics. On the other hand, other researchers have stated that recent studies have shown that there is little correlation between a genetic susceptibility to alcoholism and the genetic factors in influencing susceptibility to BN or an eating disorder.  Researchers also state that there is new evidence of independent genetic transmission of obsessive-compulsive disorders, anorexia and bulimia. They have found preliminary data that point to a connection between AN and obsessive-compulsive personality disorder which combines rigid perfectionism with asceticism.

 Attachment and an Eating Disorder

In addition to family connections, attachment processes and their role in the development of psychological disturbances underlying dysfunctions of eating behavior have assumed an important place in the study of an eating disorder. The attachment relationship, according to attachment theory, is an interplay between the baby’s attempts to stay close to the primary caregiver (initially the mother) in times of threat and the ability of the primary caregiver to respond to the infant’s needs.

Attachment theory proposes that secure attachment occurs when babies develop the expectation that the parent will be available, will meet their needs appropriately, and let them know they are cared for.  Insecure attachment happens when the baby expects the parent to be present and the parent is not either because the baby doesn’t perceive that the parent is there or the caregiver inappropriately responds to the baby.  As a result of the baby’s needs not being met, personal self-worth does not develop. Hilde Bruch describes abnormal attachment patterns quite simply. Abnormal attachment involves “a mother who superimposes on her infant daughter her own concept of the infant’s needs such that the infant’s needs and impulses remain poorly differentiated.”  The baby never learns to determine what her (or his) needs are. This results in a sense of separateness and ineffectiveness that underlies the development of the eating disorder.

Cultural Pressures can Influence an Eating Disorder

Much has been written in magazines, journals, and books on the current cultural pressures on women to be thin.  Since the 1960s, western society has placed increasing demands on women to be thin. Being thin is believed to symbolize competence, success, control, beauty, and sexual attractiveness. Today, being thin and physically fit has become a cultural ideal. The mass media has been relentless in portraying this image to women via magazines and television. The idealization of thinness has been accompanied by a high degree of body-image dissatisfaction among women of all ages. For many, self-worth has become tied to thinness. Thus, the pressure on women to be thin has contributed to the prevalence of dieting in American society.

By fourth grade, nearly 80% of all girls have already been on a diet. Chronic dieting has been cited as a contributing factor in the development of eating disorders, particularly binge eating disorder and bulimia nervosa.

Conclusion

In summary, preconditions for an eating disorder include sociocultural influences (such as the culture of thinness), familial influences, biologic and genetic factors, personality and psychological variables (such as low self-esteem) and chronic behavioral patterns (such as dieting), that have developed in response to cultural and individual predispositions. The preconditions set the stage for a possible precipitating event that will lead a high-risk person to develop a clinical eating disorder.

About the Author

Jeanne Rust, PhD is the Founder and CEO of Mirasol, a holistic, integrative, eating disorders treatment center located in Tucson, AZ. She was the first in the country to use holistic and complementary interventions for eating disorder treatment. She has been written up in various newspapers such as the Chicago Tribune, USA Today, the San Francisco Chronicle among them, as well as other print publications such as Time magazine in the United States and Flair magazine in Canada. You can access Mirasol's listing in our treatment directory by clicking here: Mirasol Eating Disorder Treatment Center

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