Eating Disorders: It's Not What You Think
Linda Paulk Buchanan, Ph.D.
Did you know that at least as many people die from eating disorders as breast cancer (1,2,3,4), yet the National Institutes of Health (NIH) spends 25 times more on research and treatment of breast cancer than on eating disorders (7)? These numbers are even more alarming when you consider that only about a third of the people who have an eating disorder ever receive treatment (5) implying that many people are never identified as having an eating disorder, unlike most other illnesses.
As a breast cancer survivor, I am grateful for the dollars spent and the incredible gains made in this field in recent years. However, as a Psychologist who treats individuals with eating disorders, I am dismayed at the serious lack of interest in eating disorders; a possibly more fatal disease. Why such a differential? The answer may be in large part due to lack of awareness and myths related to why a person develops an eating disorder. People with eating disorders do not wish to have an eating disorder, do not choose it, cannot just get over it, are not usually raised by bad parents, are not selfish (in fact they doubt their self-worth in the face of overwhelming evidence), are not only young white girls and CAN fully recover. Given the statistics about prevalence, you know someone who has an eating disorder!
The truth is that people who develop eating disorders are typically born with differences in their brain chemistry which increase their sensitivity to stimuli (8,9,10,11). This sensitivity produces a heightened awareness of their own experiences and of those around them that generally leads to harm avoidant behaviors such as perfectionism, social avoidance and eating disorders. The parents of these individuals often describe them as having been sensitive and perfectionistic since a very early age. The young women afflicted with eating disorders are among our brightest and most talented individuals. They are generally selfless and extremely caring.
With a mortality rate estimated at about 12 times higher than the annual death rate due to all causes of death among females aged 15-24 in the general population, drastic measures should be taken quickly.
Although there have been amazing strides and developments in the understanding and treatment of breast cancer in the last 20 years, I have seen much less development in the understanding and treatment of eating disorders. If awareness of these truths is raised, increased funding for research will eventually follow and romanticizing thinness may diminish.
1. Someone with an eating disorder can just get over it if they want to: Eating disorders are caused by a combination of physiological factors and other factors such as society, learning, family stress and trauma. Research in the last 10 years (6,7,8,9) has revealed that there are physiological differences in the brains of people with eating disorders. Studies have shown that developing an eating disorder at least 50% and up to 80% biologically/genetically determined. These physiological vulnerabilities lead to an increase in anxiety, increased sensitivity to emotional experiences, and changes in the way satiety works in the brain. Recent studies have shown that the majority of people with Anorexia and Bulimia exhibit childhood perfectionism, obsessive-compulsive personality patterns, and anxiety that predate the onset the eating disorder. Moreover, studies done on 3 continents have shown that people with eating disorders who also have an anxiety disorder diagnosis, the anxiety disorder most often began in childhood before the onset of the ED. The most common premorbid childhood disorders were OCD and social phobia.
“Getting over an eating disorder” will require learning specific skills to manage these differences brain differences. It will not happen just by changing their mind. “Environmental factors (bullying, diet pressures, media, trauma, etc.) may then come into play with the underlying genetics in such a way that the vulnerable individual develops an eating disorder” says Dr. Steven F. Crawford — the associate director of the Center for Eating Disorders at Sheppard Pratt.
2. People with eating disorders are just going through a phase and it’s not really that serious. Actually, more people die from eating disorders than from breast cancer every year. Females aged 15-24 are 12 times more likely to die of an eating disorder than any other cause of death. More people die of eating disorders than any other mental/behavioral disorder including depression (1,2,3,4).
3. Once a person has developed an eating disorder, they will struggle for the rest of their lives. Most people recover. Studies show that about 30% fully recover, about 30% continue to struggle with some symptoms but go on to live productive lives, about 30% don’t recover and about 10% die (5,6). People can recover with intensive outpatient treatment.
Eating disorders can be successfully and fully treated; unfortunately only about a third of people with an eating disorder ever receive treatment, often due to lack of resources and lack of adequate coverage by insurance companies.
4. Someone with an eating disorder is vain: People who are vain think highly of themselves and think that they are better than others. People with eating disorders are not vain. They usually have low self-esteem and, regardless of their accomplishments, they cannot see themselves as good enough.
5. People with eating disorders are selfish: This couldn’t be farther from the truth. Individuals who develop eating disorders are usually very sensitive. They are physiologically more sensitive from birth than the average person. They are very in tune with the feelings of others and have a strong drive to want everyone around them to be happy. This often leads to perfectionism as they try to reduce any negativity that they or others will experience. The attempt to be perfect is primarily a way to ensure that nothing about them will cause anyone else any distress and to ensure that others will not find fault in them; something that they are very sensitive about.
6. Developing an eating disorder is due to family problems: As mentioned before, developing an eating disorder is at least 50% due to genetic/biologic factors. Developing an eating disorder may involve many other factors as well such as societal pressures, environmental stressors, and trauma. People with eating disorders are very sensitive to family stress so it is often one factor in developing an eating disorder. Parents should not worry about being blamed but will need to be willing to support the individual through family therapy so that they can become part of the solution.
7. We primarily need to be concerned about childhood obesity: Actually one study showed that we are perhaps too concerned with obesity to the detriment of those vulnerable to other types of eating disorders. There has been an increase in the numbers of younger children developing eating disorder symptoms as a result of health classes in elementary school that are focusing on the dangers of fat and instruction on how to read food labels. Similarly, health care givers often have a bias toward thinness and underestimate the needs of those children they see that are underweight, even after significant weight loss.
8. You can tell if someone has an eating disorder by looking at them. People with eating disorders are often terrified by the possibility that someone will say to them “Well you don’t look like you have an eating disorder.” People with eating disorders can be any body size or shape and usually have difficulty believing that they are thin enough regardless of their size.
9. An eating disorder is a “rich, white girl” problem: 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 (2,5) . The age range for individuals with eating disorders has greatly expanded in recent years. The latest statistics provided by The National Eating Disorders Association (6) indicate that by the age of six, children already begin to express concerns about their own weight or shape. The American Academy of Pediatrics also reports that hospitalizations for eating disorders in children eight to 12 years old increased 119 percent between 1999 and 2006 (14). Recent studies have also highlighted growing numbers in women aged 40 and up. One recent study found that as many as 13 percent of women over the age of 50 have eating disorders.
The Truth About Eating Disorders
In summary, people who develop eating disorders are born with differences in their brain chemistry which increase their sensitivity to stimuli. This sensitivity develops into a heightened awareness of their own and other’s reactions which generally leads to harm avoidant strategies such as perfectionism, obsessive-compulsive behaviors, social avoidance, shyness and ultimately eating disorders. These strategies are faulty attempts to control the level of distress they may experience. Treatment involves recognizing that their sensitivity is both a blessing and a burden and learning more effective tools for coping.
Eating disorders can be successfully and fully treated; unfortunately only about a third of people with an eating disorder ever receive treatment.1
Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with Anorexia Nervosa and other eating disorders. Archives of General Psychiatry, 68(7), 724-731
Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61(3), 348–358.
Le Grange, D., Swanson, S. A., Crow, S. J., & Merikangas, K. R. (2012). Eating disorder not otherwise specified presentation in the US population. International Journal of Eating Disorders, 45(5), 711-718.
Smink, F. E., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: Incidence, prevalence and mortality rates. Current Psychiatry Reports,14(4), 406-414.
National Eating Disorders Coalition. (2016). Facts About Eating Disorders: What The Research Shows as downloaded from http://eatingdisorderscoalition.org.s208556.gridserver.com/couch/uploads/file/fact-sheet_2016.pdf
National Eating Disorders Association
Marsh R, Steinglass JE, Gerber AJ, Graziano O’Leary K, Wang Z, Murphy D, Walsh BT, Peterson BS. Deficient activity in the neural systems that mediate self-regulatory control in bulimia nervosa. Archives of General Psychiatry. 2009; 66(1):51–63.
Kaye, W. (2008). Physiological Behavior.April 22; 94(1): 121–135
Gaudio, S., et.al. (2017). Psychiatry Res. White matter abnormalities in treatment-naive adolescents at the earliest stages of Anorexia Nervosa: A diffusion tensor imaging study. Psychiatry Res..Jun 20;266:138-145
Marques, L., Alegria, M., Becker, A. E., Chen, C.-n., Fang, A., Chosak, A., & Diniz, J. B. (2011). Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: implications for reducing ethnic disparities in health care access for eating disorders. International Journal of Eating Disorders, 44(5), 4124120.