Chapter 1. Eating Disorders

Synopsis

Human Development Video Activity
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You must read each slide, and complete any questions on the slide, in sequence.
A mock-up of a food nutrition label that shows the nutrition facts for 1 meal as 0 calories, 0 grams of fat, 0 carbohydrates, and 0 grams of protein

Eating Disorders

A mock-up of a food nutrition label that shows the nutrition facts for 1 meal as 0 calories, 0 grams of fat, 0 carbohydrates, and 0 grams of protein

Author

Martina Marquez, Fresno City College
Catherine Robertson, Grossmont College

Synopsis

This activity introduces the three main types of eating disorders and outlines the signs and symptoms for each. These illnesses pose very serious health risks, and few who suffer with these diseases receive treatment. The slight bit of good news is that there are successful treatment plans that can help those who are seriously committed to their recovery.

REFERENCES

American Association of Suicidology. “Suicide and Eating Disorders.” Retrieved July 15, 2013 from http://freepdfdb.org/pdf/suicide-and-eating-disorders-85308342.html

American Psychological Association > Psychology Help Center > Eating Disorders

http://www.apa.org/helpcenter/eating.aspx

Anorexia Nervosa and Related Eating Disorders

http://www.anred.com

Brumberg, J. (1989). Fasting girls: The history of anorexia nervosa. Boston: Harvard University Press.

Claude-Pierre, P. (1998). The secret language of eating disorders. New York: Times Books/Random House.

Dounchis, J., Hayden, H., & Wilfey, D. (2001). Obesity body image and eating disorders in ethnically diverse children and adolescents. In J. L. Thompson & L. Smolak (Ed.), Body image, eating disorders and obesity in youth (pp. 67-98). Washington, D.C.: American Psychological Association.

Eating Disorders Coalition

http://www.eatingdisorderscoalition.org

Eating Disorder Hope

http://www.eatingdisorderhope.com

Healthy Place: America’s Mental Health Channel

http://www.healthyplace.com/eating-disorders/

Hoffman, L., & Rose, L. (April 6, 2005). Costly calories. Forbes. Retrieved August 24, 2005 from

http://www.forbes.com/home/health/2005/04/06/cx_lrlh_0406costlycalories.html

Martin, J. B. (2010). The Development of Ideal Body Image Perceptions in the United States. Nutrition Today, 45 (3), 98-100.

Retrieved from http://www.nursingcenter.com/pdf.asp?AID=1023485

Miller, M., & Pumariega, A. (2005). Eating disorders: Culture and eating disorders. HealthyPlace. Retrieved August 24, 2005 from http://www.healthyplace.com/Communities/Eating_Disorders/minorities_1.asp

Mirasol Recovery Centers

http://www.mirasol.net/eating-disorders/information/eating-disorder-statistics.php

Mitchell, J., & McCarthy, H. (2000). Eating disorders. In L. Champion & M. Power (Eds.). Adult psychological problems: An introduction (2nd ed., pp. 103-130). Hove, England: Psychology Press.

Nasser, M. (1997). Culture and weight consciousness. London/New York: Routledge.

National Association of Anorexia Nervosa and Associated Disorders, Inc.

http://www.anad.org/

National Eating Disorders Association

http://www.nationaleatingdisorders.org

National Institute of Mental Health > Health & Education > Mental Health Information > Eating Disorders

http://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml#part4

Something Fishy Eating Disorders Online Website (2002). Cultural Issues. Retrieved August 30, 2005, from http://www.something-fishy.org/whatarethey/anorexia.php

Office on Women’s Health, U.S. Department of Health and Human Services > Body Image > Eating Disorders

http://www.womenshealth.gov/body-image/eating-disorders/index.html

Perriello, V. A. (2001). Aiming for healthy weight in wrestlers and other athletes. Contemporary Pediatrics, 18(9), 55-74.

South Carolina Department of Mental Health

http://www.state.sc.us/dmh/anorexia/statistics.htm

Steinhausen, H.C. (2009). "Outcomes of eating disorders." Child and Adolescent Psychiatric Clinics of North America, 18 (1): 225-242.

Tene, W. (1997). Not just a woman’s disease: Misconceptions of male eating disorders keep men from getting the help they need. Daily Sundial Online. Retrieved August 30, 2005.

The ABC’s of Eating Disorders

www.abceatingdisorders.com

email: info@abceatingdisorders.com

phone: 305-607-7169

Copyright 2005 Zakto Film

The Japan Times (January 27, 2002). Eating disorders claiming ever younger victims. Retrieved July 27, 2013, from http://www.japantimes.co.jp/community/2002/01/27/general/eating-disorders-claiming-ever-younger-victims/#.UfPZpGeyFuI

The Mayo Clinic: Eating disorders

http://www.mayoclinic.com/health/eating-disorders/DS00294

Thompson, R. A., & Sherman, R. T. (1993). Helping athletes with eating disorders. Champaign, IL: Human Kinetics Publishers.

Zerbe, K. (1995). The body betrayed. Carlsbad, CA: Gurze Books.

What are Eating Disorders?

As far back as medieval times, saints like Catherine of Siena fasted as an announcement of spirituality. During Victorian times, women fasted as a protest against societal rules. Anorexia has been a known disorder since the late 19th century (Brumberg, 1989). Even so, beginning in the 1950s, it became a recognized diagnosis. Bulimia was first identified in 1979 (Miller, Pumeriega, 2005).

Eating disorders are complex conditions that have severe mental and physical health aspects. While these diseases most obviously manifest in the body, eating disorders are, in fact, mental illnesses that are outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is the premier reference manual used by medical, healthcare, and health policy professionals in the U.S. There are three main types of eating disorders: anorexia nervosa, bulimia nervosa, and binge eating disorder. Eating disorder not otherwise specified is a catchall category that describes an eating disorder characterized by any combination of symptoms from the three main types while not meeting any single classification.

Types of Eating Disorders

A dangerously thin woman is measuring her waist with a tape measure

Anorexia nervosa (also called anorexia) is literally self-imposed starvation that yields a body weight that is 85% of what is healthy for a particular age and height. Severe restriction of caloric intake and/or excessive exercise in order to burn vast quantities of calories often result in a dangerously thin individual. Anorexics commonly suffer from a distorted body image that reinforces their behaviors. They continue to see themselves as overweight in spite of their alarmingly thin reality.

Bulimia nervosa (also called bulimia) is defined by bouts of bingeing, or excessive, uncontrollable eating, followed by purging. Because feelings of being out of control accompany bingeing, bulimics compensate for their excess with purging behaviors, such as abuse of laxatives, self-induced vomiting, excessive exercise, and/or even fasting, which may help them to feel as if an element of control is being restored. The cycle continues as the bingeing becomes recurrent and repeated behavior. While bulimics may demonstrate some of the same behaviors that anorexics do, bulimics may be underweight, normal weight, or overweight because purging is not generally a successful method for losing weight.

Binge eating disorder (BED) is the newest of eating disorders. Insatiable cravings lead to bingeing. Like bulimics, the binges of those with BED may be prompted by stress, poor body image, low self-esteem, and/or other dysfunctional thoughts, but unlike bulimics, those with BED do not purge. Therefore, those with BED are generally overweight or obese.

Eating disorder not otherwise specified is a descriptor for abnormal, unhealthy eating disorders that may include some but not all of the criteria for a specific diagnosis of the three illnesses described above.

Signs and Symptoms of Anorexia

Some clinical symptoms of anorexia nervosa include:

– being at least 15% below ideal body weight accompanied by a refusal to maintain a weight that is at or above a normal body weight for height and age;

– intense fear of being fat or gaining weight;

– having a body image distortion that causes the anorexic to see self as overweight even if that is not at all the case;

– loss of at least 3 menstrual periods in women;

– growth of a downy layer of hair called lanugo, which is the body’s effort to keep itself warm.

Some behavioral signs that accompany anorexia include:

– restricting whole categories of foods, such as fats or carbohydrates, or developing food rituals, like eating foods in a certain order;

– denying hunger;

– making excuses to avoid meals;

– obsessing about control of weight and control of food;

– withdrawing from normal activities and avoiding friends and family;

– abusing laxatives and/or diet pills;

– excessive and obsessive exercising.

Meet Stephanie. Observe her to see if she demonstrates any of these symptoms and signs of anorexia.

Signs and Symptoms of Bulimia

Some clinical symptoms of bulimia nervosa include:

– binge eating large quantities of food in a short time frame accompanied by the feeling that one cannot stop eating;

– purging, such as self-induced vomiting, abusing laxatives, fasting, or exercising excessively, that follows the bingeing as perhaps a way to compensate for the bingeing;

– bingeing/purging cycle that occurs more than twice a week for at least 3 months;

– self-esteem that is too dependent upon body image.

Some physical and behavioral signs that accompany bulimia include:

– stained teeth, calluses on knuckles or hand, swelling of jaw area, broken blood vessels in eye from self-inducing vomiting;

– a rigid exercise routine that may appear excessive or obsessive;

– frequent trips to the bathroom after meals;

– abuse of laxatives and/or diet pills.

A special note: It may be difficult to identify those who suffer from bulimia because they may not necessarily demonstrate dramatic weight loss. For example, some bulimics may be within 10 pounds of their normal weight range.

Meet Rick. Observe him to see if he demonstrates any of these symptoms and signs of bulimia.

Signs and Symptoms of Binge Eating Disorder

An overweight man standing in front of a very full open refrigerator

Some clinical symptoms of binge eating disorder include:

– out-of-control eating;

– significant distress over binge eating;

– binge episodes that occur 1 or more times per week for 3 months or more.

Some behavioral signs that accompany binge eating disorder include:

– choosing to eat alone;

– lying about the amount of food eaten;

– hiding stashes of food in the house, at the office, or in the car.

Eating Disorder Statistics

A very thin fashion model
This is an example of the ideal body type for fashion models. This body type is plastered all over the magazines that young girls are reading and the TV that young girls are watching.

Because of the secrecy inherent to eating disorders, many statistics available are simply educated estimates. An aspect of eating disorders is the desire to hide the illness from others in order to be able to continue the disordered behavior, and as a result, many eating disorders are not always obvious to family and friends. Therefore, those with eating disorders do not always receive or seek treatment. Often eating disorders accompany other health or mental conditions that may get treated while the eating disorder may get overlooked. All of these nuances mean that those with eating disorders are not ones to stand up and be counted easily or willingly. Statistically, only 1 in 10 men and women with eating disorders receives treatment. Furthermore, treating physicians are not required to report eating disorders to any health agency, yet another reason why statistics are difficult to obtain.

The National Eating Disorders Association cites that 20 million women and 10 million men in the U.S. have suffered from an eating disorder at some point in their lives. Estimates on how many in the U.S. actually have eating disorders vary quite a bit from 8 million according to the South Carolina Department of Mental Health to 11 million according to the Eating Disorders Coalition. According to The National Association of Anorexia Nervosa and Associated Disorders, up to 24 million are “affected by” eating disorders, and this figure may include those with the illness, family, friends, classmates, teachers, teammates, therapists, and anyone in relationship with those with eating disorders.

While this wide range of estimates is characteristic of how difficult it is to measure the number of individuals with these diseases, trends do reveal that the rate of incidence of new cases of eating disorders has been increasing regularly since 1950. Today’s culture of diets, weight loss, and thinness is surely a major contributing factor to the rise in eating disorders. To give an idea of the misrepresented body image being peddled by U.S. media, the female body type that is promoted in advertising as the ideal appears naturally in only 5% of U.S. women according to the National Association of Anorexia Nervosa and Associated Disorders. As an example of the impact of this distorted, media-promoted body image in the U.S., a study revealed that 69% of U.S. elementary school girls say that photos in magazines influence their concept of an ideal body image and that 47% of U.S. elementary school girls say that these same photos make them want to lose weight (Martin 2010). These are young girls feeling this influence!

Health Risks of Eating Disorders

A girl slumped down in a bathroom stall as if she has just thrown up

While eating disorders are likely to accompany other mental illnesses, such as depression, anxiety disorders, obsessive-compulsive disorder, and even substance abuse problems, there are serious physical health risks that result from the starving, fasting, bingeing, and purging behaviors of eating disorders.

This chart displays the following information: Anorexia –  Starvation behaviors prevent the body from receiving the essential calories and nutrients that it needs to function properly, so the body slows down its processes in order to conserve energy.  The result may be: – low blood pressure and slow heart rate which can lead to heart failure; – osteoporosis or weak, porous bones that are susceptible to fracture; – dehydration which can lead to kidney failure; – irregular bowel movements or dependence on laxatives; – muscle loss; – difficulty concentrating, poor memory, tendency to faint; – amenorrhea (the absence of menstruation).  Bulimia –  The bingeing and purging behaviors can injure the digestive system and cause electrolyte imbalances that may affect the heart and other organs.  The result may be: – electrolyte imbalance that can lead to irregular heartbeats or even heart failure; – damage, inflammation, or even rupture of gastrointestinal tract; – peptic ulcers; – pancreatitis; – tooth decay or gum disease from exposure to stomach acids during vomiting; – irregular bowel movements or dependence on laxatives; – muscle fatigue.  Binge eating disorder –  Bingeing behaviors can lead to many of the same health risks as obesity.  The result may be: – high blood pressure; – obesity; – cardiovascular disease; – diabetes; – high cholesterol; – gallbladder disease.

Mortality and Eating Disorders

Death is a real risk of having an eating disorder. Research has found that eating disorders demonstrate the highest mortality rate of any mental illness. One study found that the mortality rate among anorexics is 18 times higher than among their peers without eating disorders. Eating disorders pose severe mental and physical health risks. For example, 20% of anorexics die prematurely from complications of their disorders. Suicide is a major cause of death among those with eating disorders. Anorexics and bulimics are 23 times more likely than the general population to commit suicide. This rate of suicide is among the highest of all mental illnesses. Since 95% of those suffering with eating disorders are between 16 and 25 years old, these young adults and adolescents may even be more susceptible to the physical and mental aspects of these illnesses since they are severely taxing bodies and minds that may not have finished developing. The mental and physical consequences of these diseases make them extremely dangerous.

Meet Isabelle Caro, a French actress and model. She has suffered from anorexia for about 12 years. In spite of the hope and thoughts of the future that she alludes to throughout the interview, she passed away 3 years after this interview at the age of 28.

Who is At Risk for Eating Disorders?

A girl looking at herself in a full length mirror.  She is of a healthy-looking body weight, yet she sees her reflection as significantly heavier than her actual body.

Generally, eating disorders appear in teens and young adults between the ages of 12 and 25 although they can develop later as well. Mostly girls and women are likely to suffer from eating disorders, but men with eating disorders are growing in numbers. Five to fifteen percent of those with anorexia or bulimia are male. One quarter of the preadolescent cases of anorexia is boys. There are about an equal number of men and women who struggle with binge eating disorder. There seems to be no gender, ethnicity, or socioeconomic group immune to these illnesses.

Those prone to eating disorders tend to:

– diet;

– live in societies (like the U.S.) that value being thin;

– have low self-esteem;

– have high self-expectations;

– have family history of eating disorders and/or of being overly concerned with appearance or dieting;

– have characteristics determined by genes, or a genetic predisposition, toward eating disorders;

– have trouble expressing their emotions;

– have a preoccupation with weight;

– have other emotional disorders (like depression, anxiety, obsessive-compulsive disorder) or substance abuse problems;

– maintain a distorted sense of own body image;

– participate in weight-conscious sports or careers (gymnasts, ice skaters, wrestlers, dancers, runners, jockeys, actors/actresses, models);

– be compulsive, impulsive, and/or perfectionistic;

– be dissatisfied with own appearance;

– be victims of teasing or bullying about body size or shape;

– be victims of trauma, abuse, and/or sexual trauma.

Please note that this is not a checklist of the qualities of individuals who are going to get eating disorders. However, these characteristics do represent some themes and commonalities among those who do suffer from these illnesses.

Question 1.1

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It could be argued that Stephanie demonstrates a great deal of dissatisfaction with herself and her body as well as an obsessive or compulsive attitude toward improving what she considers a poor body. She provides examples of many items from this list in her interview. Rick describes himself as a kid and an adult who was teased and bullied and had trouble expressing his frustration. He also showed childhood photos of a healthy-looking boy, whom he described as a chubby kid. List his specific references to many other items on this list.

Treatment for Eating Disorders

Unfortunately, those with eating disorders are often reluctant to seek treatment. Statistics cite that only 1 in 10 people with eating disorders receives treatment. Men with eating disorders are the least likely to pursue treatment because of the stereotype of having a “women’s” illness. The good news is that eating disorders are treatable. The overall treatment goals for eating disorders are:

to get to and maintain a healthy body weight;

to explore and help alleviate the emotional issues that contribute to the disorder;

to investigate and hopefully eliminate the bad behaviors surrounding food.

There is no one single treatment plan for eating disorders. The greatest chance of success occurs with a treatment that is customized to the individual and his/her emotional and physical needs. There is quite an array of treatment tools available from which to design specialized treatment programs for those with eating disorders. Successful therapeutic methods for eating disorders include some, if not all, of the following:

– medication (antidepressants, antipsychotics, mood stabilizers);

– individual cognitive therapy (also called “talk therapy”) to work on improving thoughts, attitudes, behaviors, to develop a positive body image and a healthy relationship with food and eating;

– family or marital counseling to work with other members of the household;

– group therapy;

– nutritional education to learn how to nourish the body properly.

Successful and professional treatment is not a quick process. It can take months or years and may be inpatient, outpatient, or include components of both. No matter where it takes place, treatment is most likely to succeed when being administered by skilled, accredited clinicians with experience treating eating disorder patients. Early intervention is best. The earlier that the eating disorder sufferer gets into treatment, the greater the chance is of recovery.

In spite of the benefits of these methods, relapses do occur, and patients do drop out of treatment programs for various reasons, such as financial hardship, lack of insurance coverage, relapse, or lack of support from family, friends, or employers. Research demonstrates that those who commit to their treatment and who put in time and energy to get better do recover and can stay recovered.

Listen to the recovery prospects for Stephanie, Rick, and Dave. What do you think the likelihood is that they will recover and stay recovered?

Assessment: Check Your Understanding

A dangerously thin woman is measuring her waist with a tape measure

Question 1.2

NodvX9C6XSB/fGOeitHastG16qYuUAbWu934EHj1ZipAdOxBCiMNGOZofh+w1De9efe9K9xoi/rK3n+vf2NYlL6yMgryXMLWA4goSZ8Gp19i8dUepORkd2cRrL1LSCLr
Correct. Eating disorders first appeared in stories from medieval times, and anorexia was first recorded as a disorder in the late 19th century.
Sorry. Eating disorders first appeared in stories from medieval times, and anorexia was first recorded as a disorder in the late 19th century.

Assessment: Check Your Understanding

A girl looking at herself in a full length mirror.  She is of a healthy-looking body weight, yet she sees her reflection as significantly heavier than her actual body.

Question 1.3

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
Correct! This statement is false. Ninety-five percent of those suffering with eating disorders are between 16 and 25 years old.
This statement is true.

Assessment: Check Your Understanding

A very, very thin girl walking away from the camera with her arms clasped around her neck as if in distress

Question 1.4

eYy4vNN8p3u91k1n20Y0emlnqdCvMvn57T7Iug+FYIQdT3mXpRSA+wFsdWVyW24mkGABjrjgyQFC6+ZD35D5mMw84TNi5CugcwLfRFAIZtaffmVnRF5eiqPJ9HfST4aGWO453F3vpgfC6FIuFBEGa1rcHlZzkVheFMwVbHN5dnLfUFQ5moQmOf+ekq5DhgFdy06SG0RV2XD5D9yqg0c8RjSbkZRTttVDHB29PNZp1rUVFoIMCfSdpBUSBeT9q1XSNH+Cgn1A7x8PARAkdVEESktzQT9Nwd9YgrQQe+puK04ria6tg5TRwQZVJhWHchina7hC9vt0bWU2cOp4t+CoWrGWjr/Bl/yfA7wTKvrDt93Eke7sQRABjjpgfXxbIqV/kYuVOA46Mpcw2zkKqRL4ia8lhUAyhN2h
Correct! This is NOT one of the recommendations for a successful treatment program for eating disorders.
This is one of the recommendations for a successful treatment program for eating disorders.

Assessment: Check Your Understanding

A girl slumped down in a bathroom stall as if she has just thrown up

Question 1.5

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Revisit the screens that discuss the signs and symptoms and risk factors for eating disorders. Consider the components for a successful treatment program while also considering the challenges that you observed in the videos of Stephanie, Rick, and Dave. Incorporate these ideas into a plan that can be used in school. Explain in what age group and in what class setting this plan would be most effective.

Congratulations! You have completed this activity.Total Score: x out of x points (x%) You have received a provisional score for your essay answers, which have been submitted to your instructor.