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What is an Eating Disorder?
Some Basic Facts
Eating disorders -- such as anorexia,
bulimia, and binge eating disorder -- include extreme emotions,
attitudes, and behaviors surrounding weight and food issues.
Eating disorders are serious emotional and physical problems
that can have life-threatening consequences for females and
males.
Anorexia Nervosa is
characterized by self-starvation and excessive weight loss.
Symptoms include: Refusal to maintain body weight at or above a
minimally normal weight for height, body type, age, and activity
level; intense fear of weight gain; feeling "fat" or overweight
despite dramatic weight loss; loss of mentrual periods in
females; and extreme concern with body weight and shape.
Bulmia Nervosa is
characterized by a secretive cycle of binge eating followed by
purging. Bulimia includes eating large
amounts of food--more than most people would eat in one meal--in
short periods of time, then getting rid of the food and calories
through vomiting, laxative abuse, or over exercising.
Symptoms include:
Repeated episodes of bingeing and
purging; feeling out of control during a binge and eating beyond
the point of comfortable fulness; purging after a binge
(typically self induced vomiting, abuse of laxatives, or diet
pills and/or diuretics, excessive exercise of fasting); frequent
dieting; and extreme concern with body weight and shape.
Binge Eating Disorder (also
known as Compulsive Overeating) is characterized primarily by periods of
uncontrolled, impulsive, or continuous eating beyond the point
of feeling comfortably full. While there is no purging, there
may be sporadic fasts or repetitive diets and often feelings of
shame or self-hatred after a binge. People who overeat
compulsively may struggle with anxiety, depression, and
loneliness, which can contribute to their unhealthy episodes of
binge eating. Body weight
may vary from normal to mild, moderate, or severe obesity.
Other Eating Disorders can
include some combination of the signs and symptoms of anorexia,
bulimia, and/or binge eating disorder. While these behaviors may
not be clinically considered a full syndrome eating disorder,
they can still be physically dangerous and emotionally draining.
All eating disorders require professional help.
What Causes Eating
Disorders?
Eating disorders are complex conditions that arise from a
combination of long-standing behavioral, biological, emotional,
psychological, interpersonal, and social factors. Scientists and
researchers are still learning about the underlying causes of
these emotionally and physically damaging conditions. We do
know, however, about some of the general issues that can
contribute to the development of eating disorders.
While eating disorders may begin with preoccupations with food and
weight, they are most often about much more than food. People
with eating disorders often use food and the control of food in
an attempt to compensate for feelings and emotions that may
otherwise seem over-whelming. For some, dieting, bingeing, and
purging may begin as a way to cope with painful emotions and to
feel in control of one’s life, but ultimately, these behaviors
will damage a person’s physical and emotional health,
self-esteem, and sense of competence and control.
Psychological Factors that can contribute to Eating
Disorders include low self-esteem, feelings of inadequacy or
lack of control in life, depression, anxiety, anger, or
loneliness.
Interpersonal Factors that can contribute to Eating
Disorders include troubled family and personal relationships,
difficulty expressing emotions and feelings, history of being
teased or ridiculed based on size or weight, history of physical
or sexual abuse.
Social Factors that can contribute to Eating
Disorders include cultural pressures that glorify “thinness” and
place value on obtaining the “perfect body,” narrow definitions
of beauty that include women and men of specific body weights
and shapes, cultural norms that value people on the basis of
physical appearance and not inner qualities and strengths.
Biological Factors: Scientists are still researching possible
biochemical or biological causes of eating disorders. In some
individuals with eating disorders, certain chemicals in the
brain that control hunger, appetite, and digestion have been
found to be unbalanced. The exact meaning and implications of
these imbalances remains under investigation. Eating disorders
often run in families. Current research is indicates that there
are significant genetic contributions to eating disorders.
Eating disorders are complex conditions that can arise from a
variety of potential causes. Once started, however, they can
create a self-perpetuating cycle of physical and emotional
destruction. Professional help is recommended in the
treatment of eating disorders.
How Can You Help Prevent Eating Disorders?
Learn all you can about
anorexia nervosa, bulimia nervosa, and binge eating disorder.
Genuine awareness will help you avoid judgmental or mistaken
attitudes about food, weight, body shape, and eating disorders.
Discourage the
idea that a particular diet, weight, or body size will
automatically lead tohappiness and fulfillment.
Choose to challenge
the false belief that thinness and weight loss are great, while
body fat and weight gain are horrible or indicate laziness,
worthlessness, or immorality.
Avoid categorizing
foods as “good/safe” vs. “bad/dangerous.” Remember, we all need
to eat a balanced variety of foods.
Decide to avoid
judging others and yourself on the basis of body weight or
shape. Turn off the voices in your head that tell you that a
person’s body weight says anything about their character,
personality, or value as a person.
Avoid conveying an
attitude that says, “I will like you better if you lose weight,
or don’t eat so much, etc.”
Become a critical
viewer of the media and its messages about self-esteem and body
image. Talk back to the television when you hear a comment or
see an image that promotes thinness at all costs. Rip out (or
better yet, write to the editor about ) advertisements or
articles in your magazines that make you feel bad about your
body shape or size.
If you think
someone has an eating disorder, express your concerns in a
forthright, caring manner. Gently but firmly encourage the
person to seek trained professional help.
Be a model of
healthy self-esteem and body image. Recognize that others pay
attention and learn from the way you talk about yourself and
your body. Choose to talk about yourself with respect and
appreciation. Choose to value yourself based on your goals,
accomplishments, talents, and character. Avoid letting the way
you feel about your body weight and shape determine the course
of your day. Embrace the natural diversity of human bodies and
celebrate your body’s unique shape and size.
Support local and
national nonprofit eating disorders organizations — like the
National Eating Disorders Association — by volunteering your
time or giving a tax-deductible donation.
Don’t Weigh Your
Self-Esteem,
It’s What’s Inside
That Counts!
Ten Steps to Positive Body Image
One list
cannot automatically tell you how to turn negative body thoughts
into positive body image, but it can help you think about new
ways of looking more healthfully and happily at yourself and
your body. The more you do that, the more likely you are
to feel good about who you are and the body you naturally have.
1.
Appreciate all that your body can do. Every day your body
carries you closer to your dreams. Celebrate all of the amazing
things your body does for you --running, dancing, breathing,
laughing, dreaming, etc.
2.
Keep a top-10 list of things you like about yourself -- things
that aren’t related to how much you
weigh or what you look like. Read your list often. Add to it as
you become aware of more things to like about you.
3.
Remind yourself that “true beauty” is not simply skin-deep. When
you feel good about
yourself and who you are, you carry yourself with a sense of
confidence, self-acceptance, and openness that makes you
beautiful regardless of whether you physically look like a
supermodel. Beauty is a state of mind, not a state of your
body.
4.
Look at yourself as a whole person. When you see yourself in a
mirror or in your mind, choose not to focus on specific body
parts. See yourself as others see you--as a whole person.
5.
Surround yourself with positive people. It is easier to feel
good about yourself and your body when you are around others who
are supportive and who recognize the importance of liking
yourself just as you naturally are.
6.
Shut down those voices in your head that tell you your body is
not “right” or that you are a "bad" person. You can
overpower those negative thoughts with positive ones. The
next time you start to tear yourself down, build yourslef back
up with a few affirmations that work for you.
7.
Wear clothes that are comfortable and that make you feel good
about your body. Work with your body, not against it.
8.
Become a critical viewer of social and media messages. Pay
attention to images, slogans, or attitudes that make you feel
bad about yourself or your body. Protest these messages: write a
letter to te advertiser or talk abck to the image or message.
9. Do something nice for yourself -- something that lets your body
know you appreciate it. Take a bubble bath, make time for
a nap, find a peaceful place outside to relax.
10. Use the time and energy that you might have spent worrying
about food, calories, and your weight to do something to help
others. Sometimes reaching out to other people can help you feel
better about yourself and can make a positive change in our
world.
How to Help a Friend with Eating and Body
Image Issues
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You cannot force someone to seek help, change
their habits, or adjust their attitudes. You
will make important progress in honestly sharing
your concerns, providing support, and knowing
where to go for more information!
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If you are
reading this handout, chances are you are
concerned about the eating habits, weight, or
body image of someone you care about. We
understand that this can be a very difficult and
scary time for you. Let us assure you that you
are doing a great thing by looking for more
information! This list may not tell you
everything you need to know about what to do in
your specific situation, but it will give you
some helpful ideas on what to do to help your
friend.
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Learn
as much
as you can about eating disorders. Read
books, articles, and brochures.
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Know
the differences between
facts and myths about weight, nutrition, and
exercise. Knowing the facts will help you
reason against any inaccurate ideas that
your friend may be using as excuses to
maintain their disordered eating patterns.
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Be
honest. Talk
openly and honestly about your concerns with
the person who is struggling with eating or
body image problems. Avoiding it or ignoring
it won’t help!
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Be
caring, but be firm. Caring
about your friend does not mean being
manipulated by them. Your friend must be
responsible for their actions and the
consequences of those actions. Avoid making
rules, promises, or expectations that you
cannot or will not uphold. For example, “I
promise not to tell anyone.” Or, “If you do
this one more time I’ll never talk to you
again.”
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Compliment
your
friend’s wonderful personality, successes,
or accomplishments. Remind your friend that
“true beauty” is not simply skin deep.
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Be a
good role model in
regard to sensible eating, exercise, and
self-acceptance.
-
Tell
someone. It may
seem difficult to know when, if at all, to
tell someone else about your concerns.
Addressing body image or eating problems in
their beginning stages offers your friend
the best chance for working through these
issues and becoming healthy again. Don't
wait until the situation is so severe that
your friend's life is in danger. Your friend
needs as much support and understanding as
possible
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Remember that
you cannot force someone to seek help, change their habits, or
adjust their attitudes. You will make important progress in
honestly sharing your concerns, providing support, and knowing
where to go for more information! People struggling with
anorexia nervosa, bulimia nervosa, or binge eating disorder do
need professional help. There is help available and there is
hope!
Statistics: Eating
Disorders and Their Precursors
The Prevalence of Eating Disorders
In the
United States, as many as 10 million females
and 1 million males are
fighting a life and death battle with an eating disorder such as
anorexia or bulimia. Approximately 25 million more
are struggling with binge
eating disorder (Crowther et al., 1992; Fairburn et al., 1993;
Gordon, 1990; Hoek, 1995; Shisslak et al., 1995). Because of the
secretiveness and shame associated with eating disorders, many
cases are probably not reported. In addition, many individuals
struggle with body dissatisfaction and sub-clinical disordered
eating attitudes and behaviors. For example, it has been shown
that 80% of American women are dissatisfied with
their appearance (Smolak, 1996).
For females between
fifteen to twenty-four years old, the mortality rate associated
with anorexia nervosa is twelve times higher than the death rate
of ALL other causes of death (Sullivan, 1995).
Anorexia nervosa
has the highest premature fatality rate of any mental illness
(Sullivan, 1995).
In a 2003 review of
the literature, Hoek and van Hoeken found:
40% of newly
identified cases of anorexia are in girls 15-19 years old.
Significant
increase in incidence of anorexia from 1935 to 1989 especially
among young women 15-24.
A rise in incidence
of anorexia in young women 15-19 in each decade since 1930.
The incidence of
bulimia in 10-39 year old women TRIPLED between 1988 and 1993.
Only one-third of
people with anorexia in the community receive mental health
care.
Only 6% of people
with bulimia receive mental health care.
The majority of
people with severe eating disorders do not receive adequate
care.
Despite the
prevalence of eating disorders they continue to receive
inadequate research funding. In 2005, the National Institutes of
Health estimates funding the following disorders accordingly:
Illness
Prevalence
NIH Research Funds (2005)
Eating
disorders: 10 million
$12,000,000*
Alzheimer’s disease:
4.5 million
$647,000,000
Schizophrenia:
2.2 million
$350,000,000
*
The reported
research funds are for anorexia nervosa only. No estimated
funding is reported for bulimia nervosa or eating disorders not
otherwise specified.
Research dollars
spent on eating disorders averaged $1.20 per affected
individual, compared to $159 per affected individual for
schizophrenia.
In March 2005, NEDA
contracted with Global Market Insite, Inc. (GMI), a leader in
global market research, to conduct a 1,500 nationwide sample of
adults in the U.S. Their findings concluded from
those surveyed that:
Three out of four
Americans believe eating disorders should be covered by
insurance companies just like any other illness.
Americans believe
that government should require insurance companies to cover the
treatment of eating disorders.
Four out of ten
Americans either suffered or have known someone who has suffered
from an eating disorder.
Dieting and the Drive for Thinness
Over one-half of teenage girls and nearly one-third of teenage
boys use unhealthy weight control behaviors such as skipping
meals, fasting, smoking cigarettes, vomiting, and taking
laxatives (Neumark-Sztainer, 2005).
Girls who diet
frequently are 12 times as likely to binge as girls who don’t
diet (Neumark-Sztainer, 2005).
42% of 1st-3rd grade girls want to be thinner
(Collins, 1991).
81% of 10 year olds
are afraid of being fat (Mellin et al., 1991).
The average
American woman is 5’4” tall and weighs 140 pounds. The average
American model is 5’11” tall and weighs 117 pounds.
Most fashion models
are thinner than 98% of American women (Smolak, 1996).
46% of 9-11
year-olds are “sometimes” or “very often” on diets, and 82% of
their families are “sometimes” or “very often” on diets
(Gustafson-Larson & Terry, 1992).
91% of women
recently surveyed on a college campus had attempted to control
their weight through dieting, 22% dieted “often” or “always”
(Kurth et al., 1995).
95% of all dieters
will regain their lost weight in 1-5 years (Grodstein, et al.,
1996).
35% of “normal
dieters” progress to pathological dieting. Of those, 20-25%
progress to partial or full syndrome eating disorders (Shisslak
& Crago, 1995).
25% of American men
and 45% of American women are on a diet on any given day
(Smolak, 1996).
Americans spend
over $40 billion on dieting and diet-related products each year
(Smolak, 1996).
National Eating Disorders Association
Statistics References
Collins, M.E.
(1991). Body figure perceptions and preferences among
pre-adolescent children. International Journal of Eating
Disorders, 199-208.
Crowther, J.H.,
Wolf, E.M., & Sherwood, N. (1992). Epidemiology of bulimia
nervosa. In M. Crowther, D.L. Tennenbaum. S.E. Hobfoll, & M.A.P.
Stephens (Eds.). The Etiology of Bulimia Nervosa: The Individual
and Familial Context (pp. 1-26) Washington, D.C.: Taylor & Francis.
Fairburn, C.G.,
Hay, P.J., & Welch, S.L. (1993). Binge eating and bulimia
nervosa: Distribution and determinants. In C.G. Fairburn & G.T.
Wilson, (Eds.), Binge Eating: Nature, Assessment, and Treatment
(pp. 123-143). New York: Guilford.
Gordon, R.A.
(1990). Anorexia and Bulimia: Anatomy of a Social Epidemic. New York: Blackwell.
Grodstein, F.,
Levine, R., Spencer, T., Colditz, G.A., Stampfer, M. J. (1996).
Three-year follow-up of participants in a commercial weight loss
program: can you keep it off? Archives of Internal Medicine. 156
(12), 1302.
Gustafson-Larson,
A.M., & Terry, R.D. (1992). Weight-related behaviors and
concerns of fourth-grade children. Journal of American Dietetic
Association, 818-822.
Hoek, H.W. (1995).
The distribution of eating disorders. In K.D. Brownell & C.G.
Fairburn (Eds.) Eating Disorders and Obesity: A Comprehensive
Handbook (pp. 207-211). New York: Guilford.
Hoek, H.W., & van
Hoeken, D. (2003). Review of the prevalence and incidence of
eating disorders. International Journal of Eating Disorders,
383-396.
Mellin, L., McNutt,
S., Hu, Y., Schreiber, G.B., Crawford, P., & Obarzanek, E.
(1991). A longitudinal study of the dietary practices of black
and white girls 9 and 10 years old at enrollment: The NHLBI
growth and health study. Journal of Adolescent Health, 27-37.
National Institutes
of Health. (2005). Retrieved November 7, 2005, from
http://www.nih.gov/news/fundingresearchareas.htm
Neumark-Sztainer,
D. (2005). I’m, Like, SO Fat!. New York: The Guilford Press. pp. 5.
Shisslak, C.M.,
Crago, M., & Estes, L.S. (1995). The spectrum of eating
disturbances. International Journal of Eating Disorders, 18 (3),
209-219.
Smolak, L. (1996).
National Eating Disorders Association/Next Door Neighbors Puppet
Guide Book.
Sullivan, P.
(1995). American Journal of Psychiatry, 152 (7), 1073-1074.
Please also note the
National Eating Disorders Association's
Information and
Referral Helpline: 1-800-931-2237 and website:
www.NationalEatingDisorders.org
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