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Eating Disorders: Frequently Asked Questions

by Avis Rumney, LMFT and Eating Disorder Specialist | May 2009

WHAT CAUSES EATING DISORDERS?

Eating disorders are complex in origin.  A convoluted interplay of sociocultural, psychological and physiological factors contributes to their development.

Eating disorders have become more prevalent as society has changed and science advanced.  We live in a culture characterized by information overwhelm and speed.  Multiple media blast sound bytes and images of how we should look, think, feel, live, work, eat, sleep, talk, play and buy.  Family structure has been strained by the changes.  Roles of men and women are stereotypically the same, but their content is something our great-grandparents would not recognize.

For millennia, each generation has faced new and different challenges.  Parenting has morphed as society has changed -- but kids still need to be raised and parents need support to do a good job.  Extended families and close knit communities used to provide what television and the internet can't.  Families are stressed and emotional connection is strained.  Parents cannot be an emotional fountain when their own reservoirs are dry.

Meanwhile, food is abundant in large sectors of the population and the media provide mixed messages about food and weight.  Food fixes everything, but thinness is the ideal.  Food is plentiful, available and proffered on every occasion, but eating it can make us fat and guilty.   

Eating disorders are born out of a desire for control an attempt to control something external when internally there is insufficient capacity to manage the emotional challenges of life.  With a solid social, psychological and physiological foundation, this internal capacity develops during infancy and childhood.  But when something is awry in one or more of these arenas, development is thwarted.  The sound base needed to manage oneself and one's emotions is incomplete. Manipulation of food and weight is one way to try to compensate for the missing elements.  Food is a necessity, but also a commodity which can be employed for purposes unrelated to physical hunger.

Physiologically, recent brain research shows that low levels of the neurotransmitters dopamine and serotonin are present in people who develop eating disorders. Neurotransmitter imbalances similar to those found in alcoholism or drug addiction appear to be present in those who develop eating disorders. Some of these neurochemical anomalies predispose an individual to feel less pleasure and more impulsivity.  Balance of brain chemistry directly affects mood, and significant anxiety and depression exist among those with eating disorders.  While deciphering cause and effect in brain function is still a new science, imbalances in brain chemistry seem to predispose an individual to develop an eating disorder.  Combinations of various internal and external factors can then act as triggers that provoke the appearance of symptoms.

Innate personality traits, which are genetically imprinted, can impair coping skills and thereby contribute to development of an eating disorder.  Among these traits are perfectionism, shyness, problems handling change, difficulty expressing feelings, a need to please others or fear of making mistakes.  Biological idiosyncrasies such as food allergies or digestive problems may play a role.

Sometimes an eating disorder begins innocently enough with a diet gone awry.  Significant weight loss triggers physiological and psychological processes which, in susceptible individuals, can lead to the development of an eating disorder.

Various sociocultural and life situations can act as triggers which provoke the development of an eating disorder in someone who is biologically and emotionally susceptible.  Sometimes it can be a single precipitating event, although more often it is a series of events or situations that are the trigger.  These include trauma, significant loss, family stress, peer pressure, and school, sports or job competition.

HOW COMMON ARE EATING DISORDERS?

Eating disorders are alarmingly prevalent. Current statistics suggest that 10% of this country's population, or over 30 million people, suffer from eating disorders. About 10% of these are anorexics, 20% are bulimics, and 35% are binge eaters. The remaining 35% suffer from atypical eating disorders in which they meet some but not all the criteria for a specific eating disorder diagnosis.

Of those with eating disorders, recent research suggests that males comprise 10% of anorexics, 25% of bulimics and 40% of binge eaters.

Although eating disorders can lead to obesity, not all those who are obese are considered to have eating disorders.  Genetic propensity to heaviness coupled with consistent consumption of a large amount of food can cause overweight without binge eating being present.  Statistics suggest that 30% of school age children are obese, and it is estimated that about 40% of these are binge-eaters. About 60% of adults in the United States are overweight or obese, and probably about 40% of these adults are binge-eaters. 

Eating disorders can cause severe health risks. Sadly, anorexia has the highest mortality rate of all mental illnesses.

DO PEOPLE RECOVER FROM EATING DISORDERS?

Recovery from an eating disorder is possible. Sustained recovery generally requires professional assistance, and early intervention enhances the probability of positive outcome. Psychotherapy is central to the healing process, and the relationship with the therapist is key.

Families suffer as well, and can benefit from help in repairing their emotional wounds. Families, too can recover.

For additional information, contact us.

HOW CAN FAMILIES HELP?

Families can play an important role in the recovery of a loved one with an eating disorder, and recovery of the family is also crucial to the healing process of anyone with an eating disorder.

First and foremost, family members should follow the recommendations of the therapist or the eating disorder program treating the individual with the eating disorder. This may include some of the following: attending regular family therapy sessions, different family members attending individual or couples therapy, each individual family member following his or her personal program of self-care, and going to 12-step meetings such as Al-anon, which supports healing of family members in situations where a loved one is grappling with drug, alcohol, food or any other addiction.

The person with the eating disorder and other family members must communicate with respect and clarity about feelings, needs and expectations. If you are wondering how your loved one with an eating disorder feels about your asking specific questions or talking about certain subjects, ask! That said, be aware that topics relating to weight and appearance are likely to be sensitive and triggering for anyone recovering from food-related issues. Avoid these subjects if possible. If you believe it is important to talk about weight or appearance, do so by expressing your need or feeling instead of your opinion. For example, "I need reassurance that you are eating the way your nutritionist is suggesting. I get scared when I hear you say you're only going to eat in the morning and not the rest of the day." This will likely evoke a much less defensive reaction than "You're not eating enough" or "You're starting to develop weird eating habits again."

Someone recovering from an eating disorder suffers from considerable self-hatred. Trying to counter self-pejorative comments is likely to be ineffective. Instead, express genuine love and appreciation for aspects of who they are as a person – things you know they enjoy, how they are as a friend, a daughter or a sister.

Engage in activities with your loved one with an eating disorder that do not revolve around food or appearance (in other words, meals, snacks, buying makeup or clothes). Spending quality time together is important, and finding mutually satisfying pastimes is one key to having this time be meaningful.


If you know of a child, young adult, or adult who might have an eating disorder, please contact us. The earlier the intervention, the sooner the individual can return to normal development and healthy functioning.     



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