What are eating disorders?

Eating disorders are conditions characterised by severe disturbances in eating behaviour that may involve insufficient or excessive intake of food to the detriment of the person’s physical and mental health. People with eating disorders place their value and self worth exclusively on their shape and weight to the point where this becomes their only concern. Even though the media is often blamed for causing eating disorders, the real issues are a lot more complex than that, and psychotherapeutic work is needed for the person to be liberated from the disorder.

Risk Factors

There is no one cause for eating disorders only predisposing factors. An eating disorder is the end point of many of the following interactive factors including:

Genes:

Research has found concordance of 55% for anorexia in monozygotic vs. 5% in dizygotic twins. Concordance in bulimia of 35% and 30% respectively.

Family:

• Family scripts about food, weight, overeating or dieting. Unhealthy eating behaviour or control behaviour with food like using food for punishment or reward.
• Unhealthy body image in mothers. Bulimia can be unwittingly passed from mothers to daughters even if the behaviour is believed hidden.
• Abusive families (physical or emotional) where the child’s emotional needs are neglected. Similarly in families where the child is called to meet the parent’s emotional needs.
• Trauma such as aggression, death and divorce.
• Over enmeshed with a controlling parent.

Personality Issues:

• Perfectionism: This is a very common characteristic with people with anorexia nervosa. Risk taking and impulsivity is more common with people with Bulimia nervosa.
• Uncomfortable with the expression of feelings. Either it is unacceptable to express feelings or appears in control of feelings.
• People pleaser: overly conscious of other people’s perceptions of self, need for approval, denial of own needs.
• Obsessional personality: focus on weight or food can be a substitution of real anxiety.
• Low self esteem.

Traumatic events:

A trauma history is more common in bulimics.

Culture:

Cultural ideal body sizes have changed dramatically over the last 30 years, and today’s cultural ideal is unrealistically thin. However not everybody reacts to culture pressures. What seems to be the link between culture pressures and eating disorders is the internalisation of the cultural ideal. An example of internalisation is when two girls look at the same picture of a thin model and whereas one girl would say, “she looks great”, the other one would say “I am so fat”.

Development:

Early puberty, weight gain in puberty.

Research shows that food restriction (dieting) usually precedes most eating disorders. Dieting does NOT cause eating disorders since vast numbers of people diet and only a few develop eating disorders. However dieting is the “necessary condition” from which the eating disorder emerges.