With social and mainstream media pushing the “ideal” body images on men and women, red flags and warning signs of eating disorders are becoming normalized. It is not strange for a woman to forgo meals because she is “watching her figure” in these times, and the fact that the society today, especially the western cultures, equates thinnes with “health and beauty” only exacerbates the problem (Comer, 2018).
In an effort to point out the already normalized warning signs and to raise awareness, this article will go over the most common of the eating disorders, Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder, including their symptoms and possible causes.
Purposely maintaining significantly low body weight, being severely critical of her weight and shape, and possessing a distorted view of her body paired with an intense fear of becoming overweight are all signs of anorexia nervosa (Comer, 2018). According to Abnormal Psychology by R. J. Comer, anorexia nervosa is a mental disorder where people living with this disorder pursue “extreme thinness” and “extreme weight loss.” Becoming “thin” is the key goal for people living with anorexia nervosa, but their fear of “becoming obese… losing control of their size” is what motivates them (Comer, 2018).
At least “half of the people” with anorexia nervosa follow a pattern called “restricting-type anorexia nervosa,” meaning they seek to lose weight by eliminating certain foods out of their diet. They tend to start this pattern by cutting out “sweet or fattening snacks,” then eventually cut more and more foods out of their diet (Comer, 2018). The same pattern also manifests in different ways-while some might cut out foods out of their diet, others might place rigid rules around their eating, maintain a low calorie count per day, or simply eat only one meal a day (Eating Disorders Victoria, 2019). Although most people recover, there are cases where the patient “become[s] so seriously ill that they die,” mostly from starvation and suicide (Comer, 2018).
Because people with restricting-type anorexia nervosa are most often depriving them of food, their minds behave extremely similarly to people who are starving: they are “preoccupied”with food. Their “dreams are filled with images of food and eating,” they often spend a considerable amount of time reading about food, and planning their next small meals (Comer, 2018).
The starvation habit of the disease damages their physical bodies on top of altering their way of thinking- it brings forth several medical conditions. One such condition is “amenorrhea,” meaning “the absence of menstrual cycles” (Comer, 2018). This is often accompanied by various other problems, such as slow heart rate, rough, dry, and cracked skin, reduced bone density, and metabolic imbalances. Some may even develop “lanugo,” the thin, fine hair that covers newborns.
On top of what is stated above, anorexia nervosa also brings “distorted way of thinking,” causing people to possess alarmingly low opinions of their body shape and size, and many consider themselves undesirable (Comer, 2018). They also cause people to overestimate their body size, thinking they are bigger than they actually are. Their distorted way of thinking also takes a form of misplaced goals and misconceptions, holding harmful beliefs such as how they will be “a better person if [they] deprive [themself],” or how they “must be perfect in every way” (Comer, 2018).
Bulimia nervosa, also known as binge-purge syndrome, is a disorder characterized by frequent eating binges followed by “extreme compensatory behaviors” in an effort to avoid gaining weight. Examples of such extreme compensatory behavior includes forced vomitation, abusing of laxatives, diuretics, or even fasting and excessively exercising. In short, people with bulimia nervosa engage in a cycle composed of binging, episodes of uncontrollable eating, followed by extreme compensatory methods (Comer, 2018). Thus, in order to fully understand the disorder, the understanding of the two pieces of bulimia is needed.
Bulimia Nervosa- Binging
People with bulimia often carry out their binging episodes in secret, as few as once, and as many as thirty episodes per week (Fairbun, Cooper, Shafran, Terence, 2008). Furthermore, in most cases, people in binge episodes usually eat soft, and “high calorie” foods, such as ice cream, cookies, and sandwiches (Engel, Steffen, Mitchell, 2017). Furthermore, the person most often feels powerless to stop themselves from eating and, despite the binge itself may be accompanied by a pleasurable feeling, it is often accompanied by feelings of “extreme self-blame, shame, guilt, and depression” (Comer, 2018).
Bulimia Nervosa- Compensatory Behaviors
People with bulimia nervosa turn to behaviors such as vomiting in order to compensate for their binges. However, vomiting fails to undo the effects of binge eating, for it does not prevent the human body from absorbing half of the calories consumed during the binge. Furthermore, because the act of vomiting decreases a person’s ability to feel full and satiated, this leads to more binges and hunger in greater frequencies (Mitchell, 2016).
Binge Eating Disorder
Binge-eating disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, is characterized by recurring “episodes of binge eating” (2013). The key difference between bulimia nervosa and binge-eating disorder is, however, the binge-eating disorder’s lack of “inappropriate compensatory behavior” (Comer, 2018).
In order for a person to be diagnosed with the binge-eating disorder, the person must have been bingeing at least once a week for three months minimum, feel distress over their own bingeing behavior, and feel a lack of control during their episodes (American Psychiatric Association, 2013).
Eating Disorders: Possible Causes
While there are solid possible causes for anorexia nervosa and bulimia nervosa, the binge-eating disorder is still under scientific investigation. The disorder, because it is the “new” disorder out of the three, significantly less facts are known about its possible causes. Today’s findings about the causes of eating disorders could be categorized under three main umbrellas: sociocultural, psychological, and biological (Comer, 2018).
Eating disorders do not occur at the same rate around different cultures and societies- it is “concentrated in cultures in which food is abundant,” because in cultures where food is scarce, their ideal body image is most likely to be “rotund” (Polivy & Herman, 2002). While the nature of the sociocultural environment one grows up in affects the overall rate of eating disorder occurrence, it should not be seen as its main cause. The likelihood of developing eating disorders are more dependent on how much the individual comes to internalize the cultural worship of thinness rather than which culture they were born into (Polivy & Herman, 2002).
The media, such as social media and mainstream television, has worked to increase the occurrence of eating disorders, for not only it projected unnatural beauty standards through photoshop to the wider audience, it also provided resources to people who were not satisfied with their bodies and wished to be thinner (Polivy & Herman, 2002).
Some theorists believe that because many people with eating disorders have depression, that depression helps “set the stage” for eating disorders (Comer, 2018; Kelin & Attia, 2017). Comer defines four supporting reasons for this claim:
Many more people living with depression qualify for eating disorders, more than the general population.
Close relatives of people with eating disorders seem to have a higher rate of depression.
Brain circuit pathways relating to depression are very similar to the pathways of eating disorders.
Some people with eating disorders have experienced alleviation of their symptoms through antidepressants (2018).
Some biologists claim that certain genes make people susceptible to eating disorders, and the fact that relatives of people with the mental illness seems to support the claim (Bulik, Kleiman & Yilmaz, 2016). Furthermore, in identical twins, if one developed anorexia nervosa, there is a seventy percent chance of the other twin developing the same mental illness. In fraternal twins, who are less genetically similar, the percentage is twenty percent. For bulimia nervosa, the percentage is twenty three in identical, and nine in fraternal (Kendler, Ohlsson, Keefe, Sundquist and Sundquist, 2018).
Treatment of Eating Disorders
Treatments for people living with eating disorders differ little by little, but they follow a similar pattern of nursing the patient to a healthy weight as they work to treat the underlying psychological causes for their disorder.
In the case of anorexia nervosa, the first step in their journey to recovery is gaining weight, a phase called “nutritional rehabilitation” (Steinglass, 2016). For patients who refuse to eat, clinicians often resort to tube and interventional feedings. Some clinicians use reward systems to encourage patients to gain weight, but that leads to a lack of trust between the clinician and the patient (Rocks, Pelly, Wilkinson, 2014). The most popular method to treat anorexia nervosa is, however, is a combination of supportive “nursing care,” “nutritional counseling,” and a high-calorie diet. With this method, the clinicians gradually increase the patient’s diet over “the course of several weeks,” and the nurses offer encouragement for the patients (Steinglass, 2016).
The patients must also work to overcome their underlying psychological problems, however, in order to make a lasting recovery. For this, various methods such as cognitive behavioral therapy, family therapy, and education.
In cognitive behavioral therapy, clients are asked to monitor and record their feelings, hunger level, and food intake, and the relationship between those variables. On top of this, the clients are taught healthy ways to cope with stress and solving problems to keep them from repeating their maladaptive cycle. Furthermore, they are taught to not place their value in their shape and size, and their inability to control them. They are further educated about their illness, and also given tools, such as careful, healthy ways to exercise control, to help them make a lasting recovery (Pike, 2017)
Another useful tool for a lasting recovery is family therapy. This is especially helpful if the client is a child or a minor, for it can help fix troublesome patterns and interactions within the client’s family (Pike, 2017). During each session, the therapist teaches the family how to help the client, and make appropriate changes to make a healthy environment for the client. The role in family members in developing eating disorders are not yet clear, but studies have found that family therapy is helpful in treating the disorder (Cook-Darzens, 2016).
About the Author
HeeJoo Roh is a Korean-American studying Art and Psychology at Pepperdine University. She aspires to combine her passions and pursue art therapy in the future. In the past, she has worked with various volunteer organizations, leading a group of Korean-American students to various community service events to represent her community. Her drive to represent and bringing down stigmas, as well as her passion for psychology, led to Speaking Grey. She now hopes to represent the mental health community in a more positive, informative light, and work to educate the masses about the truth of mental illnesses.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Arlington, VA: Author.
Bulik, C. M., Kleiman, S. C., & Yilmaz, Z. (2016). Genetic epidemiology of eating disorders.
Current opinion in Psychiatry, 29(6), 383-388.
Cook-Darzens, S. (2016). The role of family meals in treatment of eating disorders: A scoping
review of the literature and implications. Eating and Weight Disorders,21(3), 383-393.
Engel, S., Steffen, K., & Mitchell, J. E. (2017, March 6). Bulimia nervosa in adults: clinical
features, course of illness, assessment, and diagnosis. UpToDate. Retrieved from
Eating Disorders Victoria (2019, April 11). What Is Anorexia Nervosa? Retrieved August 01,
2020, from https://www.eatingdisorders.org.au/eating-disorders-a-z/anorexia-nervosa/
Fairburn, C. G., Cooper, Z., Shafran, R., & Wilson, G. T. (2008). Eating disorders: A
transdiagnostic protocol. In D. H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual (p. 578–614). The Guilford Press.
Kendler, K. S., Ohlsson, H., Keefe, R. S. E., Sundquist, K., & Sundquist, J. (2018). The joint
impact of cognitive performance in adolescence and familial cognitive aptitude on nrisk for major psychiatric disorders: A delineation of four potential pathways to illness. Molecular Psychiatry.
Klein D., & Attia, E. (2017, February 15). Anorexia nervosa in adults: Clinical features, courses
of illness, assessment, and diagnosis. UpToDate. Retrieved from www.uptodate.com
Mitchell, J. E. (2016, July 28). Bulimia nervosa in adults: Cognitive-behavioral therapy (CBT).
UpToDate. Retrieved from www.uptodate.com.
National Institute of Mental Health. (n.d.). Eating Disorders. Retrieved August 04, 2020, from
Polivy, J., & Herman, C. P. (2002). Causes of Eating Disorders. Annual Review of Psychology,
53(1), 187–213. doi:10.1146/annurev.psych.53.100901.135103
Pike, K. (2017, March 17). Anorexia nervosa in adults: Cognitive-behavioral therapy (CBT).
UpToDate. Retrieved from www.uptodate.com.
Rocks, T., Pelly, F., & Wilkinson, P. (2014). Nutrition Therapy during Initiation of Refeeding in
Underweight Children and Adolescent Inpatients with Anorexia Nervosa: A Systematic Review of the Evidence. Journal of the Academy of Nutrition and Dietetics, 114(6), 897–907. doi:10.1016/j.jand.2013.11.022
Steinglass, J. (2016, September 28). Anorexia nervosa in adults and adolescents: Nutritional rehabilitation (nutritional support). UpToDate. Retrieved from www.uptodate.com.