Suggested citation: Bahuguna, A. (2022, January 11). Eating Disorders. Queer Academia. URL.

A lot of us might have experienced concerns regarding our body weight at some or the other point in our lives. The regular bombardment of weight loss journeys on our social media feeds, instant fat burning recipe advertisements or trends like intermittent fasting reflect how widespread our concerns can be regarding our body weight and shape. Not to mention, with the boom in social media platforms, people are getting exposed to unrealistic beauty standards and skinny fashion models (Butcher et al., 2018). People try a plethora of methods to control their diet and their weight to look in good shape, but when does this need to control weight turn into an eating disorder?

The Diagnostic and Statistical Manual of mental disorders (DSM-5) defines eating disorders as “disorders characterized by a persistent disturbance of eating or eating-related behavior that results in altered consumption of food and significantly impairs physical health or psychosocial functioning” (American Psychiatric Association, 2013). 

In simpler words, an eating disorder can be described as an abnormal and maladaptive practice of consuming food. This can include limiting the consumption of food or/and overeating. The person might even take extreme efforts to remove the food consumed (purging). Such problematic eating styles interfere with their everyday functioning and health.

However, eating style isn’t the only characteristic feature. Distorted cognitions, fear of gaining weight, compensatory behaviors etc are some more characteristics on the basis of which we have three major eating disorders:

1. Anorexia Nervosa

This type of eating disorder is mainly characterized by excessive fear of gaining weight, eating little or no food and dangerously low body weight. The individual also engages in multiple behaviors like purging, using laxatives, diuretics, enemas, excessive exercise, etc to control or lose weight. Such behaviors are called compensatory behaviors. According to the DSM-5, anorexia nervosa is diagnosed when:

• The individual restricts food consumption to a point leading to dangerously low body weight for his/her age, height and sex.

• There is a profound and irrational fear of gaining weight, in response to which the person might engage in compensatory behaviors.

• The individual has a problematic perception of his/her body weight. There is a preoccupation with losing weight and staying thin.

• The individual’s self-perception highly depends on their body weight.

The lack of poor insight causes anorexics to perceive their body to be overweight even when they might be looking “painfully thin” to others (Butcher et al., 2018). Based on the compensatory behaviors used by Anorexics to control their weight, there are two subtypes:

i) The Purging type- In this compensatory style, a person with anorexia might overeat a portion of food inappropriate to be consumed in a short period of time. This portion is more than what other people in the same situation and same duration can consume. This is then followed by extreme attempts to remove the food from the body through vomiting (self-induced), laxatives, diuretics, excessive exercise or fasting. Such compensatory behaviors are done to avoid the weight gain that might result from the binge episode.

ii) The restricting type- In this compensatory style, no stone is left unturned by the individual to control (restrict) food intake. This involves not having food for long periods to the point of starvation. In the presence of others, they might deliberately eat slowly so as to control the amount of food consumption (Beaumont, 2002)

In social settings, people with anorexia might overdress or consume excessive liquids in case they’re being weighed. Their irrational cognitions noted by Bulik & Kendler (2000) include perception of death from starvation as an accomplishment and distorted thoughts like “Bones define who we are, let them show”. Severe medical consequences follow as a result of low body weight, which can include kidney failure, brittle hair and nails, osteoporosis (weak and brittle bones), damaged teeth enamel (due to repeated vomiting) and cessation of menstrual cycles. Anorexia Nervosa is found to be three times more prevalent in females than in males (Jones & Morgan, 2010). Although anorexia nervosa is rarer than other eating disorders, it has a very high morbidity rate (Sullivan, 2002). 

2. Bulimia Nervosa-

This eating disorder is quite similar to the symptoms shown by that of anorexia nervosa in terms of fear of gaining weight, binging and compensatory behaviors. However, one of the key distinguishing feature is the presence of normal or slightly obese body weight in contrast to the severely low weight in Anorexia. The DSM-5 defines Bulimia Nervosa with the following symptoms:

• The individual overeats food in a time duration too short for the amount to be consumed. Such incidents happen repeatedly.

• The individual experiences an inability to stop overeating during the binge episodes.

• In response to these episodes, the person engages in compensatory behaviors like purging, excessive exercise, and fasting to prevent weight gain.

The self-perception of an individual with bulimia nervosa is influenced by his/her body shape and weight. Due to the lack of control over the binge episodes, the individual might experience a variety of negative feelings like guilt, shame and hopelessness about the lack of control over his/her eating style. While someone with Anorexia might not acknowledge their maladaptive eating practices and their seriously low body weight, a person with bulimia has a better insight into their problem (Butcher, 2018).

3. Binge Eating Disorder-

Binge eating disorder involves consuming large amounts of food in a short period of time but unlike Bulimia Nervosa, it does not involve compensatory behaviors like misusing laxatives, diuretics, fasting, excessive exercise, etc. The DSM-5 mentions the following symptoms for binge eating disorder:

• The individual overeats food in a time duration too short for the amount to be consumed. They might eat the food rapidly till they are uncomfortably full. Such incidents happen repeatedly.

• During such episodes, the individual feels unable to stop eating even if he/she might not be hungry. 

• The individual eats  alone to avoid embarrassment about his/her eating style.

• Negative feelings like guilt, shame, self-disgust or depression over the lack of control over eating are experienced by the individual.

Binge eating disorder is found to predispose a person to obesity (Hudson et al., 2007).

Risk factors and causes of eating disorders-

1. Biological factors - due to factors like genes, abnormalities in hypothalamus, different biological set points and disruption in serotonin systems, the individual might not realize when he/she is sated. Such factors can also predispose a person to overeating.

2. Sociocultural Factors- Being exposed to Western beauty standards is found to create a social pressure on young girls and women to remain thin. (Becker et al., 2002)

3. Individual risk factors-  Being female is found to be the strongest risk factor (Jacobi et al., 2004). This might be because young women make for the majority of consumers of entertainment sources like magazines, tv shows, etc which further emphasize thinness in the fashion industry (Sypeck et al., 2004). An individual with perfectionism would also have a tendency to chase unrealistically high standards like a perfectly thin body leading to eating disorders. (Bruch, 1973).

4. Childhood sexual abuse- Incidents of sexual abuse in the childhood is also found to have a weak but positive correlation with eating disorders (Jacobi et al., 2004). However, the explanation behind this link is not clear.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5) (5th ed.). Washington, DC: American Psychiatric Association.

Beaumont, P. J. V. (2002). Clinical presentation of anorexia nervosa and bulimia nervosa. In C. G. Fairburn & K. D. Brownwell (Eds), Eating disorders and obesity: A comprehensive handbook (2nd ed., pp. 226-30). New York: Guilford Press.

Becker, A., Burwell, R. A., Gilman, S., Herzog, D. B. & Hamburg, P. (2002). Eating behaviors and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls. Brit. J. Psychiatry, 180, 509-14.

Bulik, C. M., & Kendler, K. S. (2000). “I am what I (don’t) eat”: Establishing an identity independent of an eating disorder. Am. J. Psychiatry, 157(11), 1755-60.

Butcher, J. N., Hooley, J. M., Mineka, S., & Dwivedi, C. B. (2018). Abnormal Psychology. Sixteenth Edition. New Delhi: Pearson.

Hudson, J. I., Hripi, E., Pope, H. G. & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol. Psychiatry, 61(3), 348-58.

Jacobi, C., Hayward, C., de Zwaan, M., Kraemer, H. C., & Agras, W. S. (2004). Coming to terms with risk factors for eating disorders. Psych. Bull., 130(1), 19-65.

Jones, W. R., & Morgan, J. F. (2010). Eating disorders in men: A review of the literature. J. Pub. Ment. Health, 9, 23-31.

Sullivan, P. F. (2002). Course and outcome of anorexia nervosa and bulimia nervosa. In C. G. Fairburn & K. D. Brownwell (Eds), Eating disorders and obesity: A comprehensive handbook (2nd ed., pp. 226-30). New York: Guilford.