Eating disorders are extremely complicated, difficult to treat, and have become a major public health issue, affecting more and more females and males of all ages. It is known that eating disorders do not discriminate and appear in more than 40 cultures worldwide.
Biogenetics play an important role in the development of an eating disorder. There is strong evidence supporting the presence of a heritable component to eating disorders. However, the genetic mechanisms are difficult to understand. It is exciting to know there are strides being made and there is advancement in this area. In our work with eating disorders, we seem to understand more about the significant influences from psychological, social and cultural forces.
Psychologically, individuals with eating disorders are emotionally dysregulated. They often present with low self-esteem, feelings of inadequacy, shame, and a lack of control in life. Patients with eating disorders often have difficulty expressing emotions and feelings, and may have difficulty in interpersonal relationships. They also have a higher tendency for other psychiatric conditions, such as obsessive compulsive disorder, depression, anxiety, and PTSD. We often see those struggling with an eating disorder having a history of trauma, including physical, sexual and emotional abuse, such as bullying about their weight.
Media and cultural influences play a part into the influences of eating disorders as well. The pressure to pursue thinness, the focus of weight and size in our society, and the dieting industry’s messages about the importance of “health” at all costs could contribute to unhealthy behaviors triggering the onset of an eating disorder.
While men can develop eating disorders, the conditions are more common in women. However, it is important to emphasize that men and boys do develop eating disorders. There is stigma that eating disorders are just a girl’s disease, so there may be a lack of awareness allowing eating disorders to go underdiagnosed in males.
Multidisciplinary assessment and treatment of the individual with an eating disorder is extremely important. Eating disorders have the highest mortality rate of any mental illness. However, with proper treatment, recovery is possible.
The case of Anna Westin
When Anna Westin lost 34% of her body weight as a sophomore in college, her parents realized the anorexia she had battled in high school had returned as a critical issue. Her doctor recommended immediate hospitalization.
That concern and quick action would have helped many patients get back on the road to recovery. It wasn’t to be for Anna.
The insurance company determined that inpatient care wasn’t medically necessary and refused to cover it. Due to many factors, Anna felt despondent, guilty about being a burden to her family and the cost of her care. In 2000, 21-year-old Anna Westin committed suicide.
In recognition of the dangers of eating disorders, U.S. Reps. Ted Deutch (D-Fla.) and Ileana Ros-Lehtinen (R-Fla.) recently introduced the Anna Westin Act of 2015 to clarify the Mental Health Parity Act, establishing that treatment for eating disorders must receive equal treatment with other healthcare issues. The act also calls for research into advertising practices that encourage eating disorders.
It takes more than just willpower
Eating disorders such as anorexia, bulimia and binge-eating disorder are serious illnesses that put sufferers at risk of death from heart attacks, esophageal tears, and other physical consequences. The medical, nutritional, and physical complications are vast. Equally devastating is the intense shame, anxiety, and low self-esteem that is often experienced. Many people don’t know that not all insurances cover eating disorders. In fact, eating disorders are still seen as choices, attempts to get attention, and disorders of vanity. It is important to understand the predisposing factors in effort to understand the complicated nature and etiology of these devastating disorders.
Recovering from anorexia and bulimia isn’t as simple as exercising more willpower. Instead, those are complex disorders that often occur in individuals with a predisposition to them and the illness can be triggered by biological, psychological, social circumstances outside of the patient’s control.
The value of early screening
Understanding what predisposes someone to an eating disorder can help medical professionals provide early detection and intervention. Perhaps as the risk factors are better understood, pediatricians will begin screening children and adolescents for the conditions just as primary care physicians now screen for depression. Further, treatment should be a right, not a privilege just as any other physical illness. Recognizing predispositions and triggers, then seeking help as soon as a problem is detected can be a life-saver for individuals with eating disorders.