The Psychology of Eating Disorders
Eating disorders are on the rise in North America. While many people think they are the result of a conscious choice influenced by culture alone, this is not the case. Recent research demonstrates that eating disorders are illnesses with psychological and neurobiological roots.
What Are Eating Disorders?
Eating disorders are a range of issues associated with eating, food, and body image. Despite popular belief, eating disorders are not a lifestyle choice. They are serious illnesses, which can be life-threatening. In fact, eating disorders are considered to be psychological disorders, especially when they interfere with an individual’s life.
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Eating disorders are more common among females than males. However, males do suffer from eating disorders, too. Men are just less likely to seek help for their condition.
Types of Eating Disorders
There are many types of eating disorders, but three of the most common are: anorexia nervosa, bulimia nervosa, and binge-eating disorder.
Individuals with anorexia nervosa fear weight gain and fat. Their goal is usually to maintain a very low body weight and they do this by severely restricting food, excessively exercising, and constantly weighing themselves. Unfortunately, they don’t realize when this obsession crosses the line and becomes a danger to their health. Individuals with anorexia nervosa can be extremely underweight, yet see themselves as being fat. This leads to low self-esteem, as they believe their value lies in their thinness.
This is a very serious disorder which may cause thinning of bones, brain damage, infertility, and low blood pressure.
Individuals with bulimia nervosa, contrary to those with anorexia nervosa, do eat a lot of food. In fact, they typically eat uncontrollably, but this causes them to feel some guilt or anxiety about weight gain. So, to make up for the binge-eating, they purge (for example, inducing vomit), exercise excessively, or go on a fast.
Sufferers of bulimia nervosa tend to have a normal body weight, but they may have a chronically inflamed throat, acid reflux disorder, severe dehydration, and electrolyte imbalance (which is a risk factor for stroke).
Binge-eating disorder is the most common eating disorder in the United States. It is characterized by eating large amounts of food (even when you’re not hungry). However, it isn’t followed by purging behaviors, so binge-eaters are typically overweight or obese. Those with the disorder may try dieting, but may not lose weight.
What Causes Eating Disorders?
Eating disorders typically appear during the teen years, but they can begin in childhood or adulthood. We still do not have a clear understanding of what causes eating disorders, but research is being done to figure it out. What we do know is that eating disorders are caused by a variety of factors, including:
- Studies find that eating disorders run in families
- Researchers are trying to find the DNA variations associated with a higher risk of eating disorders
Social and Cultural
- Our culture idealizes thin bodies and this may encourage dieting, which can lead to an eating disorder
- A history of physical, verbal, or sexual abuse may contribute to the development of eating disorders
Psychological and Neurobiological
- Low self-esteem, depression, and anxiety may all contribute to eating disorders
- Anxiety disorders run in the families of individuals with eating disorders
- Individuals with eating disorders have a faulty reward-processing system and failure in the frontostriatal circuits that regulate behaviors
- They also have structural differences in the orbitofrontal cortex
Now let’s dive a little deeper into the psychology of eating disorders.
Co-morbidity with Mental Illnesses
Often, an individual does not present solely with an eating disorder. They typically have another mental illness, too.
Anxiety and Eating Disorders
In one study, 65% of women with an eating disorder also had an anxiety disorder. In the majority of cases, the anxiety disorder preceded the eating disorder.
One theory is that controlling one aspect of their life (eating and weight) temporarily relieves individuals’ anxiety. However, by continually practicing these behaviors, the development of an eating disorder may occur. Further research needs to be done to establish exactly why the comorbidity rates are so high between the two types of disorders.
Depression and Eating Disorders
Depression is another common psychological disorder that is comorbid with eating disorders. In women with anorexia nervosa, major depression is the most common comorbid disorder. Sadly, those with anorexia are 50 times more likely to commit suicide than the average person. In those with binge-eating disorders, an estimated 50% also have depression.
Why do these types of disorders occur together? Well, it may be that eating disorders can lead to depression, as these may cause physiological changes. Or, it may be the other way around — with depression and feelings of low self-worth causing the eating disorder.
Is Anorexia an Anxiety Disorder?
So, anxiety and eating disorders are comorbid. But, is it possible that anorexia itself is actually an anxiety disorder?
In one study, researchers hypothesized that it is. So, they looked at the prevalence of anxiety disorders in first-degree relatives of those with anorexia. They found that first-degree relatives had three times greater risk of having generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD). These findings suggest that anorexia should be classed under anxiety disorders, but more research is needed.
The Role of Low Self-Esteem
There are many different definitions of self-esteem, but the most commonly used definition is “a favorable or unfavorable attitude toward the self.” Perhaps you know someone with low self-esteem. They are likely to say negative things about their looks, intelligence levels, future, and overall value as a person.
People with eating disorders tend to have low self-esteem and there’s a vicious cycle between the two.
Many studies suggest that low self-esteem is a risk factor for the development of an eating disorder. Now, you may be thinking that this association is really due to the high association between eating disorders and depression (since depressed individuals tend to have low self-esteem). But, that isn’t the case. One study found that low self-esteem occurs in patients with eating disorders, even in the absence of depression.
So, chronic low self-esteem seems to contribute to the development of an eating disorder. But, having an eating disorder further decreases self-esteem.
Altered Brain Circuits
When you eat a delicious dessert, your brain releases dopamine (the “pleasure” hormone) and you feel rewarded. But, in individuals with an eating disorder, this reward system is broken.
Researchers have found that in women with anorexia, brain circuits involved in reward processing are less active when they should be more active and vice-versa. Interestingly, dopamine triggers anxiety rather than pleasure in those with anorexia.
So, when some individuals bite into that same delicious dessert, their reward processing system is not as active as it should be and they experience anxiety, instead of pleasure. It’s no wonder, then, that they stay away from food.
What are the Structural Differences in the Brain?
In order to understand why the reward system is faulty in individuals with eating disorders, researchers have begun looking for brain areas which may be involved. They discovered that one brain area, known as the orbitofrontal cortex, is structurally different in those with eating disorders. This brain area normally signals us to stop eating.
Women with anorexia also have more activity in the dorsal striatum, the area linked to habitual behavior. In addition, their brains exhibit differences in the right insula, which normally helps us to process taste sensations.
So, what does all of this mean? Do these brain changes occur as a result of eating disorders or is it the other way around? The truth is, we don’t know. It’s likely that some pre-existing differences exist and those predispose an individual to an eating disorder. Then, further differences result due to the eating disorder.
The Impact of Explanations
Interestingly, one study looked at how different explanations for eating disorders impacted patients (in terms of how much they blamed themselves for the disorder and their treatment outlook). The study recruited individuals who scored high on the Eating Disorder Examination Questionnaire but had never received treatment.
The results were that those who were given a biological explanation of eating disorders were more likely to see the illness as set in stone — and less treatable — than those who were given a cognitive-behavioral explanation (i.e. they were told the illness is rooted in things such as body image).
This suggests that professionals (therapists, counselors, doctors, etc.) should focus on educating patients that their disorder has roots in both biological and behavioral factors, but that doesn’t mean that it’s permanent. There are many options out there for those who need help.
Outlook & Treatments
Based on the information presented, it is quite clear that eating disorders are true psychological disorders. Perhaps this will allow the stigma surrounding eating disorders to fade away.
Knowing that eating disorders are comorbid with mental illnesses (such as depression and anxiety), linked to chronic low self-esteem (even in the absence of depression), and associated with altered brain circuits and structural differences in the brain may help in treatment.
Currently, some common treatments for eating disorders are:
One type of psychotherapy approach is family-based therapy. A common example of this is the Maudsley approach, in which parents play an active role in restoring their adolescent’s weight and eating behaviors. There are three phases to this method: weight restoration, returning control over eating to the adolescent, and establishing healthy adolescent identity.
Another type of psychotherapy treatment used by individuals with eating disorders is cognitive behavioral therapy. This helps individuals to recognize and change their distorted thinking patterns.
Studies have found that medications used in treating psychological disorders, such as anxiety, depression and mood disorders, are also useful in the treatment of eating disorders.