Eating Disorders: No long shrouded in darkness
January 09, 2019
It’s not clear if we’re seeing an increase in eating disorder cases or simply a greater public exposure to a devasting disease that’s gone largely under-reported. An individual suffering with disordered eating can more easily conceal their addiction. Anorexia, Bulimia, binge/purge, binge eating, avoidant/restrictive intake and others aren’t obvious, perhaps undetectable until the disease begins to disrupt a person’s health, social and familial relationships, occupation and daily activities.
Shame and guilt keep patients from seeking treatment or reporting their problem, or they will deny having a problem. As a result, most of the numbers available are simply estimates, and more research is urgently needed. The numbers we do have (which many experts consider conservative) are staggering.
Today, in the United States, a death occurs every 62 minutes as a direct result of an eating disorder.1 And virtually all eating disorder patients suffer from a comorbidity issue, such as substance use, self-harming, Body Dysmorphic Disorder (BDD), mood disorders such as depression or anxiety, social phobias or any one a number of other co-occurring conditions, adding to the complexity of diagnosis and treatment planning.
The stakes are high for those with an eating disorder. There is a death toll: ten percent of all eating disorder sufferers will die of the disease. Those afflicted with Anorexia Nervosa are at greatest risk.
EMERGING FROM THE SHADOWS OF A NATIONAL OPIOID CRISIS Perhaps the disease has been overshadowed by the opioid catastrophe, or just cloaked in the darkness of misunderstanding and lack of research over the decades. It is clear, however, that disordered eating should be considered a national health emergency. At least 30 million people (of all ages) suffer from an eating disorder in the U.S., and that number swells to 70 million worldwide.1,2 Considering that eating disorders have the highest mortality rate of any mental illness, combined with the number of individuals at risk, what we’re seeing is nothing short of a crisis.
A DISEASE WITHOUT DISCRETION Eating disorders are seen in all age groups, all races and ethnic groups.8 Current research reports that genetics, environmental factors, and personality traits all combine to create risk for an eating disorder.9 Increasingly, the demographics of eating disorder patients are widening. Dr. Molly McShane, Medical Director for Monte Nido & Affiliates and Oliver-Pyatt Centers explains, “We’re seeing younger women, men and even children under the age of 12 struggling with this dangerous disorder.” McShane believes that a part of the cause may be found in modern society itself. “While we know that yes, there are environmental triggers, living in a fully developed, first-world country puts people at risk of an eating disorder.”
Research on the causes of eating disorders is evolving quickly and we continue to gain increased insight into risk factors that may contribute to the illness as serious study of the disease expands. We do know that causes are multi-factorial, and they reflect a complex stew of biopsychosocial factors that may intersect differently for each person. Dr. McShane and others use a variety of specialties, including medical, psychiatric and clinical care, nutritional counseling, along with Cognitive Behavioral Therapy (CBT) in their treatment of eating disorders. “To be successful [in treating eating disorders] treatment must be multi-faceted,” says McShane.
THE FAMILY, EATING DISORDERS AND RECOVERY Studies have reported that an astounding 46% of 9-to-11-year-olds, and 82% of their families are sometimes, or very often, on diets.5
Research also indicates that families of individuals with eating disorders tend to be overprotective, perfectionist, rigid, and focused on success. They have high, often unreasonable expectations for achievement and may place exaggerated attention on external rewards. Many children from these kinds of families try to achieve the appearance of success by being “thin and attractive,” even if they do not feel successful. If children perceive that they are failing to live up to the family’s expectations, they may turn to something that seems “easier to control,” something over which they would have more control or achieve success, such as restriction or weight loss.
Pathology within the family may also contribute to the disease of disordered eating. Many individuals with an eating disorder live in, or grew up in, families that exhibited dysfunctional or negative behaviors, such as alcohol and drug use.
In addition, domestic violence and divorce are not uncommon issues for those suffering with an eating disorder. Some individuals turn to an eating disorder after they’ve experienced a family trauma, such as sexual abuse, physical abuse or neglect. Significant trauma may lead to PTSD. Frightening events may cause severe anxiety, flashbacks and unwanted, repeated memories of the event.
TRAUMA Traumatic events such as physical or sexual abuse can promote the development of disordered eating.6 It is the aftermath of trauma, including shame, guilt, lack of control and more. The eating disorder may become the individual’s attempt to regain control or to simply cope with the powerful emotions. It’s estimated that as many as 50% — half — of those with an eating disorder may also be struggling with the memory of previous trauma.
At Kipu, we’re jumping in the fight against eating disorders and we’re currently working with a number of treatment facilities across the country that specialize in the treatment of disordered eating and behavioral health patients. Information and education are essential and we know that information makes the difference. When you see research stating that 50% – 80% of those at risk for Anorexia and Bulimia is genetic, you know too well that we have work to do.
Eating Disorder Coalition. (2016). Facts about Eating Disorders: What the Reasearch Shows http://eatingdisorderscoalition.orgs208556,gridserver.com/couch/uploads/file/fact-sheet 2016.PDF
LeGrange, D. Swanson, S.A. Crow, S.J., & Merikangas, K.R. (2012) 711-718
Marques, L., Alegria, M., Becker, A.E., Chen, C.-n.’ Fang, A., Chosak, A.’ & Diniz, J.B. (2011) Comparative prevelence , correlates of imparement, and service utilization for eating disorders across US ethnic groups. Implications for reducing ethnic disparities in health care access for eating disorders. International Journal of Eating Disorders.
Culbert, K.M. Racine, E.E., and Klump, K.L. (2015) Research Review: What we have learned about the causes of eating disorders — A synthesis of sociocultural, psychological and biological research. Journal of Child Psychology and Psychiatry, 56(11), 1141-1164.
Gustafson-Larson, A.M., & Terry, R.D. (1992) Weight-related behaviors and concerns of fourth-grade children. Journal of American Dietetic Association, 818-822.
Dancky BS, Brewerton TD, Kilpatrick DG, O’Neil PM. The National Women’s Study: Relationship of victimization and post-traumatic stress disorder to bulimia nervosa. Int J Eat Disord. 1997; 21(3):213-228.