Eating disorders are a big problem among young women (and to a lesser extent, men and older women) and the social stigma around conditions like anorexia nervosa and bulimia nervosa can prevent people from seeking treatment. Magazines and newspapers are full of stories featuring pictures of actresses and models with jutting hip bones and visible ribs, accompanied by captions proclaiming them to be ‘shockingly thin’ and suggesting they ‘eat a few cheeseburgers’. What they don’t seem to appreciate is that some of the women they are shaming and gossiping about may be suffering from a serious mental illness. No one would publish an article saying that someone undergoing chemotherapy’s hair was looking a little thin, but stigmatising dangerously thin women seems to acceptable in the media.
The reason for this seems to be the lack of understanding about the causes of eating disorders. People often assume that sufferers are just extreme dieters – shallow people who could easily start eating properly again if they wanted to. In reality, it’s not that simple. A variety of biological and cultural factors play a part in causing and triggering eating disorders.
Eating disorders arise as a result of dieting and an extreme fear of gaining weight. We live in a society that tells us that thin = beautiful, therefore people diet in order to achieve the ‘perfect’ body. Of course, not everyone who diets develops an eating disorder; a variety of biological and environmental factors push some people into disordered eating habits that can cause severe health problems and even death.
It has recently been suggested that eating disorders have a complex genetic cause, with family studies showing that concordance rates in monozygotic (identicle) twins are around 55% for anorexia and 35% for bulimia. Prevalence of other psychiatric conditions with genetic risks, such as anxiety and substance abuse, is greater in people with eating disorders than the general population, suggesting some shared risk.
Research into the neurobiology of eating disorders has shown that 5-HT (also know as serotonin) dysfunction may be a biochemical contributor. 5-HT is a monoamine neurotransmitter with numerous functions, including regulating mood, sleep, and eating patterns, and altered 5-HT signalling has been associated with a number of behavioural illnesses. Studies focussing on anorexia have found decreased numbers of 5-HT2A receptors and a reduction in brain 5-HT turnover. Reduced serotonin can cause anxiety, which can in turn trigger obsessive restriction of eating.
Psychological disturbances are also known to contribute towards development and maintenance of eating disorders. Inability to control various aspects of their lives causes many sufferers to restrict their food intake in an effort to gain back control over their own lives. Body dysmorphia, where a person’s perception of their body looks is greatly different from the reality of the body size or shape, can lead to sufferers believing that they are larger than they really are, driving them to lose dangerous amounts of weight.
Going back to the idea that thin = beautiful, social pressures are another factor in the development of eating disorders. Young girls whose friends are dieting are more likely to diet themselves, and believe that they must be thin in order to ‘fit in’. Outside of the immediate peer group, things like fashion magazines and films almost exclusively contain thin women whose bodies are seen as aspirational. Higher socioeconomic status increases the risk of eating disorders. The exact reasons for this relationship are unclear, but it could be due to things like high-achieving parents pushing their children academically, resulting in anxiety and a feeling of not being in control of their own lives.
Many factors contribute towards development of eating disorders, and the science behind them is still unclear. However, what is clear is that they are serious illnesses that need to be destigmatised in order to encourage sufferers to talk to someone about their problems and seek help.
Janet Treasure, Angélica M Claudino, & Nancy Zucker (2010). Eating disorders The Lancet
Fairburn, C., & Harrison, P. (2003). Eating disorders The Lancet, 361 (9355), 407-416 DOI: 10.1016/S0140-6736(03)12378-1
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