Eating Disorders Is There a Link/Relationship Between

Eating Disorders

Is there a link/relationship between pathological dieting and eating disorders in young adolescents? (no American quotes or stats as I'm in Australia)

Eating disorders and pathological dieting: An overview

According to the Australian Psychological Society (2011) it is estimated five percent of all women and girls are suffering from anorexia nervosa, and two to three per cent have bulimia nervosa and other eating disorders. Males also suffer from eating disorders, affecting an estimated ten percent of the total national eating disordered population. This translates into 0.5% and 0.5-1% of the Australian population as a whole who are identified as 'eating disordered' (Eating disorders, 2011, Women's Health).

Physicians and psychologists have reported a notable increase in the past decades in eating disordered patients in Australia. In 2004-05, 14% of all hospitalisations for mental and behavioural disorders in women aged 12-24 were due to eating disorders and in 2003, according to the Australian government, anorexia nervosa and bulimia accounted for 4, 639 years of healthy life lost due to illness or injury (Eating disorders, 2011, Women's Health). From 2004-2007 there was a reported four-fold increase in admissions for eating disorders in the past three years in hospitals (Clark 2010).

However, the reasons for this sharp increase are uncertain. Some eating disorder specialists hypothesize that this may be due to cultural factors, such as the increased valorization of thinness in the modern media. Another hypothesis is that affluence, urbanization, and the availability of food increase the cultural pressures to be thin for females. The increase in dieting, and the popularization of the 'diet industry' has also been cited as a reason for an increase in eating disorders, not simply anorexia, creating the physiological conditions for a 'feast and famine' cycle. Dieting has been credited with generating an unhealthy fixation on food. Binging after starvation diets is a common pattern in compulsive over-eating. Bulimia is often seen as one way of 'having one's cake and eating it too,' or finding a way to acquiesce to the pressures to indulge while still embodying an emaciated ideal.

One difficulty in accurately deducing the causes of eating disorders is that most of the data is based upon women who have been hospitalized. Many women with eating disorders are subclinical, or not severe enough in their behaviors to be detected by physicians, although they still engage in potentially dangerous and psychologically distressing behaviors. And while much higher rates of disordered behavior are reported in teenage girls, this could partially be a self-fulfilling prophesy of diagnosis, as physicians are far more apt to spot anorectic symptoms as such in teens, versus older adults and males who might initially be assumed to have a disorder which causes weight loss for medical reasons.

Individuals with eating disorders are often not forthcoming about their behaviors. It is estimated that for bulimics who did seek treatment, about five years lapsed between the onset of their full-blown symptoms and their decision to obtain aid (Eating disorders, 2011, Women's Health). Anorexics are even less willing to submit to treatment, and must be often coerced by family members to do so. Said Dr. Tracey Wade, a Senior Lecturer in the School of Psychology at Flinders University in Adelaide: "People with anorexia are actually proud of the problem. This is something they have worked hard to get and they see is it as an achievement. It makes them special and in control, and is a solution to their problem" (Ford 2003).

Regarding the relationship with engaging in extreme dieting behaviors and the development of full-blown eating disorders, one longitudinal survey of more than 3000 people in South Australia found an interesting trend: "The number of people regularly binge eating, abusing laxatives, making themselves sick or undergoing extreme fasting jumped from 4.7% in 1995 to 11% in 2005" (Clark 2007). The numbers of the same population manifesting full-blown eating disorders requiring clinical treatment remained relatively steady, but a wider swath of the population was engaged in disordered behaviors than before. According to the study's authors, this remains a cause of concern, given that subclinical manifestations can easily become full-blown. Many of the study's respondents identified the fear of being obese, and the rhetoric of the anti-obesity campaign of the modern media as the reasons for their disordered behaviors.

However, one common criticism of this and other studies of eating disorders is that even the designation between 'full blown' and 'subclinical' eating disorders can feel somewhat arbitrary. The DSM-IV has extremely specific, numerical criteria for what constitutes an eating disorder -- such as binging and purging at least twice weekly over three months for bulimia. Rates of clinically-identified bulimia would be much higher if the limits were raised to once a week (Ford 2003). The requirement of amenorrhea or cessation of menstruation for anorexics is an irrelevant diagnosis for males and can result in lower diagnostic rates for boys and men for the disorder. Additionally, even young women who are on the pill and artificially menstruate because of hormonal supplementation alone may be excluded simply on this basis (Ford 2003).

It should also be noted that even though eating disordered literature and hospital admissions focus on anorexia nervosa, and to a lesser extent bulimia, Bing Eating Disorder (BED) affects around 2% of the population, at a comparable rate to other EDs. The degree to which there has been an increase in BED is even more difficult to measure than anorexia, given that BED was only identified as disordered behavior and classified in the DSM very recently. The rapid increase in obesity does suggest, however, that the disorder is increasing given that being overweight is one of the primary symptoms of the disorder.

Perhaps the most significant finding has been in twin studies, comparing manifestations of all of the major eating disorders in twins. One study of the Australian Twin registry found that 59% of variance is genetic and 41% is non-shared environment related regarding eating disorders (Ford 2003). This supports the notion that the media, including dieting literature, cannot be entirely blamed for the rise in eating disorders. Conversely, however, it also underlines that subclinical and clinical symptoms can be environmentally related, given the clear impact of non-shared environmental factors in eating disordered behavior.