Disordered - eating disorders.

Nicole Gendelman

December 14, 2003

Disordered

Open up a popular magazine. Watch a major motion picture. Flip to your favorite TV show. Undoubtedly you will be bombarded with depictions of “perfect” human bodies. Models whose thighs have diameters equal to that of their wrists, actors with abdomens that one could literally do laundry on, and celebrities whose exposed, impossibly flat midriffs only add to the magnificence of their designer gowns. In recent years, media such as this has come under scrutiny as being at the root of the epidemic of the eating disorder. Adolescent girls and sometimes boys, and although less common, adults, see these images as beautiful and turn to desperate and unhealthy measures of dieting in effort to replicate them, they say. It is true that the icons of our media present us with extremely high standards of beauty and very rarely represent what the average American truly looks like and, more specifically, weighs. However, since most Americans in their teens and twenties are both exposed to the media and experience natural insecurities about their looks, wouldn’t it make sense that more than 6% of them would develop eating disorders according to this model? Simply digging beneath the stereotypical and often glamorized view of what an eating disorder actually is proves that deeper motives and issues are at hand.

Consider the state of a patient about to become a casualty of anorexia nervosa:

“The starved body aches all the time. The skin bruises, the muscles cramp and deteriorate, the brain slows and slurs, the bowels stop working on their own, the bones splinter and hurt and break, the body is constantly weak but ceases to be able to sleep restfully... the mouth dries, the eyes fog, the heart flutters and beats hard and painfully, before ultimately quitting all together”.

The anorexic patient typically dies weighing under 60% of their former body weight, and is typically between the ages of 18 and 28 (ANRED). Here is a similar view of the lethal bulimia nervosa:

“The heart is damaged, the stomach and digestive system are unable to work properly and the aches and pains of simple digestion are horrible, including gas and heartburn of abnormal proportions, constipation and diarrhea, headaches and bellyaches and constant sore throats... the skin is aged and often broken out and grayish or yellowish… the body feels constantly nauseous, dizzy, agitated, anxious, and nervous.”

Most bulimics die over a toilet bowl while in the act of purging, and are also between the ages of 18 and 28 (ANRED). Glamorous, isn’t it?

Here’s the question: would anyone who experiences a simple desire to be thin and not a more complex emotional problem really consciously do this to their bodies, often destroying their health and ensuring an untimely death? The truth of the matter is that eating disorders are mental disorders, not diets, and the issues that cause so many young people to develop them must go deeper than the simple desire to be thin. There is much evidence to suggest that childhood situations, environments, and events can have a strong influence on many later developed mental problems, some of which have potential to manifest themselves as EDs (Kog). Thus, we need to be careful to avoid thinking of EDs in simplistic terms, like "anorexia is just a plea for attention," or "bulimia is just an addiction to food" and explore the reasons such individuals suffer from the disordered thoughts that lead to their disordered eating. In this way, more can be discovered about how to prevent eating disorders altogether, rather than just how to treat those that are already suffering.

This is a preview of the whole essay

Although both causes and symptoms vary widely from case to case, one trait that is believed to be at the root of every eating disorder is low self-esteem (Something Fishy). In fact, scientific research has proven that girls with low self-esteem are more likely to develop disordered eating in the next few years (Kog). Sufferers can feel like they do not deserve to be happy, and that the misery they undoubtedly experience is all that they are worthy of. They often feel like a burden to others, trivialize their own problems and feel as though other people deserve help more than them. It is not uncommon for eating disorder sufferers to be viewed by others as compassionate, warm, giving, sensitive, and intelligent people; but person suffering cannot see in themselves what others may. Many psychologists believe that this inability is developed during the first 7-8 years of life (Kog). Perceived rejection is a conditioned response.

This particular brand of low self esteem that ED sufferers experience often comes from the internalization of family dysfunction. Case studies of family interaction in households of ED patients show families to be enmeshed, intrusive, hostile, and negating of the patient's emotional needs (Something Fishy). The most obvious and brutal type of family dysfunction is child abuse. Abuse has been shown to predispose the development of a variety of psychological disorders, including depression and anxiety, both of which are also found in 76% of individuals suffering from eating disorders. Thirty to forty percent of ED sufferers experienced verbal, physical, or sexual abuse by a parent or close family member. Those that turn to an ED tend to feel that the abuse was deserved, that they were and are wrong, and that they deserve to hate themselves. Sexual abuse in particular can lead one to a severe feeling of detachment and shame towards their body, leading to the abuse of it with an ED. In some cases the child may develop anorexia, where they feel "disgusting" and "dirty", want to push others away and feel a desire to be "invisible"; they may even starve themselves over the simple principle that they do not deserve food. In bulimia and compulsive overeating, even more common among former abuse victims, food is used to fill a void inside and numb all the negative feelings and keep them internal, quite like a drug. Purging for bulimics often serves as not only a way to rid oneself of calories, but also a huge release of their emotions and a punishment for enjoying something they don’t feel they deserve (Kog).

Emotional, physical, and sexual abuse are the most clear-cut and easily recognizable family issues that lead to unhealthy psychological pathology. However, the remaining 70% of ED sufferers that did not experience outright abuse experienced a different, less detectable, less deliberate kind of damage to their self-esteem. In fact, in a recent poll of teenage and young adult eating disordered women, 47% described their family life growing up as “normal, healthy, and usually happy”. The psychological state one develops prior to an eating disorder can be a manifestation of unhealthy parenting strategies that would go undetected to many of us (Polivy).

Imagine a typical American family sitting around the dinner table. Since these days, the typical American family is divorced; there is a mother and her two children. The 6-year-old girl announces proudly to her mother that she climbed to the top of the jungle gym by herself for the first time today at recess, but her mother, immersed in the front page of the newspaper, answers with a preoccupied “that’s nice, honey”. Reading an article about Miss America’s current charity work, the mother haphazardly comments out loud on how important it is to be beautiful to make it somewhere in the world. Putting down the newspaper, the mother glances at her younger daughter’s plate and threatens no dessert if her vegetables are not finished. “I finished mine, Mommy,” boasts the older 8-year-old sister. When the younger daughter questions why her mother is not eating any spaghetti, her mother replies that she is on a diet. “You ask too many questions all the time, Suzy,” she adds.

This may seem like a somewhat normal scene. But although not outright dysfunctional or abusive, a constant family dynamic such as this is putting children at risk for developing an ED in various ways:

1. 58% of ED sufferers come from broken homes (ANRED). Of course, a divorce in the family does not automatically lead to mental problems or an ED. However, many parents tend to become withdrawn from their children during a separation progress. Depending on the child’s age, this can lead to significant disruption of normal attachment development. Within the past few years, several studies have found that attachment processes are abnormal in eating-disordered teens and young adults (Polivy). Lack of a strong parental bond leads to lifelong feelings of loneliness and seclusion in the world as well as an inability to form other healthy relationships. All of these problems are common in ED sufferers. Also, a common tendency of children of divorce is to turn their familial problems inward, often feeling as if they have done something wrong or the divorce is in someway their fault. These feelings, although they may be subconscious, understandably promote a low self-esteem.

2. Children naturally seek acceptance from their parents and require a certain level of validation from them in order to develop a healthy sense of self worth. Giving a child appropriate praise and showing genuine interest in their accomplishments is essential in order to raise a child with adequate independence and confidence.

3. More often than one might imagine, young girls pick up on their mothers’ emphasis on weight and/or looks and apply this outlook to their own lives. Many mothers even allow their superficiality to transmit to their daughters, making comments about weight and beauty as early as age 3 (Something Fishy). Obviously, constant judgments of outward appearance can have devastating effects on a child’s self-esteem. Even without these direct judgments, though, mothers who overstress the significance of appearances in general nearly double their daughters’ chances for developing an ED. Also, simple modeling of weight and shape concerns (i.e. a child whose mother is overly concerned with her own weight starts her own extreme diet) is very common and something that mothers are often unaware of. Girls as young as 6 were found to be actively “dieting” in a recent study, and when asked why, the most common response was “because Mommy does it” (Polivy).

4. A very common mistake made by parents is the use of food as a form of discipline. Threatening such things as smaller dessert or no dinner as punishment subconsciously teaches children to view food as a prize, something that should be desired but must be deserved. In the future, they may continue to use food as a form of punishment; low self-esteem leads anorexics to deprive themselves of food because they don’t feel they deserve it, for example. This type of discipline also can lead to a pre-occupation with food and the placement of too much importance on it in everyday life. One of the biggest symptoms of any ED is an obsession with food. Many ED sufferers think of their lives as revolving around food—whether it be deprivation of it, overindulgence in it, or stress over it (Kog).

5. Jealousy and competition between family members is a common complaint of patients suffering from specifically bulimic or compulsive overeating disorders. Children who must compete with a sibling for parental attention, for example, may begin to go to extreme measures to be noticed or develop extreme anxiety about their situation. A more disturbing but surprisingly common feeling of resentment often exists between a mother and her daughter. Many mothers cannot help feeling jealous of their teenage daughters youth and appearance, but this is something that should never be commented on. Fitness competitions, weight-loss races, and dueling diets are things that should never take place in a healthy mother-daughter relationship (Kog).

6. ED patients almost always describe a critical family environment growing up. Parents who expect too much from their children in any aspect of life or pressure them too hard put their children at risk for the development of many future psychological problems. Even parents who simply want the best from the children often go about it the wrong way. Encouragement and positive reinforcement are healthy ways of helping to drive children toward success, while criticism and obvious dissatisfaction can not only lead to low self-esteem and feelings of tremendous guilt, but also the extreme perfectionist behavior that is common in anorexics (Something Fishy). In many cases, parents are not purposely or explicitly critical of their children, rather they fail to recognize the drastic effects casual haphazard comments and indirect judgments can have on their child’s pathology. A common reaction in specifically females to criticism is the belief that everything would get better and everyone would love them if they could just lose weight.

More directly, these negative features in the family dynamic lead to depression and anxiety problems during adolescence. It is depression and anxiety though, that often lead patients to try to drastically control their weight in an attempt to gain control over their lives in general (ANRED). In any case, it is poor self-esteem, problems with identity, and lack of control that are central characteristics in ED sufferers, and these are all features whose directions are determined mainly during childhood. As we have seen, the underlying contributions to these problems are not always as explicit as we may think. It is essential that parenting not be overlooked when we explore why certain people develop eating disorders. Although it is difficult to determine from studies whether family dysfunction contributes to EDs, EDs contribute to family dysfunction, or some common factor contributes to both, the two conditions seem to almost always exist mutually, and so it is worthwhile to explore the possible negative effects family influences can have. The attempt of individuals to resolve problems of their life by investing emotionally and behaviorally in the pursuit of slimness or the abuse of food is an unfortunate and deadly trend that must be addressed, but perhaps more beneficial will be to explore where these problems originate in the first place.