There is a high rate of reported child sexual abuse experiences in clinical groups of who have been diagnosed with anorexia. Although “prior sexual abuse is not thought to be a specific risk factor for anorexia, those who have experienced such abuse are more likely to have more serious and chronic symptoms” (GoogleHealth, paragraph 15).
Family and twin studies have suggested that genetic and environmental factors account for 74% and 26% of the variance in anorexia nervosa, respectively (K.L. Klump, pg 737). This evidence suggests that “genes influencing both eating regulation, and personality and emotion, may be important contributing factors. In one study, variations in the norepinephrine gene promoter were associated with restrictive anorexia nervosa, but not binge-purge anorexia (though the latter may have been due to small sample size).” (R.E. Urwin, page 652).
Trauma plays an important part in the development of anorexia, and it is extremely important to note this; as it is something very evident (I have had personal experience with trauma and eating disorders) and is proved by many studies, like the ones above. This topic of whether or not trauma is important in the development of anorexia is a debate that seems to have come to a bit of a conclusion: YES! It is important.
The video below is an excerpt from the show Intervention and it focuses on an extremely anorexic female named Emily, whose disease reared its head following a rape she experienced in college. The discussion of the rape starts in part I at 8:35 and continues into part II. Emily’s eating disorder started immediately after the rape, and it is detailed in part II at 0:43. This is part I and part II of the episode; the rest can be found here: http://www.youtube.com/view_play_list?p=FE28432A38BFD4CF&search_query=emily+intervention
EMILY – INTERVENTION SEASON 4 EPISODE 51
Does competition affect food choice in women? Women are typically very competitive within their sex (as are men), and a study was done by Patricia Pliner, Sana Rizvi, and Abigail K. Remick (PhD, BSc, and MA, respectively) with the objective of examining women’s food choices “after exposure to a threatening upward social comparison in an achievement situation.” (Pliner, Rizvi, & Remick, paragraph 3).
In the study, female university students performed three tasks in the presence of another person; for some, the situation was competitive and the women were made to feel that the other person was likely to outperform them, whereas the remainder performed under noncompetitive circumstances. After completing the tasks, all participants chose a food to eat in a supposedly unrelated taste test. The researchers expected and found that participants in the high threat condition, in comparison with those in a low threat condition, would be highly motivated to restore their sense of self-worth by successfully competing in an area unrelated to the original inferiority and would, therefore, choose a lower calorie/more nutritious food. A secondary analysis revealed that it was primarily dieters whose food choices were affected by the threat. This is extremely important because it implies that, for dieters, competition by means of food choice can provide a means of restoring self-regard when self-esteem has been threatened in some other area. This is extremely important to note because it is in keeping with a trait that is seen in almost all anorexics, including myself: perfectionism – and thus competition as well as a desire to be the best at everything. In this study, dieters were found to be the most competitive. I liked this study because it doesn’t just focus on anorexics (yet it can be applied to them), it focuses on average women – some who diet and some who do not. It is interesting to see the correlation between food restriction/dieting and the competitive desire to be the absolute best.
Researchers mainly agree that these traits are present in anorexics, and I believe that further research on this topic should focus on determining how similar dieters and anorexics are and use that information to figure out what exactly causes eating disorders, because there are many factors that may cause an eating disorder – but these speculations are very vague.
Additionally, it is important to note the competitiveness in women when dealing with food and dieting, especially when faced with side effects like these:
What drives a woman to put herself at the mercy of these problems? Is it purely competition or are there other factors? Research on this topic, I believe, is crucial!
The A&E documentary Intervention follows drug, sex, food, shopping, and gambling addicts as they go about their lives. It focuses on their addictions until the family stages an intervention for the addict. One of the episodes chronicles the eating disorders of two sisters, Sonia and Julia. Additionally, it shows how detrimental codependence is when dealing with anorexics (who are impressionable people to being with). Sociocultural studies have highlighted the role of cultural factors, such as the promotion of thinness as the ideal female form in Western industrialised nations, particularly through the media (GoogleHealth, paragraph 11). “A recent epidemiological study of 989,871 Swedish residents indicated that gender, ethnicity, and socioeconomic status were large influences on the chance of developing anorexia, with those with non-European parents among the least likely to be diagnosed with the condition, and those in wealthy, white families being most at risk.” People in professions where there is a particular social pressure to be thin (such as models and dancers) were much more likely to develop anorexia during the course of their career, and further research has suggested that those with anorexia have much higher contact with cultural sources that promote weight-loss. (J. Toro, pg 147-151).
Indeed, codependence often plays a huge part in the development of anorexia, especially when there is trauma involved. Anorexics may find it hard to be alone and instead prefer to be codependent. This “presents a way to be competitive while still clinging onto something ‘safe'; it is quite important to [anorexic] patients”. (J.C. Carter, pg 270).
INTERVENTION – SEASON 7 EPISODE 91
The social impacts on Anorexia are typically negative and detrimental to the health of the anorexic. In America, one can view the trend that seems to be happening: the more the exploitation, the worse the disease (this is only applicable for people who have a predisposition to eating disorders). Lindsay Lohan is a great example: this actress is all over television and magazines, and the poor girl has been publicly struggling with an eating disorder for a long time. The rape that I experienced led me to believe that I was worthless. After I was raped, I woke up behind a dumpster and tried to find my way home. I immediately told my mother and we went to the police station. My rapist was caught and put in jail. Somehow, people at my school discovered what happened to me and were actually disgusted by me, which was something I feared from the start. From that moment, the rape seemed like a catch-22: I’m damned if I do, and I’m damned if I don’t. Reporting the rape proved to be more detrimental than helpful because of the fact that I was only in sixth grade and everyone was treating me like trash. A couple of weeks later, my eating disorder developed.
Ever since that day I have wondered, do other anorexics feel like I did? Do they see social determinants that have affected their disease? Although anorexia is a mental disorder, there are so many social aspects that need to be discussed. The debate in question is whether or not anorexia is influenced socially, and although I and other research believe that it is, there are some researchers who believe it is solely a mental disorder that takes place in the anorexic’s brain. Anorexics are impressionable and often described as “lost” (helpguide.org, pg 2), meaning that they will be “socially influenced more than people who have healthy eating habits.” (MayoClinic.org, pg 5).
The prevalence of eating disorders in society has been increasing exponentially every year. Anorexia Nervosa is characterized by extremely low body weight, distorted body image, and an obsessive fear of gaining weight. Anorexia has, according to Mayo Clinic(.org) “an incidence of between 8 and 13 cases per 100,000 persons per year and an average prevalence of 0.3% using strict criteria for diagnosis.” The condition mainly affects young adolescent females, with “females between 15 and 19 years old making up 40% of all cases.” (MayoClinic.org, pg 6). Furthermore, the majority of cases are unlikely to be in contact with mental health services, since anorexics often believe that their disorder is “a way of life” rather than something that will kill them. Additionally, approximately 90% of people with anorexia are female (helpguide.org, pg 2).
EDNOS, or Eating Disorder Not Otherwise Specified occurs when one does not meet the criteria for either anorexia or bulimia as stated in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), but still shows signs of disordered eating, which is a term that is used by the DSM-IV-TR to describe “a wide variety of irregularities in eating behavior that do not warrant a diagnosis of a specific eating disorder such as anorexia nervosa or bulimia nervosa.
The main difference between anorexia nervosa and bulimia nervosa is that according to the DSM-IV-TR criteria, anorexics possess a “refusal to maintain body weight at or above a minimally normal weight for age and height (e.g. weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected)”, while bulimics are of normal weight for their given height or are overweight.
A study that I will briefly mention examined the course of EDNOS compared with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) through a prospective study of 385 participants meeting DSM-IV criteria for the these disorders who were studied for four years.
The results shows that people with EDNOS remitted significantly more quickly than AN or BN but not BED. There were no differences between EDNOS and full ED syndromes, or the subtypes of EDNOS, in time to relapse following first remission. Only 18% of the EDNOS group “had never had or did not develop another ED diagnosis during the study; however, this group did not differ from the remaining EDNOS group.” (Agras, W. Stewart, paragraphs 4 – 7).
EDNOS appears to be a way station between full-ED syndromes and recovery, and to a lesser extent from recovery or EDNOS status to a full eating disorder.