Eating Disorders in Young Women
Growing up, Savannah always wanted to be a gymnast. At thirteen years old, her dream was finally achieved when she joined a competitive gymnastics team. In eighth and ninth grade, she was homeschooled in order to keep up her rigorous practice schedule. Throughout tenth grade and the rest of high school, she went back to school but continued practicing four hours before school and four hours after school. Needless to say, gymnastics consumed her life. However, all of her hard work paid off when she became a college gymnast at a private school in Pennsylvania. Throughout her time as a gymnast, her diet had always been extremely regulated. Therefore, when she first began purging at seventeen years old, she thought it was normal. Other girls were doing it, so she thought it must be acceptable. Soon she was eating only two meals a day and throwing up after both. Ten months later, Savannah was diagnosed with bulimia nervosa.
On the outside, Daisy never had body image issues. At her private school, everyone was paper-thin. Her thighs and hips might have been a little bigger than everyone else’s, but she embraced her status as a “thick girl” (who was by no means overweight) and joked about her love of food. Throughout high school, she had been dating the same boy for about three years when he broke up with her in the middle of junior year. The very next week, he was dating another girl who was considerably skinnier than her. She assumed that if she lost some weight, she could get his attention and get him back. She stopped eating; she enjoyed the high of being lightheaded and having an empty stomach. She lost nearly twenty pounds. She was never officially diagnosed with anorexia nervosa. However, her unhealthy eating behavior decreased during the summer. No longer surrounded by her peers and no longer seeing her ex-boyfriend daily, her motivation to starve herself decreased, and she began eating in a healthier manner.
In middle school, Kayla was ashamed of her nickname “Chicken-Legged Chappell.” She was self-conscious about being too skinny, but she loved being able to eat anything and everything she wanted without gaining weight. In a case similar to Daisy’s, Kayla’s boyfriend broke up with her the summer before her senior year. Since she was so upset from the break up, she lost some weight. She was feeling more confident in herself until she gained some of the weight back. She panicked and started trying everything to lose weight. After failing to lose any weight using diet pills, starving herself, and working out, she resorted to purging. At her worst point, she was forcing herself to vomit twelve times a day. She refused to admit that this behavior was unhealthy and went on to attend the Naval Academy. While at school, she began seeing a psychiatrist who helped her through her first semester. By the end of the year, the stress was overwhelming, and she began throwing up again in order to relieve stress. After multiple hospitalizations throughout the year, Kayla finally allowed herself to realize that she was suffering from bulimia nervosa.
Savannah is my “twin” in my sorority. Daisy is my best friend from home. Kayla is my roommate. Eating disorders have affected three of my closest friends, and I am only one of millions of young women in the United States. Eating disorders, especially bulimia and anorexia, are extremely prevalent among young women. The Diagnostic Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists six main eating and feeding disorders, including pica, rumination, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nervosa, and binge eating disorders (American Psychiatric Association, 2013). The first three disorders typically take place in childhood and are generally found in intellectually disabled children, while binge-eating disorders possibly correlate with obesity. As previously mentioned, anorexia nervosa and bulimia nervosa are the ones that affect young women the most. At any given time, nearly 44% of high school women are attempting to lose weight in comparison to 15% of males (Oltmanns & Emery, 2015). Generally, girls are trying to lose weight due to standards of beauty set by American society, while guys are trying to gain weight in order to abide by societal standards set for males. Males are expected to be strong, tough, and muscular, while females are expected to be thin. Thus, both disorders are ten times more common in females than in males and also mostly occur among women in their teens and twenties. Over a twelve-month period, the prevalence of anorexia nervosa among young women is .4% (American Psychiatric Association, 2013). The frequency of anorexia increased from 1 case per million people from 1930-1940 to 54 cases per million people from 1995-1996 (Oltmanns & Emery, 2013). This huge increase points to the changing standards of beauty in American culture, but these standards are relative to individual cultures. Bulimia’s lifetime prevalence is 1.5, and 50% of all people with anorexia often binge and purge as well (American Psychiatric Association, 2013).
Although the word anorexia is derived from a word meaning “loss of appetite,” (Oltmanns & Emery, 2015), anorexia is actually a disorder in which one starves oneself. However, people suffering from anorexia do not have a decreased appetite; they are hungry and refuse to eat or eat very minimally in order to lose weight. According to the DSM-5, anorexia nervosa is characterized by three symptoms: significantly low body weight, intense fear of gaining weight, and a distorted body image. Significantly low body weight is generally described as a Body Mass Index below 18.5 kg/m2 (American Psychiatric Association, 2013). A distorted body image results from evaluating one’s self-worth based on one’s body weight and also contributes to the fear of gaining weight. People with anorexia have an expectation of how they want their bodies to look, and they see nothing unhealthy about their appearance nor do they understand the effects that starvation can have on their bodies. As a matter of fact, 5% of people suffering from anorexia pass away from simply starving themselves to death (Oltmanns & Emery, 2015). The other 95%, however, can still suffer from medical complications that are brought about as a result of this disorder, including amenorrhea, abdominal pain, anemia, impaired kidney function, bone loss, cardiovascular problems, dental erosion, and electrolyte imbalance (American Psychiatric Association, 2013). Not providing one’s body with enough food can have dangerous consequences.
Bulimia nervosa is similar to anorexia in that both disorders result from an emphasis on weight and shape, but bulimia differs in the actual execution of that desire to lose weight. Anorexics starve themselves, while bulimics engage in binge eating then compensate that over-eating with an unhealthy behavior, such as purging, misuse of medicine, extreme exercise, or rigid fasting (American Psychiatric Association, 2013). Binge eating is characterized by a lack of control and may be triggered by an unpleasant event; people gorge themselves on food to the point that it makes them sick. After binge eating, bulimics then purge their stomachs by forcing themselves to vomit or using laxatives, diuretics, or enemas. This method is obviously not healthy and not that effective for weight loss. Often, amount of food vomited from one’s stomach depends on the amount of food eaten during the binge. In a study conducted by Kaye, W. H., et al., the researchers found that both participants who ate significantly large amounts of calories (more than 2600 kcal) and participants who ate smaller amounts of calories (less than 2100 kcal) retained about the same amount of calories after vomiting (1993). Thus, a larger binge dictates a smaller calorie intake. However, bulimia brings about other serious medical complications, including dental erosion, enlargement of the salivary glands, electrolyte imbalance, and rupture of the stomach or esophagus. Although bulimics may not necessarily starve themselves to death, they can still suffer dangerous consequences from repeatedly forcing their stomachs to such an unnatural task as purging.
Numerous factors influence the onset of both bulimia nervosa and anorexia nervosa, and like most mental disorders, one specific cause does not exist. Instead, the onset of both disorders is due to social, psychological, and biological factors. Social factors include the prevalence of the thin ideal in popular media, the positive and negative effects of social media, and familial conflicts. In the psychological realm, perfectionism, body dissatisfaction, and thin ideal internalization can also affect the onset of eating disorders. Biological factors may include genetics, but ultimately, no one cause exists. The combination of all of the factors is different for everyone and is what determines the appearance of eating disorders.
First and foremost, eating disorders are often affected by social circumstances, not only in an individual’s life but also in society and culture as a whole. Social factors include, but are not limited to, popular media, social media, and family relationships. All of these factors contribute to standards of beauty, which vary in different cultures. In more industrialized societies, the ideal woman is considered slender, but poorer cultures celebrate heftiness as a “symbol of beauty and success” (Oltmanns & Emery, 2015). Reasons vary as to why the ideal of thinness has become so widespread, but the most prevalent reason is the rise of popular media. Over the years, young women have gained more access to magazines, television programs, and movies, and the media has emphasized a thinner and thinner body type. Over a ten-year period from 1980-1990, researchers Wiseman, C., et al. measured the decreasing body weights and body measurements of Playboy centerfolds and Miss America contestants to determine how much the ideal of thinness decreased. Although a little outdated, the results found that the measurements and body weight stabilized at 13-19% below expected body weight (Wiseman, C. V., 1992) in comparison to the diagnostic criteria of 15% for anorexia nervosa in the DSM-III-R, the most recently published DSM at the time (American Psychiatric Association, 1987). Basically, some of the most beautiful women in America were represented in the media as having a body weight that is considered anorexic by the criteria in the DSM. Young women look to these women as role models and as an ideal of beauty and a standard to which they hold their own bodies. This standard is one that obviously cannot be attained by most women, but this standard that is so prevalent in the media contributes to the prevalence of eating disorders as young women attempt to morph their bodies to such an unreachable standard.
Another factor that affects young women with eating disorders is social media, a phenomenon that has only arisen in the past decade or so. As of June 2016, Facebook reports 1.13 billion daily active users (“Company Info,” 2016). Twitter claims 313 million monthly active users in June 2016 (“Twitter Facts,” 2016). Needless to say, a lot of people are using Facebook and Twitter and are using it often, and these two sites are only two of numerous social media sites available. However, since social media has not been around for long, not much research has been done. That being said, the available research brings up the concern of whether or not social media sites contribute to the increase of disordered eating. Based on a study done on Pro-Eating Disorder Twitter accounts, the researchers advocate that social media could provide a community in which people with eating disorders could find social support among those who are also suffering (Arseniev-Koehler, et al., 2016). The socialization of the topic could also decrease stigma and help get people talking about the mental illnesses (Arseniev-Koehler, et al., 2016). However, such communities could reinforce the identity of people with eating disorders and encourage poor body image and body dissatisfaction (Bardone-Cone & Cass, 2006). In study done on Facebook use and its relation to eating disorders, both benefits and negative effects were found. Similar to the Twitter study, the researchers found that Facebook can also provide “social and emotional support” (Walker, et al., 2015) which cultivates friendships and decreases loneliness. People who feel less lonely and feel more secure in their relationships with friends and family are less likely to suffer from eating disorders (Walker, et al., 2015). On the other hand, Facebook can also increase tendencies for eating disorders by increasing physical appearance comparison, which can lead to disordered eating (Walker, et al., 2015). Seeing one’s own pictures next to a friend’s can encourage poor body image and foster jealousy or desire to change one’s own body. The nature of social media promotes a superficial, appearance-based culture and contributes to women’s self-esteem issues. Overall, social media has numerous negative effects in regards to encouraging disordered eating behavior but could also possibly be used in a positive manner as a prevention and intervention strategy.
Another social factor in the prevalence of eating disorders is the quality of familial relationships. In a 2009 study conducted by Latzer, Lavee, and Gal, two groups of families were compared—thirty families with daughters suffering from anorexia or bulimia and thirty families with healthy daughters in the control group. According to their report, previous research has been done on the presence of conflict within the parents’ marital relationship and the parent-child relationships within families who have a daughter suffering from anorexia or bulimia. However, this study sought to find a correlation between the quality of these relationships and the severity of the disorder (Latzer, et al., 2009). Indeed, the researchers revealed that the families suffering from eating disorders seem to have “higher levels of distress within their marital relationships and less favorable parent-child relationships” (Latzer, et al., 2009) in comparison to the healthy families. However, the study found an association between these variables but cannot definitely determine the sequence effects. Does the eating disorder affect the relationship with her parents? Or does the relationship with her parents affect her eating disorder? Overall, the parent-child relationship is the mediating factor between the quality of the parents’ marriage and the severity of the child’s eating disorder (Latzer, at al., 2009). The findings ultimately contribute to family systems theory by reinforcing the concept that a supportive, communicative relationship between parent and child can help a child manage her symptoms in a healthy manner (Latzer, et al., 2009). Even if marital quality is poor, a healthy parent-child relationship can lessen the effects of an eating disorder.
Both bulimia and anorexia are influenced by psychological factors as well, such as the, perfectionism, body dissatisfaction, and thin ideal internalization. Perfectionism is shown to be a factor in eating disorders, but again, it is not clear whether perfectionism causes a tendency to gain an eating disorder or whether eating disorders result in perfectionist tendencies. According to a review article done by Bardone-Cone et al., perfectionism can contribute to eating disorders because of the drive to “attain or maintain social status” (2007). Perfectionists tend to search for validation through social feedback. Since body weight is a value that is easily measured and compared, young women are easily able to use their weight as a means to compare themselves to others and as a means to measure their success. Perfectionism also results in women desiring to cover up imperfections or mistakes (Bardone-Cone, et al., 2007), which makes sense because women with eating disorders have body images which they perceive as imperfect. Women develop these eating disorders in an attempt to perfect their bodies. Overall, the thin ideal internalization is a prevalent factor among individuals with eating disorders. As previously discussed, both the popular media and social media contribute to the internalization of the “thin ideal.” Societal standards hold that being skinny is equivalent to being happy, and when young women internalize that concept, they become more susceptible to eating disorders. Internalization of the thin ideal results in more body dissatisfaction, which leads to disordered eating behaviors. Specifically, body surveillance is a mediating factor that can also increase body dissatisfaction; body surveillance is the behavior of constantly checking the appearance of one’s body (Fitzsimmons-Craft, 2012). Thus, perfectionism and body surveillance lead to body dissatisfaction, which makes young women more likely to fall prey to eating disorders.
Lastly, biological factors also contribute to the appearance of eating disorders. Since cultural effects are so widespread, why do more women not suffer from eating disorders? Obviously, some biological factors must be in play. However, not as much research has been done on the topic, and not much can be proven, especially when it comes to genetics. Ultimately, not everyone is affected by the social and cultural influences of the thin ideal (Culbert, 2015). Secondly, psychological factors that were previously discussed, like perfectionism or other personality traits, could be “rooted in one’s genes and neural circuitry” (Culbert, 2015). Thus, genetics may result in a susceptibility to develop an eating disorder, but overall, no one cause is responsible for eating disorders. All factors interact and create the perfect storm that is unique to every individual that allows for disordered eating behaviors.
The bottom line is that eating disorders affect so many young women, and more research needs to be done in order to find out more specific causes, develop effective methods of treatments, and determine prevention strategies. Like I mentioned previously, I am only one person, and I know three women in my life whose lives have been altered because of eating disorders. In my opinion, I think that young women should be taught about healthy eating habits and healthy body image from a young age in order to prevent disordered eating behaviors from even becoming an option. If girls could be taught that self-esteem is worth so much more than one’s appearance, I think that girls could challenge society’s thin ideal and refuse to succumb to the body dissatisfaction that results in disordered eating.