Over the past few decades, both men and women have been subjected to strong social pressures to stay thin at all cost. We tend to point the finger at these social pressures as the single factor responsible for the increasing incidence of anorexia and bulimia, whereas they often simply activate an individual's existing vulnerabilities.

Understanding these illnesses and their causes is essential to preventing and treating eating disorders, and promoting healthy lifestyles for affected people.

What are eating disorders?

Eating disorders are complex illnesses characterized by an intense preoccupation with food, weight and and body image that is abnormal and often dangerous (a systematic refusal to eat or induced vomiting) and coexists with other potentially serious problems like depression, anxiety, alcohol, and drug abuse. Eating disorders go far beyond excessive dieting. They must be treated to prevent serious physical, psychological or social consequences.

An eating disorder may fall within three chronic disorders though some people may exhibit symptoms of more than one eating disorder:

Bulimia

The word bulimia, from the Greek boulimiôn, literally means “ox hunger” or “excessive hunger.” This disorder is also related to binge-eating disorder, or compulsive overeating.

Bulimia nervosa is a serious disorder that is characterized by episodes of uncontrolled binge eating. This excessive food intake can occur after extended periods of food restriction or caloric deprivation. Often accompanied by feelings of shame or guilt, episodes of binge eating are frequently followed by vomiting or the use of laxatives or diuretics to avoid weight gain. These compensatory actions are called purges.

Purging makes people with this disorder feel in control of their bodies. In reality, it makes them lose control, as they no longer feel guilty about overeating. Purging may seem like a way to control weight, but it actually does more harm than good and is even dangerous over the long term.

Binge-eating disorder

Binge-eating disorder is characterized by episodes of binge eating followed by feelings of shame and guilt without compensatory actions. Also called compulsive overeating, this disorder is often linked to diets or depression.

Anorexia nervosa

Anorexia nervosa is characterized by a refusal to maintain a normal body weight for one's age and height. Individuals suffering from anorexia nervosa are afraid of becoming obese and force themselves to follow very restrictive diets that can include episodes of bulimia and purging.

Even when anorexics lose weight, they live in continual fear of gaining it back, as they have a distorted perception of their body image and see themselves as “fatter” than they really are.

Symptoms of eating disorders

Bulimia nervosa

• Episodes of compulsive eating
• Purging behaviour
• Frequent mood swings, irritability
• Withdrawal or isolation
• Impulsivity or actions without regard for consequences

Anorexia nervosa

• Significant weight loss
• Intense fear of gaining weight or losing control over weight gain
• Preoccupations and obsessions with low-fat/low-calorie food
• Appearance of rituals and particular eating habits
• Excessive exercise
• Social and emotional withdrawal

Who is affected?

Eating disorders usually start during adolescence or young adulthood and are more common among youth in industrialized societies.

Eating disorders affect girls and women more than boys and men. Men represent about 10 percent of individuals with eating disorders.

In Quebec, approximately 3 percent of women between 13 and 30 (i.e. 30,000 people) are affected by an eating disorder. This number can triple if we include the partial forms of these disorders that can have a significant impact on affected people.

Experts agree that more and more people are struggling with eating disorders. Although statistics show a higher incidence of EDs among school-age Western women, the truth is that everyone is at risk.

• Although more present in industrialized societies, eating disorders occur even in developing countries.
• Eating disorders affect all socio-economic classes equally.
• Although African and Asian populations are the least affected, the risk of eating disorders among these populations is never zero.

Causes of eating disorders

Eating disorders are likely caused by a combination of biological, psychological, and social risk factors.

Biological factors

They include heredity, weight problems, and family history of depression, anxiety, or eating disorders.

Many studies have demonstrated the role of genetics in eating disorders. EDs are clearly transmitted within families, meaning that heredity is indeed a factor. While study data have not proven that eating disorders are automatically transmitted from mother to daughter, for example, they do indicate a possible transmission of temperamental traits or a vulnerability to other stressors that seem to increase the risk of developing these disorders.

Defects involving the neurotransmitters that regulate appetite and mood are also thought to have an influence on eating disorder development. Researchers at the Douglas are now carrying out cutting-edge studies on this subject. Their research also focus on the genetic factors of eating disorders and the brain activity of the persons suffering from the disease.

Social factors

They include family or peer group problems, lack of support, a tendency to judge or value people according to their physical appearance, sports and occupations that emphasize physical appearance and weight, and sociocultural pressure linked to the importance of being thin.

Society has always conveyed an ideal model of beauty, and over time this ideal has become thinner and thinner to the point of emaciation. The media contribute to this ideal by reinforcing many stereotypes and standards that put pressure on women and drive them to follow draconian diets that are harmful to health.

This cult of thinness also stems from multi-billion dollar marketing strategies. Women must appear submissive and are only valued when seen as objects or as delicate and dependent. However, these ideals of thinness and femininity are simply marketing tools that help fuel a prolific industry.

Social pressure is associated more with the different forms of bulimia rather than with anorexia. Indeed, bulimia seems to have increased noticeably in recent years and is localized more specifically to industrialized societies. Anorexia, on the other hand, has been present around the world for a long time and is therefore thought to be less connected to social factors.

Diets
The media is filled with advertising about so-called miracle or foolproof diets, and dieting often acts as an eating disorder trigger in many people with a genetic predisposition. Without doubt, the first step for these individuals is to stop dieting.

Diets can also have harmful physical effects. For example, a moderate three-week diet can alter cerebral function and reduce the substances that control mood, thought and satiety.

Family influence
It is the position of the Academy for Eating Disorders (2010) that "whereas family factors can play a role in the genesis and maintenance of eating disorders, current knowledge refutes the idea that they
are either the exclusive or even the primary mechanisms that underlie risk."

Psychological factors

They include low self-esteem, poor body image, a feeling of not being adequate or of losing control, isolation or anger.

People in the grip of an eating disorder often exhibit specific behaviours:

Certain personality traits differ depending on whether the disorder is a purely restrictive type of anorexia or another kind of eating disorder. The distribution of these traits occurs along a continuum between two typical models, depending on the type of disorder.

The axis through the middle represents personality traits. People with eating disorders are spread out along this axis and their personalities vary between one of the typical models presented. (A list of traits for each typical model is shown at either end.)

It should be noted, however, that the majority of those with restrictive-type anorexia present more traits listed at the left of the figure, under the "X".

Consequences of eating disorders

Psychological consequences

• Anxiety
• Impulsivity
• Withdrawal
• Sleep disturbances
• Obsessive thoughts
• Emotional changes
• Difficulty concentrating
• Food preoccupations
• Depressed mood, irritability
• Impaired intellectual abilities.

Physical consequences