Chapter Two: Eating Disorders
overview of the chapter
In the podcast episode, I spoke to Dr. Meek about eating disorders and disordered eating. After reading this chapter, you will distinguish what is considered an eating disorder vs. disordered eating. You will also understand a few different types of eating disorders, including anorexia, bulimia, and binge eating disorder, and be able to identify their differences. Additionally, I will summarize the primary causes that contribute to these disorders’ onset and provide some helpful resources and the ones mentioned during the episode.
In the first section of this chapter, you will learn about eating disorders, disordered eating, and the differences between these two terms. Moreover, this section will also include an overview of the most prevalent eating disorders among undergraduate students and their underlying symptoms.
In the second section, I explain the multiple underlying causes of eating disorders. This section will highlight genetic, biological, sociocultural, multicultural, and environmental factors that influence eating disorders.
The third section will cover the useful resources mentioned in the podcast episode and add more beneficial resources.
Understanding Eating Disorders Among Undergraduate Students
Eating disorders (EDs) are complex mental health disorders that cause unhealthy eating habits that can take over your life and make you ill (Petre, 2019). Around 20 million women and 10 million men in the US have had or have an eating disorder (Hudson et al., 2007). Unfortunately, EDs are becoming more and more prevalent in universities (Roberts, 2018). College is a time when students may begin to be aware of their bodies in new ways as they form different relationships and undergo a transition period in their lives. This period can leave them especially susceptible to EDs. As mentioned in the podcast episode, EDs have high university student rates, ranging from 8%-32% (Roberts, 2018). Anorexia Nervosa (AN) affects 0.6 % – 2% of women and around 0.2% – 1.1% of men while around 3% – 14% of women and 0.02% – 0.2% of men in college are affected by Bulimia Nervosa (BN)(Iarovici, 2014). Alarmingly, around 80% of female university students express a desire to lose weight, while 90% are worried about being thinner (Roberts, 2018). Moreover, EDs can often occur with other mental health disorders, such as depression, anxiety, and addictions and comorbidity rates of EDs range from 23% to 90% (Iarovici, 2014).
However, to begin to understand EDs, we first have to distinguish them from disordered eating. Disordered Eating (DE) is a spectrum of irregular eating behaviors; however, it is a descriptive phrase and not a formal diagnosis (Anderson, 2018). DE differs from EDs because of the exact diagnosis criteria of various EDs, defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) based on specific patterns, behaviors, and symptoms. Formal EDs are most often diagnosed using the DSM-5.
It is vital to understand that these disorders lie on a continuum. In many cases, most disordered eating problems are considered “subclinical” as they do not meet all the criteria from the DSM-5 to be considered EDs (Iarovici, 2014). As Dr. Meek mentioned during his interview, DE is viewed as less severe than EDs. However, it is fundamental to attend DE as it becomes problematic and interferes with physical and emotional health and wellbeing since DE can often evolve into EDs if left unattended.
DE’s symptoms can include frequent dieting, meal skipping, weight fluctuations, guilt and shame regarding eating, worry about food, exercising to make up for unhealthy eating, fasting, and purging (Anderson, 2018). Although some of these characteristics could be present in EDs, there are rigid symptom criteria to be met to be considered an ED. Four principal types of EDs commonly occur in college students (Roberts, 2018):
- Anorexia Nervosa (AN)
- Bulimia Nervosa (BN)
- Binge Eating Disorder (BED)
- Other Specified Feeding or Eating Disorder (OSFED)
Anorexia Nervosa (AN) ‘s main symptoms consist of persistent energy intake restriction, an intense fear of gaining weight or ‘becoming fat,’ or persistent behavior that interferes with weight gain (American Psychiatric Association, 2013). Individuals with AN regularly view themselves as overweight, even if the opposite is true, and AN affects more women than men (American Psychiatric Association, 2013). The most common symptoms are severely restrictive eating patterns, the unyielding pursuit of thinness, and distorted body image (Petre, 2019). AN frequently develops during adolescence or young adulthood and is often correlated with stressful life events (American Psychiatric Association, 2013). Bipolar disorder, depression, and anxiety disorders are often comorbid with AN.
Bulimia Nervosa (BN) is characterized by frequent binge eating episodes, like eating larger amounts of food than what most people would eat in a similar time. Other symptoms include relentless behaviors to prevent weight gain, like self-induced vomiting, the use of laxatives, fasting, and excessive exercise (American Psychiatric Association, 2013). Like AN, BN tends to originate during adolescence and young adulthood, affecting more women than men (Petre, 2019). Comorbidities are highly prevalent in BN, with an increased frequency of depression or bipolar disorder.
Like bulimia, Binge Eating Disorder (BED) is also characterized by binge eating episodes, which often include a lack of control over the eating episode (American Psychiatric Association, 2013). Moreover, another symptom is extreme stress when binge eating, but unlike bulimia or anorexia, BED is not associated with inappropriate compensatory behavior to make up for excessive eating (American Psychiatric Association, 2013). Individuals with BED are often overweight or obese (Petre, 2019). Around 1.6% of US adult women have BED, while 0.8% of US men have BED (American Psychiatric Association, 2013).
Other Specified Feeding or Eating Disorder (OSFED) can cause clinically significant distress. However, they do not meet the criteria for any specific EDs from the DSM-5 (American Psychiatric Association, 2013). OSFED could include atypical AN, low-frequency BN, or BED or purging disorder, which includes symptoms like self-induced vomiting and misuse of medications like laxatives (American Psychiatric Association, 2013).
The Multiple Causes of Eating Disorders
There is debate regarding the underlying reasons why DEs occur, but there are overlapping patterns with the causes for EDs. This section explores these causes in more depth. Since EDs are highly complex disorders, it logically follows that their causes are also complex, multifaceted, and multiple. EDs can be highly influenced by environmental factors, as well as cultural differences. Although there is still contention over which factors are most important in determining EDs, there are some general causes that researchers agree can influence the onset of EDs.
Firstly, we begin with the common debate of nature vs. nurture to understand the causes of EDs. From the genetics perspective, research on twins indicates that a significant portion of the onset of EDs can be hereditary (Culbert et al., 2015). Culbert et al., 2015, a meta-analysis on the factors that lead to EDs, found that in twin studies, there is moderate to high heritability of AN, BN, and BED, indicating that there is around a 50% likelihood of twins developing these EDs. Another study stated that heritability estimates range between 23% to 83% (Mayhew et al., 2018). However, the specific genetic risk factors have not been conclusively identified. There are many candidate genes, such as LEP, LEPR, POMC, HTR1D, and HTR2A, but although these genes indicate associations to EDs such as AN, BN, and BED, a conclusive causal relationship is yet to be established (Mayhew et al., 2018).
Despite the influence of both genetic factors, the environment also significantly contributes to the onset of EDs. Sociocultural factors, such as media exposure to unrealistic body standards and pressures to lose weight, have been proposed to explain the gender differences and skewed diagnoses for various EDs, such as AN and BN (Culbert et al., 2015). However, currently, limited data is testing this hypothesis. One study found that BN shows more significant variability cross-culturally, making it more susceptible to cultural influences (Keel & Klump, 2003). However, some limitations of this study were that the data available for BN was severely limited, harming the study’s generalizability and external validity.
It is practically impossible to separate the two as both effects significantly contribute to the risk of developing EDs or DE. Consequently, the causes of EDs should be modeled using a comprehensive and complex systems model that accounts for genetic, biological, behavioral, sociocultural, and environmental factors (see Figure 1).
Figure 1. A General Overview of the Multiple Causes of Eating Disorders. This chart depicts the multiple causes that can lead to eating disorders. The primary factors are listed at the top: biological, environmental and sociocultural, and genetic and epigenetic. These factors can lead to specific symptoms, behavioral or psychological, depicted in the second row. Combined, the factors and symptoms can cause eating disorders. Adapted from Mayhew et al., 2018.
useful resources for undergraduate students
Now that you understand what some eating disorders consist of and the causes that can lead to them, I will provide additional resources if you want to continue doing more research independently. As mentioned in the podcast episode, I would highly recommend Emily Nicole’s YouTube channel, where she vlogs about her ED recovery journey and shares intimate moments from her experience (Garlock, 2020).
If you want to read more personal accounts of people’s ED recovery, I would recommend Nia Marie Patterson’s blog. Her articles describe how she has endured recovery and what inspires her while she faces the challenges of having an ED (Patterson, 2020).
Another useful resource is the website Eating Disorder Hope, a site that offers information and resources for individuals struggling with eating disorders, their families, and treatment providers (Eating Disorder Hope, 2020).
