Trigger Warning: Eating Disorders
It is undeniable that people who suffer from mental illnesses are stigmatized in our society. When it comes to eating disorders (EDs), such stigma paints the people who suffer from them as shallow or attention seeking. Many believe that these disorders are not real and anyone can just "snap out of it" if they would "just eat more/less." Yet, nothing could be farther from the truth. EDs are some of the most complex disorders, and have the second highest mortality rate of any mental illness, with that of Anorexia Nervosa being around 10% (8). The stigma that surrounds eating pathology is largely due to a lack of understanding of these disorders as well as an inaccurate portrayal of them in the media. Thus, with this article, I hope to shed light on the complicated etiology of EDs and demonstrate that they are not "just to be pretty."
Initially, EDs were understood as stemming solely from a "fear of fatness," with the behaviors exhibited by those suffering being seen as a desperate attempt to fit into a certain beauty standard. More recently, however, models have been created to show that this relationship is not so straightforward, and that a large number of aspects interact to lead to such pathology. One such model is presented by Williamson et al. (2004), and emphasizes the interaction of environmental stimuli, cognitive biases, and psychological risk factors with the body self-schema (9). A schema is a mental structure that people use to organize their thoughts and beliefs about different topics (1). According to this model, the body self-schema (meaning, the set of beliefs one holds about their body size and eating) of those who suffer from EDs is highly developed and is thus easily activated by both external and internal cues. The person's attention is therefore frequently directed towards body and food related stimuli, which, when combined with a negative affect, leads them to engage in cognitive biases. An example of this bias is when a neutral comment from others about one's body is interpreted negatively (9). Such a biased interpretation, however, can also lead to negative emotions, creating a feedback loop. This is then experienced by the person as feelings of obsession and anxiety, which leads them to try to soothe these negative feelings by engaging in certain behaviors, such as restrictive eating or purging. These behaviors often end up reducing these negative emotions and are thus negatively reinforced, creating a continuous cycle that is extremely difficult to break (9). Certain factors are seen as placing people more at risk for engaging in this destructive cycle. Some examples are extreme perfectionism and behavioral inflexibility, a history of dieting and a negative energy balance (burning more calories than one consumes), having a close relative with an ED (7), and a diagnosis of other mental illnesses such as anxiety or depression (6).
Another aspect that is often talked about when it comes to EDs is control. It has been claimed that behaviors associated with such illnesses are "one’s attempt to achieve 'mastery' in one particular area of life in an otherwise chaotic existence" (2). This feeling of control is achieved in a few ways. Firstly, the person is able to fixate all of their attention towards their eating habits and thus pay less attention to other stressful happenings in their life that are perceived to be outside of their control. This was demonstrated in the Minnesota Starvation Experiment, where the participants were required to have an extremely low caloric intake for a period of six months during which their behavior was carefully observed (10). One of the most common behavioral changes displayed by the participants was a sudden obsession with food and food-related items, coupled with a disinterest in anything else that they used to previously enjoy. Professionals have suggested that such fixation “is reinforcing in the sense that the individual struggling thinks less about other things that may be stressful – but seemingly less in the individuals’ ‘control'” (5). In this way, control over eating is seen as a success in the person's life and is subsequently strengthened.
Additionally, starvation clouds one's judgement in such a way that they do not experience certain negative emotions that they are trying to avoid, thus the person achieves a perceived sense of control over their affective state (3). A study by Froreich et al. (2016) provided support for the implication of control in EDs by showing a correlation between different control scales and ED behavior. Interestingly, "none of the items in any of the control scales administered in this study directly refer to eating, weight or shape," which demonstrates the general nature of these control beliefs (4). Therefore, it is clear that EDs begin as an illusory sense of control over an area of a person's life but they often end up controlling the person's life instead.
Overall, these models illustrate that EDs are much more than a fear of being fat or a desire to be beautiful. A sense of control, cognitive biases, and risk factors are just some of the many reasons that lead to the self-destructive cycles that are eating pathologies, which indicates that they are very real and not a choice by any means. This feeling was put forth brilliantly by Finch when he said "the truth is, eating disorders aren’t choices. If they were, we wouldn’t have chosen them to begin with" (3). Yet, the complicated nature of such disorders is not to say that they cannot be overcome. Many types of treatment plans are used for EDs and recovery is very much possible. Reach out if you think you are struggling.
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References
1. Cherry, K. (2019, September 23). The Role of a Schema in Psychology. Verywell Mind. https://www.verywellmind.com/what-is-a-schema-2795873
2. Ekern, B. (2019). The Illusion of Control in the Development of Eating Disorders. Eating Disorder Hope. https://www.eatingdisorderhope.com/blog/illusion-control-development-eating-disorders
3. Finch, S. D. (2019). 7 Reasons Why ‘Just Eat’ Is Not Going to ‘Cure’ My Eating Disorder. Healthline. https://www.healthline.com/health/mental-health/just-eat-doesnt-work-with-ed#Just-eat-implies-that-eating-is-a-simple,-uncomplicated-thing.-But-for-someone-with-an-eating-disorder,-it-isnt
4. Froreich, F., Vartanian, L., Grisham, J., & Touyz, S. (2016). Dimensions of control and their relation to disordered eating behaviours and obsessive-compulsive symptoms. Journal of Eating Disorders, 4(14).
5. Gil, C. (n.d.). The Starvation Experiment. Duke Health. https://eatingdisorders.dukehealth.org/education/resources/starvation-experiment
6. Muhlheim, L. (2021, January 5). The Different Causes of Eating Disorders. Verywell Mind. https://www.verywellmind.com/what-causes-eating-disorders-4121047
7. NEDA. (n.d.). RISK FACTORS. National Eating Disorders Association.
https://www.nationaleatingdisorders.org/risk-factors
8. NEDA. (n.d.). STATISTICS & RESEARCH ON EATING DISORDERS. National Eating Disorders Association. https://www.nationaleatingdisorders.org/statistics-research-eating-disorders
9. Williamson, D., White, M., York-Crowe, E., & Stewart, T. (2004). Cognitive-Behavioral Theories of Eating Disorders. Behavior Modification, 28(6), 711-738.
10. Ferreira, A. J. (2021). The Minnesota Starvation Experiment – How it happened and what it taught us. MAZE Magazine. https://maze.wp.st-andrews.ac.uk/2021/05/04/the-minnesota-starvation-experiment-how-it-happened-and-what-it-taught-us/
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