What is an Eating Disorder?
Eating disorders (ED) can be expressed in a myriad of ways including extreme restrictions on one’s food intake, binge eating, purging attempts, mental distortions of body image, and extreme exercise. An excessive obsession with food, weight, and body shape are potentially all alarming signs of an eating disorder. Despite this, not everyone with such thoughts and behaviours may be suffering from such a disorder. A professional diagnosis utilising the criteria from the newly updated 5th edition of the Diagnostic Statistical Manual of Mental Disorders (DSM-5), is required to conclusively identify whether an individual may have an eating disorder.
The DSM-5’s criteria have been deemed highly reputable in its encapsulation of what constitutes a certain mental disorder. For example, in Anorexia Nervosa (AN), the DSM included the following as its criteria: reduction in energy intake, low body weight, intense fear of weight gain, denial of current low body weight, and mental distortions of body image.
There are various types of ED, as follows:
- Anorexia Nervosa (AN)
- Bulimia Nervosa (BN)
- Binge Eating
- Rumination Disorder
- Avoidance/restrictive food intake disorder (ARFID).
- Other Specified Feeding or eating disorders (OSFED).
Among various types of EDs, AN and BN are the most common ones treated as an outpatient. AN was addressed in abundant research due to its increasing prevalence in adolescents throughout the decade. It has since become the third most common chronic disease in adolescents, next to asthma and obesity.
Furthermore, in contrast to males, females have higher prevalence rates in most types of eating disorders. For AN, the research concluded that around 0.9~2.0% of females had developed this disorder, a percentage that is approximately sevenfold that of a male. Here we will discuss this mental health condition through research findings regarding ED among female adolescents, and young adults.
There are several etiological and risk factors that contribute to the development of ED:
- Genetic factors
Among various studies, evidence indicated that females are significantly more likely to develop ED if a biological family member had ED prior. Both the inherited traits of personality and temperament may explain the influence. In addition, the environment in which one grew up is associated with genetic factors that may result in the development of an ED.
- Neurobiological factors
Neuropsychological functioning plays the role of mediating between underlying neurobiological abnormalities and psychological functioning in eating disorders. Nonetheless, the relationship is bidirectional. While neurobiological abnormalities can contribute to the development of ED, consequences following ED, such as constant low weight and underconsumption of nutrition, also lead to the poor neurobiological wellbeing of the individual. Emphasising the severity of an ED due to such a cycle.
- Psychological factors
EDs are highly related to underlying psychological distress. Grief, low self-esteem, trauma, or other mental disorders can be associated with its development. Family, especially parents, were often found to be responsible for such conditions. Literature indicated that restrictiveness of the authoritarian parenting style is highly at fault for lower self-esteem and higher levels of depression in their children, two main psychological distresses identified in an early ED pathology.
According to the research of the risk factors contributing to EDs, mothers who are highly critical and overbearing were found to have caused the development of an eating disorder attitude towards their daughters. The study “Family Interactions and Disordered Eating Attitudes: The Mediating Roles of Social Competence and Psychological Distress” conducted an investigation with a sample group of 286 families in the University of Arizona. Dr. Analisa concluded that young females tend to have poorer social and relationship skills if the individual’s mother frequently communicates with overt criticism, which is a rather unhealthy pattern to be subjected to at such a young age. In these emotional obstacles, the individual experiences are known to cause higher levels of psychological distress and a disordered eating attitude in their daughters.
The research revealed that the negative form of family communication between mother and daughter impacted the sense of self and social skills of the young female significantly in this developmental stage. This was linked to their struggles over control and self-enhancement. Consequently, disordered eating is developed to deal with negative emotions or compensate for their incompetence in social life.
These risk factors, along with the developmental changes of young females, are not only associated with the development of an ED but also the maintenance of thoughts and behaviours with such conditions. Clinically, we need a holistic assessment of these aspects of a client’s life to deduce and proceed with the most effective strategy for support.
ED can manifest at any age, but the most common age of onset is adolescence. As a result, families are at the front line in preventing, identifying, and supporting their young family members with ED. Adolescents are experiencing tremendous changes in their psychosocial development, including an increased sense of autonomy, a shift in focus from family to peers, and the emergence of abstract thinking. Therefore, self-image awareness and confusion in identity evolving in this stage deeply affects the young adolescent’s social life and overall well-being.
According to the attachment theory, a secure attachment can create a crucial buffer for young adolescents when facing psychological challenges. In the present, families must have open and transparent communication with the younger generation. By conveying messages clearly and listening carefully, parents can help enforce an environment in which proper guidance is provided in terms of well-respecting the children’s volition.
In essence, parents are role models to children, emphasising the importance of demonstrating how grown-ups maintain a healthy relationship with food, appearance, identity, and social interactions. In addition to the family, the community, like schools and peers are also vital in the prevention and recovery of young people with ED.
Early treatment is the key
ED, especially AN is highly related to risks of potential morbidity and mortality. Despite such statistics, nearly 45% of people with ED do not receive professional treatment for their eating disorders. It is beyond crucial to seek help earlier before it further affects the health of both the client and the family.
Eating disorders can indeed be treated, but preparations for adverse situations like negative reactions and relapses, are quintessential. It is an emotional and delicate journey for not only the individual who succumbed to it but the family who also walks alongside the young adolescent through such disorder. If you are aware of someone undergoing these conditions, please reach out to your GP or qualified healthcare provider for a professional assessment and support as soon as possible.
If you would like to speak with a counsellor about how Megan or AMindset can support you, please contact us.
1. Common Types of Eating Disorders (and Their Symptoms)
2. Over-bearing mothers can produce daughters with poor social skills and disordered eating attitudes
3. Bryant-Waugh R. and Lask, B. (2013) Overview of eating disorders in childhood and adolescence.
In: Bryant-Waugh, R. and Lask, B. (eds) Eating Disorders in Childhood and Adolescence, 4th edn. Hove: Routledge, pp. 33-49.
4. Teens Visiting ER for Eating Disorders Doubled During Pandemic
5. Stice E & Bohon C. (2012). Eating Disorders. In Child and Adolescent Psychopathology, 2nd Edition, Theodore Beauchaine & Stephen Linshaw, eds. New York: Wiley.
6. Analisa Arroyo, Chris Segrin. Family Interactions and Disordered Eating Attitudes: The Mediating Roles of Social Competence and Psychological Distress. Communication Monographs, 2013; 1 DOI: 10.1080/03637751.2013.828158
7. Bohrer BK, Carroll IA, Forbush KT, Chen PY. Treatment seeking for eating disorders:
Results from a nationally representative study. Int J Eat Disord. 2017 Dec;50(12):1341-1349. doi: 10.1002/eat.22785. Epub 2017 Sep 30. PMID: 28963793.
8. Nicholls, D. (2013). Aetiology. In B. Lask & R. Bryant-Waugh (Eds.), Eating disorders in childhood and adolescence (p. 50–76). Routledge/Taylor & Francis Group.
9. Fonagy, P., Gergely, G., Jurist, E.L. and Target, M. (2004) Affect Regulation, Mentalization, and the Development of the Self. London: Karnac Books.
10. Enten R.S., Golan, M. (2009) Parenting styles and eating disorder pathology, Appetite,Volume 52, Issue 3, Pages 784-787, ISSN 0195-6663,