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Psychologist and Eating Disorder Specialist Q&A

Thanks for the information providing by Dr. Robson & Dr. Romand

Q: what’s anorexia or eating disorders in general?

A: Eating disorders are illnesses, not character flaws or choices. Individuals don’t choose to have an eating disorder. You also can’t tell whether a person has an eating disorder just by looking at their appearance. People with eating disorders can be underweight, normal weight or overweight. It’s impossible to diagnose anyone just by looking at them.

Anorexia and bulimia are not  the only forms of eating disorders. There are also non-classified eating disorders, which are just as serious. In fact, someone can die from a short-term eating disorder. They’re caused by a complex combination of factors, including genetic, biochemical, psychological, cultural and environmental. While researchers haven’t been able to pinpoint the specifics behind these causes, they can identify various factors that make individuals susceptible to eating disorders.

Unfortunately, because of the media, eating disorders sometimes seem as though they are almost encouraged and admired. Yet this is unfortunate as they’re serious, devastating illnesses that need to be treated. A person can lose their health, their family, their motivation for living and ultimately their life.

Q: what are some factors that may contribute to eating disorders?

Genetics

Genetics has a significant contribution and may predispose individuals to eating disorders. Researchers have found that eating disorders tend to run in families. Also, there seem to be higher rates of eating disorders in identical twins than in fraternal twins or other siblings. In addition, specific chromosomes have been linked to both bulimia and anorexia.

Biochemistry

Individuals with eating disorders may have abnormal levels of certain chemicals that regulate such processes as appetite, mood, sleep and stress. For instance, both people with bulimia and anorexia have higher levels of the stress hormone cortisol. Some research also suggests that individuals with anorexia have too much serotonin, which keeps them in a constant state of stress.

Psychology

Various psychological factors can contribute to eating disorders. In fact, eating disorders are common in individuals who struggle with clinical depression, anxiety disorders and obsessive-compulsive disorder. Other factors include:

• Low self-esteem
• Feelings of hopelessness and inadequacy 
• Trouble coping with emotions or expressing your emotions 
• Perfectionism 
• Impulsivity

Culture

Dieting, body dissatisfaction and wanting to be thin are all factors that increase the risk for an eating disorder. Unfortunately, our society encourages all three. You can’t walk by a cash register without seeing a magazine that encourages rapid weight loss, calorie counting or feeling guilty after a meal. Here are some aspects of our culture that contribute to eating disorders:

• An over-emphasis on appearance, at the expense of more meaningful attributes
• Societal beauty standards that promote an unrealistically thin body shape 
• Associating thinness with positive qualities like attractiveness, health, success and love 
• Media’s focus on dieting and striving for a slim and toned silhouette 
• Messages that perpetuate a fear of fat and food; viewing fat as undesirable or foods as “good,” “bad” or “sinful”

Environment

Your environment can also play a major role in developing an eating disorder. These factors include:

• Family or other relationship problems
• Difficult or turbulent childhood
• History of physical or sexual abuse
• Activities that encourage thinness or focus on weight, such as gymnastics, dancing, running, wrestling and modeling
• Peer pressure 
• Being bullied because of weight or appearance in general

Q: What are some underlying issues beside eating disorder?

A: There are many misconceptions in our society about what causes eating disorders. Although the symptoms of anorexia largely surround food and eating, the truth is that at its core, anorexia and other eating disorders do not solely have to do with food and weight. Instead, sufferers use food and unhealthy behaviors like dieting, starving, binging and purging to cope with unpleasant and overwhelming emotions and stressful situations. Eating disorders can be part of an overall picture of the struggle in a person’s life. Often we find that people with eating disorders are experiencing underlying emotional distress, relationship or psychological conflicts, difficult life transitions or past trauma. At least in the short term, these behaviors relieve anxiety and stress. Long term, however, they actually increase anxiety and stress and create other serious complications.

Q: What are some key points about anorexia in overall populations?

A: Anorexia does occur in males! There is a common stereotype that anorexia is a female illness; however, that is not the case. We know that 10% to 15% of anorexia cases are diagnosed in males, and those are just the cases that go reported. Experts feel the rate may be significantly higher; however, many men feel a greater stigma about eating disorders, so they may not seek treatment. Male athletes have a higher reported rate of eating disorders than the general population, due in part to the belief that weight loss is a necessary requirement for peak athletic performance in their sports, and a higher rate of anorexia has also been reported in homosexual and bisexual males. Body image dissatisfaction is fairly stable across the age span. For example many of the same risks of eating disorders in younger women can be precursors for older women as well.

Q: What are some treatments for someone with an eating disorder?

A: When combined with genetic and biological factors, these struggles can sometimes be a precursor to eating disorder symptoms. For some people, anorexia serves as a complex distraction from other painful, seemingly uncontrollable feelings or life events. Part of the recovery process from anorexia is learning other, healthier ways of coping with life’s challenges.  

Psychotherapy Individual psychotherapy can help you learn how to exchange unhealthy habits for healthy ones. You learn how to monitor your eating and your moods, develop problem-solving skills, and explore healthy ways to cope with stressful situations. Psychotherapy can also help improve your relationships and your mood. A type of psychotherapy called cognitive behavioral therapy is commonly used in eating disorder treatment, especially for bulimia nervosa and binge-eating disorder. Group therapy also may be helpful for some people.

Family-based therapy is the only effective treatment for children and adolescents with eating disorders. This type of therapy begins with the assumption that the person with the eating disorder is no longer capable of making sound decisions regarding his or her health and needs help from the family. An important part of family-based therapy is that your family is involved in making sure that your child or other family member is following healthy-eating patterns and is restoring weight. This type of therapy can help encourage support from concerned family members.

Weight restoration and nutrition education If you're underweight due to an eating disorder, the first goal of treatment will be to start getting you back to a healthy weight. No matter what your weight, dietitians and other health care providers can give you information about a healthy diet and help design an eating plan that can help you achieve a healthy weight and instill normal-eating habits. If you have binge-eating disorder, you may benefit from medical supervised weight-loss programs.

Hospitalization If you have serious health problems or if you have anorexia and refuse to eat or gain weight, your doctor may recommend hospitalization. Hospitalization may be on a medical or psychiatric ward. Some clinics specialize in treating people with eating disorders. Some may offer day programs, rather than full hospitalization. Specialized eating disorder programs may offer more intensive treatment over longer periods of time.

Medications Medication can't cure an eating disorder. However, medications may help you control urges to binge or purge or to manage excessive preoccupations with food and diet. Medications such as antidepressants and anti-anxiety medications may also help with symptoms of depression or anxiety, which are frequently associated with eating disorders