Taylor Swift recently discussed how she developed an unhealthy relationship with food, restricting her daily food intake while exercising excessively to reduce her body weight and change her shape (e.g., thin ideal). Taylor Swift elaborates on being a very low body weight (e.g., size two) at one stage, a body weight that was extremely low and potentially dangerous. Probably one of most publicized and tragic stories that really raised awareness of eating disorders was the singer Karen Carpenter from the band the Carpenters. Karen Carpenter had Anorexia Nervosa and passed away at the very young age of 32.
Anorexia nervosa is a serious and difficult condition to treat, where extreme weight loss is driven by fears of gaining weight or becoming “fat”. Anorexia nervosa consists of several disordered eating practices: (1) rule-driven dietary practices versus eating when hungry, (2) compulsive exercise, and (3) use of laxatives or other substances to control weight. Two common types of Anorexia are (1) restrictive type and (2) binging and purging. Anorexia nervosa impacts more females than males, in some cases up-to 8 times more, noting a lifetime prevalence around 1-2% of the population. This means that 1-2 out of every 100 people may experience anorexia nervosa at some point in their lives. Lastly, anorexia nervosa often emerges in adolescence or early adulthood, although it can occur at any age. The peak age of onset is typically between 15 and 19 years, however symptoms can exists as early age 6.
It may be common for people to speculate single causes for what may cause Anorexia Nervosa. A common cause people may argue is peer pressure from friends or media of being a certain weight and shape, however the research supporting singular causes is not strong, with research arguing that Anorexia is a combination of genetic, personality traits (e.g., neuroticism and perfectionism) and environmental experiences (e.g., childhood trauma). Individuals with anorexia have an intense fear of gaining weight and becoming fat. These fears lead to self-imposed starvation and other behaviors to achieve an extremely low body weight (body mass index < 18). It is not uncommon for individuals to not recognize their dangerously low body weight, denying they have an eating issue, making this very distressful for family and friends.
Individuals with anorexia nervosa may also possess a distorted perception of their own “body weight and shape”, often perceiving themselves as overweight or obese even when they are dangerously underweight. More recent research suggests perceptions of distorted body image can also be implicit (e.g., without conscious awareness), suggesting these disturbances are more pervasive and embedded then previously understood. This distorted body image, along with a drive to be “thin”, and fear of putting on body weight, contribute and maintain the restrictive eating patterns observed in anorexia nervosa.
Personality traits like control and perfectionism are associated with anorexia nervosa. Negative emotions and stressful situations in people that possess higher levels of wanting to control situations, may adopt strategies around their eating to help regulate or manage these emotions as a coping mechanism. While control is only one variable associated with anorexia, it is important to note that research suggests that disorders like depression, anxiety and obsessional compulsive disorder may predate the emergence of an eating disorder, suggesting emotion and regulation strategies may be important in its emergence and treatment.
Perfectionism is a personality trait also commonly associated with anorexia nervosa. Individuals with anorexia often have a distorted body image and posses an intense desire to achieve an unrealistic and "perfect" body size or shape. Individuals high in trait perfectionism may strive to meet unrealistic and unachievable body image standards. The distress of not being perfect can lead to the paradox of emotional discomfort, and the need for control. Research shows perfectionism is often associated with a need for control. It is important to note that individuals with anorexia see themselves larger than what they are, meaning there ability to strive towards perfectionistic goals from a distorted starting point may further increase the gap between current body shape and ideal, leading to constant distress.
The management and treatment of anorexia nervosa is usually undertaken by a multidisciplinary team.
First line evidence-based treatment interventions for anorexia nervosa are:
(1) Family based treatments and Cognitive-behavioral therapy enhanced (CBT-E),
(2) Dialectical behavior therapy (DBT) and
(3) Possible hospitalization (inpatient therapy)
These therapy modalities are aimed to help individuals with weight restoration and help recognize and challenge their thinking and develop healthier coping strategies. These treatments also focus on promoting self-acceptance and a more realistic body image. Please note if you are diagnosed with an eating disorder Medicare may allow up to 40 psychological sessions per year.
