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Factors that Contribute to the Development and Maintenance of Eating Disorders

 

Although researchers have not been able to pinpoint a single cause for the development of eating disorders, there are 16 factors that are common among eating disordered women that give us a clue into the development and maintenance of these issues.

 

  1. History of Dieting in the Family– If a woman has been exposed to a family that is on diets consistently, this gives a woman a heightened sense of anxiety about her body and about her body image. In general, a child’s number one motivation is to gain acceptance and approval from her parents. In a dieting family, the daughter has an idea about what is “acceptable” and “unacceptable” about her body based upon what the family deems “acceptable” and “unacceptable” by what she picks up in the dieting family.
  2. Control– In a family where there tends to be a lot of control over what goes on, what people say, what they don’t say, how they think and feel, how they act, how they dress, the eating disorder becomes the one thing that the woman CAN control. “If they want to control me, at least they can’t control what goes into and comes out of my mouth.” This is something I can control.
  3. Psychological Issues– Many women with eating disorders fit the diagnostic criteria for other mental illnesses including Obsessive Compulsive Disorder and Depression. The question we as clinicians ask is “which came first?”  OCD develops many times out of trauma from childhood. A child’s mind may begin repetitive rituals in an attempt to control something outside of their control that is anxiety producing or traumatic. For example, in a child’s mind, if mom and dad happened to not fight the day she cleaned her room in a certain way, then surely if she cleaned her room in that precise way everyday they won’t fight anymore. This disorder manifests itself in eating disorders through the obsessive counting and recounting of calories, weighing several times a day etc.
  4. Lack of validation for feelings– In a family where feelings are not validated, and children are indirectly told that their feelings are not ok or bad, a child who feels angry, scared or pain assumes that there is something wrong with her because she feels this way. After all, no one else in the family is showing emotion. So, the eating disorder becomes a way to mask or cover up painful feelings. Just like any other addiction, eating disorder behavior changes the way we feel. Bingeing and purging masks painful emotion.
  5. Culture/Media– We live in a body obsessed society. Covers of magazines have women who are a size zero, whose bodies many times have been computer altered to look thinner than they are. Magazine producers go for an image that says that the unattainable image they portray is what readers need to look like. This creates a “not good enough” feeling amongst readers that drive them to buy products and obsess about their bodies. Also, we live in a society that is obsessed with food. Commercials tell us that a “Big Mac” and large French fries and a drink is considered a lunch. This meal has enough calories for one person for an entire day.
  6. Teasing and Early Maturation– Kids are very insecure about their changing bodies and it has been found that an unusually high number of women with eating disorders started puberty early and developed breasts and secondary sex characteristics at an earlier age than most women. This level of teasing can be unbearable for girls and the assumption that is made is that something is wrong with their bodies.
  7. Maturation Issues– Girls get their examples about what it means to be a woman from their mothers. If for some reason the mother is particularly unhappy with her lot in life or discontented in some way, subconsciously girls will think, “If that is what it means to be a woman, I don’t want anything to do with it.” Eating disorders are a way to short circuit the growth process and psychologically stay a child. Hormonally, development is arrested as the period stops and through restriction a girl has the promise to stay a girl.  
  8. Distant Dad– Girls long for an emotional connection with their fathers. This is such a driving force for young women, several books have been written on this subject alone. If the father in the family is emotionally distant and disconnected, the eating disorder becomes a way to draw the father closer to herself. Even though the attention is conflictual, it is attention nonetheless. It is also typical for fathers to withdraw somewhat from their daughters as they approach puberty, not knowing how to respond to their changing bodies. If the girl received emotional validation as a child, the eating disorder becomes a way to “stay a child” in a subconscious hope to keep the connection they once had. Girls look to their fathers to see what manhood is like and whom they should select as a husband. They need emotional closeness and understanding from their fathers.
  9. Trauma– Various things and events can be traumatic in a girls life and in a family’s life. Anything from divorce to a pet dying can be traumatic. The most common trauma that we see in women with eating disorders is childhood sexual trauma. The subconscious message is that sex is bad and to become sexual is dangerous and terrifying. Therefore, the eating disorder becomes a way to keep the self childlike and asexual and prevent the terrifying from occurring.
  10. Food Issues– This goes along with a history of dieting in the family. If a woman grew up with rules around food, i.e. you can only eat these kinds of things, or boys eat these things, girls eat other things, girls may react against these rules in adulthood by “breaking all the rules” in an eating disorder.
  11. Weight Issues– Along with the others, if there are people in the family who have weight issues, this can be a contributing factor to an eating disorder. Seeing people in the family discontented with their weight and possibly using food to numb emotional pain can be an example for women regarding a way to cope with emotions themselves.
  12. Perfectionism– A high number of women with eating disorders have perfectionistic thinking. This is an all-or-nothing pattern of thinking that says “If I’m not a 10- I’m a zero.” There is no balance or middle ground in this style of thinking. The way this perfectionistic thinking manifests itself in an eating disorder is through weight, calorie counting and fat grams. Perfectionistic thinking is a recipe for feeling “not good enough,” because who is perfect?
  13. Low Self-Esteem and High Sensitivity– Many women with eating disorders have low self-esteem. Of course, the question remains, did the eating disorder cause the low self-esteem or did the low self-esteem contribute to the cause of the eating disorder? In any case, women with eating disorders tend to have a co-occurring low sense of self and self-worth. They turn to and rely on calories and weight to give them the worth that they so desperately seek.
  14. Overprotection– Like control, in many families with eating disorders, we see age inappropriate rules from parents who are making a desperate attempt at holding onto their little girl. The eating disorder becomes a way to gain some autonomy in a world where mom and/or dad are dictating the young woman’s world. Again, “you can control a lot of things, but not what comes into and goes out of my mouth.”
  15. Exercise Issues– Like weight and dieting, we see in women with eating disorders a disproportionately high number of families with exercise dependency or addiction. These are people who will risk their health and well being to complete their exercise regimens. Exercise becomes an obsession and one of two things are likely to happen, either the daughter learns from her parents how to deal with emotional pain through exercise, or the daughter “rebels” against the parents obsession by not taking care of her body on the other end of the spectrum, through bingeing and purging.
  16. Genetics– There is a growing body of research that states that some women may be genetically predisposed to developing an eating disorder. In one study of anorexia in 2,163 female twins, researchers found that genes accounted for 58 percent of the risk for developing anorexia nervosa. In a similar study of bulimia, the researchers found that the heritability of that disorder was 59 percent. There is much more research needed in this area.

A Multidisciplinary Approach to the Treatment of Eating Disorders

       The very nature of addictions makes eating disorders difficult to treat in an outpatient setting. It is important to have an additional support network as well as added structure to ensure proper treatment. This structure can be obtained either by admitting to an inpatient facility for eating disorders or by engaging a multidisciplinary team for treatment outpatient. Below, we will discuss important members of a multidisciplinary team for treatment.

1. Emotional Intervention and Evaluation – Therapist/Psychologist (Click here for recommended professionals in the Southern Nevada area)

It is important to start building your team with a therapist or psychologist. This professional will work with you on a regular (usually weekly) basis to discuss issues related to your eating disorder. It is important to find a therapist who is knowledgeable and experienced in the treatment of eating disorders. Depending on their orientation and your specific needs, therapists or psychologists will help you address one or more of the following issues:

            1. Relationship Issues- Eating disorders have a lot to do with relationships, whether inside or outside of the family environment. It is important to discuss relationships and how they are affected by the eating disorder.

            2. Body Image Issues

            3. Help clients learn skills to combat the eating disorder in practical ways and to prevent relapse.

            4. Spiritual connections- Your therapist/psychologist may help you explore spiritual connections as a way to gather strength to fight the eating disorder if this is important to you.

            5. Perfectionism- Many clients with eating disorder issues struggle with perfectionistic thinking, your therapist/psychologist will help you give yourself room to be human. J

            6. Understanding and expressing feelings in a positive way – Because the eating disorder is a way to “shut off” feelings, it is important in recovery to learn how to express feelings in a positive way.

2. Medical Evaluation and Structure: Physician (Click here for recommended physicians)

            Because eating disorders can cause significant damage to one’s body, it is important to see a physician for a thorough physical examination and maintain regular follow up appointments. Seek a physician that knows about eating disorders.   In this evaluation, it is important to do the following:

            1. Comprehensive lab work to identify any potential electrolyte imbalances, including sodium and potassium irregularities.

            2. Address any gastrointestinal difficulties or irregularities including slowing of gastric emptying, patterns of diarrhea, constipation, bloating, and esophageal damage such as dilation or rupture, constant sore throat or reflux.

            3. Explore coronary problems and potential risks associated with long term eating disorders which can include significant arrhythmia, chest pain, slow heart rate, low blood pressure, reduced body temperature, weakness and fatigue.

            4. Discuss any irregularities in menstrual cycle including amenorrhea.

            5. Look for dental and bone problems like osteoporosis, tooth decay and gum erosion.

3.Dietary Intervention and Structure: Registered Dietitian (Click here for recommended dietitians)

            When seeking treatment for an eating disorder, it is imperative to have the proper dietary guidance and consultation to address the nutritional aspects of the disorder. It is important to find a dietitian that specializes in eating disorders. When looking for a dietitian, consider the following:

            1. Find a dietitian who has had experience working with clients that struggle with eating disorders.

            2. Look for a dietitian who does not focus on dieting, watching fat grams, and counting calories, but who understands the obsessive nature of eating disorders and who can provide needed structure and guidance without increasing obsessions.

            3. Find a dietitian who is familiar with the exchange program and intuitive eating.

            Many clients believe that they already know about diet and nutrition, but oftentimes their knowledge has been distorted significantly by the disorder. They need an expert to challenge their false notions and to provide accountability. Dietitians also offer much needed encouragement and reassurance.

4. Psychiatrist (Click here for recommended psychiatric providers)  

Research has shown that therapy in conjunction with psychotropic medications can be more effective in the treatment of eating disorders than therapy alone. A psychiatrist is a medical doctor that specializes in psychological problems and challenges. He or she can assist you by prescribing medications for you depending on your unique situation. He or she can also evaluate the effectiveness of your medications through regular (usually monthly) follow-up appointments. Psychiatric medications may help with:

1. Anxiety or panic attacks

2. Depression

3. Urges to binge and purge or possibly restrict your food intake.

Again, it is important to find a psychiatrist who knows about eating disorders and therefore can make the proper assessment.

5. Support groups- (Click here for support and therapy groups in Southern Nevada)

Recovery from an eating disorder requires a tremendous amount of support from others.  Group therapy is a great way to get support from others. Some of the advantages of group therapy are:

            1. Learning that you are no longer alone in your struggles.

            2. Having the opportunity to have a sense of belonging.

            3. Seeing others’ victories in recovery which increases hopefulness.

            4. Revealing secrets which combats shame and guilt.


HUNGER/FULLNESS SCALE

Adapted from “Diets Don’t Work,” by Bob Schwartz

 

An important skill to learn is how to become in touch with your hunger/fullness level. A normal eating person listens to their body to know when to eat and when he or she is full. Children are totally in touch with their hunger/fullness when they are allowed to regulate their intake. On a scale from zero to ten, zero is starving and ten is Thanksgiving Day full. Below are some guidelines to help you get in touch with your body.

  • You’re wobbly and dizzy. You can hardly think. Most people have to go all day without food to get close to a zero.
  • You’re still very hungry, but you could probably stagger to the dinner table. You’re irritable and cranky.
  • You’re very hungry, on the verge of a “starving” feeling.
  • You could definitely eat, but you’re not on the verge of collapse. The urge to eat is strong.
  • You’re only a little hungry. Your body is sending messages that you might want to eat.
  • You’re not hungry, not satisfied…neutral. If you quit eating now, you’ll need to eat again in 1 ½ to 2 hours.
  • You’re a notch past being neutral. You could definitely eat more.
  • You are feeling more satisfied… getting full. If you stopped eating here you would need to eat again in 4 to 4 ½ hours.
  • You are quite satisfied, full in fact. If you stopped eating here, this would sustain you for 5 to 6 hours.
  • You are becoming uncomfortable. You could force down another three bites even though your body no longer wants anything.
  • Your body is screaming, “get me out of here!” This is no fun anymore. If you eat anymore, you’ll POP!
  • Working with hunger levels sometimes confuses people in the beginning. If you have been eating disordered for a long period of time and have not experienced physical hunger, the slightest body sensation may seem like a 1 or a 0. At this point you will probably be closer to a 3 or a 4. Determining what your level of hunger is takes a great deal of time, effort, and practice.