Eating disorders are complex, multifaceted physical and mental health problems. Their development usually involves a number of different contributing and perpetuating factors. The exact processes are unclear and it is uncertain how they interact to develop or maintain an eating disorder (Fairburn & Harrison, 2003).
Contributing factors could include one or a combination of physical, emotional or sexual trauma; cultural emphasis on body image ideals; peer influences; loss and grief; brain chemistry; physiological effects of dieting, starvation or purging behaviours; relationship issues; stress; and maladaptive coping skills. The complexity of eating disorders means there are no simple solutions.
Development of an Eating Disorder
There are many environmental, cultural, psychological and biological factors which combine in different ways in the development of an eating disorder. These factors can be divided into 3 factors – click here to view the Model of Development and Maintenance of an Eating Disorder, by Garner & Garfinkel).
Important factors which predispose a person to developing an eating disorder include being female, living in Western society, being an adolescent, having low self-esteem, perfectionism, and/or depression, and having a family history of any type of eating disorder, obesity, depression, or substance abuse.
Significant precipitating factors which may trigger the disorder include dieting to lose weight, occupational or recreational pressures to be slim, critical comments about weight and shape, and sexual abuse. Key factors which maintain the disorder once it has developed primarily involve the psychological, emotional, and physical effects of starvation.
Stages of an Eating Disorder
Lemberg (1992) also proposes a model of development whereby a person moves from voluntary dieting through a number of stages to reach a fully entrenched eating disorder.
Stage 1: Normal, voluntary dieting behaviour. Unfortunately dieting behaviours have become the “norm”, with 47% of people in Australia having tried to lose weight in the past twelve months. 68% of fifteen year old girls are dieting at any one time, 8% of these are on a severe diet (Lemberg, 1992).
While these diets are severe enough to be considered an eating disorder, they are unhealthy and result in rapid weight changes, disrupted metabolism, dehydration, low energy and lack of essential vitamins, minerals and nutrients.
Stage 1B: (in Bulimia Nervosa only). The hunger associated with dieting and restriction leads to severe and constant cravings, which result in loss of control and overcompensation by bingeing on large amounts of food.
Stage 2: A Diagnosable Disorder. At this stage the dieting behaviour has become a diagnosable mental illness according to the Diagnostic & Statistical Manual IV-TR (APA, 2000). At this stage there are serious consequences and a morbid fear of fatness, and the dieting is no longer under the person’s control.
However the person is unable to see the negative consequences and is in denial of the eating disorder. In bulimia nervosa the bingeing behaviours, rather than being due to dietary restriction, occur more generally as a result of stress or negative emotional states.
Stage 3A: Autonomous Behaviour. At this stage the person is generally able to see there is a problem, but as the behaviours are no longer under the person’s control, the disorder does not resolve even if precipitating conditions have been resolved.
Stage 3B: Illness becomes the identity. At this stage, rather than the eating disorder behaviours being a solution to a problem, the person now identifies him or herself only with the eating disorder and has difficulty separating themselves from the illness.
The eating disorder behaviours are now constant rather than used as coping strategies, and the person feels they are nothing without their illness. They identify with being the illness, i.e. I am anorexic, rather than I have anorexia.
The prospect of giving up the disorder can lead to existential fears of nothingness. Recovery requires not only finding alternative coping strategies, but helping the person identify themselves without the eating disorder.
More Information
Click on the links below to access further information about this topic:
· The Starvation Syndrome
· Anorexia Nervosa
· Bulimia Nervosa
