Leigh Holman, PhD, LPCS, RPTS Process Addictions Committee International Association of Addiction & Offender Counselors

81% of 10 year olds are afraid of being fat 51% of 9 & 10 year old girls feel better about themselves if they are on a diet 91% college women who had attempted to control their weight through dieting

22% dieted "often" or "always

95% of all dieters will regain their lost weight in 1-5 years 55% of "normal dieters" progress to pathological dieting

35% of these progress to partial or full-syndrome eating disorders

Americans spend over $50 billion on dieting and products each year 58 million of the adult U.S. population are overweight or obese

up from 25% of American adults in 1980 to 33% today Adapted from: http://www.divorcedoc.com/psychotherapy/statistics.htm
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 Most

theorists subscribe to a multidimensional risk perspective:

Several key factors place individuals at risk
More factors = greater risk Leading factors:

Sociocultural conditions (societal and family pressures) Psychological problems (ego, cognitive, and mood disturbances) Biological factors

Genetics

Relatives of patients with anorexia are eight times

more likely to develop an eating disorder Twin studies:

Neurochemical

Monozygotic twins have a 58-76% concordance, while dizygotic twins with 35-45% concordance Monozygotic twins have a 46%-56% concordance, while dizygotic twins with 18%-35% concordance for bulimia

Serotonin precursor (5-HIAA) reduced in anorexia

when ill and normalize upon recovery Recovery from bulima associated with high levels of serotonin

 Psychosocial

Difficulty with transition to adulthood Changes of body associated with puberty Adult autonomy Stressful times of transition Family conflicts Ineffective attempts to cope with stress

 Many

theorists believe that current Western standards of female attractiveness have contributed to increases in eating disorders
Standards have changed throughout history

toward a thinner ideal

Miss America contestants have declined in weight by 0.28 lbs/yr; winners have declined by 0.37 lbs/yr Playboy centerfolds have lower average weight, bust, and hip measurements than in the past
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 Certain

groups are at greater risk from these pressures:

Models, actors, dancers, and certain athletes Of college athletes surveyed, 9% met full criteria for an eating disorder while another 50% had symptoms 20% of surveyed gymnasts met full criteria for an eating disorder

 Societal

attitudes may explain economic and racial differences seen in prevalence rates
In the past, white women of higher SES expressed

more concern about thinness and dieting

These women had higher rates of eating disorders than African American women or white women of lower SES

Recently, dieting and preoccupation with food,

along with rates of eating disorders, are increasing in all groups

 The

socially accepted prejudice against overweight people may also add to the fear and preoccupation about weight
About 50% of elementary and 61% of middle

school girls are currently dieting

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Changes in Body Image over Time

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15% of young women in the United States (who are NOT diagnosed with an eating disorder), have disordered eating attitudes and behavior, according to the National Institute of Mental Health.

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Anne Becker, Harvard researcher, studied the influence of American television on eating patterns in Fiji
Fiji had traditionally been a nation that has cherished the fuller

figure

Since the arrival of TV to the island of Fiji in 1995, the percentage of eating disorders among young girls aged 15-19 years increased from 3% to 15% The number of girls dieting (62 per cent) and girls feeling "too big or fat" (74 per cent) has also increased since 1995. It is believed that the sudden infusion of Western cultural images and values through TV changed the way Fijian girls view themselves and their bodies

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 Families

may play an important role in the development of eating disorders

As many as half of the families of those with eating

disorders have a long history of emphasizing thinness, appearance, and dieting Mothers of those with eating disorders are more likely to be dieters and perfectionistic themselves

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 Abnormal

family interactions and forms of communication within a family may also set the stage for an eating disorder
Minuchin cites enmeshed family patterns as causal

factors of eating disorders These patterns include over involvement in, and over concern about, family members lives

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 Bruch

argues that eating disorders are the result of disturbed motherchild interactions, which lead to serious ego deficiencies in the child and to severe cognitive disturbances

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 According

to Bruch, parents may respond to their children either effectively or ineffectively

Effective parents accurately attend to a childs

biological and emotional needs Ineffective parents fail to attend to childs internal needs; they feed when the child is anxious, comfort when the child is tired, etc.
There

is some empirical support for Bruchs theory from clinical reports

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 Many

people with eating disorders, particularly those with bulimia nervosa, experience symptoms of depression
Theorists believe mood disorders may set the

stage for eating disorders

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 There

is empirical support for the claim that mood disorders set the stage for eating disorders:

Many more people with an eating disorder qualify for

a clinical diagnosis of major depressive disorder than do people in the general population Close relatives of those with eating disorders seem to have higher rates of mood disorders People with eating disorders, especially those with bulimia nervosa, have low levels of serotonin Symptoms of eating disorders are helped by antidepressant medications
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 Biological

theorists suspect certain genes may leave some people particularly susceptible to eating disorders
Consistent with this model: Relatives of people with eating disorders are 6 times more likely to develop the disorder themselves Identical (MZ) twins with bulimia: 23% Fraternal (DZ) twins with bulimia: 9% These findings may be related to low serotonin

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 Other

theorists believe that eating disorders may be related to dysfunction of the hypothalamus
Researchers have identified two separate areas

that control eating:

Lateral hypothalamus (LH) Ventromedial hypothalamus (VMH)

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 Some

theorists believe that the LH and VMH are responsible for weight set point a weight thermostat of sorts
Set by genetic inheritance and early eating practices,

this mechanism is responsible for keeping an individual at a particular weight level If weight falls below set point: hunger, metabolism binges If weight rises above set point: hunger, metabolism Dieters end up in a fight against themselves to lose weight
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Activities with heightened weight/shape demands Childhood obesity Familial psychiatric history and/or obesity Diabetes Routine Dieting or restrained eating Premorbid personality disorder(s)

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