Eating Disorders

   Eating disorders are dangerous mental and physical health concerns that will affect 9% of Americans at some point within their lifetime, equivalent to 28.8 million individuals (Deloitte Access Economics, 2020). Eating disorders affect multiple components of an individual’s life, including self-esteem. Biological, psychological, and sociocultural factors can influence the development of eating disorders (National Eating Disorders Association [NEDA], n.d.). 

   Like many illnesses, eating disorders can be challenging to treat and cause various long-term health consequences for the individual. Anorexia Nervosa (AN) causes 10,200 deaths each year (Deloitte Access Economics, 2020) and has the highest mortality rate of all psychiatric diseases (Edakubo & Fushimi, 2020). Males are twice as likely to die from anorexia nervosa compared to females and may be due to lack of social support during treatment and waiting longer to obtain treatment (Deloitte Access Economics, 2020). Check out our social media pages (Facebook, Instagram, and Twitter) to learn more about eating disorders in males. 

   Elements that can impact an individual’s probability of an eating disorder include race, age, gender, sexual orientation, health, and life events. Racial differences also affect the likelihood of obtaining treatment for eating disorders. Black, Indigenous, and People of Color (BIPOC) are half as likely to receive treatment for eating disorders or be diagnosed (Deloitte Access Economics, 2020).

   The disparity in care exhibits how some communities encounter barriers when attempting to receive medical care compared to other groups. A study by Uri et al. (2021) found that Asian American college students reported higher levels of body dissatisfaction and more negative perceptions of obesity than their White and Black, Indigenous, and People of Color (BIPOC) peers. The study also observed that Asian American college students demonstrated an increased probability of restricting food consumption or purging.

   The highest prevalence of eating disorders is in individuals between 20-29 years old, with females having a higher prevalence than males across all age groups (Deloitte Access Economics, 2020). Although young adults exhibit the highest prevalence of eating disorders, adolescents also report a higher prevalence than middle-aged and older adults. A recent study observed that over two-thirds of adolescents receiving treatment for an eating disorder experienced a trauma (Groth et al., 2020). The increased prevalence among adolescents and young adults implies that individuals within this age range are at an increased risk.

   Research examining the role sexual orientation plays on body image observed that heterosexual females were more affected by society’s beauty standards than homosexual and bisexual women and placed a higher prominence on striving for thinness (Henn et al., 2019). Trans college students were four times more likely to engage in disordered eating than their cisgender classmates. The increased disordered eating habits may be partially due to gender dysphoria and body dissatisfaction (Muhlheim, 2021). Various components of our lives, such as life experiences and health challenges, play a significant role in the development and course of eating disorders. 

   Research has observed a relationship between trauma and eating disorders (Gomez et al., 2021; Groth et al., 2020), which can generate additional complications when implementing a successful treatment plan. Therefore, medical professionals must consider additional factors such as life experiences or other health challenges when selecting a treatment plan for patients. Experiencing trauma increases the probability of an eating disorder, affects coping strategies, experience additional trauma-associated symptoms, exasperate eating disorder symptoms, and has been associated with decreased effectiveness regarding treatment (Arabaci et al., 2021; Brewerton, 2019; Gomez et al., 2021; Groth et al., 2020; Rienecke et al., 2020; Scharff et al., 2021; Scharff et al., 2021; Serra et al., 2020; Trim, 2021). These factors can produce additional struggles for the individual during their recovery and may benefit more from a different treatment approach than individuals that have not experienced trauma. Research suggests that individuals that have experienced trauma would benefit most from a trauma-centered treatment approach addressing both eating disorder symptomology and helping the individual heal from the trauma (Rienecke et al.,2020).

   Experiencing trauma has been associated with numerous mental health struggles, including obsessive-compulsive disorder (OCD), anxiety, depression, posttraumatic stress disorder (PTSD), and body dysmorphic disorder (BDD), which can exacerbate eating disorder symptoms. A trauma-focused approach also has the potential to concentrate on reducing body dysmorphic disorder (BDD) symptoms that are two times as likely in patients with posttraumatic stress disorder (PTSD) (Valderrama et al., 2020).

   Recovery is a challenging and often non-linear process that often includes setbacks, additional challenges, and frustration. Developing a positive body image can be difficult due to the messages we receive from the media concerning what the “ideal body” looks like and culture. Some ideas that can help improve body image include focusing on all the things our bodies are capable of, reminding ourselves that our worth isn’t dependent or influenced by our body, speaking kindly to ourselves, and surrounding ourselves with others that are body positive. Some individuals suggest posting positive affirmations in locations where you will see them throughout the day to remind yourself how wonderful and talented your body is. It’s also important to remember that it’s never too late to ask for help or seek treatment. There isn’t just one appropriate treatment plan for eating disorders, and recovery is often a lifetime process. Some individuals find support groups to be beneficial, or cognitive-behavioral therapy. National Eating Disorders Association (NEDA) provides a list of in-person and virtual support groups offered in the United States, screening tools for eating disorders, support via online chat, phone, or text message, or match you with a recovery mentor, for more information. For more information regarding the services and resources NEDA offers, please visit their website at https://www.nationaleatingdisorders.org/.

References

• Arabaci, Buyukbayram Arslan, A., Dagli, D. A., & Tas, G. (2021). The relationship between university students' childhood traumas and their body image coping strategies as well as eating attitudes. Archives of Psychiatric Nursing, 35(1), 66–72. https://doi.org/10.1016/j.apnu.2020.09.017 
• Artoni, P., Chierici, M. L., Arnone, F., Cigarini, C., De Bernardis, E., Galeazzi, G. M., … Pingani, L. (2020). Body perception treatment, a possible way to treat body image disturbance in eating disorders: A case–control efficacy study. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 26(2), 499–514. https://doi.org/10.1007/s40519-020-00875-x 
• Brewerton, T. D. (2018). An overview of trauma-informed care and practice for eating disorders. Journal of Aggression, Maltreatment & Trauma, 28(4), 445–462. https://doi.org/10.1080/10926771.2018.1532940 
• Deloitte Access Economics. (2020). The social and economic cost of eating disorders in the United States of America: A report for the strategic training initiative for the prevention of eating disorders and the academy for eating disorders. https://cdn1.sph.harvard.edu/wp-content/uploads/sites/1267/2020/07/Social-Economic-Cost-of-Eating-Disorders-in-US.pdf 
• Edakubo, S., & Fushimi, K. (2020). Mortality and risk assessment for anorexia nervosa in acute-care hospitals: A nationwide administrative database analysis. BMC Psychiatry, 20(1). https://doi.org/10.1186/s12888-020-2433-8 
• Gomez, F., Kilpela, L. S., Middlemass, K. M., & Becker, C. B. (2021). Sexual trauma uniquely associated with eating disorders: A replication study. Psychological Trauma: Theory, Research, Practice, and Policy, 13(2), 202–205. https://doi.org/10.1037/tra0000586 
• Groth, T., Hilsenroth, M., Boccio, D., & Gold, J. (2019). Relationship between trauma history and eating disorders in adolescents. Journal of Child & Adolescent Trauma, 13(4), 443–453. https://doi.org/10.1007/s40653-019-00275-z 
• Henn, A. T., Taube, C. O., Vocks, S., & Hartmann, A. S. (2019). Body image as well as eating disorder and body dysmorphic disorder symptoms in heterosexual, homosexual, and bisexual women. Frontiers in Psychiatry, 10. https://doi.org/10.3389/fpsyt.2019.00531 
• Muhlheim, L. (2021, October 11). Eating disorders in transgender people. Verywell Mind. Retrieved February 22, 2022, from https://www.verywellmind.com/eating-disorders-in-transgender-people-4582520  
• National Eating Disorders Association. (n.d.). What are eating disorders? National Eating Disorders Association. Retrieved February 19, 2022, from https://www.nationaleatingdisorders.org/what-are-eating-disorders  
• Rienecke, R. D., Blalock, D. V., Duffy, A., Manwaring, J., Le Grange, D., Johnson, C., … McClanahan, S. F. (2020). Posttraumatic stress disorder symptoms and trauma‐informed care in higher levels of care for eating disorders. International Journal of Eating Disorders, 54(4), 627–632. https://doi.org/10.1002/eat.23455 
• Scharff, A., Ortiz, S. N., Forrest, L. N., & Smith, A. R. (2019). Comparing the clinical presentation of eating disorder patients with and without trauma history and/or comorbid ptsd. Eating Disorders, 29(1), 88–102.   https://doi.org/10.1080/10640266.2019.1642035                         
• Serra, R., Kiekens, G., Tarsitani, L., Vrieze, E., Bruffaerts, R., Loriedo, C., … Vanderlinden, J. (2020). The effect of trauma and dissociation on the outcome of cognitive behavioural therapy for binge eating disorder: A 6‐month prospective study. European Eating Disorders Review, 28(3), 309–317. https://doi.org/10.1002/erv.2722 
• Trim, J. (2021). An introduction to the special issue on trauma, PTSD, and eating disorders. Eating Disorders, 29(3), 205–207. https://doi.org/10.1080/10640266.2021.1903700 
• Uri, R. C., Wu, Y.-K., Baker, J. H., & Munn-Chernoff, M. A. (2021). Eating disorder symptoms in Asian American college students. Eating Behaviors, 40, 101458. https://doi.org/10.1016/j.eatbeh.2020.101458 
• Valderrama, J., Hansen, S. K., Pato, C., Phillips, K., Knowles, J., & Pato, M. T. (2020). Greater history of traumatic event exposure and ptsd associated with comorbid body dysmorphic disorder in a large ocd cohort. Psychiatry Research, 289, 112962. https://doi.org/10.1016/j.psychres.2020.112962 ​