Eating Disorders: Definitions, Causes, Risk Factors, by Moe Gelbart, PhD.

Moe Gelbart, PhD

Among the most frightening, and dangerous mental health issues teens struggle with are eating disorders. In this blog I hope to to share the basic facts, statistics, causes, and strategies for coping with this wide-spread problem. 

Facts:  The incidence of eating disorders is generally growing, and disproportionately affects teenagers.  While most prevalent in ages 12 to 25, children younger than 12 are at danger, especially due to health issues that can be caused by refusing to eat at such a young age.  Following are some alarming facts:

  • 40-60% of elementary school girls (6-12) are concerned about their weight.

  • In High School, 44% of females and 15% of males have attempted to lose weight

  • 15% of female teens have disordered eating

  • 81% of 10 year olds are afraid of being fat

  • 9% of 9 year olds have vomited to lose weight

  • Cases of anorexia nervosa among girls 15-19 have increased every decade since 1930

  • The incidence of bulimia in women has tripled since the 90’s

  • Every 62 minutes at least one person dies as a result of an eating disorder. 

  • The mortality rate of those that suffer from anorexia is 12 times higher than the death rate for all other causes of death

Types of Eating Disorders:  In general, eating disorders constitute an unrealistic and all-consuming fear related to weight gain and the desire to be thin. They are fueled by early trauma, personality issues, psychological factors, genetic components, and are very much driven by social media.

Anorexia - There are two main types of anorexia, both characterized by fear of weight gain and abnormal eating patterns. In the restrictive type, the teen aggressively limits food and caloric intake, effectively starving the body of the nutrition and calories needed. They feel an intense fear of gaining weight or becoming fat, and are blind to the seriousness of their weight loss. Their body self -image drives their self-worth and self-confidence. The other type of anorexia is the binge/purge type, in which they purge after they eat, causing an additional set of health problems. A teen may have an atypical anorexia, where they may be overly concerned with weight and food intake, but may not be severely underweight.  

Bulimia - The most common form of bulimia is the binge and purge type, whereby the teen eats a large amount of food in a short time, with an accompanying sense of lack of control around their eating. They then compensate for their behavior, and intense fear of gaining weight with things like excessive exercise, use of laxatives or diuretics, periods of fasting, and most commonly, self-induced vomiting.  

Binge Eating Disorder - This problem is different from bulimia in that the teen does not compensate for their binge eating. It is characterized by a sense of uncontrollable excessive eating, followed by feelings of shame and guilt. Criteria for the disorder is the behavior occurring at least once a week for a period of three months.  The compulsion to eat often results in the teen eating in secret and eating when they do not feel hungry.

Avoidant Restrictive Food Intake Disorder (ARFID) -  With ARFID, the teen begins to limit his/her range of preferred foods, which become less and less and narrower over time.  It usually results in dramatic weight loss. They become obsessively picky eaters, though they are not driven by body image fears of fears of gaining weight.  

Orthorexia -  This problem is similar to, and has elements of ARFID.  The teen develops an unrealistic and compulsive concern about the health of food ingredients, and eat only limited and narrow food groups that they deem as healthy or “pure”.  The teen will cut out an increasing number of food groups, and the thought of food selection will be obsessively considered throughout the day.

Risk Factors:  Risk factors for eating disorders fall into biological, social, and psychological categories.  Genetics play a role, and if a teen has a close relative with a diagnosed eating disorder, their risk for developing such a problem is greater. In the same vein, if there is a family history of significant mental health issues, such as depression, anxiety, or addiction, it may predispose the teen for developing an eating disorder. Psychologically, the trait of perfectionism is a leading cause for ED. When teens experience unrealistic high expectations, and are faced with prospect of needing to control the outcome of things, they often transfer those unrealistic expectations to trying to control their food intake or appearance. Along with perfectionism comes the need to control. Trying to control results when one does not have control of all the factors leads to frustration, anxiety, and a distorted attempt to control certain things like food intake and body weight. Body image dissatisfaction and distortion is a significant factor in unhealthy use of food to achieve unrealistic results. Social risk factors are numerous, and grow daily with teen’s devotion to social media. The internet is filled with messages to teens regarding “the ideal body”, often unrealistic and unattainable. A Stanford study found that 96% of young eating disorder patients admitted they learned about purging and weight-loss methods from the Internet. There are extremely dangerous websites for teen girls, Pro-Ana (for pro anorexia) and Pro-Mia (for pro bulimia), which provide “thinspiration” for girls, accompanied by photos of bony-thin fashion models, along with advice about losing weight, being thin, attracting male attention, and other destructive suggestions.  As an example, here are the “Thin Commandments” from one of the websites:

1. If you aren't thin you aren't attractive.

2. Being thin is more important than being healthy.

3. You must buy clothes, style your hair, take laxatives, starve yourself, do anything to make yourself look thinner.

4. Thou shall not eat without feeling guilty.

5. Thou shall not eat fattening food without punishing oneself afterwards.

6. Thou shall count calories and restrict intake accordingly.

7. What the scale says is the most important thing.

8. Losing weight is good/gaining weight is bad.

9. You can never be too thin.

10. Being thin and not eating are signs of true willpower and success

Powerful, and painful messages, aimed at vulnerable teenagers.

Another risk factor, closely associated with social media, is bullying and cyber bullying.  60% of teens with eating disorders reported that bullying contributed to the development of their problem. The anxieties faced by teens as they post pictures of themselves on line, fearful of how others will respond, is so overwhelming that they often will take hundreds of photos before they are willing to post the perfect one. Once a teen forms a negative body image, they may strive in unhealthy ways to achieve what the media portrays as the ideal body.

There are more subtle societal factors, such as constant bombardment in the media of photo-shopped perfect figures among teen celebrities, and advertisements designed to manipulate purchases to make one look “better”.  The attitude that parents demonstrate towards weight plays a significant role in how a teenager feels about themselves physically. While most of us as parents understand the need to avoid direct criticism of our children’s weight or eating habits, we are conflicted about trying to help them feel and stay healthy while at the same time maintaining their self-acceptance and self-care. Very well meaning parents will ask their child, “Do you think you really need to eat that piece of cake?”, not knowing that it may have a devastating effect on their child’s self-image. There are also powerful messages parents give off without realizing it. I believe this is especially true when the fathers of young girls are unaware of the impact of their comments about another person’s appearance. Remarking on the beauty or body of someone on TV, at the beach, or somewhere else, either positively or negatively, will be absorbed by their teenage daughter, and often lead to unrealistic self-expectations.  

Interestingly, most experts agree that ultimately eating disorders are not really about wanting to be thin, but rather, expressions of underlying issues of anxiety, depression, and trauma. Controlling food intake is a way of managing internal pain, emotional discomfort, and trying to control. Although the vehicle for the problem is food - restricting, purging, etc,- the main issue is of control, and obsession of thought.  The teen with eating disorder is constantly thinking about their body and their weight, and what they are eating. It becomes a round the clock obsession which greatly impairs normal functioning.

The most important thing for a parent is to be aware of their child’s thinking and behavior surrounding food and body image, and to get them help if there is any concern.  Food restrictions and purging carry extremely dangerous physical consequences, and if one has concern, they should seek out knowledgeable pediatricians and/or mental health professionals.

Moe Gelbart, Ph.D.

Executive Director, Thelma McMillen Center