Although dieting may not be a direct cause of anorexia nervosa or other eating disorders, it may act as a precursor to teens developing an eating disorder and subsequently requiring an anorexia nervosa treatment program. According to the National Eating Disorders Association, 35 percent of teens and young adults who diet periodically may develop an obsession with dieting. Research has found that eventually, between 20 and 25 percent of habitual dieters will be diagnosed with an eating disorder. For parents worried that their teen’s dieting has progressed to an eating disorder, getting their teen into anorexia nervosa treatment as soon as possible is vital to their long-term physical and psychological health.
Dieting, Body Dysmorphic Disorder and Eating Disorders
Young women who are height and weight proportionate may start exploring fad diets if they have a distorted perception of their appearance. In some cases, body dysmorphic disorder (BDD) begins when a family member or friend makes an offhand remark about their physical appearance. For example, someone may mention they haven’t lost their “baby fat” or they have cute, “chubby” cheeks. Young women who may have a lower level of self-esteem, who are depressed or anxious due to family dysfunction, have an obsessive preoccupation with weight or thinness or exhibit characteristics of a perfectionist could take such comments seriously and obsess over them.
Positive responses from friends or family members, such as “Oh, you look great!” “You have lost weight” may further intensify the desire to correct nonexistent physical flaws and lead to an increase in anorexia nervosa symptoms. As symptoms worsen and these individuals begin to hear comments such as, “You’re too skinny”, they may already be too deep into their eating disorder to correctly “hear” these statements. Instead, young adult women needing anorexia nervosa treatment may interpret critical statements about their appearance as meaning they are still not “perfect”.
Consequently, women with anorexia nervosa and bulimia nervosa may resist changing their eating habits while going to great lengths to hide their weight loss (wearing loose clothing, pretending to eat at dinner, secretly dumping food in the garbage, etc.) until the point they suffer serious medical complications and are in need of treatment.
Why Is Thinness Viewed as Attractive in Women?
The United States and many other Western countries are experiencing an obesity epidemic, while being “thin” is, in some cases, still considered desirable and attractive. Increasing obesity rates in children and adults are due to multiple factors involving lifestyle, easy access to high-caloric foods and workplace automation increasing the number of hours people stay sedentary. Unfortunately, this mismatch is worsening another epidemic, that of body dissatisfaction, depression, low self-esteem and eating disorders in women of all ages.
Hundreds of years ago, when food commodities such as sugar and fat were considered luxuries, thinness in women was viewed as less desirable. Being thin meant you were poor and possibly unhealthy. Wealthier women deliberately gained weight and dressed in “puffy” clothing to make themselves look heavier and more attractive to men. It was not until the rapid rise of the Industrial Age and mass production of food after WWI that a sense of thinness become more popular. Fueled by 1930s film celebrities such as Greta Garbo, Jean Harlow and Myrna Low, women striving to be just like them led to the creation of the diet supplement industry, fad diets and provocative ads featuring lonely, overweight women looking for husbands.
Cultural norms, technology and the media have all contributed to eating disorders being among the leading mental disorders affecting women today. While treatment modalities for anorexia nervosa and bulimia nervosa are continuing to help women overcome their eating disorder, regain their health and go on to lead productive, satisfying lives, there is still much more we do not know about the epidemiology and pathology of eating disorders. Ongoing research is essential for developing new and more effective treatment programs for eating disorders currently affecting nearly 30 million Americans of both genders.
When Symptoms of Anorexia Nervosa are More Than “Just Dieting”
Anorexia nervosa is a psychiatric disorder that compels someone to resist eating enough food to maintain reasonably good health. Accompanied by cognitive biases and distorted self-image perceptions that make an individual think they are overweight, women with anorexia eat only very limited quantities of food and may use laxatives, diuretics or purging as a way to expedite weight loss. In some cases, women with anorexia may starve themselves to the point of needing hospitalization and IV feedings.
Although an anorexia nervosa diagnosis is mostly seen in young women, it is now being seen more often in boys of the same age, possibly due to society’s lessening restrictions on defining gender and masculinity. However, causes of anorexia nervosa are complex and may involve the interaction of hormones, genetics and environment.
In addition to chronic dieting and/or eating small amounts of food, other signs precipitating an eating disorder, such as anorexia nervosa and bulimia nervosa include:
- Obsessing over body shape and weight at an early age
- Constantly comparing themselves to thin celebrities, making statements that they wish they were as thin as this or that individual, etc.
- Being diagnosed with an anxiety or personality disorder as a child or teenager (especially borderline, obsessive-compulsive or avoidant personality disorders)
- Becoming severely anxious if they gain a few pounds
- Obsessing over calories and fat content in food
- Experiencing rapid, dramatic weight loss that others notice but they refuse to acknowledge
- Offering to cook meals for others but not eating the food themselves
- Engaging in ritualistic food behaviors, such as moving food around their plate with a utensil or cutting food into smaller and smaller portions to make it appear as if they are eating
- Exercising vigorously several hours a day
- Acting secretive when it involves eating meals with family or friends
Physical signs of anorexia nervosa and bulimia nervosa may include:
- Swollen cheeks (purging by vomiting enlarges salivary glands)
- Severe halitosis
- Tooth decay/gum disease caused by malnutrition and chronic dry mouth
- Hair thinning/hair loss (adopting different hairstyles to hide hair loss is common in women with eating disorders)
- Irregular periods/amenorrhea
- Academic problems (grades dropping, missing classes)
- Episodes of fainting
- Sleepiness/complaining of feeling tired all the time
- Yellowish skin
- Experiencing frequent respiratory or gastrointestinal illness (reduced functioning of the immune system)
Normal dieting practices will not typically cause any of these serious physical or psychological symptoms. When dieting becomes obsessive and severely unhealthy, anorexia nervosa treatment or other eating disorder treatment is essential to restore the health and well being of the individual in the grips of an eating disorder.
Anorexia Nervosa Diagnosis: What to Expect from an Anorexia Nervosa Treatment Program
Cognitive behavioral therapy and dialectical behavioral therapy are two evidence-based psychotherapies used to treat individuals with eating disorders, such as anorexia nervosa and bulimia nervosa. During individual counseling sessions, eating disorder patients, with careful guidance from their therapist, address past and present events in their lives that may be contributing to their eating disorder. Treatment for eating disorders is intensive and thorough, consisting but not limited to the following topics:
- Bio-psychosocial aspects of eating disorders (provides insight into patients wanting to understand why they have an eating disorder)
- Treatment care continuum; as the individual moves through the stages of treatment, they gain more responsibilities and develop positive coping methods for negative thoughts that may arise
- Effective psychological tools and strategies that support the motivation to succeed while reducing the chance of relapse in the future
- Recognizing situations that may be triggering and creating positive recovery plans for these times
- Learning how to positively structure unfilled time to avoid feeling bored, restless or fixated on ruminating thoughts about food and weight
- Learning how to extinguish maladaptive thinking patterns that may create self-doubt and low self-esteem
With CBT and DBT, women with eating disorders develop a deep understanding of themselves by improving their ability to perceive reality without cognitive distortion. Psychotherapists help their clients talk about their feelings, while managing any negative emotions that may arise. Therapy sessions also focus on uncovering repressed emotions and the powerful influence a person’s subconscious has on their thoughts and behavior.
Psycho education following an anorexia nervosa diagnosis is especially helpful for eating disorder patients as they learn more in-depth information about their disorder. Therapists discuss the hopes, goals and motivations behind self-perceptions with patients as well as how the brain acquires and
learns new skills and knowledge. Additionally, aspects of developmental psychology are incorporated into psycho educational information, such as the uniqueness of individual growth, biological fundamentals of human development and other factors vital to shaping the essence of a person’s self-identity. Integrating cognitive psychology practices with psycho education is also important to the success of an anorexia nervosa treatment program.
Mindful Eating Practices As Opposed To Dieting
To support individuals with eating disorders in restoring their ability to recognize hunger and fullness cues, counselors teach mindful eating techniques. Mindful eating involves focusing on the senses to get in touch with one’s body and to nourish your body based on internal needs and cues. Eating slowly, concentrating on a food’s flavor and texture and paying attention to fullness and hunger prompts from the body are just a few mindful eating techniques that can help women learn to appropriately nourish their bodies. Questions an eating disorder patient should ask while eating mindfully include:
- Where is my fullness or hunger level right now?
- Do I enjoy eating this kind of food or do I want to eat something else?
- What could I do to make eating more pleasurable at this time?
- What influenced my food choices today? Was it an external or internal influence?
Dieting should not negatively impact someone’s physical and mental health, nor should it interfere with their school, work or relationships. Like other mental health disorders, eating disorders such as anorexia nervosa and bulimia nervosa cannot be self-treated. They require a professional intervention by experienced eating disorder therapists who understand and empathize with a patient and can support the patient in understanding the underlying causes of the disorder and developing more positive coping tools to handle any triggering thoughts or situation.