No single cause: the truth about eating disorders

Posted 23/03/2016

After reading Baroness Bakewell’s views, “Eating disorders like anorexia are a sign of ‘narcissism’ and ‘overindulgence’”, I was angry and upset. Angry that someone could believe and was willing to publicly state that all the years of internal torture I, and so many others, have faced was due to the desire to be “beautiful, healthy and thin”. Upset that vulnerable people may read and be influenced by a view that dismisses the need to take seriously those with a life-threatening illness. This frustration was only deepened on reading comments left by readers on the Telegraph’s website. Comments that anorexia nervosa is “self-inflicted”, a “fad”, and that people with anorexia should go and volunteer in migrant camps in order to “get over” their eating disorders or, as one commenter so eloquently put it - just eat cake.

There was also a small part of me – likely the anorexic mind-set that still persists – that thought maybe they are right? Am I vain? Have I caused all the years of misery for those around me? This thought was quickly rationalised; Bakewell’s statement that people with anorexia want to be “beautiful (and) healthy” was so wrong.  In fact, it is a juxtaposition to the self-disgust many people with anorexia have regarding their appearance and the serious health risks of the illness. Additionally, I can now see that I was never in control of my eating disorder. As much as I perceived the illness to give me the control I so craved for in life, it was in charge of me.

I do not believe the Baroness meant to cause harm by the comments she made – she was uneducated in this issue and chose to speak out before doing her research. However, given the seriousness of the illness and the dangers of stating her uninformed view, this is concerning.

This is why I chose to write this article; to inform people of some of the research that is out there and as an attempt to challenge some of the myths that persist regarding eating disorders, in particular anorexia nervosa.

It is important to remember that there is not a single cause to anorexia nervosa but instead, like many illnesses, it develops due to multiple factors. It is also important to state that there are many different perspectives on the disorder, but what is generally agreed upon by clinicians is that anorexia nervosa is “one of the most frustrating and recalcitrant forms of psychopathology” (Vitousek, Watson & Wilson, 1998). This would not be the case if, as the Baroness suggests, anorexia was “called hunger when (she) was young”.

One evidence-based theory surrounding the cause of anorexia is the cognitive behavioural theory of eating disorders, which suggests that anorexia nervosa is an illness that occurs due to a need for self-control (Fairburn, Shafran & Cooper, 1999).

Often this need is the result of the individual’s low self-esteem, as well as the misalignment with their feelings of inadequacy yet desire for perfection. Restriction of one’s diet provides the control the individual seeks; it allows the individual to focus solely on their eating so that other aspects of their lives can be blanketed over. Through this initial restriction and attempt to regain control, the cognitive behavioural theory suggests that there are three main feedback mechanisms which cause the disorder to become self-perpetuating. These include the culturally specific mechanism prominent in the majority of Western societies – that thinness is desired. Although this perpetuating mechanism of anorexia nervosa links to Bakewell’s idea of those with the illness desiring to be thin, there is a definitive difference between Bakewell’s suggestion that thinness is sought after to be beautiful, and the increase in self-control and self-worth that weight loss can bring those with anorexia.

Other influences on the likelihood of developing anorexia nervosa are genetic factors, with studies such as that by Wade et al. (2000) suggesting that genetics form 60 – 85% of a person’s risk for developing the illness.

As well as this potential predisposition to the illness, environmental factors are also likely to play a role in the onset of anorexia nervosa. Western societies promote the unhealthy view that thin is beautiful, thin is good and thin is successful. We praise people when they lose weight, teach children from a young age that there are good and bad foods, and are continually bombarded by the latest diet. Social media encourages us to compare our lives and our appearances to others, and increases our self-scrutiny. So although anorexia nervosa isn’t caused by wanting to be “beautiful...and thin”, the values we are faced with in Western societies are likely to be a maintaining factor to the illness and make it more challenging for those battling the illness to recover.

Whilst there is a higher prevalence of anorexia nervosa in Western countries compared to non-Western countries, anorexia nervosa is not confined to Western countries (Makino et al., 2004) as Bakewell insinuates.

Anorexia nervosa is also not something that only “young girls” suffer from. Although the onset of the illness is more likely to occur during the teenage years, probably due to the physical and emotional changes that puberty brings about, it is not restricted to this age range. Likewise, despite anorexia nervosa being more prevalent in females compared to males, approximately 10% of people with anorexia are thought to be male (Fairburn and Harrison, 2003) and it is likely that this figure is an underestimation due to a lack of males coming forward about their illness. This highlights the dangers of reinforcing false stereotypes regarding eating disorders, since this may impact upon those who then seek help for their illness or how they are treated when they do.  

Although I appreciate that Bakewell has since apologised for her statement regarding eating disorders, I worry that her views will have reiterated the myths that many still hold about the illness. I only hope that the discussion the article has sparked helps to tackle these myths and informs people of the truth behind eating disorders; that they are life-threatening illnesses that develop through no-one’s fault and that need to be fought against, rather than trivialised and dismissed. I hope that this article can play a part in the education of such misinformed, and potentially damaging views.

References:

Fairburn, C.G., and Harrison, P.J. (2003). Eating disorders. The Lancet, 361, 407 – 416.

Fairburn, C.G., Shafran, R., and Cooper, Z. (1999). A cognitive behavioural theory of anorexia nervosa. Behaviour Research Therapy, 37, 1 – 13.

Makino, M., Tsuboi, K., and Dennerstein, L. (2004). Prevalence of eating disorders: a comparison of Western and Non-Western countries. Medscape General Medicine, 6(3), 49.

Vitousek, K., Watson, S., and Wilson, G.T. (1998). Enhancing motivation for change in treatment-resistance eating disorders. Clinical Psychology Review, 18(4), 391 – 420.

Wade, T.D., Bulik, C.M., Neale, M., and Kendler, K.S. (2000). Anorexia nervosa and major depression: shared genetic and environmental risk factors. The American Journal of Psychiatry, 157(3), 469 – 471. 

Contributed by Emily