This week highlights the fact that body size and shape are strongly influenced by biological factors, while also calling attention to new discoveries surrounding the role of genetics in the development of eating disorders. Wayne Bowers, MD, director of Psychological Services at University of Iowa Hospitals and Clinics, talks about eating disorders and treatment:
What is an eating disorder?
An eating disorder is a disorder of eating behavior and it results from an over-valued belief regarding the desirability of weight or shape change and usually it's of sufficient duration and intensity to result in abnormal behaviors leading to impairment—either medically, behaviorally, or psychologically—often all of the above. And it's diagnosed by looking at the positive features of an eating disorder in absence of some other clear medical or psychiatric cause.
How many different eating disorders are currently diagnosed?
There are currently four:
- Anorexia Nervosa, the one most people are aware of, comes from a significant weight loss
- Bulimia Nervosa, usually characterized by binge eating and some sort of purging—laxatives, could be something else
- Binge Eating Disorder, a new category, generally seen with individuals who might be overweight, but different from bulimia in that the individuals with binge eating disorder generally do not compensate in the sense they may not use laxatives or they may not restrict
- Eating Disorders Not Otherwise Specified, for those who don't fulfill the criteria for anorexia or bulimia
Who is most likely to develop an eating disorder?
Right now if you look at the literature, women are more likely to develop an eating disorder than males in a sense that 85 to 90 percent of those diagnosed with an eating disorder are female; 10 to 15 percent are male.
It sounds like an ‘eating' disorder is all about food. Are there other issues involved in eating disorders?
Food is probably, in a very global sense, the smaller issue. Food is often a place that a person will focus on with a desire to develop some control in their life. There are many other things that probably precipitant the disorder. Things like concerns about what people may have said about somebody's shape—it might be a friend, it might be a significant other, sometimes health care professionals may overemphasize weight loss—so a person gets caught up in things like that. And then food is often one way of controlling that. Another thing that they often control is exercise. So again, the food is probably a small portion of what we would work with.
What causes an eating disorder?
I think it's hard to identify specific cause because there are many things that contribute to it. For example, as I was saying comments or criticisms about maybe weight, shape, size, and appearance could be from friends, teachers, boyfriends, girlfriends.
We have a culture that has an extreme, at times, overemphasis on thinness or weight loss. Occasionally individuals who have been involved in some sort of previous abuse (could be emotional, could be sexual abuse), they tend to be more vulnerable to developing an eating disorder. There are factors that tend to sustain it once a person gets caught up in it. If you have a sense of being in control, that tends to make people feel better about themselves.
Individuals who tend to be maybe more perfectionistic in how they see themselves are likely to be more vulnerable. There are neurochemical mechanisms—serotonin being one—that are looked at as related to the development of an eating disorder. But it's a very complex set of issues and we really don't understand the specific cause for it yet.
Is there a genetic link to developing an eating disorder?
Yes, there's a lot of ongoing research in genetics. There is good data to see that individuals who develop eating disorders may have had somebody in their family who has had an eating disorder (could be a parent), and there are studies going on trying to identify specific genes that might be creating a vulnerability to an eating disorder.
Can eating disorders be prevented?
That's an interesting topic and there are quite a few people looking at prevention programs. Truthfully, one of the best ways to prevent it within families is to:
- Eat healthy, sensible meals
- Have good communication within the family so they're able to talk about concerns that come up within the family.
That would go a long way to reducing some of the emphasis on weight, shape, size, and appearance and probably works the best. Although there have been programs on the Internet, there are some universities that are specifically looking at prevention programs. Often they're run through the mental-health counseling center at that university. But it's still an area that we don't know enough about to say we can actually prevent it.
How are eating disorders treated?
That's probably, in some sense, a bit of the good news. Individuals who have bulimia nervosa—there are very good treatments. The two primary ones are:
- Psychotherapeutic intervention, also called cognitive therapy, and is currently considered the gold standard
- Antidepressants and other medicines also help people with bulimia
We are not fortunate yet with anorexia to say we have specific interventions that have been shown to be as beneficial as the interventions for bulimia. So there's still research being done with that. There is some indication that medications and therapy will also help individuals who have binge eating disorder, although that disorder has been around for a shorter period of time. We don't have good literature on what can be used to treat it. There's still a lot of research going on, particularly for anorexia and how best to treat it.
Can an eating disorder be ‘cured'?
I guess I stay away from “cure”, and most of my professional colleagues stay away from it also because that suggests, to some degree, things would never come back. The natural history of the disorder for some people is that they may have periods of time where they don't have any problem with it but it could reoccur. I stay away from and am very hesitant to talk about a cure. What we want to do is help a person cope effectively so they can overcome the symptoms that interfere with their day-to-day functioning.
Is UI Hospitals and Clinics involved in any research with regard to eating disorders?
Currently we don't have anything that somebody could be involved with. We are beginning to work on developing several projects, including neuroimaging of the brain, to look for specific areas that may be contributing to either the development or the maintenance of this disorder. We're also beginning to look at potential psychotherapeutic treatment trials, but those are both in the early stages of development. |
