Eating Disorders
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Many of us have something about our appearance that we'd like to change, but for some people these desires can develop into actual disorders. How are body dysmorphic disorder and eating disorders related? This lesson gives you a closer look at these disorders and the impact they can have on people.
Most of us have things about our bodies we'd like to change. Maybe it's a nose with a small bump on it; maybe it's hair that never lies flat. Usually these are things that most other people don't notice about us, but that still bother us when we look in the mirror. I think I have big, ugly knuckles on my hands, but if I mention this to friends they think I'm nuts for focusing on it. These little obsessions with our bodies seem to be an unavoidable consequence of owning a mirror. But sometimes, this dissatisfaction with our bodies can turn into something more serious.
Body dysmorphic disorder (BDD) is a term used to describe a preoccupation with the body's faults, to the point of getting in the way of daily life. People with BDD spend way too much time in front of the mirror, obsessing about their 'problem' feature and trying to find the best way to cover or distract from it. BDD is often associated with compulsive grooming behaviors like picking at skin, plucking eyebrows or combing hair; in fact, this combination of body obsession plus grooming compulsion has led many therapists to treat the disorder similarly to a more typical presentation of obsessive compulsive disorder, in which patients experience involuntary, intrusive thoughts and develop ritualistic compulsive behaviors to deal with anxiety (see 'Anxiety Disorders' for more on OCD). BDD is also associated with depressive symptoms and suicidal thoughts. Patients with BDD will often pursue plastic surgery to correct their 'flaw.' A recent Belgian study found that 43% of patients seeking nose-jobs showed signs of BDD.
BDD has gained more attention in recent years due to the fear that young girls are increasingly pressured by media images of models and celebrities to look 'perfect'. There was even a reality show, called 'The Swan,' that can be viewed as an unintentional public service announcement about BDD: in it, 'ugly duckling' contestants are given lots of plastic surgery and compete at the end in a beauty pageant which praises the best 'transformation.' With plastic surgery so mainstreamed, it's easy to imagine that young girls might become more preoccupied with their flaws. Though BDD does exist in areas of the world where access to these kinds of images is limited, it does seem that looking at pictures of 'perfect women' may be a trigger for those already likely to develop the condition.
The media has also been suggested as a trigger for eating disorders. These are related to BDD in that people with both kinds of disorders are obsessed with bodily flaws. Eating disorders are distinguished by specific behaviors toward food that are different than most people's. There are two main eating disorders, and you may have heard of them: anorexia and bulimia. In both cases, patients take extreme measures to reduce weight, even if their weight is already normal or below-normal. You don't have an eating disorder just because you've decided to go on the Atkins diet; healthy weight-loss is healthy, and obesity is a real problem in this country. But just as a person with BDD might always think her nose has a bump on it - or her knuckles are enormous - patients with eating disorders have an unrealistic sense of how much they weigh and how they look.
Anorexic patients severely restrict calorie intake in an effort to lose weight. People who are overweight and want to diet are typically advised to keep their calorie intakes above 1,200; the average anorexic eats more like 600-800 calories a day. Just imagine trying to survive on this. For perspective, most burritos at Chipotle clock it at 800+, and that's just one meal! Because it's really hard to eat so little, many anorexics develop strategies for tricking their bodies into thinking they've eaten more; cutting food into small portions, for example, or eating mainly vegetables like celery.
Limiting calorie intake so severely can have serious health consequences. Being extremely thin can stop women from getting their periods (no periods), since the body (rightly) judges that a baby couldn't survive on so few nutrients. Anorexia can also cause serious kidney and heart malfunctions, dental problems and osteoporosis. It really can lead to death. In the past few years there have been several prominent fashion models who have died from the disease, prompting the fashion industry to pass regulations to disallow models who are at starvation-levels of thinness from walking runways. Once identified, anorexia is typically treated from several angles. Doctors focus on restoring a healthy weight while also treating psychological symptoms.
Instead of limiting calorie intake, patients suffering from bulimia follow a cycle of binging and purging, or eating lots of food and then attempting to rid themselves of the calories by vomiting, abusing laxatives or exercising excessively. Again, exercising to burn some calories and lose some weight is totally fine and normal - but exercising for hours to entirely burn away the calories of a food 'binge' enters into disordered territory. Bulimics are more likely than anorexics to have a body weight in the normal range, but suffer from medical consequences related to the purging phase of their disease. Many end up with fluid or electrolyte imbalances, or permanent damage to their stomach and esophagus. Some even have teeth that erode due to excessive exposure to stomach acids. Treatment generally includes psychotherapy, as well as medications to help with depression and other psychological conditions.
Eating disorders in general affect more women than men, though body dysmorphic disorder is diagnosed equally across genders. Even so, some men, especially those with jobs that require careful monitoring of body weight - like modeling, but also certain sports, like wrestling and jockeying - do develop eating disorders and sometimes go undiagnosed due to their primary association with adolescent women.
Eating disorders are serious and often difficult to identify, since the people suffering from them go to great lengths to conceal their problem. But not getting help can be dangerous, even fatal. Body dysmorphic disorder is related to the eating disorders through shared obsession with the body and its faults, but patients with BDD focus more on grooming than on changing eating patterns. Increases in the frequency of both kinds of disorders have been attributed to the media's focus on perfect bodies.