“Eating disorders (EDs) are polysymptomatic syndromes, defined by maladaptive attitudes and behaviors around eating, weight, and body image.” (Blaney & Millon, 2009, p. 431) The primary disorders in this category are anorexia nervosa (AN), bulimia nervosa (BN), and eating disorders no otherwise specified (EDNOS). Examples of EDNOS might include “AN-like” with preoccupations with thinness, normal-weight people purging food without binging or simply binging without purging (Binge Eating Disorder, or BED). (Blaney & Millon, 2009, p. 432)
Epidemiological data suggests that EDs occur more often in women than in men (by a factor of roughly 10); although there is some evidence indicating that the gender gap is closing. Although AN/BN tend to be most prevalent in late adolescence and early adulthood, BED defies the stereotype by manifesting in an older age group (typically around 40 years of age). There is also little linkage to socioeconomic status, despite the common belief that Eds are disorders of the affluent. (Blaney & Millon, 2009, p. 433) This totally astounds me… how can people who are already undernourished give up what sustenance they are offered?
EDs frequently co-occur with mood, anxiety, substance-abuse, personality, and other psychiatric disorders. There are so many comorbid mood disorders noted in individuals with EDs that it is easier to exclude mood disorder (singular) that is unrelated… bi-polar disorders. Personally, I believe the single mood disorder that is currently excluded should be considered. “The disorders are believe to depend on similar family/developmental determinants (e.g., attachment problems or trauma), and both have been thought to have similar neurobiological substrates.” (Blaney & Millon, 2009, p. 434) Social phobias and OCD were among the most prevalent anxiety related comorbid disorders. Since anxiety disorders often precede ED onset, it has been suggested that an anxious or obsessive-compulsive attitude predisposes an individual to ED development. (Blaney & Millon, 2009, p. 435)
Not only are PTSD and substance abuse disorders often comorbid with EDs, but they are often comorbid with each other. “Substance abusers in an eating-disordered population show significantly more Social Phobia, Panic Disorder, and Personality Disorders. In addition, comorbid substance abuse was found to predict elevations in Major Depression, Anxiety Disorders, Cluster B personality disorders, as well as greater impulsivity and perfectionism.” (Blaney & Millon, 2009, p. 435)
Finally, personality disorders are frequently present in individuals whom suffer from EDs. Restrictive type EDs seem to be associated with Anxious-Fearful PD diagnosis (anxiousness, orderliness, introversion, preference for sameness and control). Binge-purge types have a pronounced affinity for the dramatic-erratic PDs including attention/sensation seeking, extroversion, mood lability, and proneness to excitability or impulsivity. (Blaney & Millon, 2009, p. 435)
EDs are assumed to be multiply determined by complex interactions including constitutional factors, psychological/developmental processes, social factors, and secondary effects in the biological, psychological and social spheres of maladaptive eating practices themselves. (Blaney & Millon, 2009, p. 443) All of the above features generally manfest in eating-specific cognitions related to bodily appearance and appetite regulation, body image or weight considerations, and social values that heighten concerns with all of the above. As a result, it is currently conceived that EDs represent a “tightly woven” expression of causes and symptoms that have an interrelationship between and among each other.
Blaney, P. H., & Millon, T. (2009). Oxford textbook of psychopathology (2nd ed.). New York, New York: Oxford University Press.