By Melissa Simkol
This week, February 23rd through March 1st, is National Eating Disorders Week. More often than not, this means one can expect to be bombarded with messages encouraging women (and men) of all shapes and sizes to love and accept their bodies and to reject the unrealistic beauty standards that are heavily promoted by the media. While promoting positive body image is certainly a good cause, it isn’t right to equate it with eating disorder awareness and prevention. In fact, these body image campaigns—which focus primarily on the common stereotype that eating disorders are superficial in nature—might actually be counterproductive to that mission.
In 2005, Global Market Insite, through a contract with the National Eating Disorders Association, published a poll that surveyed the American public’s perceptions of eating disorders. One particularly notable finding is that approximately 2/3 of American adults think that the media is the primary cause of eating disorders, while only 30% consider genetics to play any role in their onset. These numbers are disheartening because, as it turns out, the media’s “thin ideal” that stigmatizes weight does not cause eating disorders. Can airbrushed models and an onslaught of weight loss commercials contribute to their development? Sure. But do any one of them alone cause an eating disorder? Absolutely not.
Like all mental illnesses, the psychopathology of eating disorders is extremely complex. Because we are all unique individuals, eating disorders develop and manifest differently from person to person. This means that what might trigger one individual to develop an eating disorder might not be a significant stressor for another. This also means that a desire to be thin or a fear of being fat is not at the core of every eating disorder. That’s not to say it’s never a central feature of eating disorders, but rather that the degree of fat phobia varies from person to person. For instance, a 2000 study of Hong Kong patients with Anorexia nervosa (AN) found that some patients were consistently fat phobic, some never displayed fat phobia, and others started off as fat phobic but eventually lost that phobia, or vice versa.
Still not convinced? Let’s explore another concept: if the media and thin models were the sources of eating disorders, then someone who had never been exposed to them would be at zero risk for developing an eating disorder, right?
Wrong. Numerous case studies exist of women with AN or Bulimia nervosa (BN) who have been blind since birth or from a very young age. In one such case study, a woman who was blind since age two had a troubled childhood consisting of alcoholic parents, a grandparent committing suicide, and her father cheating on her mother. As a young child she was constantly pressured to eat more, resulting in an aversion to eating food: “she would claim not to like certain foods, even if she did, because she didn’t like being forced to eat” (Yager, 1986). Once she began to menstruate at age 13, she developed a fear of gaining weight. She went on to study at a music school, but as her teachers were unsure how to handle her blindness she was eventually forced to leave, causing her to become severely depressed. So if she had no idea what being fat looked like and certainly had no fat phobia, what caused her eating disorder? Said Yarbo:
“Her fussiness with food, use of food in control struggles with her parents during childhood, and weight preoccupation during early adolescence all provided a background of vulnerability. Her subsequent AN coalesced during a time when she was without a sense of direction or purpose – when her sense of self, always shaky at best, was lowest since she was no longer a musician or university student; AN then provided her with an identity, at a time when she desperately needed one… The perfectionistic strivings she had as a student and musician, the presence of binge eating episodes in one sister, and the harsh, critical nature of her father are all possible contributing factors.”
A more recent study in 2006 detailed a case of BN in a 47 year old blind woman from Barcelona, Spain. The woman had been engaging in binging and purging behaviors 2-4 times a week for 4 years. She had never expressed a desire to be thinner until psychosocial stressors led to her gaining weight, and she wanted to lose weight “not because of shape concerns, but because of physical reasons” (Fernandez-Atanda et al., 2006). She also exhibited symptoms of anxiety and depression, low self-esteem, and “deficits in social and problem-solving skills, which were the result of interpersonal conflicts she had with her family, especially with her children” (Fernandez-Atanda et al., 2006). Her treatment consisted of non-symptom-oriented cognitive-behavioral therapy that focused more on the patient’s behavioral and emotional symptoms than her eating symptoms. At 12 months follow-up, she was not engaging in any ED symptoms. The researchers concluded that “in the current case, the ED seems to be a consequence of inappropriate coping skills with stress. Indeed, patients who present some behavioral handicaps or deficits are more vulnerable to the development of an ED… the ED is not due to an overemphasis on physical attractiveness, but to a personal difficulty to cope with stress” (Fernandez-Atanda et al., 2006).
These three studies mentioned above strongly suggest that eating disorders arise from a multifaceted mixture of psychological, social, and genetic factors. When we boil eating disorders down to a product of bad body image, we understate the immense significance of the many other dynamics that interact with each other. Furthermore, by focusing just on the symptom of body dissatisfaction we convey eating disorders as superficial, further perpetuating the exact stereotype we’re working to disprove. Eating disorders have the highest mortality rate of all mental illnesses—how can it be possible that there are so many people starving themselves to death just because they want to look good? People suffering from EDs go through the process of restricting their caloric intake, binging on food, and purging after meals because—for them—these behaviors have anxiolytic (anxiety-reducing) effects on the brain, and they are unable to use healthier coping mechanisms to achieve those same results. In other words, alcoholics abuse alcohol because it helps them escape from their life troubles and inner turmoil, not because they actually enjoy alcohol or want to be drunk. Similarly, eating disorder symptoms are indicative of underlying problems that go far beyond the thin ideal that the media helps to perpetuate.
Again, I would like to reiterate that I am not saying the media does not play any part in the onset of eating disorders, because it could certainly be a precipitating factor for some, nor am I trying to undermine the indisputable effects of unrealistic beauty standards on the self-esteem of the general population. But I am saying that we invalidate the experiences and potentially even impede the recovery of many sufferers when we only discuss poor body image.
So why, then, do we only see eating disorder awareness and prevention campaigns attacking the thin ideal? My best guess is that they’re easy to put on, fun to participate in, and most attractive to the general public. I mean, let’s be real here; I can’t think of any engaging activities centering on the interplay of genetic, social, and psychological factors in eating disorders. But I do think that instead of focusing on the negative role of the media, we should work to incorporate education about positive coping skills and more adaptive emotion regulation behaviors into our programming. One would be hard-pressed to find someone perfectly content with their body; therefore, having the ability to productively manage body image issues seems to me far more practical and effective than eliminating negative body image entirely. We know that urging someone with depression to “just think positive” isn’t going to cure them, so why do we think that simply telling an individual with an eating disorder to love their body is going to be any more successful?
It’s time to seriously reevaluate how we talk about eating disorders. If we really want to reduce and prevent the onset of these potentially deadly illnesses, we need to do more than just talk about the media’s role. We need to acknowledge that eating disorders evolve from more than just a desire to look a Hollywood star; it is this widespread misconception that often prevents men, minorities, and older adults from being diagnosed and receiving proper treatment. We need to accept that not everyone with an eating disorder is afraid of being fat or has a negative body image to respect sufferers who don’t exhibit those symptoms. And we must teach young men and women to not just reject thin models and magazines marketing new ways to attain a “bikini-ready” body, but to cope with the negative emotions that arise from their unavoidable presence. So in honor of National Eating Disorders Awareness week, join me in raising awareness about the reality of eating disorders.
GMI (2005). American public opinion on eating disorders, Seattle: National Eating Disorders Association.
Fernández-Aranda F, Crespo JM, Jiménez-Murcia S, Krug I, & Vallejo-Ruiloba J. (2006). Blindness and bulimia nervosa: a description of a case report and its treatment. The International journal of eating disorders, 39(3), 263-265.
Ngai ,E.S., Lee, S., & Lee, A.M. (2000). The variability of phenomenology in anorexia nervosa. Acta psychiatrica Scandinavica, 102(4), 314-317