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April 10, 2026
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"Suicide in anorexia nervosa and bulimia nervosa is a major cause of death. Risk factors for suicide and attempted suicide (which in many cases results in successful suicide) in anorexia nervosa include: purging type, chronic disease, and during treatment, obsessive symptoms and drug abuse, major depression, and for anorexia nervosa low body mass index (BMI) at presentation. In anorexia nervosa suicide has been considered the first cause of death and attempted suicide is a serious threat to these individuals. Data concerning suicide in bulimia nervosa has still scarce whereas attempted suicides are easily found in clinical histories of patients. No doubt suicidal behavior is underestimated amongst patients with anorexia nervosa and bulimia nervosa. An effort to reconcile with subject of suicide and a better evaluation of these patients' psychopathology should improve suicide prevention strategies amongst these individuals."
"To date, more than 1365 trials have been generated by searching and over 100 trials have been evaluated in detail. Because of a relatively high number of original exclusions (n=12) the trial inclusion criteria were broadened to include those with non-blinded outcome assessment, providing 34 trials for analyses. Because of incomplete published and available data, at best up to 12 studies had data available for any single analysis. The maximum number of total patients included in a single analysis was 602. The majority of studies evaluated patients with bulimia nervosa of a purging type. The review supported the efficacy of cognitive-behavioural psychotherapy (CBT) and particularly CBT-BN in the treatment of people with bulimia nervosa and also (but less strongly due to the small number of trials) like eating disorder syndromes. CBT had been used with efficacy in group settings. Other psychotherapies were also efficacious, particularly interpersonal psychotherapy in the longer-term. Self-help approaches that used highly structured CBT treatment manuals, were promising albeit with more modest results generally, and their evaluation in bulimia nervosa approach merits further research. Exposure and response prevention did not appear to enhance the efficacy of CBT. Psychotherapy alone is unlikely to reduce or change body weight in people with bulimia nervosa or similar eating disorders."
"There was a small body of evidence for the efficacy of cognitive-behaviour therapy in bulimia nervosa and similar syndromes, but the quality of trials was very variable (e.g. the majority were not blinded) and sample sizes were often small in comparison to pharmacotherapy trials. More trials are needed, particularly for binge eating disorder and other EDNOS syndromes, and trials evaluating other psychotherapies and less intensive psychotherapies."
"This article describes the qualitative analysis of a randomized control trial that explores the use of parent-to-parent consultations as an augmentation to the Maudsley model of family-based treatment for anorexia. Twenty families were randomized into two groups, 10 receiving standard treatment and 10 receiving an additional parent-to-parent consultation. Parents of all families were interviewed regarding their experience of treatment and transcripts were analyzed with the assistance of QSR N-Vivo. Parents described parent-to-parent consultations as an intense emotional experience that helped them to feel less alone, to feel empowered to progress, and to reflect on changes in family interactions. These results suggest that parent-to-parent consultations are seen as a useful augmentation to the Maudsley model of family-based treatment for anorexia nervosa."
"The development of eating disorders including anorexia nervosa, bulimia nervosa, binge eating disorder, and atypical eating disorders that affect many young women and even men in the productive period of their lives is complex and varied. While numbers of presumed risk factors contributing to the development of eating disorders are increasing, previous evidence for biological, psychological, developmental, and sociocultural effects on the development of eating disorders have not been conclusive. Despite the fact that a huge body of research has carefully examined the possible risk factors associated with the eating disorders, they have failed not only to uncover the exact etiology of eating disorders, but also to understand the interaction between different causes of eating disorders. This failure may be due complexities of eating disorders, limitations of the studies or combination of two factors. In this review, some risk factors including biological, psychological, developmental, and sociocultural are discussed."
"Studies have reported that the oral health status is jeopardized in patients with eating disorders. The aim was to review the oro-facial manifestations in patients with eating disorders. The address the focused question was "What is the oro-dental health status in patients with eating disorders?" MEDLINE/PubMed and Google Scholar databases were searched from 1948 to March 2012 using the following terms in various combinations: "Anorexia nervosa", "bulimia nervosa", "eating disorders", "dental", "oral health status". Letters to the editor, unpublished data and articles published in languages other than English were excluded. Dry lips, burning tongue and parotid gland swelling are common manifestations in patients with eating disorders as compared to medically healthy controls. The association of dental caries and periodontal disease in patients with eating disorders remains debatable. Temporomandibular disorders have also been reported to be more prevalent in patients with eating disorders as compared to healthy controls. A critical oral-dental examination during routine dental check-ups may reveal valuable information regarding the presence or absence of eating disorders in routine dental patients. This may be important information, updating the medical history, supporting the role of the physician."
"According to the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV), bulimia nervosa is characterized by recurrent episodes of binge eating followed by 1 or more compensatory behaviors to eliminate the calories (vomiting, laxatives, fasting, etc.) that take place on average a minimum of twice weekly for 3 or more months.5 Patients who do not meet the frequency or length criteria may be diagnosed with DSM-IV eating disorder not otherwise specified. Bulimia nervosa is also delineated into 2 distinct subtypes: purging and nonpurging. With the purging subtype, patients engage in some method to remove the binged food from their bodies. This is most often accomplished by self-induced vomiting but can include the misuse of laxatives, enemas, or diuretics. Nonpurging bulimics use fasting or excessive exercise as the primary compensation for binges but do not regularly purge. Regardless of subtype, bulimic patients have negative self-evaluations, placing inappropriate importance on weight and body image."
"To date no trial has focused on the treatment of adolescents with bulimia nervosa. The aim of this study was to compare the efficacy and cost-effectiveness of family therapy and cognitive behavior therapy (CBT) guided self-care in adolescents with bulimia nervosa or eating disorder not otherwise specified."
"Of the 85 study participants, 41 were assigned to family therapy and 44 to CBT guided self-care. At 6 months, bingeing had undergone a significantly greater reduction in the guided self-care group than in the family therapy group; however, this difference disappeared at 12 months. There were no other differences between groups in behavioral or attitudinal eating disorder symptoms. The direct cost of treatment was lower for guided self-care than for family therapy. The two treatments did not differ in other cost categories."
"Compared with family therapy, CBT guided self-care has the slight advantage of offering a more rapid reduction of bingeing, lower cost, and greater acceptability for adolescents with bulimia or eating disorder not otherwise specified."
"For females, bulimic symptoms increased from age 14 to 16 and declined slowly thereafter. For males, the symptoms decreased between ages 14 and 16 and returned in the early 20s. Females had higher levels of symptoms than males at every age. Age-associated trends in body mass index, appearance satisfaction, and symptoms of anxiety and depression were associated with some of the trends for both genders. For females, changes in alcohol consumption and cohabitation status functioned as predictors as well."
"It has been hypothesized that eating disorders have multiple and often shared etiologies including biological, psychological, developmental, and sociocultural. A tightly woven network of causes, symptoms, and outcomes of eating disorders makes the study of etiology of these disorders very challenging. Some suggested risk factors for eating disorders require to be defined as either integral parts of eating disorders syndrome such as body dissatisfaction, and perfectionism or outcome of prolonged disordered eating such as functional alterations in serotonin, and some mood disturbances. Researchers should structure their thought processes around this concept that some of currently well-known risk factors for eating disorders are concurrent symptoms of eating disorders. Hence paying special attention to the new and evolved concepts is highly recommended while studying the etiology of eating disorders."
"Comorbid personality disorders in eating disordered patients may seriously affect the treatment and course of their illness. Several studies show such a comorbidity, though with inconsistent findings. Qualitative reviews attribute this to methodological shortcomings, but the qualitative method may itself create new shortcomings. To circumvent this, the present, more extensive review applies a meta-analytic approach. Using the databases MEDLINE and PSYCHLIT, the 28 articles published between 1983 and 1998 that presented empirical evidence for an eating disorder and personality disorder comorbidity suitable for meta-analysis were included. We found a higher proportion of eating disordered patients with any personality disorder (average proportion = 0.58) related to comparison groups (average proportion = 0.28). Compared with anorexia nervosa patients, a higher proportion of patients with bulimia nervosa had a concurrent cluster B personality (average proportion = 0.44) and a borderline personality disorder (average proportion = 0.31). However, no differences between anorexia nervosa and bulimia nervosa patients in proportions of cluster C were found (average proportion = 0.45 and 0.44 respectively). Patients with eating disorders and patients with bulimia nervosa in particular, should be routinely assessed for a concurrent personality disorder using structured clinical interviews. In future research, more stringent assessment procedures are highly recommended to address the question of causality between eating disorders and personality disorders, and how eating disorder symptoms and personality disorder symptoms are related to treatment effects."
"The cognitive model of eating disorders (EDs) states that the processing of external and internal stimuli might be biased in mental disorders. These biases, or cognitive errors, systematically distort the individual's experiences and, in that way, maintains the eating disorder. This chapter presents an updated literature review of experimental studies investigating these cognitive biases. Results indicate that ED patients show biases in attention, interpretation, and memory when it comes to the processing of food-, weight-, and body shape-related cues. Some recent studies show that they also demonstrate errors in general cognitive abilities such as set shifting, central coherence, and decision making. A future challenge is whether cognitive biases and processes can be manipulated. Few preliminary studies suggest that an attention retraining and training in the cognitive modulation of food reward processing might be effective strategies to change body satisfaction, food cravings, and eating behavior."
"An individual who is a first degree relative of someone who has had or currently has an eating disorder is seven to twelve times more likely to have an eating disorder themselves. Twin studies also show that at least a portion of the vulnerability to develop eating disorders can be inherited, and there is evidence to show that there is a genetic locus that shows susceptibility for developing anorexia nervosa."
"Of the empirical studies undertaken, few investigated a cultural group's eating pathology in both its country of origin and a Western country using the same methodology. To date, the research findings are mixed and it is still unclear if the presentation of an eating disorder differs across cultures. Acculturation has not been consistently taken into consideration and psychological control has not been examined in relation to eating disturbances in nonâWestern groups."
"Patients with eating disorders (ED) frequently exhibit additional psychiatric disorders. This study aimed to examine whether psychiatric comorbidity in ED patients is associated with increased severity of ED symptoms in a sample of 277 women with a current ED (84 anorexia nervosa, 152 bulimia nervosa, 41 eating disorders not otherwise specified). Psychiatric comorbidity of Axes I and II was determined using the Structured Clinical Interview (SCID) for DSM-IV. Severity of ED-related symptoms was assessed using interviewer-rated scales from the Structured Interview for Anorexia and Bulimia Nervosa (SIAB). Affective and anxiety-related disorders of both axes were linked with increased intensity of weight- and appearance-related fears and concerns. Frequency of binge-eating and frequency of purging both were associated with Axis I anxiety disorders, substance-related disorders, and Cluster B personality disorders. Frequency of dieting was related to anxiety disorders on both axes. Multivariate analyses revealed that Axis I anxiety disorders were more closely linked with severity of ED symptoms than affective or substance-related disorders. The results showed that psychiatric comorbidity of both axes is linked with increased severity of ED symptoms and that there are associations between specific ED symptoms and specific forms of comorbidity."
"Eating disorders, such as anorexia, bulimia, and binge eating disorder, commonly involve a dysregulation of behavior (e.g., a lack or excess of inhibition and impulsive eating patterns) that is suggestive of prefrontal dysfunction. Functional neuro-imaging studies show that prefrontal-subcortical systems play a role in eating behavior and appetite in healthy individuals, and that people with eating disorders have altered activity in these systems. Eating behavior is often disturbed by illnesses and injuries that impinge upon prefrontal-subcortical systems. This study examined relationships between executive functioning and eating behavior in healthy individuals using validated behavioral rating scales (Frontal Systems Behavior Scale and Eating Inventory). Correlations demonstrated that increased dysexecutive traits were associated with disinhibited eating and greater food cravings. There was also a positive association with cognitive restraint of eating, suggesting that increased compensatory behaviors follow disinhibited eating. These psychometric findings reinforce those of other methodologies, supporting a role for prefrontal systems in eating."
"Eating disorders are significant causes of morbidity and mortality in adolescent females and young women. They are associated with severe medical and psychological consequences, including death, osteoporosis, growth delay and developmental delay. Dermatologic symptoms are almost always detectable in patients with severe anorexia nervosa (AN) and bulimia nervosa (BN), and awareness of these may help in the early diagnosis of hidden AN or BN."
"Of the empirical studies undertaken, it is clear that anxiety disorders are significantly more frequent in subjects with eating disorders than the general community. Researchers have shown that often anxiety disorders pre-date eating disorders, leading to a suggestion that early onset anxiety may predispose individuals to developing an eating disorder. To date however, the research presents strikingly inconsistent findings, thus complicating our understanding of eating disorder and anxiety co-morbidity. Furthermore, despite indications that eating disorder prevalence amongst individuals presenting for anxiety treatment may be high, there is a distinct lack of research in this area."
"Substance abuse has been shown to predict poor outcome in eating disorder (ED) samples, and prior cross-sectional data on personality subtypes of EDs suggest that substance abuse is associated with dysregulated and possibly avoidant-insecure subtypes."
"The present review focused on the personality profiles of patients with eating disorders. Studies using the Structured Clinical Interview for DSM-III-R Personality Disorder showed high rates of diagnostic co-occurrence between eating disorders and personality disorders. The most commonly observed were histrionic, obsessive-compulsive, avoidant, dependent and borderline personality disorders. Studies using the Cloninger's personality theory suggested that high Harm Avoidance might be relevant to the pathology of anorexia nervosa and high Novelty Seeking and Harm Avoidance to bulimia nervosa. Moreover, high Self-Directedness was suggested to be associated with favorable outcome in bulimia nervosa. The assessment of personality in a cross-sectional study, however, might be influenced by the various states of the illness. Therefore, a sophisticated longitudinal study will be required to advance this area of research."
"One out of four subjects showed a significant risk of an eating disorder and 6-7% probably already had one. No significant differences were found between the two samples. Significant differences were found in risk behaviors: more Spanish girls reported body dissatisfaction and binging; more Mexican girls had a history of psychiatric and psychological treatment, pressure from parents and friends to lose weight, dieting, physical activity and vomiting to lose weight, and a history of greater weight loss. In both the groups around 50% of subjects wanted to increase the size of their breasts. However, significantly more Mexican girls desired thinner arms and narrower shoulders and back, and more Spanish girls wanted thinner hips, buttocks, and legs, parts of the body that many Mexicans wanted to increase."
"Risk behaviors and the ideal body models of these Spanish and Mexican adolescent girls varied significantly, indicating major socio-cultural differences. However, the prevalence of ED was similar. Further research should aim to clarify whether the similarities found between this Spanish sample and a Mexican sample taken from an upper-middle class urban environment, a minority that is unrepresentative of the general population, are also observed in samples from other sectors of Mexican society."
"This Seminar adds to the previous Lancet Seminar about eating disorders, published in 2003, with an emphasis on the biological contributions to illness onset and maintenance. The diagnostic criteria are in the process of review, and the probable four new categories are: anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified. These categories will also be broader than they were previously, which will affect the population prevalence; the present lifetime prevalence of all eating disorders is about 5%. Eating disorders can be associated with profound and protracted physical and psychosocial morbidity. The causal factors underpinning eating disorders have been clarified by understanding about the central control of appetite. Cultural, social, and interpersonal elements can trigger onset, and changes in neural networks can sustain the illness. Overall, apart from studies reporting pharmacological treatments for binge eating disorder, advances in treatment for adults have been scarce, other than interest in new forms of treatment delivery."
"There are a number of differences in the aetiology of subtypes of eating disorder. The present results suggest that cognitive styles pertaining to the social arena in adolescence, and prior to the onset of any eating disorders, may play a causal role in the development of anorexia nervosa of the binge/purge subtype, but not anorexia nervosa of the restricting subtype."
"Eating disorders, including anorexia and bulimia nervosa, are characterised by abnormal eating behaviour and typical psychopathological features, including fear of fatness, drive for thinness, and body image disturbance. In most patients, there is no detectable focal brain abnormality. Nonetheless, associations of anorexia and bulimia nervosa with history of perinatal complications and head injuries suggest a role of cerebral pathology in some cases. A number of case studies describe eating disorders with intracranial tumours, injuries, or epileptogenic foci. However, many clinical descriptions are limited to changes in appetite and lack psychopathological features characteristic of eating disorders. A previous review of 21 anorexia cases associated with brain tumours found that only three of them fulfilled formal diagnostic criteria. In the present paper, we provide a systematic review of published case reports and highlight those relatively rare cases where typical eating disorders appear to be causally associated with localised brain damage."
"This review of published case reports challenges the traditional view that hypothalamic disturbance underlies eating disorders. Although hypothalamic lesions are the most commonly reported neural causes of anorexia-like syndrome, most of them lack the typical psychopathology. Of the eight cases with characteristic psychopathological presentation and suggestive evidence for a causal association, four had frontal and temporal cortical lesions, two brain stem tumours, one hypothalamic tumour, and one hydrocephalus. Implication of frontotemporal circuits is consistent with functional neuroimaging research in eating disorders and with benign changes in eating, such as the gourmand syndrome.49 Therefore, we conclude that evidence favours cortical mechanisms in the genesis of eating disorders over hypothalamic ones. An association of disordered eating with epilepsy was reported in 12 cases. In six of these, remission after a surgical removal of an epileptogenic focus or anticonvulsant treatment suggests that eating disorder may be actively maintained by an epileptogenic focus rather than being a deficit syndrome due to missing normal brain tissue. In five of the reviewed cases, disturbed eating occurred alongside obsessive compulsive psychopathology. This finding parallels the comorbidity and familial cooccurrence of eating disorders and obsessive compulsive disorder50 51 and suggests a common or overlapping neural substrate of the two."
"All dominant models of the eating disorders implicate personality variables in the emergence of weight concerns and the development of specific symptoms such as bingeing and purging. Standardized measures of personality traits and disorders generally confirm clinical descriptions of restricting anorexics as constricted, conforming, and obsessional individuals. A less consistent picture suggesting affective instability and impulsivity has emerged from the assessment of subjects with bulimia nervosa. Considerable heterogeneity exists within eating disorder subtypes, however, and a number of special problems complicate the interpretation of personality data in this population. These include young age at onset, the influence of state variables such as depression and starvation sequelae, denial and distortion in self-report, the instability of subtype diagnoses, and the persistence of residual problems following symptom control."
"Social media have become a significant means for peer-related communication, self-presentation, and identity management. So-called eating disorder websites that propagate a drastic thin ideal and unhealthy eating behaviors have triggered a debate about the harmful facets of social Internet activity. Little research has addressed the language that is used by the authors of these websites. The present study focuses on personal weblogs, a popular form of mostly text-based, diary-like, online journals. We compared 31 proâeating disorder blogs, 29 recovery blogs, and 27 control blogs by the means of computerized quantitative text analyses. The language of proâeating disorder blogs featured lower cognitive processing, a more closed-minded writing style, was less emotionally expressive, contained fewer social references, and focused more on eating-related contents than recovery blogs. A subset of 12 language indicators correctly classified the blogs in 84% of the cases. The distinct language patterns appear to reflect the psychological conditions of the blog authors and provide insight into their various stages of coping."
"I was intrigued when my articles on eating disorders began to be translated, over the past few years, into Japanese and Chinese. Among the members of audiences at my talks, Asian women had been among the most insistent that eating and body image werenât problems for their people, and indeed, my initial research showed that eating disorders were virtually unknown in Asia. But when, this year, a Korean translation of Unbearable Weight was published, I felt I needed to revisit the situation. I discovered multiple reports on dramatic increases in eating disorders in China, South Korea, and Japan. âAs many Asian countries become Westernized and infused with the Western aesthetic of a tall, thin, lean body, a virtual tsunami of eating disorders has swamped Asian countries,â writes Eunice Park in âAsian Weekâ magazine. Older people can still remember when it was very different. In China, for example, where revolutionary ideals once condemned any focus on appearance and there have been several disastrous famines, âlittle fattyâ was a term of endearment for children. Now, with fast good on every corner, childhood obesity is on the rise, and the cultural meaning of fat and thin has changed. âWhen I was young,â says Li Xiaojing, who manages a fitness center in Beijing, âpeople admired and were even jealous of fat people since they thought they ahd a better life. . . . But now, most of us see a far person and think âHe looks awfulââ"
"There is a commonly held view that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that cause severe disturbances to a personâs eating behaviors. Obsessions with food, body weight, and shape may also signal an eating disorder."
"In their world, there is a size zero, and itâs a status symbol. The chronic dieters have been as it since they were eight and nine years old. âEpidemic of eating disordersâ is old stuff; being preached to about it turns them right off. Their world is one in which the anorexics swap starvation diet tips on the Internet, participate in group fasts, offer advice on how to hide your âanaâ from family members, and share inspirational photos of emaciated models. But full-blown anorexia has never been the norm among teenage girls; the real epidemic is among the girls with seemingly healthy eating habits, seemingly health bodies, who commit or work their butts off as a result form of anti-fat maintenance. These girls not only look ânormalâ but consider themselves normal. The new criterion circulating among teenage girls: If you get rid of it through exercise rather than purging or laxatives, you donât have a problem. Theirs is a world in which groups of dorm girls will plough voraciously through pizzas, chewing and then spitting out each mouthful. Do they have a disorder? Of course not-look, theyâre eating pizza."
"When I wrote Unbearable Weight, it was widely believed that privileged white girls had the monopoly on eating and body-image problems. The presumption was a relic of the old medical models, which accepted the âprofileâ presented by the typical recipient of therapy-who was indeed largely white and upper middle class- as definitive, and which failed to recognize the central role of media imagery in âspreadingâ eating and body-image problems across race and class (and sexual orientation). Like the Black Africans and the Fijians and the Russians (and lesbians and [Latins]] and every other âsubcultureâ boasting a history of regard for fleshy women), African Americans were believed âprotectedâ by their alternative cultural values. And so, many young girls were left feeling stranded and alone, dealing with feelings about their bodies that they werenât âsupposedâ to have, as they struggled, along with their white peers, with unprecedented pressure to achieve, and watched Janet Jackson and Halle Berry shrink before their eyes. Many medical professionals, too, were trapped in what Iâd call the âanorexic paradigm.â They hadnât yet understood that eating problems take many different forms and inhabit bodies of many different sizes and shapes. Binge eating-a chronic problem among many African American women-is no less a disordered relation to good than habitual purging, and large women who donât or wonât diet are not necessarily comfortable with their bodies. Exercise addiction is rarely listed among the criteria for eating problems, but it has become the weight control of choice among an generation emulating Jennifer Lopezâs round tight buns rather than Kate Mossâs skeletal collarbones. Just because e a teenager looks healthy and fit does not mean that she is not living her life on a treadmill-metaphorically as well as literally-which she dare not step off lest food and fat overtake her body. Until recently, most clinicians were not receptive to the arguments of feminists like Susie Ohrbach (and later, myself) that âbody image disturbance syndrome,â binge/purge cycling, bulimic thinking,â and all the rest needed to be understood as much more culturally normative than generally recognized. They wanted to draw a sharp dividing line between pathology and normality-a line that can be very blurry when it comes to eating and body-image problems in this culture. And while they acknowledged that images âplay a role,â they clung to the notion that only girls with a âpredisposing vulnerabilityâ get into trouble. Trained in a medical model which seeks the ause of disorder in individual and family pathology, they hadnât yet understood just how powerful, ubiquitous, and invasive the demands of culture are on our bodies and souls."
"Families matter, of course, and so do racial and ethnic traditions. But families exist in cultural time and space-and so do racial groups. Thus, no one lives in a bubble of self-generated dysfunctionâ or permanent immunity-especially today, as mass media culture increasingly has provided the dominant âpublic educationâ in our childrenâs lives. The âprofileâ of girls with eating problems is dynamic, not static; heterogenous, nut uniform. Therapists now report treating the anorexic daughters of anorexics, and are coming to realize the role parents play, not just in being âover-controllingâ or overly demanding of their children, but in modeling and obedience to cultural norms. And the old generalizations about race and âfat acceptanceâ while perhaps valid for older generations of Black Americans, do not begin to adequately describe the complex and often conflicted attitudes of younger people, many of whom are aware of traditional values but constantly feel the pull of contemporary demands. While working on Unbearable Weightâ, I called up organizations devoted to Black womenâs health issues, asking for statistics and clinical anecdotes, and was told: âThatâs a white girlâs thing. African American women are comfortable with their bodies.â For twenty-something Tenisha Williamson, who suffers from anorexia, such notions are almost as oppressive as her eating disorder: âFrom an African American standpoint,â she writes, âwe as a people are encouraged to âembrace our big, voluptuous bodies,â This makes me feel terrible because I donât want a big voluptuous body! I donât ever want to be fat-ever, and I donât ever want to gain weight. I would rather die from starvation than gain a single pound. [This makes me feel like] the proverbial Judas of my race. . . and so incredibly shallow.â In fact, the starving white girls were just the forward guard, the minersâ canaries warning of how poisonous the air was becoming for everyone. I could see it in the magazines the videos, and in my studentsâ journals. I could see it, as I write in âMaterial Girl,â in the transformations of Madonna and other performers of Italian, Jewish, and African American descent who seemed at the start of their careers, to represent resistance to the waifs and willows but who just couldn't hold out against what, indeed, had begun to look like a tsunami, a cultural tidal wave of obsession with achieving a disciplined, normalized body."
"At the 1983 meetings of the New York Center for the Study of Anorexia and Bulimia, Steven Levenkron charged feminism with sacrificing the care of âhelpless, chaotic, and flounderingâ children in the interests of a ârationalâ political agenda. Is he right? Does maintaining a continuity between eating disorders and ânormalâ female behavior entail a denial of the fact that anorexia and bulimia are extreme and debilitating disorders? I think not. The feminist perspective has never questioned the reality of the anoreticâs disorder or the severity of her suffering. Rather, what is at stake is the conception of the pathological as the indicator of a special âprofileâ (psychological or biological) that distinguishes the eating-disordered woman from the women who âescapeâ disorder. Feminist analysts see no firm boundary on one side of which a state of psychological comfort and stability may be said to exist. They see, rather, only varying degrees of disorder, some more âfunctionalâ than others, but all undermining womenâs full potential. At one end of this continuum we find anorexia and bulimia, extremes which set into play physiological and psychological dynamics that lead the sufferer into addictive patterns and medical and emotional problems outside the ânormsâ of behavior and experience. But it is not only anoretics and bulimics whose lives are led into âdisorder.â This is a culture in which rigorous dieting and exercise are being engaged in by more and younger girls all the time-girls as young as seven or eight, according to some studies. These little girls live in constant fear- a fear reinforced by the attitudes of the boys in their classes-of gaining a pound and thus ceasing to be âattractive.â They jog daily, count their calories obsessively, and risk serious vitamin deficiencies and delayed reproductive maturation. We may be producing a generation of young, privileged women with severely impaired menstrual, nutritional, and intellectual functioning."
"But how can a cultural analysis account for the fact that only âsomeâ girls and women develop full-blown eating disorders, despite the fact that we are all subject to the same sociocultural pressures? Donât you require the postulation of a distinctive underlying pathology (familial or psychological) to explain why some individuals are more vulnerable than others? The first of these questions is frequently presented by medical professionals as though it dealt a decisive blow to the cultural argument, and it is extraordinary how often it is indeed accepted as a devastating critique. It is based, however, on an important and common misunderstanding (or misrepresentation) of the feminist position as involving the positing of an âidenticalâ cultural situation for all âwomenâ rather than the description of ideological and institutional parameters governing the construction of âgenderâ in our culture. The difference is crucial, yet even such a sophisticated thinker as Joan Brumberg misses it completely. âCurrent cultural models,â Brumberg argues, âfail to explain why so many individuals âdo notâ develop the disease, even though they have been exposed to the same cultural environment.â But of course we are ânotâ all exposed to âthe same cultural environment.â What we âareâ all exposed to, rather, are homogenizing and normalizing images and ideologies concerning âfemininityâ and female beauty. Those images and ideology press for conformity to dominant cultural norms. But peopleâs identities are not formed âonlyâ through interaction with such images, powerful as they are. The unique configurations (of ethnicity, social class, sexual orientation, religion, genetics, education, family, age, and so forth) that make up each personâs life will determine how each âactualâ woman is affected by our culture. The search for distinctive patterns, profiles, and abnormalities underlying anorexia nervosa and bulimia is thus not, as man researchers claim, âconceptuallyâ demanded; a myriad of heterogeneous factors, âfamily resemblancesâ rather than essential features, unpredictable combinations of elements, may be at work in determining who turns out to be most susceptible. It may be, too, that patterns and profiles could one be assembled but are now breaking apart under the pressure of an increasingly coercive mass culture with its compelling, fabricated images of beauty and success."
"The shallow and unanalyzed conception of slenderness as merely âan external body configuration ârather thanâ an internal spiritual state,â an ideal without psychological or moral depth, still predominates in the literature on anorexia and bulimia. Why? One explanation is that so long as eating disorders remain situated within a medical model, those who are entrusted with the conceptualization of anorexia and bulimia will be medical professionals who have little experience in or inclination toward cultural interpretation and criticism. But more important is the fact that to begin to incorporate such interpretation and criticism within the medical model would be to transform that model itself. Susceptibility to âimagesâ can still be conceptualized in terms of a passive subject and a mechanical process. To acknowledge, however, that meaning is continually being produced at all levels-by the culture, by the subject, by the clinician as well-and that in a fundamental sense there âisâ no body that exists neutrally, outside this process of making meaning, no body that passively awaits the objective deciphering of trained experts, is to question the presuppositions on which much of modern science is built and around which our highly specialized, professionalized, and compartmentalized culture revolves. Or, to put this another way: it is to suggest that the study of the disordered body is as much the proper province of cultural critics in every field and of nonspecialists, ordinary but critically questioning citizens, as it is o the âexperts.â This audacious challenge is the legacy of the feminist reconceptualization of eating disorders."
"Although genetic research in eating disorders is frankly in its infancy, patients, families, and clinicians are aware of this research and face challenges in incorporating this knowledge into either their personal conceptions of their (or their family memberâs) illness, or in the case of clinicians, helping patients and their families to understand the implications of this knowledge. Simplistic nature versus nurture dichotomies are easy to understand, yet rarely capture the complexity of reality, and definitely fail to do so in the case of eating disorders. Clinicians and researchers must become educated in the nuances of gene x environment interplay and avoid perpetuating purely environmental or purely genetic conceptualizations of eating disorder etiology."
"By definition, eating disorders are complex traits. That means that their inheritance pattern in families does not follow traditional Mendelian patterns, and that they are influenced by multiple genetic and environmental factors of small to moderate effect. There is not one gene for anorexia nervosa or one gene for bulimia nervosa. More likely there are a number of genes that code for proteins that influence traits that index vulnerability to these disorders. Complicating the risk picture even further, these genes exist in concert with other genetic factors that may confer protection against eating disorders, along with main effects of risk and protective environments, as well as gene x environment interplay as we discuss in the following section."
"For decades, parenting styles have been unrightfully blamed for causing eating disorders. Considerable care must be taken when discussing gene x environment interplay not to convey the message that somehow parenting is to blame for these pernicious illnesses. Conversely, a purely genetic explanation should not be taken to mean that parents need not examine their parenting style and the influence that might have on their children."
"In addition to having concerns about their own shape and weight, women with eating disorders may similarly be over-concerned about their childrenâs weight, even when it is well within normal limits. One study found that 15% of mothers with a history of bulimia nervosa had attempted to âslim downâ their normal weight infants. Similarly, Waugh and Bulik found that 20% of the mothers with eating disorder histories in their sample tried to change their childrenâs appearance. Maternal restriction of childrenâs eating is a concern, as previous research suggests that maternal control of childrenâs eating interferes with the development of dietary self-regulation. These effects have been found among children as young as two years of age."
"The influence of maternal perceptions on daughtersâ eating disordered behavior appears to continue into adolescence and young adulthood. For example, mothers whose daughters engaged in eating disordered behavior were more likely to view their daughters as overweight than were mothers of non-eating disordered daughters (controlling for weight differences between groups). Further, this appearance pressure is not necessarily limited to weight, as mothers of daughters with eating disorder symptomatology also rated their daughters as less attractive than the daughters rated themselves. These results are concerning, as they suggest that daughters who engage in eating disordered behaviors may not only lack a maternal role model of healthy eating, but also feel maternal pressure to lose weight and enhance their appearance. This of course could reflect several complex intergenerational processes. On one hand, mothers may harbor threshold or subthreshold eating disturbances themselves, and their comments or behaviors could reflect their underlying pathology. Alternatively or complementarily, the daughtersâ pathology could render them more sensitive to maternal comments that in other situations may be perceived as culturally normative. These environmental experiences could facilitate the expression of an existing genetic predisposition for eating disorder symptomatology."
"One potential pitfall of genetic research on eating disorders is the misinterpretation that environmental factors such as the media do not matter. Western mediaâs idealization of an ultra-thin female body type has long been viewed as an important sociocultural risk factor for eating disorders. However, given the ubiquity of this influence in Western cultures, other factors must influence vulnerability to the thin cultural ideal. As Bulik suggests, genetically vulnerable individuals might seek out experiences, such as exposure to thin-ideal media images, which reinforce their negative body image. This hypothesis is supported by a longitudinal study which found that adolescent girls whose eating disorder symptomatology increased over a 16 month period also reported significantly greater fashion magazine reading at Time 2, compared with Time."
"Similarly, individuals genetically predisposed to eating disorder symptomatology such as thin-ideal internalization might also actively choose to affiliate with peers who place a similar high value on weight and appearance. One potential example of this form of active selection could be the decision to join a sorority (particularly for European-American women). European-American sorority members report high levels of eating disorder symptomatology, including weight preoccupation, drive for thinness, and body dissatisfaction. A longitudinal study found that sorority and non-sorority members did not differ on three measures of disordered eating (EDI Drive for Thinness, Body Dissatisfaction, and Bulimia) at Time 1 and Time 2 (first and second year of undergraduate, respectively). However, by Time 3 (third year of undergraduate), non-membersâ drive for thinness scores had decreased, while membersâ scores on this measure remained roughly the same, and this difference was statistically significant. Thus, the authors concluded that characteristics of the sorority environment could contribute to the persistence of a higher degree of drive for thinness. Although this study did not include a measure of actual or putative genetic vulnerability to eating disorders, it is plausible to speculate that an environment that promotes the maintenance of eating disordered characteristics would be particularly problematic for a genetically vulnerable individual."
"One fascinating and modifiable environmental factor that has emerged as a possible buffer against the development of eating disorders in adolescent girls is family meals. Likewise, breakfast eating may also play a role in preventing the development of eating problems. For example, FernĂĄndez-Aranda and colleagues found that women with eating disorders were less likely to have eaten breakfast regularly during childhood compared to non-eating disordered controls. Although retrospective, these findings are consistent with those of a large (n = 2216), longitudinal study which found that breakfast eating frequency was inversely associated with dieting and weight-control behaviors, and positively related to dietary quality and physical activity in adolescents. Overall, these studies offer preliminary insight into potential buffers against eating disorders; however, research in this area has not yet progressed to assess the differential effect of these protective factors in individuals at high-risk for eating disorders versus the general population."
"Another factor that offers promise as a potential buffer against the development of eating disorders is the enhancement of emotion regulation skills. As noted above, individuals with eating disorders experience relatively high levels of perceived stress and difficulties regulating emotion. Thus, interventions aimed at enhancing emotion regulation skills might be of particular benefit to high-risk groups. However, research incorporating mindfulness techniques has not specifically targeted high-risk groups. For example, a recent study investigated the effectiveness of a primary prevention program incorporating elements of mindfulness (e.g., yoga), targeting fifth-grade girls. This program integrated mindfulness into an empirically-based curriculum, which also included other elements, such as media literacy, and the promotion of dissonance regarding idealization of an ultra-slim body type. Compared to a control group, girls in the intervention reported lower body dissatisfaction and uncontrolled eating, and higher social self-concept at post-testing. However, there were no significant changes on other variables assessed including drive for thinness, perceived stress, physical self-concept and perceived competence. Nonetheless, these outcomes do provide some support for the inclusion of mindfulness-based activities in prevention. In contrast, a study with undergraduate women did not find any differences between participants in a yoga program and a control group on eating disorder symptoms at post-testing. Future studies should target high-risk groups, to evaluate the efficacy of mindfulness-based techniques within this specific sample."
"Results from focus groups and clinical case studies suggest that mothers with eating disorders are eager to learn about how best to care for their children, especially with respect to feeding. However, they report that the level of assistance they desire is not routinely offered by their health care providers. In one of the only published interventions conducted with this population, Stein et al. studied 80 mothers with eating disorders and their four to six month old infants to test whether a 13 session intervention of video-feedback treatment in conjunction with cognitive behavioral self-help was more effective than cognitive behavioral self-help alone in reducing mealtime conflict and other aspects of maternal-child interaction. Those mothers in the video-feedback group exhibited significantly less conflict than control mothers as well as significant improvements in infant autonomy and several other interaction measures. In addition, maternal eating psychopathology was reduced across both groups. Such interventions could help break the âcycle of riskâ associated with eating disorders, by providing parents with useful buffering strategies."
Heute, am 12. Tag schlagen wir unser Lager in einem sehr merkwĂźrdig geformten HĂśhleneingang auf. Wir sind von den Strapazen der letzten Tage sehr erschĂśpft, das Abenteuer an dem groĂen Wasserfall steckt uns noch allen in den Knochen. Wir bereiten uns daher nur ein kurzes Abendmahl und ziehen uns in unsere Kalebassen-Zelte zurĂźck. Dr. Zwitlako kann es allerdings nicht lassen, noch einige Vermessungen vorzunehmen. 2. Aug.
- Das Tagebuch
Es gab sie, mein Lieber, es gab sie! Dieses Tagebuch beweist es. Es berichtet von rätselhaften Entdeckungen, die unsere Ahnen vor langer, langer Zeit während einer Expedition gemacht haben. Leider fehlt der grĂśĂte Teil des Buches, uns sind nur 5 Seiten geblieben.
Also gibt es sie doch, die sagenumwobenen Riesen?
Weil ich so nen Rosenkohl nicht dulde!
- Zwei auĂer Rand und Band
Und ich bin sauer!