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    Top 20 Myths About Eating Disorders

    There are several misconceptions about eating disorders (ED) in regards to its history, diagnoses, socio-cultural factors, neuro-biology, and physiological effects. This article aims to share more accurate and truthful information that counters these myths and falsified beliefs. Hope you enjoy and can take away something from this! :) (UCSD Psyc 134 Midterm Project, Spring 2016, Student: Shahrzad Moghadam)

    1. Eating Disorders are a disease solely of the present day.

    Psychology Today / Via

    False. Eating Disorders have been observed in historical records dating back to as early as 1200 AD. One notable figure who has exhibited characteristics of Anorexia Nervosa is Saint Catherine of Siena who is famously remembered for her religious fasting termed as "holy anorexia." However, it is was not until 1873, when William Gull characterized Anorexia Nervosa.

    2. Bulimia Nervosa was first observed and originated in 1979.

    Generation Wired / Via

    Not quite. Bulimia Nervosa officially became a diagnosis in 1979 by Gerald Russell, but again, like Anorexia Nervosa, BN has also been observed in historical records as well. Both ancient Romans and Egyptians have been known to vomit in order to empty their stomachs as a means of purification. However, it was not until 1921 where the first case study of BN was carried out. The patient's name was Ellen West, and she often purged since she was fearful of weight gain.

    3. Extreme Dietary Restriction does not have any lasting effects on the body.

    Todd Tucker / Via

    False. The notable Minnesota Semi-Starvation Study conducted by Dr. Ancel Keys aimed to study both the biological and psychological effects that starvation can have on the body. The subjects underwent extreme dietary restrictions. After undergoing a "re-feeding" phase for 12 weeks, the subjects exhibited both physiological and psychological symptoms. Not only were they preoccupied with food or things related to food, they also exhibited binge eating followed by purging behavior. Most importantly, these subjects demonstrated symptoms of anxiety, depression, and social withdrawal. In addition, their metabolic rates were impacted, their body temperatures lowered, and both their breathing and heart rates were negatively affected.

    4. Looking at the history of eating disorders is irrelevant because diagnoses are only just recently being discovered. For example, Binge Eating Disorder was added as a diagnosis in the DSM-5 in the year 2013.

    Health Line / Via

    Sure Binge Eating Disorder was just added as a diagnosis to the DSM-5 only a few years ago, but when looking at the history of eating disorders dating back from the ancient times up until now, we have seen both behavioral, psychological, and physiological symptoms related to eating disorders (i.e. AN, BN, BED). Analyzing the various behaviors and symptoms over time gives us a better understanding of the disorder itself so that proper action and treatments can be implemented.

    5. Everyone with an eating disorder is stick thin and boney.

    Star Models / Via

    Not really. One cannot actually tell if someone has an eating disorder just from their outward appearance. It is true that often people with Anorexia Nervosa are very thin. But, there are other eating disorders like Bulimia Nervosa where the patient's physical appearance can actually look normal or even overweight. There are also people who suffer eating disorders like Orthorexia Nervosa (not officially an eating disorder) and Muscle Dysmorphia. These patients often have a more lean, athletic body type. As you can see, eating disorders come in all shapes and sizes.

    6. Eating Disorders only affect people who are obsessed with physical appearance and also fear weight gain.

    Sierra Sandison / Via!An-Open-Letter-to-Anyone-Who-Loves-Me-A-Confession-Some-Answers/ceg5/555cf9170cf23d0164ada6f8

    Actually, there are several types of eating disorders that are not centered around the fear of gaining weight. For example, Avoidant Restrictive Food Intake Disorder is an eating disorder where people, often children, avoid certain foods because of its texture, color, smell, or taste. For this reason, they suffer significant weight loss and nutritional deficits. Patients with ARFID are actually trying to meet nutritional needs and achieve appropriate weight. Similarly, an eating disorder like Pica, where one eats nonfood substances, is not centralized around the fear of weight gain. If anything, patients with Pica are actually eating normal foods in addition to the non-food items. Also, Rumination Disorders are not related to the fear of gaining weight. In fact, this eating disorder is present in infants. Food is often regurgitated, and this reflex is both involuntary and out of infant's control.

    7. Anorexia Nervosa applies to people who solely severely restrict their eating.

    The American Journal of Medicine Blog / Via

    This is not the only characteristic of AN. In fact, Anorexia Nervosa is divided into two sub-types: Restricting (AN-R) and Binge Eating/Purging (AN-BP). Patients with AN-R do restrict their caloric intake and normally fast for more than 6 hours at a time. Patients with AN-BP, on the other hand, usually restrict their eating during the day and then binge eat and purge during the night. All in all, patients with AN have a low body weight for their age, height, and development. They also have an extreme fear of gaining wait, and they have a psychological disturbance in the way that they perceive their bodies.

    8. Bulimia Nervosa's purging component refers to vomiting of food.

    Bel Marra Health / Via

    Almost. Bulimia Nervosa involves both binging and purging. Binging refers to a loss of control over eating such that the patient is often eating an amount of food that is much greater than what would be eaten by a normal individual. Purging refers to a behavior that takes place after eating in order to compensate for the large quantity of food ingested. It is incorrect to consider purging as only self-induced vomiting of food. There are several other methods of purging. These include fasting, excessive exercise, and inappropriate use of enemas, diuretics, and laxatives.

    9. Eating disorders are not fatal.

    Think Stock / Via

    False. In fact, Anorexia Nervosa has the highest death rate of any psychiatric illness. Why? Well, suicide is quite prevalent. Statistically speaking, 20% of AN patients attempt suicide and up to 4% actually commit suicide. Nearly 35% of the BN population attempts suicide, and the actual percentage of BN patients that commit suicide is not any different than that of the non-BN population.

    10. In regards to the Sociocultural Theory of eating disorders, men and women are equally pressured by society. Thus, both genders equally internalize the "thin ideal and body dissatisfaction" and are therefore, both equally at risk of eating disorders.

    ABC Family / Via

    Not necessarily. Yes, we do see the media objectify both men and women. Ads often display women as being thin but somehow managing a sexy hourglass figure, and men as ripped & lean with 6+ packs for abdomens. However, while both men and women are objectified and held to unrealistic physical standards in the media, the objectification theory states that there are gender differences when it comes to eating disorders and that society pressures women more so than men to base their self-worth on looks. When analyzing this difference primarily through sociocultural theory, then we see that yes, there is actually a gender difference in ED occurrence and it has to do with objectification in the media targeting more women than men.

    The ratio of eating disorders in females to males is actually 10:1. We also see that the lifetime prevalence of ED in women is 1.5% while in men it is 0.5%.

    An interesting study ("The Swimsuit Study") revealed that women who were forced to wear swimsuits had lower performance on math problems than did women who had to wear sweaters. Men performed equally well in both conditions. The take home message from this study is that when women became more aware of their bodies, this took away from the cognitive space available to do math problems. An obvious gender difference was observed.

    11. All eating disorders are culture bound syndromes.

    Calgary Health Region / Via

    Not quite. A closer look at Anorexia Nervosa reveals that the disorder has been around historically over the span of multiple centuries (Remember Saint Catherine of Siena?) . When looking at these cases of Anorexia Nervosa, there has not been a secular increase in the number of cases observed. Furthermore, historical cases of AN reveal that the disorder is not solely observed in Western cultures (Ancient Egyptians and Romans).

    When looking at Bulimia Nervosa, however, we see that observations of BN have only been recorded in the latter half of the 20th century and these cases were not observed outside of Western cultures,

    12. Just being aware of cultural norms can cause eating disorders.

    Pinterest / Via

    Nope. Internalization of the Thin Ideal, the process by which a person actually desires to achieve the thin ideal and look a certain way, is necessary for a person to develop an eating disorder. Simply being aware of societal pressures to be thin does not correlate to body dissatisfaction as much as actually internalizing a strong desire to comply with these societal pressures of thinness. The overall correlation between awareness and body dissatisfaction was 0.29, while the overall correlation between internalization and body dissatisfaction was 0.50. Essentially, it is a combination of Appearance Comparisons, Awareness, and Internalization of the Thin Ideal that lead to Body Dissatisfaction and eventually eating disorders.

    13. Eating Disorders are caused by culture alone. Furthermore, eating disorders are a choice.

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    Wrong. People do not choose to have eating disorders and socio-cultural factors are not the primary or sole cause of eating disorders. There is a strong neurobiological component behind eating disorders. Moreover, twin studies have proven that there are certain genes that predispose people to have eating disorders and that there is a 50-80% risk of inheriting ED. Furthermore, genes are responsible for certain behaviors that put people at risk of developing EDs. These behaviors include anxiety, perfectionism, and obsessive personality, to name a few.

    14. People with eating disorders have control over their eating behaviors.

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    No. Unfortunately, there are several reasons behind patients' pathological eating behaviors and they all have a neurobiological basis. In the case of Anorexia Nervosa patients, food causes a sense of anxiety and restricting dietary intake is a method by which these patients are able to lower their anxiety levels. Normally, people would get a rewarding feeling when eating food, not an anxious one. In addition, patients with Bulimia Nervosa also have a negative and anxious view towards food. Cycling between binging, fasting, and purging all help in alleviating the anxiety.

    15. The hypothalamus (responsible for energy balance) is the only brain region important in the discussion of the biology of Eating Disorders.

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    Not exactly. The hypothalamus is important because people are able to ignore the hypothalumus' signals for energy balance. Despite being hungry or famished, people with AN can ignore the hypothalamic signals telling them to eat. Similarly, even though energy levels are high, people who are obese or have BED can ignore hypothalamic signals telling them that they have enough energy stores.

    Aside from the hypothalamus' role and how it is altered in ED (as mentioned above), there are 3 neurobiological circuits involved in ED:

    1. Ventral Limbic Circuit: Responsible for Identifying Reward and Pleasure Stimuli.

    2. Dorsal Cognitive Circuit: Responsible for Making Decisions and Inhibition/Control.

    3. Salience Circuit: Identifies cues like taste and satiety and connects them with neurological processes involving emotion and motivation.

    16. Eating Disorders are due to a BALANCE of both reward and inhibition pathways.

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    Incorrect. In ED, the neurobiological circuits responsible for reward and inhibition are actually OUT OF BALANCE. In the case of AN, the Dorsal Cognitive Circuit is in overdrive and there is an excess of inhibition, causing AN patients to avoid food. Also, in AN, the Ventral Limbic Circuit is down-regulated, and thus, food is not observed as something that is rewarding or pleasurable. We see the opposite in BN. There is a down-regulation of the Dorsal Cognitive Circuit, so BN patients have less control of their eating during their binging episodes. Similarly, there is an up-regulation of the Ventral Limbic Circuit, which makes BN patients more sensitive to the rewarding feelings that come with eating food.

    17. Malnourishment is defined by having a low Body Mass Index (BMI).

    BMI Calculator / Via

    Wrong. One can have a high or even normal BMI and still be malnourished. It is best to consider the amount of weight lost and the time period in which it was lost in order to determine malnutrition. If one were to lose more than 20% of their body weight in a year or even 10% in 6 months, then they would be considered as having severe malnutrition. BMI is unreliable because it disregards the fact that people can have different body compositions despite their weight and height. For example, someone with more muscle would have a higher BMI for their height and could be considered overweight on the BMI scale.

    18. Eating Disorders only affect organs involved with digestion (i.e. the stomach).

    Diffen / Via

    False. Eating Disorders cause malnutrition and malnutrition can have detrimental and negative effects on every organ system in the body. The various systems that are affected by ED include: Cardiovascular System, Musculoskeletal System, Neuropsychiatric System, Reproductive System, Gastrointestinal System, Respiratory System, Immune System, Endocrine System, Excretory System, etc.

    For example, eating disorders cause bradycardia which is an abnormally low heart rate. This increases the chance of having a cardiac arrest. This is also the primary cause of death in eating disorders (suicide is the second). We also observe atrophy of the heart as well.

    19. Physiological effects of Eating Disorders are REVERSIBLE.

    Christine Geniza, MSN, PMHNP-BC / Via PSYC134 Lecture 5

    No. Unfortunately, there are certain medical complications associated with Eating Disorders that are IRREVERSIBLE. These include structural changes in neuro-psychiatry (reduced brain size or amount of grey and white matter). The delay of puberty or its arrest altogether cannot be reversed either. Furthermore, lowering of bone density and stunted growth are also irreversible medical complications. For the most part, certain physiological factors can be reversed with treatment and weight restoration, but as seen above, the complications that involve a "critical window for growth and development" are irreversible.

    20. Russell's Sign is the only outer physical symptom of eating disorders.

    Wikipedia / Via

    There's more! Russell's Sign refers to the scars present on the hands of patients that purge their food. However, aside from Russell Sign, there are other physical characteristics of eating disorders. Lanugo, for example, is this extra layer of hair present on the spine, face, and neck of patients with AN. Furthermore, Parotid Hypertrophy causes a "chipmunk face." This is due to excess mucus secretion from vomiting.

    21. Thanks for reading this post about eating disorders! Hope it was both helpful and informative. More importantly, I hope that it was able to clear up some misconceptions and shed more light on this important psychological and physiological disease. Help spread awareness for eating disorders by sharing this article. :)