-
3. Eating Disorders: Anorexia, Bulimia, Binge Eating, and Obesity
- State University of New York Press
- Chapter
- Additional Information
Chapter 3 Eating Disorders Anorexia, Bulimia, Binge Eating, and Obesity Eating problems are behavioral problems. Eating is something we do. Eating is behavior. Eating disorders are behavioral disorders, not brain or chemical disorders. Of course, when eating has been out of balance for an extended length of time, chemical changes do occur. But chemical imbalances and changed brain functioning are effects, not causes, of problematic eating behaviors. As with other behaviors, both adaptive and maladaptive, the causes of problematic eating behaviors lie outside of the individual, in the individual’s societal, social, and family environments, with faulty environmental associations and reinforcement contingencies. Anorexia nervosa is a behavioral problem of highly restricted food intake, self-starvation, a preoccupation with thinness, and brutal overexercise . Bulimia nervosa is a behaviorial problem of excessive eating— binges, followed by purging, usually vomiting or laxative abuse. Binge eating disorder is a behaviorial problem characterized by binges without purging. The causes and complications of bulimia and anorexia are often similar, while binge eating and obesity share commonalities. CAUSES, CONSEQUENCES, AND COMPLICATIONS OF ANOREXIA AND BULIMIA Almost all cases (over 90%) of anorexia and bulimia are young, white women and girls of upper socioeconomic status from a highly competitive environment. These eating disorders are culturally specific; they are 29 virtually nonexistent in non-Westernized countries and are only seen when these countries start to become “Americanized.” Bulimia may be the most common behaviorial problem on college campuses. In some sorority houses and women’s dorms, group binge parties occur, often followed by purging. Most males with eating disorders are homosexuals and face peer pressure to be thin (Carlat, Camargo, & Herzog, 1997). Depression often follows the development of eating disorders. Stomach acids in the mouth, the result of vomiting, cause erosion of dental enamel. “Chipmunk cheeks,” swollen cheeks, result from damaged and enlarged salivary glands. Sphincter valves may become permanently eroded and damaged, making food retention impossible without surgery. Electrolyte and fluid imbalances result in heart and kidney complications that may be fatal. Death is the most serious complication of eating disorders. As many as 20% of people suffering from an eating disorder die from it or from complications of it (see Barlow & Durand, 1999, for a review of statistics). Nothing in the brain “causes” eating disorders, but the pressure placed on women by Western-Anglo society to be thin and competitive does influence many young females to attempt to lose weight, which is the first step toward eating disorders. From being invited to a school dance, to marrying successful men, to being hired or promoted on the job, it may not be fair but it is a reality that for white Western females, more reinforcers are available to the thin than the obese. This reality causes the dieting that for some women eventually results in disordered eating behaviors and sometimes death. Compared to white girls, black American girls, on average, have virtually no risk of developing an eating disorder. Are white Americans willing to say that white girls have a “brain disorder” requiring drug treatment that black girls do not have? Or will society admit that, on average sociocultural environmental differences account for these differences ? If sociocultural environmental differences account for the differences in the rates of eating disorders (they do), then changing the sociocultural expectations that white girls face can reduce and prevent many eating disorders. As songs such as Brick House by the Commodores and Baby Got Back by Sir Mix-a-Lot can attest, shapely, full-figured women have always been celebrated and viewed as being sexually desirable in black American culture. Consequently, black women have much healthier body self-images compared to whites. Conversely, white Western females often equate thinness with self-worth. Ironically, studies (e.g., Fallon and 30 TAKING AMERICA OFF DRUGS [18.206.12.31] Project MUSE (2024-03-28 16:59 GMT) Rozin, 1985) have shown that undergraduate men (presumably the vast majority were white) rated women’s ideal weight higher than women think men would ideally like them to weigh—white guys apparently do like curves. White girls have been known to compare their body size to anorexic models in the media, or to themselves before they have reached their natural, post-puberty shape. The more TV that girls watch, and therefore the more exposure to thin actors and models, the more likely they will develop eating problems. Initial weight loss usually is reinforced. The teasing stops, compliments start, and flattering social attention and invitations are received. Before the...