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What is an eating disorder and who is affected by it?
April 30, 2009
An eating disorder is defined as an illness in which one’s attitudes and behaviors towards eating negatively affects their physical and mental health. Though many assume that anorexia nervosa is the only eating disorder, bulimia nervosa and binge eating disorder are also very common. Eating disorders can affect both males and females, but there is a significant difference between genders; women account for 90 to 95% of all cases of anorexia nervosa and 80% of all cases of bulimia nervosa (http://eatingdisorders.about.com/od/riskfactors/a/edsgender.htm). Along with this fact comes a stereotype about the type of woman who will most likely be affected by an eating disorder: a young, rich white woman. Because of this assumption, many believe that eating disorders only affect a very limited group of people. However, studies have shown that women of all ages, races, and, specifically, socioeconomic statuses are affected by eating disorders. Through analysis of scientific literature reviews, this stereotype on the basis of socioeconomic status is investigated.
What is anorexia nervosa?
Anorexia nervosa is by far the most well-known eating disorder. It is marked by an intense fear of gaining weight, and to prevent weight gain, one employs many various and extreme methods, like the restriction of food intake. According to the DSM- IV, one must meet the following criteria in order to be diagnosed with anorexia nervosa: weight loss and refusal to maintain weight in a normal range, morbid fear of becoming fat, disturbance in the experience of low weight (including denial and influence on self- evaluation), and amenorrhea, which refers to the absence of three or more consecutive menstrual periods. Anorexia nervosa has two subtypes, restricting and purging. The restricting subtype is marked solely by dieting and exercising, and the purging subtype is marked by binge eating and purging along with dieting (Maj, Halmi, Lopez-Ibor, and Sartorius, 2003).
What is bulimia nervosa?
Bulimia nervosa is the 2nd most recognizable eating disorder. It involves a cycle of binging and purging in an effort to prevent weight gain. According to the DSM- IV, one must meet the following criteria to be diagnosed with bulimia nervosa: recurrent episode on binge eating, repeated use of self- induced vomiting or laxatives, diuretics, enemas, fasting, exercising excessively or other medications to prevent weight gain (both of these must occur twice a week for three months), body shape and weight unduly influences self- evaluation, and the diagnosis of anorexia nervosa is not present. Bulimia nervosa has two subtypes: purging and non- purging. The purging subtype consists of self- induced vomiting and the misuse of laxatives, diuretics, or enemas, and the non- purging subtype consists of fasting or exercising to counteract calorie intake (Maj, Halmi, Lopez-Ibor, and Sartorius, 2003).
What is binge eating disorder?
Binge eating disorder is the most common eating disorder (http://www.win.niddk.nih.gov/publications/binge.htm#howcommon). According to the DSM- IV, one must meet the following criteria to be diagnosed with binge eating disorder: recurrent episodes of binge eating (with the binge eating episodes having three or more of the following: eating rapidly, eating until uncomfortably full, eating large amounts of food when not physically hungry, eating alone due to embarrassment of amount of food, and feeling disgusted, depressed, or guilty after overeating), marked distress with binge eating, no use of compensatory behaviors, and binge eating occurs twice a week for six months (Maj, Halmi, Lopez-Ibor, and Sartorius, 2003).
Anorexia nervosa and socioeconomic status
Striegel- Moore & Bulik reviewed research on risk factors for eating disorders. The study included many factors, such as culture, genetics, and, specifically, socioeconomic status. Through review of previously established literature, it was found that thinness increases with socioeconomic status; this finding became the backbone for the stereotype that eating disorders increase with socioeconomic status. In a study assessing the validity of this stereotype, evidence from previous research was reviewed in order to form conclusions. Many early studies were reviewed that indicated a prevalence of anorexia nervosa in high socioeconomic groups; however, this conclusion was drawn from studies with methodological problems. In one 1973 study, demographic data on anorexia nervosa was gathered through review of the psychiatric case registers of three different areas—North- East Scotland, Camberwell in London, and Monroe County, New York—and a prevalence of anorexia nervosa was found among those of higher socioeconomic status. However, this conclusion was based on only 8 patients with anorexia nervosa. In a study of the prevalence of anorexia nervosa in nine populations of schoolgirls between 1972 and 1974, it was concluded that anorexia nervosa was about 6 times more present in private schools than in public schools, which reflected a difference in socioeconomic status. Again, this conclusion was the result of methodological error. The cases of anorexia nervosa were reported by the judgment of teachers and staff at the school, rather than through self-reports by the participants themselves; the teachers and staff at the private schools may have been more aware of anorexia nervosa than at the public schools, so there were less cases reported there. In more recent studies, similar trends have been found. In a 1990 study in Britain, the demographic profiles of two different psychiatric groups—anorexic patients and patients with affective psychosis—were compared. It was found that the majority of the anorexia nervosa patients were of a higher socioeconomic status than the affective psychosis patients. Also, in a 1987 study, participants of both lower and higher income from nine communities in East Massachusetts were assessed for eating disorders. A positive trend for anorexia nervosa and socioeconomic status was noted.
Bulimia nervosa and socioeconomic status
A 2002 Spanish study (Martin, Ruiz, Nieto, Jimenez, & de Haro) analyzed the influences of family functioning and socioeconomic status on disorders of eating behaviors. In order to do this, a case- control study was conducted for adolescents and adults, ranging from 12 to 40 years of age. The cases consisted of participants diagnosed with anorexia nervosa and/ or bulimia nervosa, and the controls consisted of participants with a distribution by age and sex identical to that of the cases. The participants included various people—schoolchildren from public and private schools, university students, and public administration work-- in order to eliminate any bias, and there were 120 cases and 240 controls. Participants completed the SCOFF questionnaire, which was used to detect disordered eating behaviors, the eating disorder inventory (EDI), which evaluated attitudes and behaviors towards food intake, and the Apgar family test, which evaluated family functioning on factors such as cooperation and development. Socioeconomic status was assessed through the parents’ professions, the parents’ education level, characteristics of the home dwelling, and characteristics of the home district; these were translated into scores, ranging from 6 to 36, with higher scores indicating a higher socioeconomic status. Results showed that family dysfunction appeared more in the case participants, with family dysfunction increasing with increasing severity of anorexia nervosa and bulimia nervosa. Regarding socioeconomic status, it was found that there was no significant distribution of cases and controls by socioeconomic status, though more cases fell into the middle and upper socioeconomic groups than did the controls. Anorexia nervosa was more prominent in the higher socioeconomic status groups, and bulimia nervosa was distributed evenly across all socioeconomic groups. Thus, no relationship was found between bulimia and socioeconomic status. However, in a study on the prevalence of eating disorders in a homeless population conducted by Gard & Freeman, it was found that 19.1% of the population had an eating disorder, with 2.4% anorexia nervosa and 8.3% bulimia nervosa. With adjustment for the small population sample, there was a significant amount of eating disorders, especially bulimia nervosa, in the homeless population compared to the general population.
Binge eating disorder and socioeconomic status
A study was conducted in 1995 that examined the connection between race, gender, age, education, socioeconomic status, and psychological distress on the frequency of binge eating (Reagan & Hersch). The participants of the study were 933 individuals 18 years and older residing in metropolitan Detroit and surrounding suburban areas. Of all the participants, 573 of them were women and 360 of them were male. The study included self- reported information on binge eating and dieting behavior, height and weight (in order to calculate body mass index), demographics and socioeconomic information, age, gender, race or ethnicity, marital status, education, and family income. The participants were also asked a question regarding how of often they had an eating binge in which they ate a lot of food in a few hours. Results showed that there was no difference by gender (holding race and obesity status constant) or by race (holding gender and obesity status constant) for the frequency of binge eating. Binge eating frequency generally declines with age, and education level does not affect the frequency. Regarding socioeconomic status, it was found that the frequency of binge eating decreases with increasing family income.
The stereotype that the development of an eating disorder increases with increasing socioeconomic status came about as a result of conclusions based on inaccurate evidence. Also, the tendency of people to generalize all of the eating disorders as anorexia nervosa contributed to this misconception. Based on the reviewed literature, early studies found a positive correlation between anorexia nervosa and socioeconomic status; however, the data on which this conclusion was formed contained methodological error and participant bias and therefore, the conclusion is not valid. In more recent studies, a positive trend was noticed for anorexia nervosa and socioeconomic status. A case- control study found no relationship between bulimia nervosa and socioeconomic status while another study found a high prevalence of eating disorders, especially bulimia nervosa, among the homeless population in comparison to the general population. Finally, a study found that the frequency of binge eating decreases with increasing socioeconomic status.
Based on these results, one can conclude that socioeconomic status has a specific relationship with the development of each eating disorder, rather than one trend among them all. The prevalence of anorexia nervosa tends to be higher among higher socioeconomic status, and the prevalence of binge eating disorder is higher among lower socioeconomic status. For bulimia nervosa, the relationship may be hard to determine because the reviewed literature have contradicting conclusions. The conclusion for binge eating disorder may or may not be certain since only one study was available for review. However, since binge eating is associated with obesity, and obesity is more common in lower socioeconomic status populations, the conclusion seems reasonable. Due to the various settings of the reviewed studies, it may be accepted that the results are universal. Still, my conclusions may not be valid because there were only so many studies available to me for review.
Reagan, Patricia, & Hersch, Joni (2005). Influence of Race, Gender, and Socioecoonomic Status on Binge Eating Frequency in a Population- Based Sample. International Journal of Eating Disorders. 38, 252-256.
Gard, Maisie E, & Freeman, Chris P (1996). The Dismantling of a Myth: A Review of Eating Disorders and Socioeconomic Status. International Journal of Eating Disorders. 20, 1-12.
Striegel- Moore, Ruth H., & Bulik, Cynthia M. (2007). Risk Factors for Eating Disorders. American Psychologist. 62, 181-198.
Martin, Rodriguez, Ruiz, Novalbos, Nieto, Martinez, Jimenez, Escobar, & de Haro, Castro (2004). Epidemiological Study of the influence of family and socioeconomic status in disorders of eating behavior. European Journal of Clinical Nutrition. 58, 846-852.
Tiemeyer, Matthew (2009, February 18). Eating Disorders in Women-- Higher Risk of Eating Disorders in Women., from About.com Web site: http://eatingdisorders.about.com/od/riskfactors/a/edsgender.htm
Binge Eating Disorder. from Weight- Control Information Network Web site: http://www.win.niddk.nih.gov/publications/binge.htm#howcommon
Maj, M, Halmi, K, Lopez-Ibor, J, & Sartorius, N (2003). Eating Disorders. England: John Wiley & Sons, Ltd.
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