Anorexia and bulimia

Anorexia nervosa and bulimia nervosa are the two main categories of eating disorder. There are many similarities between the two groups: As many as 40 percent of sufferers of anorexia engage in binge eating. However most binge eaters do not go on to develop anorexia. The neat differentiation between different types of eating disorder is more imposed than real, and current advances in psychotherapeutic treatment tend to cross the diagnostic categories.

The key characteristics of anorexia are a morbid fear of being fat, significant weight loss (BMI of under 18), perceived distortions of body weight and shape, and cessation of periods. Bulimia is characterized by normal or above average weight, binge eating, regular vomiting or laxative abuse, loss of control over eating, and worries about body shape and weight.

A UK study of 13 to 19-year-old females found that there was an incidence of 50 cases of anorexia per 100,000. Bulimia is thought to affect 0.5 percent to 1.0 percent of young women.

Why do eating disorders develop? A combination of many factors

Our teenagers are exposed to the Western societal anxiety about healthy eating, body weight, and exercise. Our daughters read magazines and watch television shows and movies that promote thinness as desirable and attractive. They therefore grow up with an ideal of female beauty that is unrealistic and unachievable. An average teenage girl would need to be two and a half inches (5 cm) taller, increase her bust size by five inches (12.5 cm), and decrease her waist by six inches (15 cm) in order to resemble Barbie! Boys are also coming under increasing pressure to conform to movie-star ideals.

Different pressures

There are a considerable number of factors involved in the development of an eating disorder. These are characteristics of the individual young person, features of her family, and socio-cultural pressures. They combine in complex ways, initially to make a young person more vulnerable to developing an eating disorder, then to tip her from just having difficulties around eating into what would be recognized as a clinical and, sometimes, life threatening, condition and finally, to establish and maintain the disorder as part of her life. This makes it hard to definitely say what causes the disorder and what is a consequence of the disorder.

Each of these factors on its own is not enough to be dangerous, and in many cases, can be seen as normal adolescent issues. It is the complex interactions that lead to the worrying results.

How all these factors combine is not yet known. Some think that the normal stress of adolescent transitions—puberty, identity formation, sexual development, academic demands—and overvaluation of thinness in a young person who lacks a solid family base and strong sense of self, all combine to produce disordered eating of enough severity to constitute a clinical illness.

Genetic causes

A girl may have inherited a vulnerability that predisposes her to eating problems. If a close relative has had eating difficulties, she has a higher risk of developing a disorder, but it doesn’t mean that she definitely will.

Body image

Eating disorders often develop around puberty, when a girl will typically experience an increase in body fat. This can lead her to perceive that she is fat. She may start to diet and exercise and experience a dip in her self-esteem. Having a distorted body image, particularly thinking she is fatter than she is (and feeling unhappy about how she looks), is a key factor in the development of a disorder, but on its own is not sufficient. Underpinning this state of affairs is her belief that appearance is vital to her self-image and the approval and acceptance of others.

Dieting and exercise

She may try to diet to change her body weight and shape. Typically this is not successful, and may lead to her feeling depressed about her inability to change herself and feel good about herself. Dieting is pretty normal in adolescent girls, but it is particularly common among girls with a distorted body image. Dieting also leads to binge eating which can be the beginning of a vicious cycle of bingeing and dieting or purging. She may try using strenuous exercise to alter her body weight and shape, and in a vulnerable girl this may become obsessive in time.

Family interactions

All of these individual characteristics combine with particular family interaction patterns and parental influences to further increase the risk of an eating disorder developing. Her mother may have had an eating disorder herself or at least have had some of the characteristics. She may learn about dieting and extreme weight-loss measures from emulating her mother. She may have experienced critical comments from her parents about her weight or appearance. She is more likely to have a family that does not feel secure. They may not communicate very effectively with their adolescent daughter and may have a variety of other family difficulties, such as having lots of negative emotion being expressed without reaching comfortable resolutions. This young woman will be driven to please others more than achieve a set of her own goals. She is struggling to develop her own identity. She will not feel she has or is able to achieve autonomy from her parents, who show ambivalence about relinquishing control to their developing daughter. She will respond to their mixed messages of overprotection, over-control, and under-concern with her own version of self-control: Extreme control over her eating.

Cultural influences

Western society has produced the myth of the superwoman: Someone who is physically attractive and successful in her career, as well as being a good partner and mother. These enormous and conflicting demands place extra stress on an adolescent who wants to achieve perfection, who is struggling with her identity, who overvalues the views of others, and who has not had an easy nurturing experience. Her response to this stress is to apply more pressure to be perfect and to apply more control to the thing she can control, her body.

Media influences

Reading magazines that promote thinness and focus on body image may be one of the factors involved in eating disorders.


Although dieting is common in teenage girls, it can become obsessive.


Boys are also vulnerable to eating disorders, for much the same reasons as girls.


Lack of food, or dieting and bingeing, can affect emotions, leading to mood swings and irritability.

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