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11/16/23, 11:17 AM Realizeit for Student Etiology A specific cause for eating disorders is unknown. Initially, dieting may be the stimulus that leads to their development. Biologic vulnerability, developmental problems, and family and social influences can turn dieting into an eating disorder (Tab...

11/16/23, 11:17 AM Realizeit for Student Etiology A specific cause for eating disorders is unknown. Initially, dieting may be the stimulus that leads to their development. Biologic vulnerability, developmental problems, and family and social influences can turn dieting into an eating disorder (Table 20.1 ). Psychological and physiological reinforcement of maladaptive eating behaviors sustains the cycle. TABLE 20.1 Risk Factors for Eating Disorders Disorder Biologic Risk Developmental Family Risk Sociocultural Factors Risk Factors Factors Risk Factors Issues of developing autonomy and having control Anorexia Obesity; dieting over self and nervosa at an early age environment; developing a unique identity; dissatisfaction Cultural ideal of Family lacks being thin; emotional media focus on support; beauty, parental thinness, maltreatment; fitness; cannot deal preoccupation with conflict with achieving the ideal body with body image Chaotic family Bulimia nervosa Obesity; early Self-perceptions with loose dieting; possible of being boundaries; serotonin and overweight, fat, parental Same as above; norepinephrine unattractive, and maltreatment weight-related disturbances; undesirable; including teasing chromosome 1 dissatisfaction possible susceptibility with body image physical or sexual abuse Biologic Factors https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXP1mimyVQOPOHLAvYAjZdL7GFyh%2bBfe9WR6sPHV… 1/5 11/16/23, 11:17 AM Realizeit for Student Studies of anorexia nervosa and bulimia nervosa have shown that these disorders tend to run in families. Genetic vulnerability might also result from a particular personality type or a general susceptibility to psychiatric disorders (Bulik, Kleiman, & Yilmaz, 2016). Or, it may directly involve a dysfunction of the hypothalamus. A family history of mood or anxiety disorders (e.g., obsessive– compulsive disorder) places a person at risk for an eating disorder. Disruptions of the nuclei of the hypothalamus may produce many of the symptoms of eating disorders. Two sets of nuclei are particularly important in many aspects of hunger and satiety (satisfaction of appetite)—the lateral hypothalamus and the ventromedial hypothalamus (Keel et al., 2018). Deficits in the lateral hypothalamus result in decreased eating and decreased responses to sensory stimuli that are important to eating. Disruption of the ventromedial hypothalamus leads to excessive eating, weight gain, and decreased responsiveness to the satiety effects of glucose, which are behaviors seen in bulimia. Many neurochemical changes accompany eating disorders, but it is difficult to tell whether they cause or result from eating disorders and the characteristic symptoms of starvation, binging, and purging. For example, norepinephrine levels rise normally in response to eating, allowing the body to metabolize and use nutrients. Norepinephrine levels do not rise during starvation, however, because few nutrients are available to metabolize. Therefore, low norepinephrine levels are seen in clients during periods of restricted food intake. Also, low epinephrine levels are related to the decreased heart rate and blood pressure seen in clients with anorexia. Increased levels of the neurotransmitter serotonin and its precursor tryptophan have been linked with increased satiety. Low levels of serotonin as well as low platelet levels of monoamine oxidase have been found in clients with bulimia and the binge and purge subtype of anorexia nervosa (Call et al., 2017); this may explain binging behavior. The positive response of some clients with bulimia to the treatment with SSRI antidepressants supports the idea that serotonin levels at the synapse may be low in these clients. Developmental Factors Two essential tasks of adolescence are the struggle to develop autonomy and the establishment of a unique identity. Autonomy, or exerting control over oneself and the environment, may be difficult in families that are overprotective or in which enmeshment (lack of clear role boundaries) exists. These family environments may have an https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXP1mimyVQOPOHLAvYAjZdL7GFyh%2bBfe9WR6sPHV… 2/5 11/16/23, 11:17 AM Realizeit for Student orientation toward control, system maintenance, or conflict (Darrow, Accurso, Nauman, Goldschmidt, & Le Grange, 2017). Such families do not support members’ efforts to gain independence, and teenagers may feel as though they have little or no control over their lives. These teens begin to control their eating through severe dieting and thus gain control over their weight. Losing weight becomes reinforcing; by continuing to lose, these clients exert control over one aspect of their lives. It is important to identify potential risk factors for developing eating disorders so that prevention programs can target those at highest risk. Adolescent girls who express body dissatisfaction are most likely to experience adverse outcomes, such as emotional eating, binge eating, abnormal attitudes about eating and weight, low self-esteem, stress, and depression. Characteristics of those who developed an eating disorder included disturbed eating habits; disturbed attitudes toward food; eating in secret; preoccupation with food, eating, shape, or weight; fear of losing control over eating; and wanting to have a completely empty stomach (Mitchison et al., 2017). The need to develop a unique identity, or a sense of who one is as a person, is another essential task of adolescence. It coincides with the onset of puberty, which initiates many emotional and physiological changes. Self-doubt and confusion can result if the adolescent does not measure up to the person she or he wants to be. Advertisements, magazines, television, and movies that feature thin models reinforce the cultural belief that slimness is attractive. Excessive dieting and weight loss may be the way an adolescent chooses to achieve this ideal. Body image is how a person perceives his or her body, that is, a mental self-image. For most people, body image is consistent with how others view them. For people with anorexia nervosa, however, body image differs greatly from the perception of others. They perceive themselves as fat, unattractive, and undesirable even when they are severely underweight and malnourished. Body image disturbance occurs when there is an extreme discrepancy between one’s body image and the perceptions of others and extreme dissatisfaction with one’s body image (Mitchison et al., 2017). Self-perceptions of the body can influence the development of identity in adolescence greatly and often persist into adulthood. Self-perceptions that include being overweight lead to the belief that dieting is necessary before one can be happy or satisfied. Clients with bulimia nervosa report dissatisfaction with their bodies as well as the belief that they are fat, unattractive, and undesirable. The binging and purging cycle of bulimia can begin at any time—after dieting has been unsuccessful, before the severe dieting begins, or at the same time as part of a “weight loss plan.” https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXP1mimyVQOPOHLAvYAjZdL7GFyh%2bBfe9WR6sPHV… 3/5 11/16/23, 11:17 AM Realizeit for Student Family Influences Girls growing up amid family problems and abuse are at higher risk for both anorexia and bulimia. Disordered eating is a common response to family discord. Girls growing up in families without emotional support may try to escape their negative emotions. They may place an intense focus outward on something concrete—physical appearance. Disordered eating becomes a distraction from emotions. Childhood adversity has been identified as a significant risk factor in the development of problems with eating or weight in adolescence or early adulthood. Adversity is defined as physical neglect, sexual abuse, or parental maltreatment that includes little care, affection, and empathy as well as excessive paternal control, unfriendliness, or overprotectiveness. Sociocultural Factors In the United States and other Western countries, the media fuels the image of the “ideal woman” as thin. This culture equates beauty, desirability, and, ultimately, happiness with being thin, toned, and physically fit. Adolescents often idealize actresses and models as having the perfect “look” or body, even though many of these celebrities are underweight or use ways to appear thinner than they are. Books, magazines, dietary supplements, exercise equipment, plastic surgery advertisements, and weight loss programs abound; the dieting industry is a billion-dollar business. Western culture considers being overweight a sign of laziness, lack of self-control, or indifference; it equates pursuit of the “perfect” body with beauty, desirability, success, and willpower. Thus, many women speak of being “good” when they stick to a diet and “bad” when they eat desserts or snacks (Churruca, Ussher, & Perz, 2017). Pressure from others may also contribute to eating disorders. Pressure from coaches, parents, and peers and the emphasis placed on body form in sports such as gymnastics, ballet, and wrestling can promote eating disorders in athletes (Giel & Hermann-Werner, 2016). Parental concern over a girl’s weight and teasing from parents or peers reinforces a girl’s body dissatisfaction and her need to diet or control eating in some way. Studies indicate that bullying and peer harassment are also related to an increase in disordered eating habits for both bullies and victims. Cultural Considerations Both anorexia nervosa and bulimia nervosa are far more prevalent in industrialized societies, where food is abundant and beauty is linked with thinness. In the United https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXP1mimyVQOPOHLAvYAjZdL7GFyh%2bBfe9WR6sPHV… 4/5 11/16/23, 11:17 AM Realizeit for Student States, anorexia nervosa is less frequent among African Americans. On the island of Fiji, when there was little television, eating disorders were almost nonexistent and being “plump” was considered the ideal shape for girls and women. In the 5 years following the widespread introduction of television, the number of eating disorders in Fiji increased significantly (Call et al., 2017). Eating disorders are most common in the United States, Canada, Europe, Australia, Japan, New Zealand, South Africa, and other developed industrialized countries. As a society becomes more prosperous with increased availability of foods high in fat and carbohydrates and increased emphasis on the thinness equals beauty concept, the incidence of eating disorders increases. In addition, immigrants from cultures in which eating disorders are rare may develop eating disorders as they assimilate the thin-body ideal (Anorexia Nervosa & Related Eating Disorders, 2019). Schulte (2016) found that both male and female youths in the United Arab Emirates experienced binge eating. Obesity was a prevalent problem, as was emotional eating and body-related guilt. Eating disorders appear to be equally common among Hispanic and Caucasian women and less common among African American and Asian women. Minority women who are younger, better educated, and more closely identified with middle-class values are at increased risk for developing an eating disorder (Perez, Ohrt, & Hoek, 2016). During the past several years, eating disorders have increased among all U.S. social classes and ethnic groups. With today’s technology, the entire world is exposed to the Western ideal. As this ideal spreads to non-Western cultures, anorexia and bulimia will likely increase there as well. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXP1mimyVQOPOHLAvYAjZdL7GFyh%2bBfe9WR6sPHV… 5/5