When Lauren was fifteen years old, her family
moved across the country and she started going to a new school. Already shy, Lauren suffered
from low self-confidence and had a hard time transitioning; nothing felt right and soon
her changing body became a source of insecurity. Eventually, she began thinking that maybe
if she lost weight and focused on fitness, she'd make more friends and feel better about
herself and life would get better. Soon she became obsessed with dieting and it quickly
spiraled into her subsisting only on rice cakes and apples and candy corn and celery. She like this new feeling of control every
time she stood on the scale and saw a lower number. She was achieving something, and that made
her feel good. Soon, she thought of nothing else. But what Lauren couldn't see was that she
was no longer healthy. Even when her hair started falling out and her skin grew dry and cracked,
and when she could never get warm. When she looked in the mirror, she still saw
a chubby girl. Her family, though, did notice, and yet, at a visit
to the doctor, she was just told to eat more. She didn't. One day while jogging, she had a heart attack
and collapsed. As a teenager, she was 5'7" and weighed eighty-two pounds. Lauren was
finally admitted to a psychiatric hospital where she was treated for anorexia nervosa.
She was put on bed rest, saw a therapist twice a week, joined a support group and slowly
began eating small amounts of food again. Her recovery was slow but, with the support
of her family and doctors, she was released eight months later. Though Lauren suffered a few
relapses over the years, she is now healthy. Ultimately, she was lucky. Anorexia, bulimia, and other
eating and body dysmorphic disorders can kill. Eating disorders are among the deadliest psychological
disorders, with some of the highest rates of death directly attributable to the illness.
They slowly ruin the body, but, in order for these conditions to be recognized and treated
successfully, they have to be understood as disorders of the mind. Here's some scary figures: According to the
National Eating Disorder Association, forty-two percent of first to third grade girls want
to be thinner; eighty-one percent of ten year olds are afraid of being fat; over half of
teenage girls and nearly a third of teenage boys have used troubling weight control methods
like fasting, skipping meals, smoking, vomiting, or taking laxatives. The rate of new cases of eating disorders
in Western culture has been increasing since the 1950's, and today in the US, an estimated
twenty million women and ten million men have suffered from a clinically significant eating
disorder at some point in their lives. But get this straight: we're not talking about
fad diets or lifestyle choices spurred by vanity. Eating disorders are psychological
illnesses that often come with serious consequences. These disorders tend to fall into three main categories:
anorexia, bulimia, and binge eating disorders. Those suffering from anorexia nervosa, most
often adolescent females, essentially maintain a starving diet and, eventually, and abnormally
low body weight. As in Lauren's case, anorexia can begin as a diet that quickly spirals out
of control as a person becomes obsessed with continued weight loss, all while still feeling
overweight. Our old friend, the DSM V, actually delineates
two sub types of the disorder. The first involves restriction, which usually consists of an
extremely low-calorie diet, excessive exercise, or purging, like vomiting or the use of laxatives.
The second type is the binge/purge sub type, which involves episodes of binge eating combined
with the restriction behavior. As you can easily imagine, the physiological
effects of this psychological condition can be devastating. As the body is denied crucial
nutrients, it slows down to conserve what little energy it has, often resulting in abnormally
slow heart rate, loss of bone density, fatigue, muscle weakness, hair loss, severe dehydration,
and an extremely low body mass index. And it's that low body mass that's the defining
characteristic of anorexia nervosa - a refusal to maintain a weight at or above what would
normally be considered minimally healthy. If this condition persists, of course, it
can be deadly, which is why anorexia has what's often estimated to be the highest mortality
rate of any psychiatric disorder. That might surprise you, given the host of
troubling disorders we've already covered here on Crash Course Psychology, but mortality
rates associated with, say, major depression or PTSD or schizophrenia tend to be the result
of secondary behavior, like suicide. But with anorexia, the mortality rate is especially
high because people can die as a direct result of extreme weight loss and physiological damage. Another common eating disorder is bulimia
nervosa. While anorexia is characterized primarily
by the refusal to maintain a minimal body weight, bulimia is not. People with bulimia
tend to maintain an apparently normal, or at least minimally healthy, body weight, but
alternate between binge eating, followed by fasting or purging, often by vomiting or using
laxatives. A bulimic body may not be as obviously underweight
as an anorexic one, but that addictive cycle of binging and purging can seriously damage
the whole digestive system, leading to irregular heartbeat, inflammation of the esophagus and
mouth, tooth decay and staining, irregular bowel movements, peptic ulcers, pancreatitis,
and other organ damage. Sometimes the two diagnoses can be difficult
to discern, especially because someone may shift back and forth between anorexic diagnostic
features and bulimic diagnostic features. The DSM V recently added a third category
called binge-eating disorder, which is marked by significant binge-eating, followed by emotional
distress, feelings of lack of control, disgust, or guilt, but without purging or fasting. Although sometimes triggered by stress or
a need for, or lack of, control, the presence of an eating disorder is not a tell-tale sign
of childhood sexual abuse, as was once commonly thought. Instead, these disorders are often
predictive indicators of a person's feelings of low self-worth, need to be perfect, falling short of
expectations, and concern with others perceptions. Although the prevalence of bulimia and binge-eating
is similar among ethnic groups in the United States, anorexia is is much more common among
white women, often of higher socioeconomic status. But the prevalence of these disorders is rising
in males, too. Today, between ten and twenty percent of people diagnosed with eating disorders
are men who feel the same pressure to attain what they imagine is physical perfection,
and that's worth noting. These disorders have strong cultural and gender
components; the so-called "ideal standard of beauty" varies wildly across cultures and
time, and thinness is far from a universal desire, especially in countries where malnutrition
and starvation are problems. But in the Western world, and increasingly
in other countries, thinness is a common pursuit. And being bombarded with images of unrealistically
slender models and jacked celebrities has increased many people's dissatisfaction, or
even shame and disgust, with their own bodies. These are all attitudes that can contribute
to eating disorders. Some people have even had plastic surgery to
look more like Beyonce, or J-Lo, or...Barbie. When taken to extremes, this kind of behavior starts
inching into the realm of body dysmorphic disorder. Body dysmorphic disorder is another psychological
illness, one that centers on a person's obsession with physical flaws - either minor or just
imagined. Those suffering from this disorder often obsess over their appearance, often
staring into mirrors for hours, and feel distressed or ashamed by what they see. Although it's often lumped in with the eating
disorders, our growing understanding of body dysmorphia suggests that it actually shares
some traits with obsessive-compulsive disorder, particularly the obsession with some imagined
bodily perfection and the compulsion to check oneself over and over to discern perceived
flaws. Not surprisingly, BDD and OCD may share some
similar neurophysiological features, although that's still being researched. People suffering from BDD may exercise excessively,
groom themselves excessively, or seek out extreme cosmetic procedures, but, unless treated,
they usually remain critical and unsatisfied with their looks, to the point of fearing
that they have a deformity. People with BDD may suffer from anxiety and
depression, start avoiding social situations, and stay home for fear that others will notice
and judge their appearance negatively. Obviously, this causes a lot of emotional
distress and dysfunction. Some bodybuilders suffer from a particular type of BDD called
muscle dysmorphia, sort of the opposite of anorexia, where they become obsessed with
the notion that they aren't muscular enough, even if they're ripping shirts like the Hulk. And again, this isn't mere vanity; people
suffering from body dysmorphia disorder look in the mirror and often see a distorted, even
grotesque, image in their reflection. So, how do these disorders come about? Well, to be honest, we still have a lot of
dots to connect. Neurologically, there are a few compelling
clues. In the case of eating disorders, for example, research has long suggested that
neurotransmitters like serotonin and dopamine may play a role. Dopamine is involved in regions of the brain
connected to hunger and eating, like the hypothalamus and nucleus accumbens, and some research has
found that binge eating appears to alter the regulation of dopamine production in a way
that can reinforce further binging. The result is a neurological pattern that
can resemble drug addiction, although the addiction comparison is still pretty controversial. Genetics appear to play a role, too, as there
seems to be increased risk among genetic relatives with eating disorders as compared to controls. But a lot of attention is also being paid
to environmental and familial factors, particularly the behavioral modeling and learning processes
that shape how we think about ourselves and our bodies. Specifically, children who grow
up observing problematic or unhealthy eating behavior in parents may be at higher risk
for developing an eating disorder. And explicitly learning unreasonable or unhealthy values
about your weight or your shape from your family, and definitely from your peers, can
have a powerful effect. Eating and body dysmorphic disorders are serious
business, but they are treatable -- and perhaps even preventable. If cultural learning contributes to how we
eat and how we want to look, then maybe education can help increase our acceptance of our own
appearance, and be more accepting of others. Today, you learned about the symptoms and
sub types of anorexia, bulimia, and binge-eating disorder, as well as various types of body
dysmorphic disorder, and some of the physiological and environmental roots of these conditions. Thank you for watching, especially to all
of our Subbable subscribers. This episode of Crash Course Psychology was co-sponsored
by Subbable subscriber Matthew Woolsey and by Rich Brown of Beach Ready Auto Repair in
Outer Banks, North Carolina. To find out how you can become a co-sponsor
for one of our videos, just go to subbable.com/crashcourse. This episode was written by Kathleen Yale,
edited by Blake de Pastino, and our consultant is Dr. Ranjit Bhagwat. Our director and editor
is Nicholas Jenkins, the script supervisor and sound designer is Michael Aranda, and
the graphics team is Thought Café.
I kept seeing discussions about this and didn't know how to approach the topic, so I decided to reduce some of my ignorance and look it up. Pretty sure I am not alone in this.