Misconceptions and realities
Reprinted from "Women's" issue of Visions Journal, 2004, 2 (4), p. 16-17
What are eating disorders?
What are eating disorders? Millions of young women and girls are affected by eating disorders each year. The two most common eating disorders are anorexia nervosa and bulimia nervosa. Anorexia is characterized by severe weight loss, amenorrhea (abnormal stoppage of menstrual periods), and cognitive features such as extreme fear of weight gain. Bulimia is characterized by binge eating episodes, compensatory behaviours such as vomiting and laxative use, and basing self-worth to a large extent on shape and weight.
How common are anorexia and bulimia?
About 2% of the population will suffer from anorexia at some point in their lives; the rate for bulimia is about 5%. Approximately 10 times as many women as men have eating disorders. Although eating disorders are relatively rare in the general population, they are more common in teenage girls (about 20% of eating disorder cases) and increasingly common in teenage boys (about 7% of cases).
How common is disordered eating
Relatively few individuals suffer from anorexia or bulimia, but disordered eating behaviour and unhealthy attitudes (i.e., excessive shape and weight concerns) are common. In a recent study, 4% of college women reported using extreme weight control methods (e.g., vomiting) on a daily basis; however, more than half of college women reported daily dieting behaviour (e.g., counting calories).2 In another study about half of teenage girls reported using weight control methods (e.g., skipping a meal, vomiting) at least once in the past year. Additionally, 18% of teenage girls report frequent dieting (more than five times in the past year).3 Research indicates that North American females generally want to weigh about 10 kgs. (or 22 lbs.) less than they currently do. This may explain the high prevalence of disordered eating in girls and young women.
What are our beliefs about the prevalence of eating disorders?
Despite relatively low rates of eating disorders in the community, popular opinion is that anorexia and bulimia are common problems among women. A recent study surveyed women’s beliefs about the prevalence of bulimia in women 18 to 45.6 Of the women surveyed, 20% estimated the prevalence of bulimia to be greater than 50%, half estimated the prevalence to be from 10% to 30%, and only 10% accurately estimated the prevalence to be less than 10% of community women.
Other research has compared perceptions of eating disorder prevalence in young men, young women, their mothers, and their fathers. Of the four groups, young women were most likely to see bulimia as common.7 Studies also show that young women view eating disorder symptoms as an acceptable means of weight control.
Together, this research suggests that women mistakenly believe eating disorders are common, and they are more likely than young men or older adults to see eating disorder symptoms as acceptable.
Why do we overestimate the prevalence of eating disorders
Eating behaviours and attitudes exist on a continuum ranging from healthy to disordered. Anorexia and bulimia are at the extreme of disordered. Healthy eating behaviours and attitudes, unfortunately, are not the norm among women. What is common is a general discontent with shape and weight, and a tendency to engage in dieting and weight control practices.
It may be that people accurately perceive the high prevalence of disordered eating, but they mislabel what they observe as ‘eating disorders.’ This may be especially true in young women. Research suggests that people who engage in disordered eating are more likely to perceive others as having eating disorders, and to view these behaviours and attitudes as acceptable.
The media may also play a role in shaping our perceptions of eating dis-orders. We live in a diet culture and are bombarded with images and messages that promote the desirability of thinness and the stigma of being overweight. The highly publicized celebrity struggles with eating disorders may also contribute to the perception that eating disorders are pervasive in our society.
What are the consequences of our misperceptions about eating disorders?
People’s perceptions about the behaviour and attitudes of others often influence their own behaviour and attitudes. This can be harmful if their perceptions are incorrect. For example, women may eat less or exercise more than is healthy if they think that such behaviour is normal and/or expected. This, in turn, promotes a cycle of unhealthy eating habits and the perception that disordered eating is common.
A recent study showed that educating college women about misperceptions regarding dieting, eating and exercising led to a reduction in disordered eating behaviour and adoption of a healthier weight ideal.
Focusing on self-esteem
Prevention programs that primarily target eating disorder symptoms have been associated with increases in problematic behaviours and overestimation of the prevalence of disordered eating. Programs that promote healthy self-esteem independent of shape and weight and that involve participants in critical analysis of the ‘thin’ ideal had more promising results.
Realizing we are more than our bodies
When we focus so strongly on our bodies and how to keep them slim, we neglect the many more important contributions women make to the world. It is important to recognize, promote and embrace a broader conception of women and their talents and roles.
About the Authors
Erin is a clinical psychology post-doctoral fellow in Psychiatry at UBC
Josie is a registered psychologist, Associate Professor in Psychiatry at UBC and Director of Research at the St. Paul’s Hospital Eating Disorder Program
Kjelsas, E., Bjornstrom, C. & Gotestam, K.G. (2004). Prevalence of eating disorders in female and male adolescents. Eating Behaviors, 5, 13-25.
Minz, L. B. & Betz, N. E. (1988). Prevalence and correlates of eating disordered behaviors among undergraduate women. Journal of Consulting Psychology, 35(4), 463-471.
Neumark-Sztainer, D., Wall, M.M., Story, M. et al. (2003). Correlates of unhealthy weight control behaviors among adolescents: Implications for prevention programs. Health Psychology, 22(1), 88-98.
Dunn, E.C., Neighbors, C. & Larimer, M.E. (under review). Motivational enhancement therapy and self-help treatment for binge eaters. Psychology of Addictive Behaviors.
Cogan, J.C. (1999). Lesbians walk the tightrope of beauty: Thin is in but femme is out. Journal of Lesbian Studies, 3(4), 77-8.
Mond, J.M., Hay, P.J., Rodgers, B. et al. (2004). Beliefs of women concerning the severity and prevalence of bulimia nervosa. Social Psychiatry & Psychiatric Epidemiology, 39, 299-30.
Vander Wal, J.S. & Thelen, M.H. (1997). Attitudes toward bulimic behaviors in two generations: The role of knowledge, body mass, gender, and bulimic symptomatology. Addictive Behaviors, 22(4), 491-507.
Mutterperl, J.A. & Sanderson, C.A. (2002). Mind over matter: Internalization of the thinness norm as a moderator of responsiveness to norm misperception education in college women. Health Psychology, 21(5), 519-523.
O’Dea, J. (2000). School-based interventions to prevent eating problems: First do no harm. Eating Behaviors, 8, 123-130.
Stice, E. & Shaw, H. (2004). Eating disorder prevention programs: A meta-analytic review. Psychological Bulletin, 130(2), 206-227.