By Allison Ines
Eating disorders (EDs) have been proven to affect the global population of women while discussions of these disorders remain taboo in most countries. Despite being one of the top contributors to premature deaths of all mental disorders, the nature of EDs and the urgency to find better treatments remain mysterious to many. EDs affect five times as many people as does schizophrenia and twice the number of people affected by Alzheimer’s disease, yet are appropriated a fraction of the media attention and funding by the government. EDs, such as anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified (EDNOS), are shockingly prevalent and the highest rates are found in the U.S. However, there is a rapid emergence of EDs among women in industrialized countries such as Italy, Brazil, and Japan; EDs affect nearly 69 million women worldwide.
The media in the U.S. has fostered a feminine culture centralized around the pursuit to be thin. Girls are at a vulnerable age when they are initially exposed to this ideal and are ultimately influenced by the importance the media has attributed to weight loss, fad diets, and counting calories. In fact, the earliest onset age in the U.S. for an ED is 12 years old, while negative self-images among girls emerge as early as eight years old. Nearly 1% of women in America are anorexic; up to 4.1% suffer from bulimia; 3.5% of women are diagnosed with binge eating disorder; and anywhere from 5%-13% of women have EDNOS, a category of EDs that does not meet the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) criteria for any specific ED. Four percent of anorexics, 3.9% of bulimics, and 5.2% of those with EDNOS (including binge eating disorder) die from their disorders. Suicides account for 0.6%, 0.9% and 0.5% of those deaths, respectively.
The thriving fashion industry present in Italy plays a huge role in the rise of EDs amongst Italian women. Until recently, no one larger than a size 0 graced the runways in Italy during fashion week and a number of brand name designers believe that the addition of healthier-looking, fullbodied models imposes limits on their creativity as artists. There are about three million reported cases of EDs among women in Italy – 0.8% of women are anorexic; 1.7% are bulimic; and 8% suffer from EDNOS. Immersed in a culture that has a reputable love for food and an admiration of high fashion, Italian women may feel trapped between the choice to eat plenty and the choice to remain skinny and fashionable, all while fearing and dealing with the criticisms of an Italian family.
Brazilian women are also at high risk of developing an ED. Growing up in a society that praises a Westernized version of “beautiful,” women living in Brazil are pressured to fit into the sexy, exotic, Brazilian, supermodel prototype. In a study performed among girls 7-14 years of age in Southeast Brazil, “at-risk” individuals did not differ from their controls in body mass index (BMI) but were of higher social economic status, suggesting that there is a stronger preference for thinness among more Westernized social groups. With a television set in almost every household, everyone in this country, from the poor to the rich, are exposed to the trend to be skinny.
Similarly, the rise of EDs in Japan is linked with the media as well as with their traditional gender roles. Girls are taught at the beginning of their education the separation between male and female roles, and that womanhood is achieved through motherhood. These women commonly aren’t given an intermediate stage between childhood and motherhood, nor are they taught the life skills to mature as a female outside this particular framework. This impaired development leaves women prone to the belief that not eating is a less embarrassing way of “opting out” of an unhappy marriage and coping with their “failures” as a woman in Japanese society. Because of this, as well as the pursuit of thinness present in more industrialized areas in the country, 10% of Japanese women in their 20s, 16% of women in their 30s, and 18% of female students report a BMI of less than 18.5 kg/m2, which is very close to the diagnostic weight threshold for anorexia.
On the other end of the spectrum lies obesity, a medical condition affecting 300 million women worldwide. With 35.5% of American women, 44.0% of Saudi Arabian women, and 39.5% of Egyptian women suffering from obesity, the highest numbers of affected populations, obesity affects high- and low-income countries alike. Obesity can lead to other comorbid medical conditions, such as a number of cardiovascular diseases; musculoskeletal disorders such as osteoarthritis; and some cancers such as endometrial, breast, and colon cancer.
Due to various sociocultural backgrounds and differing biological makeup of sufferers, it is evident that there are countless factors that can lead to an ED. No two patients with an ED are driven to their condition in the exact same way – as a result, a single, one-size-fits-all treatment plan has been deemed insufficient. Treatment must be handled by a therapist on a one-on-one basis to assess the diverse psychological states experienced by each individual. One option utilizes a proven effective treatment method, cognitive behavioral therapy, creating individualized treatment plans aiming to address the root causes of EDs. An evaluation of patients’ attitudes towards food and eating are made, and goals are achieved in a step-by-step fashion which is helpful in the long-run for preventing relapse.
The undeniable rise in EDs calls for proactive treatment and further attention, as well as increased funding. Promising new technologies, including cognitive behavioral therapy aided by the use of Virtual Reality, have led researchers and healthcare providers to explore treatment options in previously unexplored fields. Changing cultural ideals and gender roles, as well as improving education on the subject for young girls, can also help to combat this growing global epidemic.
Allison Ines Interactive Media Institute U.S.A. firstname.lastname@example.org www.vrphobia.com
President of Virtual Reality Medical Institute (VRMI) in Brussels, Belgium. Executive VP Virtual Reality Medical Center (VRMC), based in San Diego and Los Angeles, California. CEO of Interactive Media Institute a 501c3 non-profit Clinical Instructor in Department of Psychiatry at UCSD Founder of CyberPsychology, CyberTherapy, & Social Networking Conference Visiting Professor at Catholic University Milan.