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There is no single cause for eating disorders. Although concerns about weight and body shape underlie all eating disorders, the actual cause of these disorders appear to result from a convergence of many factors, including cultural and family pressures and emotional and personality disorders. Genetics and biologic factors may also play a role.
• Avoidant personalities, mostly in anorexia. Such people are generally high functioning, persistent, and perfectionists.
It should be noted that any of these personality traits can appear in either patients with bulimia or anorexia; some experts believe that the patient's specific personality disorders, rather than whether they are anorexic or bulimic, may be the more important factor in determining treatment choices.
Borderline Personalities. Studies indicate that almost 40% of people who are diagnosed with bulimic anorexia (who lose weight by bingeing and purging) may have borderline personalities. Such people tend to have the following characteristics:
• Having unstable moods, thought patterns, behavior, and self-images. People with borderline personalities have been described as causing chaos around them by using emotional weapons such as temper tantrums, suicide threats, and hypochondriasis.
Some research has suggested that the severity of this personality disorder predicts difficulty in treating bulimia, and it might be more important than the presence of psychological problems, such as depression.
Narcissism. Studies have also found that people with bulimia or anorexia are often highly narcissistic and manifest the following personality traits:
• Having an inability to soothe oneself.
Accompanying Emotional Disorders
Obsessive-Compulsive Disorder (OCD). Obsessive-compulsive disorder is an anxiety disorder that occurs in up to 69% of patients with anorexia and up to 33% of patients with bulimia. In fact, some experts believe that eating disorders are just variants of OCD. Obsessions are recurrent or persistent mental images, thoughts, or ideas, which may result in compulsive behavior, repetitive, rigid, and self-prescribed routines that are intended to prevent the manifestation of the obsession. Women with anorexia and OCD may become obsessed with exercise, dieting, and food. They often develop compulsive rituals, eg, weighing every bit of food, cutting it into tiny pieces, or putting it into tiny containers. The presence of OCD with either anorexia or bulimia does not, however, appear to have any effect on whether a patient improves or not.
Other Anxiety Disorders. A number of other anxiety disorders have been associated with both bulimia and anorexia.
• Phobias. Phobias often precede the onset of the eating disorder. Social phobias, in which a person is fearful about being humiliated in public, are common in both eating disorders.
Depression. Depression is common in people with eating disorders, particularly anorexia. Depression and eating disorders are also linked to a similar seasonal pattern, as indicated by the following observations:
• In many people, depression is more severe in darker winter months. Similarly; a subgroup of bulimic patients suffers from a specific form of bulimia that worsens in winter and fall. Such patients are more apt to have started bingeing at an earlier age and to binge more frequently than those whose bulimia is more consistent year round.
Major depression is unlikely to be a cause of eating disorders, however, because treating and relieving depression rarely cures an eating disorder. The severity of the eating disorder is also not correlated with the severity of any existing depression. In addition, depression often improves after anorexic patients begin to gain weight.
Body Image Disorders
Muscle Dysmorphia. Experts are also increasingly reporting a disorder in which people have distorted body images involving their muscles. It tends to occur in men who perceive themselves as being "puny" and results in excessive body building, preoccupation with diet, and social problems.
• During historical periods or in cultures where women are financially dependent and marital ties are stronger, the standard is toward being curvaceous, possibly reflecting a cultural or economic need for greater reproduction.
In a country where obesity is epidemic, young women who achieve thinness believe they have accomplished a major cultural and personal victory; they have overcome the temptations of junk food and, at the same time, created body images idealized by the media. Weight loss brings a feeling of triumph over helplessness. This sense of accomplishment is often reinforced by the envy of heavier companions who perceive the anorexic friend as being emotionally stronger and more sexually attractive than they are.
Excessive Athleticism and the Female Athlete Triad
In the small community of athletes, excessive exercise plays a major role in many cases of anorexia (and, to a lesser degree, bulimia). In young female athletes, anorexia postpones puberty, allowing them to retain a muscular boyish shape without the normal accumulation of fatty tissues in breasts and hips that may blunt their competitive edge. Many coaches and teachers compound the problem by overstressing calorie counting and loss of body fat. Some over-control the athletes' lives and are even abusive to an athlete that goes over the weight limit. (Male athletes are also vulnerable to their coaches' influence and anorexia is also a problem among this group.)
In response, people who are vulnerable to such criticism may lose excessive weight, which has been known to be deadly even for famous athletes. The term "female athlete triad" in fact, is now a common and serious disorder facing young female athletes and dancers and describes the combined presence of the following problems:
• Eating disorders. • Amenorrhea (absence or irregular menstruation). Evidence is mounting that overly restricting calories may be more important than low weight in causing menstrual problems. Studies suggest that amenorrhea occurs even in women with normal weight if they severely diet.
In one study, female athletes who consumed a high-fat diet (35% of daily calories) performed longer and with greater intensity than those with a standard athletic low-fat diet (27% of daily calories). And such a diet appeared to be more estrogen-protective.
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