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Barbara Mangweth, a psychologist at the Innsbruck Medical University in Austria, reached similar conclusions in a study of men suffering from eating disorders conducted in 2004. In collaboration with researchers at the Biological Laboratory of Psychiatry at McLean Hospital in Belmont, Mass., Mangweth compared 27 anorexic and bulimic men with 21 male mountain climbers and 21 male controls. The subjects held similar ideas about the ideal male figure but proffered dramatically different assessments of their own bodies. Unlike the climbers and the controls, the bulimics and anorexics all believed that they had about twice as much body fat as they actually had. Mangweth concluded that a faulty body image — rather than an exaggerated notion of what is ideal — is crucial to the development of eating disorders.
We still do not have an adequate understanding of why some people are subject to such distortions. Vocks and her colleagues suspect the problem involves information processing. According to their theory, the sensory organs of people with eating disorders correctly register their form, but negative thoughts filter the input. For example, memories of being teased about their looks as a child or teen may override how some bulimics and anorexics would otherwise see themselves. Because these individuals lack the emotional support to hold up a more flattering view, insecurity flourishes in them.
Apart from a dearth of positive feedback, some individuals develop eating disorders in response to specific childhood traumas. According to the findings of Stephen Wonderlich's group at the Eating Disorders Institute in Fargo, N.D., sexual abuse in particular may increase the odds. Similarly, children whose parents are divorced or alcoholic are clearly at risk. Several teenagers seen at the Pediatric and Child Psychiatry Clinic in Essen, Germany, where one of us (Eggers) is director, reported that they felt overwhelmed when their parents divorced, unable to mediate or remain loyal to both sides. Self-hatred can easily arise from such perceived inadequacy — with terrible long-term consequences.
Certainly eating disorders are not exclusively the result of personal problems, but negative feedback from or neglect by family and friends can, at least in part, predispose an individual to anorexia, bulimia or binge eating. In these instances, many parents do not know how to help and feel guilty that they are unable to guide their child. As a result, family therapy can be an important component of an overall strategy in which problems are worked out together. Frequently, the eating disorder is merely the last link in a chain of unhappy events.
It is difficult to measure the direct effect that glossy magazines and other media images have on dieting behaviors, but Fiji offers an interesting case study. Anne E. Becker, director of the Adult Eating and Weight Disorders Program at Massachusetts General Hospital, documented eating habits in the Pacific nation throughout the 1990s. In 1995 — almost immediately after the introduction of television on the island — she found that only 3 percent of schoolgirls, who were on average 17 years old, reported that they had vomited to control their weight. By 1998, though, that number had surged to 15 percent. And 74 percent of the girls described feeling "too big or fat" at least sometimes, even though Fijians traditionally associate robust body shapes with higher social rank.
For those in Vocks's program, finding the courage to bare their perceived faults in front of a group does often pay off. The 90-minute sessions are no substitute for long-term treatment, but Vocks's patients frequently change their eating habits for the better and often manage to raise their own battered sense of self-worth. Perhaps most important, many learn that the body they have long hated is beautiful in another's eye. In the U.S., recorded cases of eating disorders have doubled since the 1960s. A faulty body image — rather than an exaggerated ideal — is crucial to the development of eating disorders.
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