Eating Disorders

By Carrie Jones, LCSW

With summer approaching, our thoughts often turn to travel, beaches, fun in the sun…and our appearance.  How many of us have had the thought that we need to shed a few pounds before the season of shorts and swimsuits?  Obviously, healthy eating and feeling confident about our bodies are positive things, but over-concern with appearance and unhealthy dieting can be dangerous things.  While eating disorders (EDs) are not a choice, many are initially triggered by an attempt to lose weight.

What Is An Eating Disorder?

Eating disorders (ED) are serious illnesses that involve extreme emotions, attitudes, and behaviors related to food and weight.  Eds do not have one single or simple cause.  Rather, as this graphic shows, several complex factors often interplay and contribute to the development of an eating disorder.

Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder are the most common EDs.

Anorexia Nervosa is generally characterized by:

-Failure to maintain a healthy body weight

-Intense fear of gaining weight or being “fat”

-Distorted body image

Bulimia Nervosa is generally characterized by:

-Periods of uncontrolled, impulsive, or continuous eating beyond the point of feeling comfortably full

-Behavior that compensates for the binge, such as vomiting, use of laxatives and diuretics, fasting, and excessive exercise

-Feelings of shame or self-hatred after a binge

Binge Eating Disorder is generally characterized by:

-A secretive cycle of binge eating beyond the point of comfortable fullness

-Feeling a lack of control over the eating and distress regarding the binge

-No purging, but there may be sporadic fasts or repetitive diets

It is important to note that some behaviors may not clinically be considered a full syndrome eating disorder but can still be extremely dangerous and should be addressed.

The Facts

Sometimes EDs are trivialized as merely a petty phase experienced by privileged teen girls.  However, this perception is untrue and dangerous for multiple reasons.  EDs also affects males, children and adults, and people from diverse ethnicities and socioeconomic backgrounds.  Scarily, eating disorders have the highest mortality rate of any psychiatric issue.  Up to 20% of people suffering from anorexia die from complications related to their eating disorder, including suicide and heart problems.  Sadly, only 1 in 10 individuals with eating disorders ever receive treatment.  A survey of eating disordered behaviors at one international school in Shanghai showed rates of eating disordered behavior among all students grades 7-12 comparable to US rates – between 7% and 13%.

In the past, it was believed that adolescents developed EDs due to highly critical, controlling, or dysfunctional family environments so parents, mothers especially, were blamed for causing their child’s eating disorder.  Unfortunately, some mental health and medical professionals still hold to these dated theories and myths.  However, current research makes it clear that EDs are caused by a combination of genetic, environmental, psychological, and temperamental factors.  Families are not to blame and can be crucial allies and resources in treatment and recovery.


Early identification and timely intervention are key.  The sooner an individual gets help, the greater the likelihood he/she will recover.  For full recovery, eating disorders must be addressed from both a medical and a mental health perspective.  In addition to a multidisciplinary team consisting of medical, psychological, and nutritional professionals, the family should also be involved in the treatment plan.  For adolescents, it can also be very helpful to have school staff aware of and involved in the treatment plan.

One of the most troublesome symptoms of anorexia and restrictive EDs especially is anosognosia – the individual’s belief that he or she is not ill.  Restrictive EDs are largely ego-syntonic, meaning that sufferers aren’t generally distressed by their symptoms and may even experience their symptoms as positive or comforting (i.e. weight loss feels like an achievement or accomplishment).  Thus, it often can be challenging for these individuals to accept that they need treatment and family and other support systems may have to play proactive roles in intervening and arranging for treatment.  Resistance can be expected but hope remains.

For adolescents, family-based treatment (FBT, also known as the Maudsley Method) is considered first-line treatment and modified forms of this are now being adapted for use with adults with anorexia as well.  Cognitive behavioral therapy, dialectical behavioral therapy, and interpersonal psychotherapy have been shown to be effective for adults with bulimia and binge eating.

Tips for Preventing Eating Disorders

-Home, school, and general society should provide an environment that promotes and models healthy behaviors and healthy body image

-Discourage dieting or counting of calories

-Children should never be weighed in public or told to lose weight

It can be all too easy to compare ourselves to each other, especially living in China where many expats feel like giants compared to the locals.  Perhaps though, part of the gift of living abroad can be learning to appreciate international diversity of all sorts and recognizing and accepting the beauty of bodies of all shapes and sizes.

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