As outlined by DSM-5 guidelines, anorexia nervosa includes restrictive energy intake even lower than daily requirements, extreme fear of gaining weight or becoming fat, and denial of increasingly lower body weight. What does a victim of anorexia look like and how can you tell?
Easy. Look at what is on magazine covers, television screens, and fashion runways: a severely underweight, starving young woman.What is more shocking is that over 1 million women in the United States suffer from anorexia in their lifetime, with 1 in 5 anorexia deaths resulting from suicide (Arcelus et al. 2011; Hudson et al. 2007). While database statistics can better represent an affected population, popular media continues to emphasize that most people who suffer from anorexia are women, women who are young, white, and middle-to-upper class. Elders, minority groups, men, gender non-conforming, the poor–all silently suffering, and current statistics are not enough to emphasize the prevalence of anorexia in these subgroups of society.
Still trying to figure out how to tell if someone is a victim of anorexia? In a world domineered by Western culture, the face is a young white woman. A mere Google search shows you almost nothing else. If other subgroups are affected by this mental disorder, why are we only beaming our eyes towards one angle and averting all other angles?
Media. One of the most influential powers of Western society, media comes in a variety of flavors, from television to Internet to the radio. In between all the sitcoms, news, and movies, commercials can subliminally speak to our hidden insecurities and inner fears, particularly those that target women’s physical appearance. What we do not realize is that others that are not directly targeted are also deeply affected.
TJ’s “nine-year nightmare” ended at the age of 22, when he died in the middle of doing sit-ups. The 2015 tragedy flooded news stations and circulated on the Internet, claiming that he was the “New Face of Anorexia.” TJ, a young white college-student with excellent grades, dreams, and manners did not “want to be skinny. He wanted to have muscles. He wanted to have a six-pack, like the health magazine covers that he had, about 100 of those under his bed. He wanted to be quicker and faster and stronger, and look good,” his mother, Susan, explained. People might be quick to blame Susan for her lack of intervention, but she did monitor him for years until he went off to college. He began lying to her because he was afraid of showing weakness or worry and giving up on his goal. TJ’s demise can be perfectly attributed to the influence of media, those magazines eventually convincing him that he had to be muscular and thin or that he would not be considered a man.
On the other hand, Ahani Ortega, a 25-year-old Latina woman, had found herself trapped in the shadows of the “white anorexia.” Ortega shares with us that as part of her traditional Mexican lifestyle, her family would only eat two meals a day, and skipping meals was even easier at her California high school because no one was watching. Her anorexia escalated into self-harm and bulimia, and at the age of 15, she was hospitalized for overdosing on diet pills and nearly suffering a stroke. She began group therapy, but she was the only Latina “in a room full of white girls.” Her group therapy failed, and her doctors then diagnosed her with EDNOS (eating disorder not otherwise specified) because she did not meet the standards for anorexia, bulimia, or binge eating disorder. Surprisingly, EDNOS is the most common diagnosis in Latina women because like Ortega, many are not focused maintaining “the perfect thin,” defined as curvy, but not too much; thus, because anorexia’s diagnostic requirement is a “preoccupation with thinness,” she fell away from the possibility of receiving the treatment appropriate for her.
Darcy, too, found herself battling with anorexia after her husband died. She stopped eating, dropped fifty pounds, and, one day, the 66-year-old widow living in an “active retirement community” found herself hospitalized after a fainting spell on the golf course. The events leading up to her collapse were a mix of her depression, other women complimenting her on her figure the more weight she lost, and her own desire to lose her “chubby belly,” although she was a 5-foot-5, 90-pound woman. Who was telling her that she was “chubby,” and who knew that she was no longer eating?
More advertisements portray what young white women should represent, but nobody talks about TJ’s starving himself to death, Anahi’s misdiagnosis because she is Latina, or Darcy’s mid-life struggle with her husband’s sudden passing. Nobody talks because the facts are wrong. Most statistics we have are recorded based on self-reported questionnaires, with questions that target specific populations and create the young white woman bias we see (Streigel-Moore and Franko, 2003).
Given what I have discussed in previous other articles I have published about eating disorders, you can recognize that the experiences of eating disorders are spectral and range from one extreme to the other. To solve part of the bias portrayed in the media, Favaro et al. 2004 suggests to conduct personal interviews across several communities; furthermore, population-based data are needed to ascertain the prevalence in not only anorexia nervosa, but also bulimia nervosa and binge eating disorder (Favaro et al. 2004). From these interviews, we will be better able to assort the data on age-of-onset, duration of the illness, and association with sociodemographic factors (e.g. race, gender, class).
Note that many of the sources in this article date back to approximately ten or more years ago, which demonstrates the evident knowledge gap in anorexia prevalence, pathology, and treatment. On the greener side of research, data analyzed from the National Comorbidity Survey Replication (NCS-R) by Hudson et al. 2007 identifies a wider range of factors to consider, such as the association of anorexia with other mental disorders, the degree of disability, and the history of mental health treatment (Hudson et al. 2007). Other work contributed to the National Institutes of Mental Health (NIMH) reveals that researchers have found that, on the whole, eating disorders are caused by “a complex interaction of genetic, biological, behavioral, psychological, and social factors.” Just from these studies alone, we can start to understand that anorexia does not look the same for every person who lives with the illness.
We like to think that we know the in’s and out’s of anorexia, but we only know what anorexia should look like because the media tells us what to believe. As serious as anorexia nervosa is, a black cloud of social issues still hovers over the mental disorder. Media portrayal of positive body image, self-love and acceptance, and mental health wellness and awareness can lead to profound changes in how we view others and ourselves. TJ, Ahani, and Darcy did not get the help they needed when they were most vulnerable, all because they were not young white women, but emphasizing the level of destruction that a disorder such as anorexia can sustain on an individual can aid in the advocacy of urgent intervention, treatment, and management.
As Gayle Brooks, vice president and chief clinical officer of the Renfrew Center, the country’s first residential treatment facility for eating disorders, says, “When eating disorders were first being recognized, people seeking treatment were young white girls, so the belief developed early that nobody else suffers from them. When that became the core of our understanding, we stopped looking at diversity being an issue. We missed a lot.”
If you or someone you know is struggling with an eating disorder, the National Eating Disorders Association has useful information and resources. Do not hesitate to get help.
American Psychiatric Association. (2013). Feeding and Eating Disorders. Retrieved from http://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm10
Arcelus J, Mitchell AJ, Wales J, Nielsen S. (2011). Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies. Arch Gen Psychiatry, 68(7):724-731.doi:10.1001/archgenpsychiatry.2011.74
Cartwright, Martina M. (2013). Does Grandma Have an Eating Disorder? Psychology Today. Retrieved from https://www.psychologytoday.com/blog/food-thought/201310/does-grandma-have-eating-disorder
Favaro A, Ferrara S, Santonastaso P. (2004). The Spectrum of Eating Disorders in Young Women: A Prevalence Study in a General Population Sample. Psychosom Med, (65):701–708.
George, J. B. E., & Franko, D. L. (2010). Cultural Issues in Eating Pathology and Body Image Among Children and Adolescents. Journal of Pediatric Psychology, 35(3), 231-242. doi: 10.1093/jpepsy/jsp064
Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3), 348–358. http://doi.org/10.1016/j.biopsych.2006.03.040
Kloepfer, Chivon. (2015). Friends for Life: Nine-Year Nightmare. WLNS 6 News. Retrieved from http://wlns.com/2015/11/23/friends-for-life-nine-year-nightmare/
Konstantinovsky, Michelle. (2014). Eating Disorders Do Not Discriminate. Slate. Retrieved from http://www.slate.com/articles/double_x/doublex/2014/03/eating_disorders_and_women_of_color_anorexia_and_bulimia_are_not_just_white.html
National Association of Anorexia Nervosa and Associated Disorders. (2016). Eating Disorder Statistics. Retrieved from http://www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics/
National Institutes of Mental Health. (2016). Eating Disorders. Retrieved from https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml