Eating Disorders: Types, Causes & Psychological Roots

TAKEAWAYS:

• Eating disorders are psychobiological conditions rooted in distorted body image, emotional dysregulation, and societal pressures, not mere "lifestyle choices."
• Anorexia nervosa (restriction), bulimia nervosa (binge-purge), and binge-eating disorder (compulsive overeating) share core psychological traits but differ in behaviors and health risks.
• Cultural factors (e.g., thinness ideals in media) and trauma (e.g., childhood abuse) are key contributors, especially in collectivist societies like Nepal.
• Biological markers (e.g., serotonin imbalance, genetic predisposition) interact with psychological stressors to trigger disordered eating.
• Treatment combines CBT (to challenge distorted thoughts), nutritional therapy, and family-based approaches—critical for recovery.
• Nepal’s context: Stigma, lack of mental health services, and rapid globalization exacerbate risks, making early intervention urgent.

1. Defining Eating Disorders: Beyond "Just Dieting"

Eating disorders (EDs) are serious mental illnesses characterized by severe disturbances in eating behaviors, body image perception, and emotional well-being. They are not about vanity or willpower but stem from a complex interplay of psychological, biological, and social factors.

Key Features Across Disorders

mindmap
  root((Eating Disorders))
    Core Traits
      Distorted body image
      Fear of weight gain
      Emotional dysregulation
    Biological Factors
      Genetic predisposition
      Neurochemical imbalances (e.g., serotonin, dopamine)
    Psychological Factors
      Perfectionism
      Low self-esteem
      Trauma history
    Social/Cultural Factors
      Media influence
      Societal beauty standards
      Peer pressure

2. Types of Eating Disorders: Symptoms and Mechanisms

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) classifies three primary EDs, each with distinct—but overlapping—behaviors and risks.

Comparison Table: Anorexia, Bulimia, and Binge-Eating Disorder

Worked Example: Anorexia in a Nepali Context Case Study: 18-year-old student in Kathmandu

• Behavior: Skips meals, exercises excessively (3+ hours/day), weighs herself 5x/day.
• Psychological: Believes she "must be thin to succeed" (influenced by Bollywood/Korean dramas).
• Physical: Missed 2 periods; doctor finds bradycardia (heart rate <50 bpm) and lanugo hair (fine body hair).
• Trigger: Teased in school for "being chubby" at age 12; mother’s comment: "You’ll never get a husband if you’re fat."

Why This Matters:

• Cultural pressure: Nepali media and arranged marriage norms amplify body-image anxiety.
• Family dynamics: Parents often enable the disorder by praising weight loss or ignoring red flags.

3. Psychological Underpinnings: The "Why" Behind the Behaviors

EDs arise from a perfect storm of cognitive, emotional, and interpersonal factors.

A. Cognitive Distortions

• Overvaluation of shape/weight: Belief that self-worth depends on appearance. Example: A bulimia patient might think, "If I vomit, I’m not a failure."
• All-or-nothing thinking: "I ate one cookie = I’ve ruined my diet."
• Emotional suppression: Using food restriction/binging to avoid feelings (e.g., sadness, anger).

B. Emotional Regulation

• Trauma link: 50–70% of ED patients report childhood abuse or neglect. Nepal-specific: Domestic violence or parental neglect may trigger disordered eating as a coping mechanism.
• Perfectionism: Common in high-achieving students (e.g., TU/PU exam stress → anorexia).

C. Family and Social Influences

• Enmeshment: Families with low boundaries (e.g., parents controlling child’s food) increase ED risk.
• Peer groups: In Nepal, school cliques may ostracize heavier students, normalizing extreme diets.

4. Biological Factors: The Brain and Body Connection

Genetics and neurochemistry play a critical role in vulnerability.

Key Biological Markers

1. Serotonin Dysregulation:

   • Low serotonin → impulsivity (bulimia) or restriction (anorexia).
   • Example: SSRIs (antidepressants) are often used to treat bulimia by stabilizing serotonin.

2. Genetic Predisposition:

   • If a first-degree relative (parent/sibling) has an ED, risk increases 5–10x.
   • Nepal’s challenge: Limited genetic research means many cases go undiagnosed.

3. Hormonal Imbalances:

   • Leptin resistance: Leptin (hunger hormone) signals are ignored → binge eating.
   • Cortisol spikes: Chronic stress → binge-purge cycles.

5. Cultural and Societal Influences in Nepal

Nepal’s rapid modernization clashes with traditional values, creating a unique risk profile.

Risk Factors Specific to Nepal

Real-World Example: Daraz and Fast Fashion

• Problem: Daraz’s influencer marketing promotes ultra-thin models, normalizing extreme diets.
• Psychological effect: Young Nepali women compare themselves to unrealistic bodies, triggering anorexia or bulimia.
• Solution: Body-positive campaigns (e.g., #LoveYourBodyNP) are emerging but face backlash.

6. Assessment and Diagnosis: How Professionals Identify EDs

Diagnosis follows DSM-5 criteria and includes:

1. Clinical Interviews: Explore eating behaviors, body image, and emotional triggers.
2. Physical Exams: Check for lanugo, amenorrhea (missed periods), or electrolyte imbalances.
3. Psychological Tests:
   • Eating Disorder Examination (EDE): Gold standard for assessing symptoms.
   • SCOFF Questionnaire: Quick screen (e.g., "Do you worry you’ve lost control over eating?").

7. Treatment Approaches: What Works?

Recovery requires a multidisciplinary approach.

A. Cognitive-Behavioral Therapy (CBT)

• Goal: Challenge distorted thoughts (e.g., "I’m fat" → "My worth isn’t tied to weight").
• Example: A bulimia patient learns to delay purging by 30 minutes to break the cycle.
• Effectiveness: ~60% recovery rate for bulimia with CBT.

B. Family-Based Therapy (FBT)

• Best for adolescents: Parents monitor meals and challenge ED behaviors.
• Nepal’s challenge: Many families deny the problem due to stigma.

C. Medical/Nutritional Intervention

• Refeeding: Gradual weight restoration (critical for anorexia patients).
• Medications: SSRIs for bulimia; antipsychotics for severe anorexia.

D. Alternative Therapies

• Art therapy: Helps express emotions nonverbally.
• Mindfulness: Reduces binge triggers (e.g., stress eating).

In the Real World

1. eSewa and Financial Stress Eating

   • Problem: Many Nepalis use eSewa for online shopping, leading to impulse binge purchases—and food.
   • Link to EDs: People with low impulse control (common in BED) may binge on cheap junk food (e.g., chips, noodles) after online shopping sprees.
   • Solution: eSewa could partner with mental health NGOs to offer budgeting + nutrition tips.

2. Khalti and Social Media Comparison

   • Problem: Khalti’s digital payments enable easy access to fast fashion (e.g., Daraz, Symbiosis).
   • ED Trigger: Seeing thin influencers on Instagram/Facebook → body dissatisfaction → restrictive dieting.
   • Real Case: A 22-year-old Khalti user developed anorexia after following a "fitness guru" who promoted extreme calorie restriction.

3. NTC and Workplace Stress Eating

   • Problem: Long hours at NTC offices or call centers lead to stress eating (e.g., vada paani, momos).
   • Link to BED: Employees with high cortisol (stress hormone) are 3x more likely to binge eat.
   • Solution: NTC could introduce mindfulness breaks to reduce emotional eating.

Exam Tip: How to Score Full Marks

1. Structure Your Answer:

   • Introduction: Define the disorder + Nepal-specific relevance.
   • Body: Use DSM-5 criteria + real examples (e.g., eSewa, Khalti).
   • Conclusion: Link to treatment or societal impact.

2. Use Key Terms:

   • Anorexia: "Restriction + fear of weight gain + BMI <17.5"
   • Bulimia: "Binge-purge cycle + normal weight + dental erosion"
   • BED: "Binge eating without compensation + obesity risks"

3. Compare and Contrast:

   • Example Question: "Compare anorexia and bulimia."
   • Your Answer:

     Aspect	Anorexia	Bulimia
     Weight	Underweight	Normal/overweight
     Behavior	Restriction	Binge + purge
     Comorbidity	OCD, depression	Impulsivity, substance abuse

4. Nepal Context is Gold:

   • Always tie answers to local examples (e.g., "Like many Nepali students, she developed anorexia after comparing herself to Bollywood stars").

5. Avoid Common Mistakes:

   • ❌ "Eating disorders are just about being vain." → Wrong: They’re mental illnesses.
   • ❌ Ignoring biological factors (e.g., serotonin, genetics). → Always include these.

Final Visual Summary:

graph LR
  A["Eating Disorders"] --> B["Anorexia"]
  A --> C["Bulimia"]
  A --> D["Binge-Eating Disorder"]
  B --> E["Restriction<br/>BMI <17.5"]
  C --> F["Binge-Purge<br/>Normal Weight"]
  D --> G["Binge Only<br/>Obesity Risk"]
  A --> H["Causes"]
  H --> I["Genetics<br/>Trauma<br/>Media"]
  A --> J["Treatment"]
  J --> K["CBT<br/>FBT<br/>Medication"]