By: Luna loves good science
If you have ever seen the movie “Mean Girls” or been a teenage girl yourself, you have an inkling of the pain and social pressures of female adolescence. Tina Fey actually based her screenplay for “Mean Girls” on the non-fiction self-help book, “Queen Bees & Wannabes: Helping Your Daughter Survive Cliques, Gossip, Boyfriends & Other Realities of Adolescence” by Rosalind Wiseman, which explores the horrors that young girls experience at the hands of each other. The reality is that while the antics portrayed in “Mean Girls” may seem trivial, they can combine with other factors to have severe long-term effects on psychological and physical health.
I am writing this article from the perspective of the anxious teenage girl I used to be who truly believed that if I could become less fat everyone would like me and my life would change. Teenage me had the perfect checklist for developing anorexia nervosa, a disorder characterized by a significant reduction of food intake resulting in extreme weight loss: a 14-year-old female from a Western society with a serious social anxiety disorder, perfectionist tendencies, and years of bullying (by other girls) for being fat, who also did sports requiring a slim figure. Some or all of these risk factors are present in 95% of cases of anorexia nervosa as well as bulimia nervosa, another eating disorder distinguished by starvation punctuated by episodes of binging and purging. The third major eating disorder, binge eating disorder, has a slightly different but fascinating etiology and is essentially an addiction to food.
When we look at the statistics we can see that my story is not unique. Even though eating disorders are diagnosed in only a small percentage of teenagers, anonymous surveys have shown that over one-half of teenage girls and one-third of teenage boys have used unhealthy weight control techniques (skipping meals, fasting, vomiting, taking laxatives). 91% of surveyed college women have tried to control their weight through dieting, with 25% of these women using binging and purging in these attempts. This means that despite the relative “rarity” of eating disorders (anorexia ~1%; bulimia ~3%; binge eating disorder ~5% of the general population), a large majority of young people develops some kind of adverse relationship with food and appearance. Most of the people surveyed indicated that peer and societal pressure to be or look a certain way led to their unhappiness with their weight and provoked their dieting behavior. This brings us back to “Mean Girls,” as young women are often the most vicious perpetrators and unfortunate victims of unattainable body image. I would love to have an open discussion on how we as a society could change our views on body image, especially for young women, but it is just as important for us to understand the science of eating disorders.
The scariest statistics of all are the mortality rates associated with eating disorders. Anorexia has the highest mortality rate of any mental illness. One in five of these deaths is due to suicide or substance abuse, the other common causes being starvation or heart problems. I couldn’t believe it when I first learned that indeed there are thousands of young women dying of heart attacks. Apparently, after a certain degree of starvation, our bodies will actually begin to eat our heart muscle for energy, reducing its pumping strength. To make it worse, electrolyte imbalances from poor diets cause abnormal heart rhythms. Individuals with bulimia are much harder to diagnose because they are often within normal weight ranges, but it is estimated that the mortality rate may be as high as in anorexia, predominantly caused by suicide.
I had a few questions after reading all this information. First, why do some people develop full-blown anorexia or bulimia while others try dieting or binging and purging a few times and stop? Second, why is the suicide rate so high in individuals with eating disorders? The answer to both of these questions may lie in the fact that most people with eating disorders have another diagnosable psychiatric disorder, including major depression, anxiety, obsessive-compulsive disorder, bipolar disorder, or schizophrenia. In some cases it is unclear which came first, but perhaps these psychiatric disorders predispose people who are already unhappy with their bodies to take extreme behavioral action to try to fix their problem. The same imbalances in neurotransmitters found in people with depression and anxiety, particularly low serotonin and dopamine levels in the brain, are found in people with anorexia and bulimia. Food is associated with pleasure and normally increases these same neurotransmitters as part of a reward system for eating, but dietary restriction and the associated “pleasure of looking and feeling thin” actually reprogram the brain to feel more pleasure in the absence of food or after purging food. Hunger, rather than motivating people with anorexia or bulimia to eat, itself becomes the rewarding sensation. Interestingly, the exact opposite pathways are activated in binge eating disorder, in which food basically becomes an addictive substance as potent as many drugs. The answers to my questions may be in the addictive and psychiatric properties of eating disorders, which make them difficult to quit and could explain the high suicide rate in these disorders.
So how do we treat eating disorders? We can’t just push all the “Mean Girls” in front of busses to get rid of one the causing factors. The strategy used in a lot of cases is forced inpatient hospitalization, to treat the medical complications and teach patients that food is important to be healthy and to train them to make eating a regular habit. Unfortunately, this means the lack of connection between food and pleasure continues even after successful “recovery.” Sadly, if we scan these patients’ brains even years after treatment, we can see no activation of pleasure centers in response to food. This makes it incredibly easy for patients to fall back into old dieting patterns, because the anorexic or bulimic pathway is still intact. To avoid this, we need to help people change the way they think.
What helped me was cognitive behavioral therapy, which also happens to be the most common form of treatment for eating disorders. Briefly, the cognitive component of the therapy addresses thought patterns such as “I can only be happy if I lose weight” and replaces them with ideas such as “my self-worth doesn’t depend on how much I weigh.” The behavioral component changes the habits of starvation or binging and purging and replaces them with healthy eating habits. This kind of treatment is more effective because it changes the emotions and thought patterns that are perpetuated in eating disorders while simultaneously altering the habitual behavior. This therapy helps restore the connection between food and pleasure, and reestablish the pathways in the brain that reward healthy eating.
It is also important to treat the underlying mental illnesses and to have a strong support system of friends and family to maintain the healthy habits. I mostly leaned on my two best friends, but the other powerful, unexpected support system was other girls who had recovered from anorexia. When I was at my thinnest, I felt invisible and alone before I would admit to anyone I had a problem. I had girls come up to me at least once a week recognizing the signs, telling me their stories, and offering help and support. These “nice girls” helped save my life.
Eating disorders are complicated and deadly. I haven’t even begun to address all the adverse health effects resulting from starvation or binging and purging. These diseases are often brushed off as rebellious teenage girls going through phases, but treating the solution as a simple matter of changing your diet is just as bad as blaming eating disorders completely on mean girls. We must treat eating disorders as seriously as any other psychological disorder or drug addiction by getting to the root of the problem and making true psychological changes. (For more information about different kinds of therapies please see my next article.)