Discussion

Findings were usually consistent throughout this IRR. Most studies identified a link between eating disorders and the associated factors presented; however, no cause-effect relationships were identified. Even in instances in which a common preceding event or condition was found, those factors were not directly identified as causal in the development of the eating disorder. Rather, common elements and possible mediating links were noted, including emotions and personality traits, particularly perfectionism, impulsivity, and shame. Interrelationships among dependent variables and eating disorders are complex and require careful consideration.

Although anxiety disorders were more common in anorexics and bulimics, the personality trait of perfectionism was more common in anorexics. In anorexics, perfectionism was found to continue even after restoration of a healthy weight (Bastiani et al., 1995) and was identified without a known precipitating stressful event (Sassaroli & Ruggiero, 2005). Perhaps perfectionism is the more likely or specific cause of the eating disorder rather than anxiety, considering that perfectionism is common in other anxiety disorders and eating disorders. Although anxiety disorders preceded the onset of the eating disorder, a perfectionistic personality may contribute to both disorders and the apparent relationship between the two.

Depression was also more associated with anorexia and bulimia than with the other types of eating disorders studied. The perfectionistic personality traits common in anorexic patients might help to explain the association with higher rates of depression in these patients, as unrealistically high expectations may contribute to guilt and a sense of worthlessness that may also occur in depressed patients.

This perfectionistic trait found in anorexics may also be responsible for the considerable weight loss that bulimic women typically do not experience. Being perfectionistic, anorexics may exercise more willpower to meet the ultimate goal of controlling their weight, explaining why these women are able to avoid consuming food instead of binging and purging. Conversely, the impulsivity noted in bulimics may lead to consumption of extravagant portions of food followed by purging, which they often view as a “quick fix.”

Impulsivity among bulimics was identified as a possible contributing factor to higher rates of substance abuse, with episodes of binge eating and/or drinking. In addition, substances such as alcohol and marijuana increase appetite, which may increase binging, suggesting a possible link between substance abuse and binging behavior. Conversely, many substances such as nicotine and cocaine have appetite-suppressing effects, which may be a motivating factor for their use.

Deep et al. (1999) found that bulimics with comorbid substance abuse demonstrated a significantly higher rate of childhood sexual abuse than controls (p<.0001). Women who experience sexual abuse may also experience depression and impulsively turn to substances to elevate their mood. However, persons “coming down” from a drug-induced high often feel depressed. Alterations in mood may lead to further misuse of substances to stabilize mood and thus develop into substance abuse.

Carter et al. (2006) found that women who reported a history of sexual abuse demonstrated increased rates of depression, anxiety, and low self-esteem. Sexual abuse and anxiety disorders often preceded the eating disorders, which may be viewed as a mechanism of control. Females who have experienced sexual abuse may feel no control over those events. Therefore, eating disorders may develop as a mechanism of control over their bodies by controlling weight and consumption. Initially, eating disorders may serve to control anxiety, but are ultimately likely to have a reverse effect, increasing depression and anxiety. Many women are aware of the stigma associated with eating disorders, with feelings of depression or anxiety increasing with efforts to hide the disorder.  Bulimics may also become anxious or depressed by the action of binging, leading to purging.

Research findings related to the association between early pubertal onset and the occurrence of eating disorders varied. The overall consensus among researchers was that maturity fears among adolescents lead to body image disturbances and dieting to avoid pubescent physiologic changes of maturation (Hayward et al., 1997; Heebink et al., 1995).  However, Stice et al. (2001) found only an indirect link associating early onset puberty with depression and substance abuse, which were both associated with eating disorders. Therefore, further research is needed to draw definite conclusions.

Depression may be the common link associated with both disturbed body image and feeling the need to diet to relieve that concern. Individuals who experience early pubertal onset may become anxious about looking different from their peers, leading them to the formation of an eating disorder to control physiological development. Similarly, adolescents who have experienced sexual abuse may fear intimate relationships or pregnancy associated with development, leading to an eating disorder in an attempt to delay development.

Implications>>