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Eating Disorders, Essay Example

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Introduction

Eating disorders affect men and women of all ages, although adolescents tend to be the age group that is more susceptible. This is because, as their bodies are changing, they may feel more pressure by society as well as peer groups to look attractive and fit in (Segal et al). Types of eating disorders include Anorexia, Bulimia and Compulsive Overeating, which can also be related to the first two. The reasons behind Eating Disorder usually stem from a reaction to low self-esteem and a negative means of coping with life and stress (Something Fishy).  Eating disorders are also often associated with an underlying psychological disorder, which may be the reason behind the eating disorder or which may develop from the Eating Disorder itself. Mental health disorders that are often associated with Eating Disorder include Anxiety, Depression, Multiple Personality Disorder, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, BiPolar, BiPolar II, Borderline Personality Disorder, Panic Disorder and Dissociative Disorder. The longer a person suffers from ED, the more probable that they will be dealing with another mental illness, most likely Anxiety or Depression (Something Fishy). The eventual outcome of Eating Disorder can be deadly. “Some eating disorders are associated with a 10-15% mortality rate and a 20-25% suicide rate. Sometimes, anorexia, bulimia and compulsive eating may be perceived as slow suicide (Carruthers).” In order to prevent the deadly consequences of Eating Disorder and to prevent it from becoming more pervasive in society, it is necessary to recognize the correct treatment method for this disease.  Traditional treatments have focused on providing risk information to raise awareness of the consequences of Eating Disorder (Lobera et al 263). However, since Eating Disorder is a mental illness, a more effective treatment is one that offers psychological evaluation, counseling and treatment. Cognitive Behavioral Therapy is emerging as a more robust and effective method that can be used not only to treat Eating Disorder but the associated mental illnesses that may accompany it.

The Problem

Eating disorder is pervasive in society and can have deadly consequences on those that suffer from it. Many time Eating Disorder goes undetected by family members and friends because those suffering will go to great lengths to hide their problem. However, there are some signs and symptoms that can be clues that a person is suffering from some sort of eating disorder. According to Segal, these signs can include:

• Restricting Food or Dieting: A change in eating habits that includes restricting food or excessive dieting. The person my frequently miss meals or not eat, complaining of an upset stomach or that they are not hungry. A use of diet pills or illegal drugs may also be noticed.
• Bingeing: Sufferers may binge eat in secret, which can be hard to detect since they will usually do it late at night or in a private place. Signs of potential bingeing are empty food packages and wrappers and hidden stashes of high calorie junk food or desserts.
• Purging: Those who suffer from bulimia will force themselves to throw up after meals to rid their body of added calories. A sign that this is occurring is when a person makes a trip to the bathroom right after eating on a regular basis, possible running water or a fan to hide the sound of their vomiting. They may also use perfume, mouthwash or breath mints regularly to disguise the smell. In addition to vomiting, laxatives or diuretics may also be used to flush unwanted calories from the body.
• Distorted body image and altered appearance: People suffering from Eating Disorder often have a very distorted image of their own body. While they may appear thin to others, they may view themselves as fat and attempt to hide their body under loose clothing. They will also have an obsessive preoccupation with their weight, and complain of being fat even when it is obvious to others that this is not the case.

There are several possible side effects from Eating Disorders, both physical and psychological. Physical damage can be temporary or permanent, depending on the severity of the eating disorder and the length of time the person has been suffering from it.  Psychological consequences can be the development of a mental illness, especially depression and anxiety. Some sufferers of Eating Disorder will also develop a coping mechanism such as harming themselves, through cutting, self-mutilation or self-inflicted violence, or SIV (Something Fishy).

Physical consequences of Eating Disorders depend on the type of eating disorder that the person has. Anorexia nervosa can lead to a slow heart rate and low blood pressure, putting the sufferer at risk for heart failure and permanent heart damage. Malnutrition can lead to osteoporosis and dry, brittle bones. Other common complications include kidney damage due to dehydration, overall weakness, hair loss and dry skin. Bulimia nervosa, where the person constantly purges through vomiting, can have similar consequences as Anorexia but with added complications and damage to the esophagus and gastric cavity due to the frequent vomiting. In addition, tooth decay can occur because of damage caused by gastric juices. If the person also uses laxatives to purge, irregular bowel movements and constipation can occur. Peptic ulcers and pancreatitis can also common negative heath effects (National Eating Disorders Association).  If the Eating Disorder goes on for a prolonged time period, death is also a possible affect, which is why it is important to seek treatment for the individual as soon as it is determined that they are suffering from an Eating Disorder.

Once it is recognized that a loved one may be suffering from an Eating Disorder, the next step is coming up with an effective intervention in time to prevent any lasting physical damage or death. The most effective treatment to date is Cognitive-behavioral therapy, an active form of counseling that can be done in either a group or private setting (Curtis). Cognitive-behavioral therapy is used to help correct poor eating habits and prevent relapse as well as change the way the individual thinks about food, eating and their body image (Curtis).

Cognitive-behavioral therapy is considered to be one of the most effective treatments for eating disorders, but of course this depends on both the counselor administrating the therapy and the attitude of the person receiving it.  According to Fairburn (3), while patients with eating disorders “have a reputation for being difficult to treat, the great majority can be helped and many, if not most, can make a full and lasting recovery.” In the study conducted by Lobera et al, it was determined that students that took part in group cognitive-behavioral therapy sessions showed a reduced dissatisfaction with their body and a reduction in their drive to thinness. Self esteem was also improved during the group therapy sessions and eating habits were significantly improved.

“The overall effectiveness of cognitive-behavioral therapy can depend on the duration of the sessions. Cognitive-behavioral therapy is considered effective for the treatment of eating disorders. But because eating disorder behaviors can endure for a long period of time, ongoing psychological treatment is usually required for at least a year and may be needed for several years (Curtis).”

  Alternative solutions

Traditional treatments for Eating Disorders rely on educating potential sufferers, especially school aged children, of the potential damage, both psychological and physical, that can be caused by the various eating disorders .

“ Research conducted to date into the primary prevention of eating disorders (ED) has mainly considered the provision of information regarding risk factors. Consequently, there is a need to develop new methods that go a step further, promoting a change in attitudes and behavior in the  target population (Lobera et al).”

The current research has not shown that passive techniques, such as providing information, reduces the prevalence of eating disorders or improves the condition in existing patients. While education about eating disorders, the signs and symptoms and the potential health affects, is an important part of providing information to both the those that may know someone who is suffering from an eating disorder and those that are suffering from one, it is not an effective treatment by itself. It must be integrated with a deeper level of therapy that helps to improve the self-esteem and psychological issues from which the eating disorder stems.

Hospitalization has also been a treatment for those suffering from an eating disorder, especially when a complication, such as kidney failure or extreme weakness, occurs. However, treating the symptom of the eating disorder will not treat the underlying problem. Hospitalization can effectively treat the symptom only when it is combined with a psychological therapy that treats the underlying psychological problem that is causing the physical health problem.

Effectively treating eating disorders is possible using cognitive-behavioral therapy. However, the sooner a person who is suffering from an eating disorder begins treatment the more effective the treatment is likely to be. The longer a person suffers from an eating disorder, the more problems that may arise because of it, both physically and psychologically. While the deeper underlying issue may differ from patient to patient, it must be addressed in order for an eating disorder treatment to be effective. If not, the eating disorder is likely to continue. By becoming better educated about the underlying mental health issues that are typically the cause of eating disorder, both family members and friends of loved ones suffering from eating disorders and the sufferers themselves can take the steps necessary to overcome Eating Disorder and begin the road to recovery.

Works Cited

“Associated Mental Health Conditions and Addictions.” Something Fishy, 2010. Web. 19 November2010.

Carruthers, Martyn. Who Has Eating Disorders?   Soulwork Solutions, 2010. Web. 19 November 2010.

Curtis, Jeanette. “Cognitive-behavioral Therapy for Eating Disorders.” WebMD (September 16, 2009). Web. 19 November 2010.

Fairburn, Christopher G. Cognitive Behavior Therapy and Eating Disorders. New York: The Guilford Press, 2008. Print.  

“Health Consequences of Eating Disorders” National Eating Disorders Association (2005). Web. 21 November 2010.

Lobera, I.J., Lozano, P.L., Rios, P.B., Candau, J.R., Villar y Lebreros, Gregorio Sanchez, Millan, M.T.M., Gonzalez, M.T.M., Martin, L.A., Villalobos, I.J. and Sanchez, N.V. “Traditional and New Strategies in the Primary Prevention of Eating Disorders: A Comparative Study in Spanish Adolescents.” International Journal of General Medicine 3  (October 5, 2010): 263-272. Dovepress.Web. 19 November 2010.

Segal, Jeanne, Smith, Melinda, Barston, Suzanne. Helping Someone with an Eating Disorder: Advice for Parents, Family Members and Friends , 2010. Web. 19 November 2010.

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• Patient Care & Health Information
• Diseases & Conditions
• Eating disorders

Eating disorders are serious health conditions that affect both your physical and mental health. These conditions include problems in how you think about food, eating, weight and shape, and in your eating behaviors. These symptoms can affect your health, your emotions and your ability to function in important areas of life.

If not treated effectively, eating disorders can become long-term problems and, in some cases, can cause death. The most common eating disorders are anorexia, bulimia and binge-eating disorder.

Most eating disorders involve focusing too much on weight, body shape and food. This can lead to dangerous eating behaviors. These behaviors can seriously affect the ability to get the nutrition your body needs. Eating disorders can harm the heart, digestive system, bones, teeth and mouth. They can lead to other diseases. They're also linked with depression, anxiety, self-harm, and suicidal thoughts and behaviors.

With proper treatment, you can return to healthier eating habits and learn healthier ways to think about food and your body. You also may be able to reverse or reduce serious problems caused by the eating disorder.

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Symptoms vary, depending on the type of eating disorder. Anorexia, bulimia and binge-eating disorder are the most common eating disorders. People with eating disorders can have all different body types and sizes.

Anorexia (an-o-REK-see-uh), also called anorexia nervosa, can be a life-threatening eating disorder. It includes an unhealthy low body weight, intense fear of gaining weight, and a view of weight and shape that is not realistic. Anorexia often involves using extreme efforts to control weight and shape, which often seriously interfere with health and daily life.

Anorexia may include severely limiting calories or cutting out certain kinds of foods or food groups. It may involve other methods to lose weight, such as exercising too much, using laxatives or diet aids, or vomiting after eating. Efforts to reduce weight can cause severe health problems, even for those who continue eating throughout the day or whose weight isn't extremely low.

Bulimia (buh-LEE-me-uh), also called bulimia nervosa, is a serious, sometimes life-threatening eating disorder. Bulimia includes episodes of bingeing, commonly followed by episodes of purging. Sometimes bulimia also includes severely limiting eating for periods of time. This often leads to stronger urges to binge eat and then purge.

Bingeing involves eating food — sometimes an extremely large amount — in a short period of time. During bingeing, people feel like they have no control over their eating and that they can't stop. After eating, due to guilt, shame or an intense fear of weight gain, purging is done to get rid of calories. Purging can include vomiting, exercising too much, not eating for a period of time, or using other methods, such as taking laxatives. Some people change medicine doses, such as changing insulin amounts, to try to lose weight.

Bulimia also involves being preoccupied with weight and body shape, with severe and harsh self-judgment of personal appearance.

Binge-eating disorder

Binge-eating disorder involves eating food in a short amount of time. When bingeing, it feels like there's no control over eating. But binge eating is not followed by purging. During a binge, people may eat food faster or eat more food than planned. Even when not hungry, eating may continue long past feeling uncomfortably full.

After a binge, people often feel a great deal of guilt, disgust or shame. They may fear gaining weight. They may try to severely limit eating for periods of time. This leads to increased urges to binge, setting up an unhealthy cycle. Embarrassment can lead to eating alone to hide bingeing. A new round of bingeing commonly occurs at least once a week.

Avoidant/restrictive food intake disorder

Avoidant/restrictive food intake disorder includes extremely limited eating or not eating certain foods. The pattern of eating often doesn't meet minimum daily nutrition needs. This may lead to problems with growth, development and functioning in daily life. But people with this disorder don't have fears about gaining weight or body size. Instead, they may not be interested in eating or may avoid food with a certain color, texture, smell or taste. Or they may worry about what can happen when eating. For example, they may have a fear of choking or vomiting, or they may worry about getting stomach problems.

Avoidant/restrictive food intake disorder can be diagnosed in all ages, but it's more common in younger children. The disorder can result in major weight loss or failure to gain weight in childhood. A lack of proper nutrition can lead to major health problems.

When to see a doctor

An eating disorder can be difficult to manage or overcome by yourself. The earlier you get treatment, the more likely you'll make a full recovery. Sometimes people can have problem eating behaviors that are similar to some symptoms of an eating disorder, but the symptoms don't meet the guidelines for a diagnosis of an eating disorder. But these problem eating behaviors can still seriously affect health and well-being.

If you have problem eating behaviors that cause you distress or affect your life or health, or if you think you have an eating disorder, seek medical help.

Urging a loved one to seek treatment

Many people with eating disorders may not think they need treatment. One of the main features of many eating disorders is not realizing how severe the symptoms are. Also, guilt and shame often prevent people from getting help.

If you're worried about a friend or family member, urge the person to talk to a health care provider. Even if that person isn't ready to admit to having an issue with food, you can start the discussion by expressing concern and a desire to listen.

Red flags that may suggest an eating disorder include:

• Skipping meals or snacks or making excuses for not eating.
• Having a very limited diet that hasn't been prescribed by a trained medical professional.
• Too much focus on food or healthy eating, especially if it means not participating in usual events, such as sports banquets, eating birthday cake or dining out.
• Making own meals rather than eating what the family eats.
• Withdrawing from usual social activities.
• Frequent and ongoing worry or complaints about being unhealthy or overweight and talk of losing weight.
• Frequent checking in the mirror for what are thought to be flaws.
• Repeatedly eating large amounts of foods.
• Using dietary supplements, laxatives or herbal products for weight loss.
• Exercising much more than the average person. This includes not taking rest days or days off for injury or illness or refusing to attend social events or other life events because of wanting to exercise.
• Calluses on the knuckles from reaching fingers into the mouth to cause vomiting.
• Problems with loss of tooth enamel that may be a sign of repeated vomiting.
• Leaving during meals or right after a meal to use the toilet.
• Talk of depression, disgust, shame or guilt about eating habits.
• Eating in secret.

If you're worried that you or your child may have an eating disorder, contact a health care provider to talk about your concerns. If needed, get a referral to a mental health provider with expertise in eating disorders. Or if your insurance permits it, contact an expert directly.

The exact cause of eating disorders is not known. As with other mental health conditions, there may be different causes, such as:

• Genetics. Some people may have genes that increase their risk of developing eating disorders.
• Biology. Biological factors, such as changes in brain chemicals, may play a role in eating disorders.

Risk factors

Anyone can develop an eating disorder. Eating disorders often start in the teen and young adult years. But they can occur at any age.

Certain factors may increase the risk of developing an eating disorder, including:

• Family history. Eating disorders are more likely to occur in people who have parents or siblings who've had an eating disorder.
• Other mental health issues. Trauma, anxiety, depression, obsessive-compulsive disorder and other mental health issues can increase the likelihood of an eating disorder.
• Dieting and starvation. Frequent dieting is a risk factor for an eating disorder, especially with weight that is constantly going up and down when getting on and off new diets. There is strong evidence that many of the symptoms of an eating disorder are symptoms of starvation. Starvation affects the brain and can lead to mood changes, rigid thinking, anxiety and reduced appetite. This may cause severely limited eating or problem eating behaviors to continue and make it difficult to return to healthy eating habits.
• A history of weight bullying. People who have been teased or bullied for their weight are more likely to develop problems with eating and eating disorders. This includes people who have been made to feel ashamed of their weight by peers, health care professionals, coaches, teachers or family members.
• Stress. Whether it's heading off to college, moving, landing a new job, or a family or relationship issue, change can bring stress. And stress may increase the risk of an eating disorder.

Complications

Eating disorders cause a wide variety of complications, some of them life-threatening. The more severe or long lasting the eating disorder, the more likely it is that serious complications may occur. These may include:

• Serious health problems.
• Depression and anxiety.
• Suicidal thoughts or behavior.
• Problems with growth and development.
• Social and relationship problems.
• Substance use disorders.
• Work and school issues.

There's no sure way to prevent eating disorders, but you can take steps to develop healthy eating habits. If you have a child, you can help your child lower the risk of developing eating disorders.

To develop healthy eating habits and lifestyle behaviors:

• Choose a healthy diet rich in whole grains, fruits and vegetables. Limit salt, sugar, alcohol, saturated fat and trans fats. Avoid extreme dieting. If you need to lose weight, talk to your health care provider or a dietitian to create a plan that meets your needs.
• Don't use dietary supplements, laxatives or herbal products for weight loss.
• Get enough physical activity. Each week, get at least 150 minutes of aerobic activity, such as brisk walking. Choose activities that you enjoy, so you're more likely to do them.
• Seek help for mental health issues, such as depression, anxiety, or issues with self-esteem and body image.

For more guidelines on food and nutrition, as well as physical activity, go to health.gov.

Talk to a health care provider if you have concerns about your eating behaviors. Getting treatment early can prevent the problem from getting worse.

Here are some ways to help your child develop healthy-eating behaviors:

• Avoid dieting around your child. Family dining habits may influence the relationships children develop with food. Eating meals together gives you an opportunity to teach your child about the pitfalls of dieting. It also allows you to see whether your child is eating enough food and enough variety.
• Talk to your child. There are many websites and other social media sites that promote dangerous ideas, such as viewing anorexia as a lifestyle choice rather than an eating disorder. Some sites encourage teens to start dieting. It's important to correct any wrong ideas like this. Talk to your child about the risks of making unhealthy eating choices.
• Encourage and reinforce a healthy body image in your child, whatever their shape or size. Talk to your child about self-image and offer reassurance that body shapes can vary. Don't criticize your own body in front of your child. Messages of acceptance and respect can help build healthy self-esteem. They also can build resilience ⸺ the ability to recover quickly from difficult events. These skills can help children get through the challenging times of the teen and young adult years.
• Ask your child's health care provider for help. At well-child visits, health care providers may be able to identify early signs of an eating disorder. They can ask children questions about their eating habits. These visits can include checks of height and weight percentiles and body mass index, which can alert you and your child's provider to any big changes.

Reach out to help

If you notice a family member or friend who seems to show signs of an eating disorder, consider talking to that person about your concern for their well-being. You may not be able to prevent an eating disorder from developing, but reaching out with compassion may encourage the person to seek treatment.

• Feeding and eating disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR. 5th ed. American Psychiatric Association; 2022. https://dsm.psychiatryonline.org. Accessed Nov. 16, 2022.
• Hales RE, et al. Feeding and eating disorders. In: The American Psychiatric Publishing Textbook of Psychiatry. 7th ed. American Psychiatric Publishing; 2019. https://psychiatryonline.org. Accessed Nov. 10, 2022.
• Eating disorders: About more than food. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/eating-disorders. Accessed Nov. 16, 2022.
• Eating disorders. National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Eating-Disorders/Support. Accessed Nov. 16, 2022.
• What are eating disorders? American Psychiatric Association. https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders. Accessed Nov. 16, 2022.
• Treasure J, et al. Eating disorders. The Lancet. 2020; doi:10.1016/S0140-6736(20)30059-3.
• Hay P. Current approach to eating disorders: A clinical update. Internal Medicine Journal. 2020; doi:10.1111/imj.14691.
• Bhattacharya A, et al. Feeding and eating disorders. Handbook of Clinical Neurology. 2020; doi:10.1016/B978-0-444-64123-6.00026-6.
• Uniacke B, et al. Eating disorders. Annals of Internal Medicine. 2022; doi:10.7326/AITC202208160.
• Fogarty S, et al. The role of complementary and alternative medicine in the treatment of eating disorders: A systematic review. Eating Behaviors. 2016; doi:10.1016/j.eatbeh.2016.03.002.
• Some imported dietary supplements and nonprescription drug products may harm you. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/some-imported-dietary-supplements-and-nonprescription-drug-products-may-harm-you. Accessed Nov. 16, 2022.
• Questions and answers about FDA's initiative against contaminated weight loss products. U.S. Food and Drug Administration. https://www.fda.gov/drugs/frequently-asked-questions-popular-topics/questions-and-answers-about-fdas-initiative-against-contaminated-weight-loss-products. Accessed Nov. 16, 2022.
• Mixing medications and dietary supplements can endanger your health. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/mixing-medications-and-dietary-supplements-can-endanger-your-health. Accessed Nov. 16, 2022.
• Lebow JR (expert opinion). Mayo Clinic. Dec. 1, 2022.
• 2020-2025 Dietary Guidelines for Americans. U.S. Department of Health and Human Services and U.S. Department of Agriculture. https://www.dietaryguidelines.gov. Accessed Feb. 3, 2023.
• Long MW, et al. Cost-effectiveness of 5 public health approaches to prevent eating disorders. American Journal of Preventive Medicine. 2022; doi:10.1016/j.amepre.2022.07.005.
• Health.gov. https://health.gov/. Accessed Feb. 7, 2023.
• Eating disorder treatment: Know your options

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The Reality of an Eating Disorder

A medical student's award-winning piece on her battles with an eating disorder.

terovesalainen/Adobestock

Ms Cursor’s essay was honored as part of the 2023 Gerald F. Berlin Creative Writing Contest for its thoughtfulness. Psychiatric Times ’ resident poet of 26 years, Richard M. Berlin, MD, established the Gerald F. Berlin Creative Writing Award at the University of Massachusetts Chan Medical School in 2005 to honor the poetry, fiction, and reflective essays of medical students, physicians in training, graduate students, and nursing students from the medical school. Psychiatric Times is delighted to share her work and insights and hopes it serves as reminder of the importance of self-care for medical professionals, including students, as well as a better understanding of the struggles experienced by those with eating disorders.

I stare at the ceiling, having lost track of time. I roll over in the hospital gurney, entangled within a pair of cheap scrubs that are much too big for me. I’m trying hard to sleep but it’s impossible. I’m also hungry; I only had Jello and saltines for dinner because the vegetarian options are sparse here, at least according to the ER nurse whose empathy I am finding increasingly attractive. Inside my room is the gurney, a TV built into the wall, a blanket, and my snack wrappers neatly consolidated on the floor inside a Styrofoam cup. There is no light and nothing on the walls except the TV. The remote is even a keypad built into the wall outside of my room. I want to change the channel, but I am too scared to venture outside, into the common area clustered with other psych patients, all of us waiting for a bed to open in the hospital. I don’t want to be here, but I am not well enough for any alternative.

Sometime within the past twenty-four hours I was admitted to the hospital from McCallum Place Eating Disorder Center. I had been in eating disorder treatment for around a month, and, unable to use my eating disorder to cope for such an extended period of time, my suicidal thoughts grew too loud for me to handle on my own.

I have lived with anorexia nervosa for the past thirteen years. You might look at me and wonder how that’s possible.

I am not emaciated; I do not look sick. This is not to say that there weren’t periods of time when I did appear unwell; however my lowest weight did not correlate with my lowest point mentally. Anorexia—in fact, all eating disorders—are deadly, regardless of weight. The body and mind shrivel while the soul deflates as your sole focus in life becomes food. Eating disorders have the second highest mortality rate of any mental illness. One of the leading causes of death of people with anorexia nervosa is suicide.

While I do not look sick, I still battle daily urges to restrict my food, to run “x” number of miles to allow myself to eat “x” amount, to relish in the feeling of size zero pants slipping from my hips, to retreat back to behaviors like these that brought me so much comfort when inside I feel chaos. My eating disorder is deeply engrained, as are the years of depression, anxiety, and obsessive thoughts it has buried.

A year and a half ago, I started my first year of medical school. If you had asked me then to predict how the year were to unfold, I would not have forecasted any of it. I had taken three GAP years prior to medical school, in part to focus on recovering from my eating disorder. I wasn’t supposed to still be struggling with this, let alone need a leave of absence from medical school to admit myself to eating disorder treatment, nor end up in the hospital as a patient myself.

The first few weeks of medical school were the first time in my life I experienced panic attacks. At first I didn’t know what they were, and I judged myself for having them. How could everyone around me be so calm? Why was I so anxious that I was on the verge of passing out? Well, I wasn’t eating enough. My eating disorder hung on as a coping mechanism to manage all the change that was happening as I transitioned to medical school. It was a way to make me feel safe when I otherwise felt like an imposter. I felt insignificant among my classmates and colleagues, and controlling my body size somehow made me feel better. Restriction provided me with the bursts of serotonin I needed when I was otherwise lonely, overwhelmed, or feeling inadequate. But when you are starving, you become hypoglycemic, diaphoretic, light-headed, anxious.

Two months into medical school, my cousin died suddenly. My family still does not disclose the details, but I do know that his death was from some form of self-harm. I didn’t see my cousin very often, but when our paths did cross, I understood he was struggling. And I struggled, too. My cousin’s death overwhelmed me. I felt as though I could have prevented it somehow, and it precipitated a deep emptiness inside of me. I reached out to one of my mentors in medical school. Her response was to make sure that I was safe with myself. Safe with myself? It had never occurred to me that I could be unsafe with myself. Until that moment.

This became a very sticky thought, and throughout my first year of medical school, it grew more persistent. As its persistence grew, so did its ability to influence my emotions. For the first time, I experienced bouts of depression. And they were scary. I was grieving the loss of my cousin, while also juggling a significant injury to my femur that forced me to drop out of a marathon three days before the race, and still battling my eating disorder. Furthermore, I didn’t just have depression; these thoughts about harming myself were obsessive in nature, and I felt anxiety about having them, further perpetuating their power.

Fast forward to April 2022. My dietitian and therapist suspect that my anxiety is the result of not eating enough, so I try to eat more to alleviate it. But when I stop using my eating disorder to cope, the thoughts that remain are quite grim. I am sitting in my room, fighting back tears as I confess to my therapist over Zoom the thoughts I’ve been having. When I take my antidepressants, I think about taking the whole bottle. When I’m driving, I’m afraid I might drive my car off the road. Questioning my purpose in this world overwhelms me with sadness and confusion. My therapist reassures me: it’s okay, I can get help for this. I can? It doesn’t have to be this way? Later that day, I make the call to McCallum Place Eating Disorder Center and schedule an intake assessment. They can and will help me with my eating disorder, depression, OCD, and anxiety.

At the University of Massachusetts Chan Medical school, there is ongoing construction of a new research building. Excitement has been circulating about this project; as a student, I receive updates at least monthly on the building’s progress. I was even invited to sign the ultimate beam that was placed as part of the scaffolding. I chose not to sign it, as this project serves as a reminder to me of my good friend’s suicide involving a school construction site in college. He was just one of so many people whose life could have been saved if he knew it was okay to get help when he needed it. Each day, as I walk past the building, I make a promise to my friend to see its completion, and make sure that others do, too. Depression and suicide are common among medical providers, even more so in the last decade. It was important that I sought out treatment when I did, even if it meant taking a medical leave with only a month left in my first year of medical school. I am so grateful that my therapist recognized the signs that I needed more support and helped me take the steps to pause my school obligations and put my life first. Treatment helped me immensely to develop coping skills outside of my eating disorder to manage my depression, anxiety, and OCD. It also helped me pharmacologically to experiment with medications in a safe setting to begin to find what works best for me. I met so many people of all different backgrounds who struggled in similar ways that I did, and this helped me feel so much less alone.

I hope that by sharing my story, I can help others recognize when they themselves or their loved ones are struggling. And that no matter who you are, it is more than okay to ask for help. Getting help for mental health should be no different than seeing a doctor for a physical ailment. Let’s keep having these conversations, destigmatize mental illness, and start saving lives.

Ms Cursor is a pseudonym for the author, who chose to use such to prevent future prejudice. She is a medical student, anticipating graduation with the class of 2026.

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Essay on Eating Disorders

Students are often asked to write an essay on Eating Disorders in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Eating Disorders

Understanding eating disorders.

Eating disorders are serious health problems. They occur when individuals develop unhealthy eating habits that can harm their body. They often start with an obsession with food, body weight, or body shape.

Types of Eating Disorders

There are three main types of eating disorders: Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. Each has different symptoms but all can be harmful.

Impact on Health

Eating disorders can damage important body parts like the heart and brain. They can also affect mental health, causing anxiety or depression.

Getting Help

If you or someone you know has an eating disorder, it’s important to seek help. Doctors, therapists, and support groups can provide treatment and support.

250 Words Essay on Eating Disorders

Introduction.

Eating disorders, a category of mental health conditions, have been a subject of increasing concern in contemporary society. They are characterized by severe disturbances in eating behaviors and related thoughts and emotions, often driven by body dissatisfaction and distorted body image.

The most common types are Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. Anorexia is defined by a refusal to maintain a healthy body weight and an obsessive fear of gaining weight. Bulimia involves frequent episodes of binge eating followed by behaviors like forced vomiting to avert weight gain. Binge Eating Disorder is characterized by frequent overeating episodes but without subsequent purging actions.

Sociocultural Influences

Sociocultural factors play a significant role in the onset of eating disorders. The media’s portrayal of an ‘ideal’ body size and shape can contribute to body dissatisfaction and consequently, disordered eating behaviors.

Health Implications

The health implications of eating disorders are severe, impacting both physical and mental health. These can range from malnutrition, organ damage, to increased risk of suicide.

Eating disorders, therefore, are serious conditions that require comprehensive treatment. Increased awareness, early diagnosis, and interventions can significantly improve the prognosis and quality of life for those affected.

500 Words Essay on Eating Disorders

Introduction to eating disorders.

Eating disorders represent a group of serious conditions characterized by abnormal eating habits that can negatively affect a person’s physical and mental health. These disorders often develop from a complex interplay of genetic, psychological, and sociocultural factors.

The Types of Eating Disorders

The most common types of eating disorders are Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. Anorexia Nervosa is characterized by an intense fear of gaining weight, leading to self-starvation and excessive weight loss. Bulimia Nervosa involves cycles of binge eating followed by compensatory behaviors like vomiting or excessive exercise. Binge Eating Disorder, the most common eating disorder in the U.S., involves recurrent episodes of eating large amounts of food, often very quickly and to the point of discomfort.

The Underlying Causes

Eating disorders are typically multifactorial and can’t be attributed to a single cause. They often coexist with other mental health disorders such as depression, anxiety, and obsessive-compulsive disorder. Genetic predisposition plays a significant role, suggesting that eating disorders can run in families. Sociocultural factors, including societal pressures to be thin, can also contribute to the development of these disorders.

The Impact on Physical and Mental Health

The physical consequences of eating disorders are profound and can be life-threatening. They range from malnutrition, heart conditions, and bone loss in anorexia, to gastrointestinal problems and electrolyte imbalances in bulimia. Binge eating disorder can lead to obesity and related complications like heart disease and type 2 diabetes.

The mental health consequences are equally severe and include depression, anxiety, and increased risk of suicide. Eating disorders can also lead to social isolation and impaired functioning at work or school.

Treatment and Recovery

Treatment for eating disorders typically involves a multidisciplinary approach, combining medical, psychological, and nutritional therapy. Cognitive-behavioral therapy (CBT) is often effective, helping individuals to understand and change patterns of thought and behavior that lead to disordered eating.

Early intervention is crucial for recovery. However, stigma and lack of understanding about these disorders can often delay treatment. Therefore, raising awareness and promoting understanding about eating disorders is essential.

Eating disorders are serious and complex mental health conditions with significant physical and psychological consequences. Understanding their multifactorial nature is crucial for developing effective prevention and treatment strategies. The importance of early intervention and the role of societal attitudes in both the development and recovery from these disorders cannot be overstated. As a society, we must strive to promote body positivity and mental health awareness to help those struggling with these debilitating conditions.

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Ozempic Hurts the Fight Against Eating Disorders

I t’s impossible to escape the soaring popularity of Ozempic and similar drugs these days—daily headlines, celebrity “success” stories, and apparent ease in procuring prescriptions (even Costco sells them now) abound. But the cumulative effect of all of this has many experts in the eating disorder field worried about how this might affect their patients. This makes sense—even for those without eating disorders, these drugs can feel both triggering and enticing. After all, research tells us about 90% of women are dissatisfied with their bodies. This sounds like a quick fix.

Then, I started hearing reports—first anecdotal, then published —that some doctors were prescribing weight loss drugs like Ozempic to their patients with eating disorders. As in, to help treat them.

As a journalist who has extensively researched the harms of eating disorders and the barriers to recovery—and as a woman who had suffered from eating disorders on and off for much of my own life—I thought I must have misunderstood. Yes, we as a society are in the midst of Ozempic Fever—and by “fever,” I’m referring to excitement, rather than a possible side effect of the drug (which it is). Researchers are continuing to find new potential applications for these drugs, initially developed to treat type 2 diabetes. In March, the FDA approved a new indication for the weight-loss drug Wegovy (which has the same active ingredient as Ozempic), allowing it to be used as a treatment to reduce the risk for heart attack and stroke. Ozempic, a diabetes drug, used off-label for weight loss, is also being studied to treat anxiety and depression , polycystic ovary syndrome, substance abuse, Alzheimer’s , and now—eating disorders.

Read More: Ozempic Exposed the Cracks in the Body Positivity Movement

It’s early days and research hasn’t yet caught up with the enthusiasm.  But our cultural misunderstanding of eating disorders, even by well-meaning practitioners, could exacerbate the illnesses for those who suffer from them—and have dire consequences.

The new class of weight loss drugs mimics the body’s GLP-1 hormone , stimulating insulin production, and lowering blood sugar levels, helpful to those with type 2 diabetes. The drugs also curb appetite and slow the speed that food moves into the small intestine—you feel full more quickly and eat less. Many patients without eating disorders who take these drugs, have reported a reduction of “food noise” in their minds—referring to obsessive thoughts and preoccupation with food. (Though, as philosopher Kate Manne wisely posited in a recent New York Times piece , isn’t “food noise,” simply, hunger?)

For folks suffering from binge eating disorder (BED) or bulimia nervosa (BN), a drug that decreases appetite may seem to make sense. Both illnesses are characterized by eating large amounts of food, eating until uncomfortably full, and feeling distress around that (bulimia is distinguished by purging after a binge).

Binge eating often emerges as part of a cycle of restriction—dieting, fasting, or eliminating entire food groups—like carbs, for example. “Many people struggling with BED view the binge episodes as the problem and the restriction as something to strive for,” said Alexis Conason, a psychologist specializing in the treatment of binge eating disorder. “When people with BED take a GLP-1 medication that dampens their appetite, many are excited that they can be ‘better’ at restriction and consume very little throughout the day.” Subsequently, Conason adds, there is a dangerous potential for BED to then morph into anorexia, starving oneself with possibly life-threatening complications.

Eating disorders are complex illnesses that aren’t yet fully understood, even by experts in the field. Underneath the behaviors around food is often an intricate web of trauma, anxiety, and even genetic predisposition, all set against the backdrop of a culture that prizes thinness . Low weight is frequently (incorrectly) conflated with good health, and people in larger bodies are often subjected to bullying, negative stereotypes, and discrimination in the workplace .

Read More: Ozempic Gets the Oprah Treatment in a New TV Special

Emerging research strongly supports that for many, eating disorders are brain-based illnesses and in most cases, there exists a co-morbidity like anxiety, mood disorders, or substance abuse.

“GLP-1’s can’t help someone deal with their stress, anxiety, [and] trauma-history,” said psychologist Cynthia Bulik, one of the world’s leading eating disorder researchers, and Founding Director of the University of North Carolina Center of Excellence of Eating Disorders. “All of that background distress—fundamental distress that might be driving the BED in the first place—is temporarily bypassed by removing the desire to eat.”

Nearly 30 million Americans will have an eating disorder in their lifetime, but only about 6% of those are medically diagnosed as “underweight,” according to the National Association of Anorexia Nervosa and Associated Disorders. This means that a person may exhibit all of the diagnostic hallmarks of anorexia, for example, extreme restriction and even malnourishment, but still present as average weight or even overweight. They may even be told by a physician to lose weight, despite the fact that they are already going to dangerous extremes to chase that “goal.”

“We tend to think that everyone in a larger body with an eating disorder must have BED and everyone in a smaller body must have anorexia, but this couldn’t be further from the truth,” said Conason. “So many people with BED seek help in weight loss settings instead of seeking eating disorder treatment; many view the problem as their weight and think they need more help sticking to their diet” when in reality, an end to the restriction would more likely regulate their eating.

It’s much easier to get weight loss treatment than help for an eating disorder. There is no standard of care for eating disorders in this country and treatment is unregulated. While there are some promising, evidenced-based treatments (cognitive behavioral therapy for adults, and family-based treatment for children and teens), they don’t work for everyone. If a person is fortunate to be diagnosed and receive adequate treatment, relapses are common and full recovery can be elusive.

Further, these drugs are often intended to be taken for a person’s entire life. “When they go off the drug, or can’t access it due to supply problems, the urge to binge comes right back and they have not developed any psychological (or) behavioral skills to manage the urge,” Bulik told me. Just like with a diet, any lost weight will likely be regained when a person stops taking the drugs. Weight fluctuations, themselves ,may increase a person’s risk of chronic illnesses like type 2 diabetes, according to multiple studies.

“The focus on weight and erasing the desire to eat could indeed do harm,” cautioned Bulik. “The potential for abuse is high and will become higher with new preparations that don’t require an injection … Remember, these drugs are ‘for life.’ Stop them, and everything comes rushing back.”

The long-term side effects of GLP-1’s are not yet known. But the harms of eating disorders are: eating disorders have one of the highest mortality rates of any mental illness (second only to opioid overdose). People with eating disorders are more likely to attempt suicide, and during COVID-19, emergency room visits and inpatient admissions for eating disorders at pediatric hospitals skyrocketed, particularly for young women. According to the CDC, emergency room visits for 12-17 year old girls who suffer from eating disorders doubled during the pandemic. Those numbers, as shown by recent studies , have not returned to pre-pandemic levels.

An even greater concern is that the gaps in comprehensive care for eating disorders invite experimental, potentially harmful treatments and leave patients vulnerable. GLP-1’s may seem like a short-term “fix,” but they won’t graze the deeper issues nor will they diminish the eating disorder crisis in this country. And it is a crisis—every year, eating disorders cost the U.S. more than $65 billion .

I know too well that if a doctor advises their patient with an eating disorder “here’s something to make you eat less” most patients would happily oblige. That’s part of the pathology of the illness. It’s the eating disorder talking. Ideally, it wouldn’t be your doctor’s voice, too.

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Eating Disorders: Anorexia Nervosa Essay

People with eating disorders are characterized by unusual food intake behaviors. These individuals who suffer from eating disorders are at risk of dying, especially those who get diagnosed with anorexia nervosa (AN). The biological basis of existence of AN includes long-term determinants of Deoxyribonucleic acid that cause the body to lose weight but the patient overlooks the same. Anorexia is influenced by brain changes and genes, which comprise the biological basis of evidence regarding this eating disorder. People with anorexia nervosa are not highly interested in food and may be sensitive to the amount they take and the weight that may be gained. In terms of brain changes, anorexia is associated with the absence of gray and white substances in the brain where sulci enlarge for a person with the disorder, as shown in Figure 1 below (Carlson & Birkett, 2021). The brain tissue shrinks and catalyzes a person to ignore the impending dangers of their lifestyle when it comes to eating. In a healthy person who does not have the disorder, the tissue structures in the brain are normal, as shown in part B.

The other biological evidence is genetic factors that may influence anorexia nervosa. Between 58-76% of the variability in the diagnosis for anorexia is controlled by genes (Carlson & Birkett, 2021). For instance, children will inherit tissue formations in the brain from their parents, which may be easily affected by shrinking anorexia nervosa from their parents. (Schlegl et al., 2020). Genetic factors contribute to anorexia’s etiology due to the molecular approaches that are characterized by deterioration of physical health. The serotonin pathway receptors are essential in controlling molecular substrates that facilitate the physiology of food intake. Other crucial elements that are genetic include dopamine peptides that regulate energy intake and how it is consumed in the body (Schlegl et al., 2020). In this case, a person with genes that are receptive to dopamine-containing neurons may have this eating disorder. This disorder needs to be contained by utilizing cognitive behavioral therapy and pharmacological medications.

Carlson, N. R., & Birkett, M. A. (2021). Ingestive behavior. In Foundations of behavioral neuroscience (10 th ed., pp. 299–300). Pearson.

Schlegl, S., Maier, J., Meule, A., & Voderholzer, U. (2020). Eating disorders in times of the COVID‐19 pandemic—Results from an online survey of patients with anorexia nervosa . International Journal of Eating Disorders , 53 (11), 179-180. Web.

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Your chance of acceptance, your chancing factors, extracurriculars, discussing my eating disorder in college essays – too personal or potentially impactful.

Hey guys, so here's the thing – I’ve battled with an eating disorder, and it’s been a significant part of my high school experience. Should I write about overcoming this challenge in my essays, or would it be better to choose a less sensitive subject?

Your courage in facing and overcoming such a personal challenge is commendable. When choosing an essay topic, the key is to focus on how the experience has shaped you and enabled personal growth. If you believe that your journey with an eating disorder has been a transformational part of your high school experience and has changed you in a significant way, it is worth considering as an essay topic.

However, ensure that your narrative is one of resilience and that it showcases how this experience has helped you build up your strengths, rather than solely focusing on the struggle itself. For example, avoid graphic descriptions of what you dealt with, as they may be uncomfortable for admissions officers to read, especially if they have struggled with eating disorders themselves—remember, you never know who is going to be reading your essay.

Rather, focus on how overcoming the hardship of this experience has taught you important life skills, by talking about accomplishments or formative experiences that were enabled by the abilities you developed as a result of your struggle with your eating disorder. This approach will give colleges what they are interested in in any personal statement, which is your ability to persevere and how your experiences have prepared you for the challenges of college life.

In summary, this topic is not too personal if framed correctly. If you're wondering if your approach is working, you can always check out CollegeVine's free peer essay review service, or submit it to an expert advisor for a paid review. Since they don't know you, they can provide an objective perspective that will hopefully give you a sense of how an actual admissions officer would read you essay. Good luck!

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CollegeVine’s Q&A seeks to offer informed perspectives on commonly asked admissions questions. Every answer is refined and validated by our team of admissions experts to ensure it resonates with trusted knowledge in the field.

101 Eating Disorders Essay Topics

🏆 best essay topics on eating disorders, 📚 eating disorders research paper examples, 👍 good eating disorders research topics & essay examples, 🎓 most interesting eating disorders research titles, 💡 simple eating disorders essay ideas, ❓ eating disorder research questions.

• Essay on Eating Disorders in Adolescents
• Anorexia Nervosa and Bulimia Nervosa
• “The Globalization of Eating Disorders” by Susan Bordo
• Effect of Social-cultural Factors on Eating Disorders
• Eating Disorders: Types and Causes
• Eating Disorders: Diagnosis and Treatment
• Orthorexia as an Eating Disorder in the DSM
• Eating Disorders Among Athletes The pressure from the necessity to become successful is one of the major factors contributing to the emergence and development of eating disorders in athletes.
• Anorexia Nervosa & Bulimia Nervosa Anorexia nervosa and bulimia nervosa are both eating disorders; due to the peculiarities of the course of disorders, it can sometimes be difficult to distinguish them.
• Obsessive-Compulsive and Eating Disorders in Children In both OCD and ED, developmental milestones are crucial to consider because they can help indicate points of positive versus adverse health.
• Anorexia Nervosa: Signs and Symptoms, Treatment One of the types of eating disorders is anorexia nervosa, which is widely spread nowadays, especially among young girls and women.
• Psychosocial Risk Factors for Eating Disorders by Keel and Forney Idealization of thinness and subsequent issues with body image and weight are emphasized by Keel and Forney in the findings.
• Media Effects on Eating Disorder Symptoms In terms of modern technology-based society, media exposure has significantly increased its influence and role in the lives of its large audience.
• Normal Dieting and Eating Disorders Healthy dieting behaviors are essential for people’s health and well-being. This paper discusses the difference between normal dieting and eating disorders.
• The Impact of Media on Eating Disorders Media and celebrities need to recognize their role in projecting body image and influencing people. Some advertisements can harm the younger generation.
• Anorexia Nervosa Among Eating Disorders in Adolescence Anorexia nervosa is characterized by an incessant desire to be thin, hence the unhealthy eating behaviors that include starving.
• Eating Disorders and Therapeutic Support Eating disorders are significant mental and physical diseases that entail complicated and harmful interactions with food, feeding, exercising, and self-image.
• Social Control in Eating Disorders The need for food is a basic need aimed at maintaining homeostasis and obtaining the energy and nutrients necessary for life.
• Eating Disorders and Programs That Address Body Image Issues The paper states that excessive weight and disordered eating are significant public health issues in America and other western countries.
• The Scoff Questionnaire: Risk of Eating Disorders The paper discusses a method to identify children at risk of eating disorders. The children were provided with both relevant referrals and treatment.
• Eating Disorders and Social Interactions The paper indicates that social surroundings can make people feel insecure and push towards the development of eating disorders.
• Eating Disorders: Finding the Right Treatment An eating disorder is becoming a significant health concern among people. There are many factors connected to the root cause of eating behavior.
• Eating Disorders: “Out of Control?” by Claes et al. The study “Out of control?” by Claes et al. aims to investigate variations between restrictive and bingeing/ purging eating disorders.
• Food Allergies and Eating Disorders Along with food allergies, mental health disorders are widely spread diseases. Eating disorders, such as anorexia, bulimia nervosa, and binge eating, are common among young women.
• Bulimia Nervosa Diagnosis and Procedural Plan The patient has been showing the tendency to vomit after every instance of food intake, which is the primary sign of bulimia nervosa.
• Anorexia and Eating Disorders Treatments In the research paper, the source could be used to discuss research gaps related to anorexia treatments and raise the topic of controversial practices in treating EDs.
• Swan’s Case as an Example of an Eating Disorder Being focused on success in ballet and becoming a recognized dancer, Swan demonstrates anxiety because of the possible weight gain.
• Teen Anorexia: Mental Illness and an Eating Disorder Adolescents have increasingly been diagnosed with anorexia. They often have a nervous type of pathology, which is a psychological illness and is accompanied by an eating disorder.
• Eating Disorders in Adult Women This paper discusses eating disorders in adult women and treatment alternatives to reverse the health care challenge, which is threatening the health of this group.
• Anorexia Among Young Adults and Family Treatment The population needs to encourage family teaching to intervene with anorexia since parents are frequently unsupportive of their children with complexes.
• Eating Disorders Like Bulimia Nervosa and Anorexia Nervosa Though the loss of weight might be a positive aspect of healthy diets, people with orthorexia Nervosa do not have a disordered body image nor a determination for thinness.
• Binge Eating Disorder: Information for Patients The paper highlights Binge-eating disorder as a serious eating disorder in which you frequently consume unusually large amounts of food and feel unable to stop eating.
• Genetic Factors as the Cause of Anorexia Nervosa Genetic predisposition currently seems the most plausible explanation among all the proposed etiologies of anorexia.
• Orthorexia Nervosa and Eating Disorder Orthorexia nervosa is becoming a serious problem for the patient’s physical and psychological health, hence the attention of nutritionists should be focused on studying this disorder.
• The Problem of Anorexia Among College Students Anorexia nervosa and eating disorders in college students and adolescents are the problems that require immediate intervention.
• Eating Disorders: Why Do We Need to Control Our Nutrition? People with confirmed diagnoses of eating disorders need qualified help from specialists since neglecting a healthy diet is fraught with dangerous health outcomes.
• Anorexia Nervosa: History, Diagnosis and Treatment Anorexia nervosa among the eating disorders which is considered in the psychiatric illness. There are categories that have been advanced in the diagnosis of this illness.
• Treatment of Eating Disorders Eating disorders are major health challenges currently and in the future if appropriate measures are not taken, so each individual should take a closer look at health issues.
• Plausible Causes for Male Eating Disorders These days, however, things have changed significantly and out of five million Americans who suffer from eating disorders each year the percentage of males is tangible.
• Anorexia Nervosa as a Brain Disorder Anorexia nervosa is an eating disorder characterized by an uncontrollable desire to be thin, low weight, food restrictions, and a fear of gaining pounds.
• Anorexia Nervosa, Its Etiology and Treatment One of the eating disorders that affect a significant number of young individuals nowadays is anorexia nervosa.
• Anorexia Nervosa: Perspectives and Treatment The purpose of this paper is to review the causes of anorexia nervosa and to propose a treatment plan for patients experiencing this health problem.
• Anorexia Nervosa: Psychological and Physiological Therapy The design of therapy of anorexia nervosa needs to incorporate both psychological and biological components so the patient could resume proper dieting and gain weight.
• Inpatients’ Eating Disorders and Countermeasures This paper explores the efficacy of meal supervision, patient and nurse education as the tools for improving the efficacy of nutrition, and enhancing patient outcomes.
• Eating Disorders in Adolescents: Causes and Treatment People should have regular checkups for any disorders, especially when they start noticing body changes anytime they eat a certain type of food.
• Eating Disorders in Adult Population The major part of this paper is the design of the group proposal about group therapy and its application in the eating disorder in adult population.
• Theoretical and Methodological Considerations for Research on Eating Disorders and Gender
• Body Dissatisfaction and Eating Disorders
• Eating Disorders Among Different Cultures
• Causes, Effects, and Solutions to Eating Disorders
• Adonis Complex Eating Disorders
• Are Eating Disorders Really About Food
• Eating Disorders and the Treatment Applicable Effectiveness
• Linking Eating Disorders With Genetics
• Childhood Sexual Abuse and Eating Disorders
• Nutrition Intervention for Eating Disorders
• Photoshopping Images and How It Impacts Eating Disorders
• Eating Disorders and Its Effects on the Lives and Relationships
• The Correlation Between Social Media and The Development of Eating Disorders
• Eating Disorders Affecting American Women
• How And Why People Develop Eating Disorders
• Theories Behind Eating Disorders: Negative Impact on Young Youth
• Examining Eating Disorders and Social Learning Theory to Draw Useful Conclusions
• Hidden Eating Disorders During Bodybuilding
• Eating Disorders and Methods of Its Treatment
• The Relationship Between Ghrelin and Eating Disorders
• Body Image and Eating Disorders Among Young Ballerinas
• Eating Disorders Are Common Among American Children
• Fashion Triggers Eating Disorders
• Bulimia and Anorexia: The Dangers of Eating Disorders
• Cognitive Behavior Therapy and Eating Disorders
• The Three Major Eating Disorders in the United States
• Childhood Factors and Eating Disorders Symptoms
• Causes and Analysis of Eating Disorders and The Theory of Social Learning
• The Prevalence and Causes of Eating Disorders in the United States
• The Role Of Social Identity In Eating Disorder
• Why Do Athletes Struggle With Eating Disorders?
• What Is the Connection Between Body Image and Eating Disorders?
• Can Affirmations End Binge Eating Disorder?
• Do People With Eating Disorders See Themselves Differently?
• What Is Eating Disorder Most Common Among College Students?
• How Does Beauty Standards Cause Eating Disorders?
• Why Is Looking in the Mirror So Hard for People With Eating Disorders?
• Do Athletes Struggle With Eating Disorders?
• How Can a Patient Overcome an Eating Disorder?
• Which Personality Trait Is Linked to Eating Disorders?
• Can You Control if You Have an Eating Disorder?
• What Kinds of Medicine Are Helpful to Patients With Eating Disorders?
• Do Eating Disorders Have a Genetic Link?
• Which Eating Disorder Is Most Likely to Be Helped by Antidepressants?
• Can Perfectionism Translate Into Eating Disorder?
• What Interpersonal Factors Can Cause Eating Disorders?
• Is Clinical Depression Associated With Eating Disorders?
• What Are the Four Main Psychological Emotional States That Associated With Eating Disorders?
• Which Personality Type Is Most Likely to Have an Eating Disorder?
• Can Stress Cause Eating Disorders and Depression?
• Why Might There Be a Strong Connection Between Eating Disorders and Depression?
• Which Eating Disorder Has the Highest Mortality?
• Do Females Have the Same Rates of Eating Disorders as Males?
• What Is the Most Important Part of Treating Eating Disorders?
• How Does Social Media Influence the Prevalence of Eating Disorders?

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A Retrospective Literature Review of Eating Disorder Research (1990–2021): Application of Bibliometrics and Topical Trends

Eunhye park.

1 Department of Food Nutrition, College of BioNano Technology, Gachon University, Seongnam 13120, Korea; rk.ca.nohcag@krape

Woo-Hyuk Kim

2 Department of Consumer Science, College of Commerce and Public Affairs, Incheon National University, Incheon 22012, Korea

Associated Data

Not applicable.

Despite the growing importance of eating disorders in society and academic literature, only a few bibliometric review studies using bibliometric analysis were available. Hence, this study aimed to explore and uncover hidden research topics and patterns in articles in terms of eating disorders over the last 30 years. In total, 4111 articles on eating disorders were analyzed using bibliometrics, network analyses, and structural topic modeling as the basis of mixed methods. In addition to general statistics about the journal, several key research topics, such as eating disorder (ED) treatment, ED symptoms, factors triggering ED, family related factors, eating behaviors, and social factors, were found based on topic correlations. This study found the key research variables that are frequently studied with EDs, such as AN, BN, BED, and ARFID. This study may help clinicians comprehend important risk factors associated with EDs. Moreover, the findings about key ED research topics and their association can be helpful for future studies to construct a comprehensive ED research framework. To our knowledge, this is the first study to use topic modeling in an academic journal on EDs and examine the diversity in ED research over 30 years of published research.

1. Introduction

According to the National Eating Disorder Association (NEDA) [ 1 ], about 30 million people in the United States (US) suffer from eating disorders (EDs), including anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED) at least once in their lifetime. NEDA also reported that people who have AN at some point in their lives account for nearly 1% of females and 0.3% of males, while those who have BN account for roughly 1.5% of females and 0.1% of males [ 1 ]. BED is more common than AN and BN, with roughly 3.5 percent of women and 2.0 percent of men experiencing BED in their lives [ 1 ].

EDs are complicated illnesses that induce a variety of mental and physical health symptoms, significantly increasing the disease burden [ 2 ]. Through a national survey with the representative US adults, Udo and Grilo [ 3 ] uncovered that psychiatric disorders, especially substance use disorders, mood disorders, and anxiety disorders, were more prevalent among groups of the US adults suffering from three types of EDs (i.e., AN, BN, and BED) than those without specific EDs. Moreover, they discovered EDs could increase rates of somatic comorbidities, such as arthritis, hypertension, sleep problems, and high cholesterol [ 3 ].

ED research has developed into a diverse and specialized field owing to the complicated nature of these diseases, having made practical and theoretical contributions in various areas, such as the conceptualization of EDs [ 4 , 5 ], diagnosis [ 6 , 7 ], treatment and intervention [ 8 , 9 ], and risk factors associated with EDs [ 10 , 11 ]. For continuous academic development, researchers must actively communicate and collaborate with other scholars, even in other disciplines or subject areas, if necessary [ 12 ]. However, the rapid growth of specialized and multidisciplinary ED research may challenge researchers, especially young researchers, to understand the progress in the sub-research topics of ED research [ 13 ]. An overall understanding of ED research can be even more difficult as trends and research foci in ED studies may change over time in line with the evolving concepts and environments around ED [ 14 ].

Formal or casual in-person meetings or researchers’ individual efforts to search for information online or offline can be helpful for scholarly communication. With the advent of online databases and bibliometrics, the development of academic achievement can be easily structured, and information exchange among researchers can be traced [ 15 ]. Therefore, bibliometric methods can provide practical, impartial approaches to evaluating the publication profiles of a journal and research outcomes [ 13 , 16 ]. Citation analysis, a part of bibliometrics, can demonstrate how scholars communicate to conduct research and revolutionize ED research [ 12 ]. This study also implemented topic modeling to discover prominent research themes and associations among research topics. A retrospective literature review of ED research can provide a broad understanding of key research areas and trends over time. Based on the findings of this study, researchers and practitioners can comprehend areas of research that have hitherto been influential or areas of study that will require greater input from fellow researchers and practitioners in the future.

Previous studies conducted an extensive review of ED research published in 1980, 1990, and 2000 through collaboration between statistical and field experts [ 17 , 18 ]. Based on solid empirical evidence, the authors successfully illustrate the historical changes in methodological approaches and hypothesis testing and draw useful implications for academic stakeholders, such as researchers, reviewers, and editorial boards. However, no studies have been conducted since 2006 that evaluate the bibliographic data and research output of ED studies to diagnose academic progress and establish sustainable development. Hence, the current study aims to summarize the history of articles on eating disorders by showcasing its intellectual structure according to authors, citations, and, more importantly, research perspectives on the topic since 1990. Of the numerous journals that accept ED-related research, this study focused on the ED-specialized journal, International Journal of Eating Disorders ( IJED ), which has been one of the most influential journals in the field of ED over the past three decades. The research questions (RQs) were as follows:

• RQ 1. What are the general characteristics of ED studies published in articles on eating disorders?
• RQ 2-1. Which articles on eating disorders received the most attention from other researchers?
• RQ 2-2. What was the status of the researchers’ collaboration in developing ED research?
• RQ 2-3. Which papers have been widely cited as grounds for ED research?
• RQ 3. What topics are being actively studied in the field of ED and how has the popularity of these topics changed over time?

To our knowledge, our study is the first to apply bibliometrics and topic modeling to content in an academic journal addressing EDs to explore the diversity of studies on the subject over 30 years. Hence, this study introduced bibliometric methods to the field of ED research. The methodology and findings of this study are expected to contribute to the continuous development of ED research and inspire researchers in the field.

2. Methodology

2.1. data collection.

The Web of Science (WoS) database was used to collect all articles published in International Journal of Eating Disorders ( IJED) between January 1990 and August 2021. For data collection, this study chose one representative ED-related journal, IJED. According to Shah et al. [ 19 ], Archives of General Psychiatry , American Journal of Psychiatry , International Journal of Eating Disorders , and Psychological Medicine published the most influential, in other words, most cited, ED research. Out of these journals, IJED was the only ED-specialized journal. Although there are other prestigious ED-specialized journals with high impact factors, such as Eating disorders, Journal of eating disorders, European Eating Disorders Review , this study focused on IJED. Since the main foci of the aforementioned ED-specialized journals can vary, we chose one journal to control the influence of journal features on bibliometric results. Papers published in Eating Disorders , for example, have been available in the WoS since 2012, and papers published in Journal of Eating Disorders have been available since 2017. Because the availability of papers published in various ED journals varies, the topic summary results may be influenced accordingly.

In the WoS database, all article-related information, such as keywords, abstracts, volumes, issues, and page counts; information about the authors, including names, affiliations, and ORCID; and citation information, such as the number of citations and cited references, were retrieved. Of the 4160 articles retrieved from the WoS, 49 that did not contain essential article information (i.e., year of publication, volume, or issue) were excluded, leaving 4111 articles for data analysis. By following the common practices of previous reviews and bibliometric studies [ 17 , 20 , 21 ], this study divided the dataset into three periods to discover the key characteristics of the journal in each decade: 1990–1999, 2000–2009, and 2010–August 2021.

2.2. Bibliometric Analysis

This study applied two computer-assisted tools to efficiently capture the massive amount of journal-related information over the past 30 years: (1) the R-based bibliometric package “bibliometrix”, and (2) structural topic modeling (STM), an R-based text mining tool.

Traditionally, bibliographic data have been analyzed manually, which largely relies on the researchers’ subjective judgments of the data and requires a significant amount of time for data analysis. However, as the size of the data increases and the reproducibility of the results becomes more important, automatic analysis techniques such as bibliometrics have been widely applied [ 15 ]. Bibliometrics are statistical or quantitative analyses of a comprehensive range of the data in the literature and have been widely applied in various academic disciplines [ 21 , 22 , 23 , 24 ]. Bibliometric analysis tools often provide statistical summaries of journals or articles, author characteristics, institution or country characteristics, and citation characteristics. This study conducted bibliometrics using the R studio (R version 3.6.3 (1 September 2021) with the R-package, “bibliometrix”. (version 3.1.4) [ 25 ]. The general statistics of the journals and citation characteristics were examined using this package.

The “bibliometrix package” was used for network analysis to identify collaborative author relationships and co-citation patterns. For the author collaborative relationship network, each node of the network indicates the author of the articles on eating disorders, and the researchers who collaborated are connected with a line. Only key edges and 30 nodes consisting of key authors were used for network visualization to improve the visibility of the network. Each node represents the cited reference for the co-citation network, and the top 30 giant nodes are included for network visualization. For both networks, betweenness centrality was calculated because of its good performance in detecting influential nodes in the network [ 26 , 27 ]. The sizes of the nodes and labels are proportional to their degree in the network. For both the author’s collaborative relationship network and the co-citation network, community detection was performed using the default setting to identify the key groups.

2.3. Topic Modeling

To identify major research topics in articles published in Eating Disorders , we conducted topic modeling , which is computer-based text analysis. Because the key information about each article is concentrated in the title, abstract, and keywords, these three pieces of information were combined and analyzed for text mining. Python3 (version 3.7.3) was used for data cleaning to improve the quality of the text mining results. We performed text cleaning using two Python packages: Natural Language Toolkit, better known as “NLTK (version 3.4.4)”, and Gensim (version 3.8.0).

For topic modeling, an STM algorithm was applied with the “stm” package (version 1.3.6) in R [ 28 ]. Topic modeling is a machine learning approach that automates the modeling process with multiple iterations. However, for machines to produce results, users of the topic modeling algorithm must determine the optimal number of topics for the dataset and provide that information as input. If the number of topics is too small, machine-generated topics may not capture important sub-research topics or research trends. If the number of topics is too large, on the other hand, multiple similar topics can be generated redundantly. To identify the proper range of topics, held-out likelihood scores were calculated for different topics and used as a quantitative index. To ensure the quality of topic modeling results, the authors of this study performed an additional review of the machine-generated results. That is, the two authors of this paper (both have expertise in the implemented methods, and one is a registered dietitian) have manually reviewed the top words and abstracts highly associated with each topic to confirm whether the results were reasonable and interpretable. Following these procedures, a topic model was built with 47 topics.

Each topic consisted of a series of terms that addressed specific themes. The algorithm examined the associations between the terms in the dataset and terms often used in the same document or context were grouped together. Because topic modeling is probabilistic modeling, the machine calculates each term’s probability of being associated with the 47 topics and each document’s probability of the same to obtain a probability score called the topic weight (β) . Because the sum of 47 topic weights per document is always one, a topic closely related to one document has a topic weight close to one, whereas the topic weight given low relatedness is close to zero.

Because the machine computes the probability of one document being associated with all 47 topics, the associations among the topics could be examined as well. More specifically, topics that often occurred together in the same document had strong associations, and topic networks were created based on these associations. To do so, the “topicCorr” function in the “stm” package was applied. This process provided us with insights into more general and broader trends in topics in the selected article sample. Based on topic correlation, the modularity optimization method (“cluster_optimal” in the igraph package in R) was used to apply a community detection algorithm with a high modularity score. The modularity score was applied to discover the optimal community structure in complex networks.

STM has a function of testing the effects of document-level metadata on topic weights, which is available as an “estimateEffect” function in the “stm” package [ 29 ]. To simulate the effects of document covariates on topic weights, a component of document-level metadata is included as a parameter ( X ) instead of a global mean prior applicable for all documents [ 29 ]. The topic weight was referred to from a multivariate normal linear distribution [ 29 ]. With the “estimateEffect” function, we compared topic weights across the three periods to uncover shifts in the popularity of topics over time. Specifically, the “pointestimate” method was used to estimate the expected topic weights ( β) by each value of covariates (that is, three-time points by each decade), and the “difference” method was used to calculate the difference in the expected topic weights and confidence intervals. Since this approach can contrast two groups with binary data, topic weights of the 1990s were compared with those of the 2000s and 2010s, and the 2000s with the 2010s.

2.4. Research Topic Classification

Two metrics, overall popularity and historical trends, were utilized for topic classification. Topic estimates were used as indicators to determine the overall popularity of topics. The topics ranking within the top 25% by median topic estimates were classified into “high”, between the 25th percentile and the 75th percentile into “moderate”, and below 25% into “low”.

For historical trend classification, topic weight estimates were compared every decade based on 95% confidence intervals as the basis for determining one of the following historical trend classifications: “increasing”, “decreasing”, and “constant”. Historical trends of topics were classified as “increasing” (or “decreasing”) if the low and high confidence intervals did not contain zeros and their weights increased (or decreased) over time. If the low and high confidence intervals contain zeros, those topics are classified as “constant”. Figure 1 illustrates a summary of the implemented methods.

Summary of methodology.

3.1. General Characteristics of Articles in Terms of Eating Disorders

As illustrated in Figure 2 , an average of 132 articles were published in the ED’s journals each year between 1990 and 2020 (2020 was excluded from the average calculation as this year was not complete at the time of data analysis). The number of publications peaked in 2004 at 341, nearly three times the annual average. Although the change in the number of articles over time was not significant, it tended to increase at the end of each 10 years. Of the 4111 articles, the number of articles published between 1990 and 1999 was 952, 1419 between 2000 and 2009, and 1740 between 2010 and 2021. Of these years, 2004 emerged as the peak year for the number of publications.

The number of articles published in Eating Disorders .

3.2. Citation Characteristics

Table 1 lists the top 20 articles of each decade that received the most citations regarding the characteristics of citations. The article that received the most citations throughout the 30 years, was “Assessment of Eating Disorders: Interview or Self-Report Questionnaire?” [ 30 ]. Among the articles published in the first decade, those on scale development tended to be cited frequently. In the second decade, the article “The Effect of Experimental Presentation of Thin Media Images on Body Satisfaction: A Meta-Analytic Review” [ 31 ] received the most citations, and studies involving systematic reviews or meta-analyses were cited most frequently. Among articles published since 2010, “Psychometric Evaluation of the Eating Disorder Examination and Eating Disorder Examination-Questionnaire: A Systematic Review of the Literature” [ 32 ] received the most citations. In the final period, studies involving systematic reviews and meta-analyses were often cited, as were those with broader research topics (e.g., ethnic groups and the Internet).

Top 20 most cited papers published in each decade.

Author collaboration was visualized using the top 30 authors with the highest betweenness centrality scores to display collaborative relationships among researchers ( Figure 3 ). Betweenness centrality in the author collaboration network represents the researcher’s capacity to influence other researchers and spread information quickly [ 33 ]. The size and label of nodes are proportional to the frequency of each node in the author collaboration network. This means that authors with larger node sizes and labels often collaborate, and these researchers quickly transfer scientific knowledge. As a result, four clusters were found, centered on researchers with high betweenness centrality: Mitchell, JE in Cluster 1; Wifley, DE in Cluster 2; Builk, CM in Cluster 3; and Crosby RD in Cluster 4.

Author collaboration network.

In addition, a co-citation network was drawn to identify the relationships among the representative sources frequently cited by articles of Eating Disorders ( Figure 4 ). Each node of the co-citation network represents a cited reference source, and links between nodes are created if the corresponding nodes are cited by the same source. Articles frequently cited in the same journal tend to be densely networked. Densely connected nodes are grouped into the same cluster, and each cluster often shares similarities in terms of research topics. In this study, two large communities were discovered. The references in community one mainly focused on the assessment of eating disorders and clinical features (e.g., [ 30 , 34 , 35 , 36 , 37 ]). The references in community 2 are mainly about theory building and tool development (e.g., [ 32 , 38 , 39 , 40 ]).

Co-citation network.

3.3. Characteristics of Research Topics

3.3.1. discovery of prominent research topics.

Topic modeling and topic network analysis revealed the 47 most prominent research topics and their associations ( Table 2 ) and the representative article for each topic ( Table 3 ). At the topic level, technology (Topic 5 and T5) was the most popular among the 47 most salient research topics, accounting for approximately 3.8% of the total topic weight. The top words for that topic were “Internet”, “online”, “professional”, “technology”, and “international”. The article most closely associated with that topic was “User-Centered Design for Technology-Enabled Services for Eating Disorders [ 41 ]”. This result indicates online space became an important medium for ED diagnosis and clinical practices.

Topic summary.

Representative articles highly associated with each topic.

Dieting (T22) and BN (T18) were also widely studied topics, accounting for approximately 3.2% of the total topic weight. This result indicates that many researchers were interested in dieting (related to weight evaluation) as well as BN. An article related to dieting is “Eating Disorders, Dieting, and the Accuracy of Self-Reported Weight” [ 42 ]. The popularity of dieting topic demonstrated that many ED researchers found self-evaluation of body weight or excessive weight control relevant to EDs.

One article associated with BN is “Comparative Validity of the Chinese Versions of the Bulimic Inventory Test Edinburgh and Eating Attitudes Test for DSM-IV Eating Disorders Among High School Dance and Nondance Students in Taiwan” [ 43 ]. Compared to other ED topics (e.g., BED [T29], AN [T20], ARFID [T15]), BN was most widely studied in IJED . However, it should be noted that Topic 29 (BED) and Topic 1 (EDNOS) were related to binge eating, and these two topics accounted for about 6% of the overall topic weight, which is larger than BN. As shown in Table 2 , both Topic 29 (BED) and Topic 1 (EDNOS) contained keywords related to binge eating. Topic 29 and Topic 1 may diverge due to revisions in the definition of BED in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and DSM-5. In the fourth edition of the DSM-IV, BED was classified as an Autonomous Eating Disorder not Otherwise Specified (EDNOS) [ 44 ]. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published in May 2013, BED was listed in addition to other eating disorder diagnoses, BN and AN [ 45 , 46 ]. As this study targeted the ED research over three decades, those topics related to binge eating may have been classified into the eating behavior group rather than ED symptoms. In summary, the most researched ED-related topics in IJED were BED (accounting for nearly 6%), BN (3.2%), AN (2.8%), and ARFID (1.7%).

3.3.2. Research Topic Network

Some topics tended to have overlapped themes and characteristics. Based on the degree of similarities shared by the topics, topic correlations were estimated and topic network structures were identified ( Figure 5 ). As a result of the topic network analysis and community detection, six groups of 37 of the 47 topics were produced, leaving 10 stand-alone topics. The groups included BED risk factors (Group 1), factors triggering ED (Group 2), AN, BN risk factors (Group 3), treatment (Group 4), social factors (Group 5), and ARFID risk factors (Group 6). Groups 1, 3, and 6 were formed by connecting important risk factors with an emphasis on key EDs. Group 1 comprised, for example, BED-related topics and risk factors that are frequently studied in the context of BED.

Topic network result.

The group with the most significant total topic weight, accounting for approximately 18.3% of the total topic weight, was mostly related to BED risk factors: EDNOS (T1), obesity (T4), food intake (T7), dieting (T22), restrained eating (T27), BED (T29), cognitive avoidance (T36), and eating behavior on mood (T46). The close link between obesity (T4) and two binge eating topics (T1 and T29) was found, which demonstrated that many ED researchers were interested in the effects of obesity on binge eating. For instance, Amianto, Ottone, Abbate Daga, and Fassino [ 44 ] conducted a systematic review study with binge eating research and many studies were conducted with obese population. Similarly, the edge of BED topic (T29) was connected to food intake (T7), dieting (T22), and dietary behavior (T46), showing that much research examined the effects of food behaviors on BED.

Another major group, accounting for approximately 17.4% of the total topic weight, was the factors triggering EDs. In that group, research topics included the effects of gender (T19 and T40), body image and self-esteem (T17, T25, and T34), internalization (T31), ethnicity (T33), and groups at risk of ED (T8). T19 and T40 dealt with gender issues, but their research foci differed. Studies related to T40 (labeled as gender/gender identity) examined whether biological gender or gender identity can influence EDs, whereas T19 (labeled as a gender stereotype) questioned the impact of social preconceptions about gender attributes, such as masculinity and femininity, on EDs.

Group 3 was labeled as “AN, BN risk factor”, accounting for 16.4% of the total topic weight. This group consists of bulimic symptoms (T6), BN (T18), AN (T20), risk of comorbidity (T30), abuse (T35), birth (T42), and purge behavior (T43). We found a close relationship between AN (T20) and the birth topic (T42), indicating that many researchers examined the effects of birth-related issues on AN. The close relationship between these two topics can be supported by many previous studies examining the relationships between birth patterns and AN [ 91 , 92 ]. Similarly, the abuse topic (T35) was closely related to bulimic symptoms (T6) and BN (T18) and purge behavior (T43). The results may indicate that researchers who investigated BN and purging disorder frequently considered various forms of abuses, such as sexual [ 93 ], physical [ 94 ], emotional [ 95 ], and substance abuse [ 96 ].

Other topic groups included ED treatment (13.7%), social factors (9.1%), and family-related factors (6.6%). ARFID was found to be often studied with the family-based treatment (FBT) topic (T24). Several previous studies suggested that FBT could be used to treat people with ARFID [ 97 , 98 ], which explains the close connection between the ARFID (T15) topic and FBT (T24). FBT is also linked to the parent effect topic (T47), indicating that ARFID was frequently considered in the context of the family.

3.3.3. Classification of Research Topics by Overall Popularity and Historical Trend

Research topics were classified according to historical trends and overall popularity based on two metrics: changes in topic weights and expected topic estimates ( Table 4 ). In addition, topics were grouped using a combination of overall popularity and historical trends in topic popularity (see Figure 6 ).

Classification of research topics by overall popularity and popularity trend.

Expected topic weight comparisons over three decades.

In terms of historical trends, the following 11 topics were classified into “increasing” as their topic weights have increased over time: cognitive-behavioral theory (T2), online (T4), special care (T9), cost of illness (T10), ARFID (T15), recovery (T23), family-based treatment (T24), network analysis (T26), risk of comorbidity (T30), stigma (T41), and inpatient treatment (T44). In particular, popularity of topics belonging to Group 5 (social factor) and Group 6 (family) tend to increase over time, considering the topic weights of three topics out of four topics in Group 5 (social factor) and two topics out of four topics in Group 6 (family) were classified into “increasing” in historical trends.

The topic weights of the following 13 topics tend to be “decreasing”: bulimic symptoms (T6), self-esteem (T17), BN (T18), dieting (T22), body size (T25), restrained eating (T27), overeating (T29), syndrome (T32), ethnicity (T33), body image, appearance (T34), abuse (T35), sexual orientation (T40), and dietary behavior (T46). This trend was evident in the topics of Group 2 (factors triggering ED), as the topic weights of six out of eight topics decreased.

Finally, 23 subjects were classified as “constant” in the historical trends because there was no significant difference in topic weights over the three decades. These topics included binge-eating diagnosis (T1), BMI (T3), obesity (T4), food intake (T7), fragile groups (T8), medical complications (T11), personality (T12), self-shame (T13), social impact (T14), pregnancy (T16), gender differences (T19), AN (T20), hormones (T21), perfectionism (T28), body dissatisfaction (T31), cognitive avoidance (T36), genetics (T37), weight change (T38), physical activity (T39), birth (T42), purge behavior (T43), medication (T45), and parental impact (T47).

Expected topic weights were considered to determine the overall popularity of the topic. The following 12 topics were in the top 25th percentile of the median topic weights: binge-eating diagnosis (T1), cognitive-behavioral theory (T2), online (T5), medical complications (T11), BN (T18), AN (T20), hormones (T21), dieting (T22), overeating (T29), body dissatisfaction (T31), syndrome (T32), and sexual orientation (T40). The results show that many ED studies on treatment have been conducted, given that three out of six topics in Group 4 (treatment) were classified as “high” in the overall popularity classification.

The following 12 topics were in the bottom 25th percentile of the median topic weights, meaning they have been understudied compared to other major topics: obesity (T4), fragile groups (T8), cost of illness (T10), personality (T12), social impact (T14), pregnancy (T16), self-esteem (T17), perfectionism (T28), weight change (T38), physical activity (T39), stigma (T41), and parental impact (T47).

4. Discussion

This study implemented bibliometric analysis and a text mining approach to answer three major research questions. To answer RQ1, this study identified the general characteristics of ED studies. We found that the number of articles published in Eating Disorders has grown steadily. This indicates that the importance of ED topics has escalated, and each paper published in Eating Disorders has received more attention from researchers than in the past.

The main goal of RQ2 is to identify how ED research was developed, and citation patterns were examined to answer three specific research questions. As the first step of citation analysis, this study pinpointed articles that received the most attention from fellow researchers interested in EDs in the first (1990–1999), second (2000–2009), and third decade (2010–2021) of the ED research and how those articles served as guidance on their own. Among the articles published in the first decade, articles concerning assessment tool development received many citations. In the second decade, systematic review and meta-analysis studies that summarize the past ED research outcomes and propose future research directions were cited frequently. In the third decade, the popularity of studies using systematic reviews and meta-analysis remained high, but internet-based studies also drew a lot of interest from academics. This finding implies that research that serves as the foundation for further investigations and summarizes previous research outcomes is widely cited. However, such citation patterns may change over time.

Secondly, the author collaboration network was examined. The author collaboration network allows tracing collaborative efforts devoted to ED research. This result could show how knowledge is disseminated among researchers in developing ED research and the researchers who played a critical role in spreading knowledge. Specifically, we discovered four major hubs of the ED research in the author collaboration network. The prolific authors were centered in the network.

The final step of citation analysis was co-citation network analysis. The co-citation network reveals the key articles or documents that establish the foundation of ED research. In addition to academic research published in academic journals, many studies frequently cited all editions of handbooks of “ Diagnostic and Statistical Manual of Mental Disorders ” by the American Psychiatric Association. This handbook is commonly used in the United States for psychiatric illness diagnosis. High centrality scores of these handbooks indicate that ED diagnosis is an important part of the ED research. By examining the associations among these cited references, this study also discovered salient research themes that underpin ED research. One stream of research themes was related to ED-related theories and tool development, and the other was related to the diagnosis and treatment of ED. This implies that articles on eating disorders are concerned with both the theoretical and clinical features.

To answer RQ3 regarding the research topic landscape, this study applied topic modeling and topic network analysis. We discovered the 47 most outstanding topics and the associations among these topics by examining the similarities among the ED research topics. As a result of the topic clustering, we found that ED researchers were particularly interested in the relationships between key EDs and risk factors. Based on the keyword network analysis, Shah, Ahmad, Khan, and Sun [ 19 ] discovered that BN and AN frequently appeared in the top 100 ED articles that are frequently cited. Alongside this previous finding, this study discovered that ED topics played an important role in the research topic clusters by linking ED-related risk factors. As a result of topic clustering, we found that EDs were studied in different contexts and variables. Many BED studies, for example, focused on eating behaviors and dietary patterns, while the effects of family-related factors on ARFID were often examined. Moreover, many AN studies focused on birth-related issues and various types of abuse were examined to comprehend BN.

Beyond that, our study revealed both snapshots and the evolution of research topics related to EDs frequently studied by researchers. This study utilized two indicators, overall topic popularity and historical trends of topic popularity, to demonstrate the progress of research development for specific research topics and track the varying popularity of each research topic over time. Higher societal and academic demands on a particular subject may lead researchers to investigate the related topic more actively than in the past. A recent bibliometric study on ED research [ 99 ] revealed that ED researchers’ interest in ED treatment has been steadily increasing. Compared to previous findings, our study can demonstrate more specific results. For example, we discovered that cognitive-behavioral theory is popular among ED researchers and its popularity is growing. In addition, we found that the overall popularity of AN was high and the popularity of this topic tends to be constant. The overall popularity of BN and BED were high, but weights of these topics tend to decrease over time. On the contrary, the overall popularity of ARFID was moderate but the popularity tends to increase over time. This result indicates that AN, BN, and BED were extensively investigated. However, BN and BED were less studied than the past as interest in ARFID grows. According to previous research in India [ 16 ], AN was the most extensively studied in India ED literature, followed by BED and BN. Similar to our findings, the share of BN research decreased over time, while the popularity of AN and BED increased significantly [ 16 ]. Based on our findings, young researchers may need to pay closer attention to these research topics, which have received more attention from ED researchers than in the past. In contrast, some topics were understudied and thus had much room for contribution, which requires more attention from researchers for the sustainable and continuous development of ED research.

5. Conclusions

This study aimed to illustrate the evolution of the articles of Eating Disorders , a leading peer-reviewed, SSCI-indexed journal for nutrition and dietetics, psychiatry, and psychology since 1990, by applying a computer-assisted bibliometric approach combined with text mining. In the process, we analyzed the major attributes of the journal, including authors, citations, and characteristics of research topics, and compared the results over three decades.

Our summary of key articles and authors in the field may facilitate a search for fundamental concepts or results prevalent in the previous ED research. Our findings regarding the research topic network demonstrated the topics that researchers and clinicians frequently considered together. For instance, a particular risk factor, such as abuse, was often studied together with BN. Based on this result, researchers and clinicians may connect the dots with regard to the evaluation of particular risk factors in different types of EDs that are understudied. Our findings concerning changes in topics published across three decades of the articles demonstrated that the popularity of research topics has evolved over time. Often the researchers choose research topics from the socially sensitive and pressing issues. Given that research topics that are actively studied can demonstrate the socially relevant ED issues within each time period, our results can benefit researchers to comprehend specific ED issues that are considered important. Clinicians and researchers can also use the summary to identify important topics related to EDs that have been continually studied by researchers or important but understudied topics for further development in the field.

Despite contributions, our study had several limitations and thus we encourage future research directions to overcome the limitations of this study. Firstly, this study chose only one journal for analysis. However, as mentioned in the methodology, there are many prestigious ED-related journals and other journals that publish ED studies. Hence, our findings may not be representative. Still, our findings can be important empirical evidence to understand ED research trends over time. Secondly, this study utilized the machine learning algorithm to identify salient ED-related research topics and to detect the relationships among them. This approach can demonstrate which topics were frequently studied together in the empirical research. However, this approach may not be consistent with the existing studies grounded on the formal classification system and frameworks. Hence, future studies need to compare the results derived from the machine learning approach and expert classifications. Thirdly, since bibliometrics are highly influenced by the quality of the database, our results could have been similarly influenced as well. For instance, WoS does not provide links or information to track authors who may have changed their names. This study focused on author collaboration networks rather than examining the general statistics of the authors to overcome this problem. Future studies need to examine the impact of authors in the ED research. Finally, we analyzed the articles according to their titles, keywords, and abstracts using an automated text mining approach. Although, such data points contain essential information about the articles and offer a good summary, more specific information (e.g., methodology used and participant profile) was inaccessible and should be considered in future analyses of the development of studies on EDs.

Funding Statement

This work was supported by Incheon National University Research Grant in 2021.

Author Contributions

Data curation, E.P. and W.-H.K.; Formal analysis, E.P. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Informed consent statement, data availability statement, conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Header menu - drawer | united kingdom, james' story: my experience with anorexia and eating disorders.

This content mentions eating disorders, body image or generally discusses weight, which some people may find triggering.

It’s ‘Eating Disorder Awareness Week (EDAW)’ from 27 February 2023, and this year’s focus is on eating disorder awareness in men . Yes, that’s us strong, tough men who hide our feelings. Oh, hang on a minute, that’s not actually true, is it?

It’s a myth that it’s only women and girls who suffer with ‘eating disorders’.

The National Association for Males with Eating Disorders estimates that 25% to 40% of people with eating disorders are men and boys.

The big blocker to getting help is stigma , together with a lack of understanding about the size and presentation of eating disorders in the male population can mean that eating disorders are not identified or treated early enough.

Of course, it is possible that men and boys are particularly resistant to early intervention. One of the main reasons for this could be a reduced likelihood of family, friends or medical professionals suspecting an eating disorder as early as they would in a female with the same symptoms.

So, this is my story about how I fell victim to the deadly disease ‘ Anorexia Nervosa ’. Thankfully and luckily, I live to tell the tale and turn my wounds into wisdom. I hope that this will help people who are affected to understand the importance of getting help, no matter what type of eating disorder they may have.

Malnourished to Manpower!

For two years in my early twenties I lived with anorexia but convinced myself that I was fine. Only when my weight dropped, did I finally agree to get the help that I needed. I now raise awareness of the illness to help others.

I was a relatively chubby child, and, as I’m sure you know, kids can be mean. I was bullied at school for the way I looked and, at one point, was even given the nickname ‘Bacon Boy.’

But looking back, it didn’t make me desperately unhappy. Not at the time. It wasn’t like those unkind words made me want to change myself or fit in or triggered an eating disorder. Although, I suppose, in some way, that’s what did happen. It just crept up, surprising me years later when I was 22.

After leaving school, I was happy. I was living at home in Milton Keynes, I studied horticulture and then ended up working for a local company. Everything felt pretty stable. As I got older, I did want to look good and feel better in my skin, so I signed up to the local gym and found that I actually really enjoyed it.

I fell into a good routine; making my own lunch in the morning, going to work and then the gym after that. I lost weight, felt good, and my life as an 18-year-old seemed very normal. Until I got offered a secondment in London which meant being away from home and the familiarity of that entire routine. That’s when things began to change and over those few months away from home, I got used to the feeling of being empty and hungry, and what’s more, I liked it.

What also happened, as I began eating all of my meals alone and doing nothing but work and going to the gym, I began to isolate myself from other people.

I didn’t feel comfortable being around anyone else, having people watch what I was (or wasn’t) eating, so I cut myself off. My work colleagues didn’t really know me, so they didn’t notice much difference, but when I went home after my secondment ended, my family saw that my behaviour had changed.

I kept telling them I was fine. I thought I was. I just wanted to be left alone, and the more they told me to eat, the less I wanted to. But I guess that deep, deep down, I knew things weren’t fine. I remember at the same time thinking that I just wanted to fade away, to not exist, to be gone by the time my sister had her baby, six months later.

However, I pushed those thoughts and feelings down and carried on. There were moments during those months, before my diagnosis, where I was feeling a lot of tension. When you’re malnourished, it plays havoc with your emotions.

I was angry, snappy and volatile. My parents didn’t understand what was happening to me or how to help, how could they when I didn’t know what was happening myself?

When I finally spoke to a GP , they told me that I was severely underweight. You might think that at this point, things would start to look up. But for me, this is where my mental health actually hit rock bottom.

The first thing that happened was that I was signed off work for eight weeks and had to declare my licence to the DVLA as I was considered a risk on the roads. It felt like I was being punished. In fact, worse, it felt like people had taken away my control and were trying to control me.

I was told that I was entitled to 30 weeks of Cognitive Behavioural Therapy . Something that I really didn’t want. It’s hard to explain, but with anorexia you can only start to accept help and get better when you hold your hands up and say, “I need help”. But I still couldn’t do that. I was in complete denial.

My aim then was just to be healthy and for it all to be over - to be left alone. So, I went from being extremely anorexic to binge eating .

I now show myself compassion, and I can give myself a ‘talking to’ when I have thoughts that might not be healthy. Of course, I’ve had setbacks, but over the last eight years I’ve really managed to get myself back on track.

I’m still very aware of what I eat. There’s no doubt about that, but I don’t restrict myself anymore. And on the days that I do indulge, it doesn’t hurt as much as it used to. They helped me see things differently, admit that I ‘did’ need help and recognise that I never want to be back in that painful place again.

People started saying that I looked good and how much ‘healthier’ I must be now that I was gaining weight. What they couldn’t see was the way I was crumbling inside. Even though it’s hard to explain or pinpoint when, why or how the therapy started to help. It just did.

I think when you start to feed yourself physically with food, and mentally with therapy, you get a better perspective and understanding. I learned to recognise the voice in my head - the one telling me that my weight needed to be as low as possible for me to be happy - and change it.

When the therapy ended, the hard work on myself really began, but the treatment had given me the tools to do that, and what’s more, I wanted to.

It’s why I’m now extremely passionate about raising awareness of male eating disorders and talking about how to recognise it in friends and colleagues - and in yourself. Luckily, Cognitive Behavioural Therapy (CBT) helped me, and I’ve turned things around. But I’m very aware that so many people are convincing their friends, family - and themselves - that they’re fine. I hope that by talking about my experience, it will help them.

Things are changing for the better!

Eating disorders continue to have the highest mortality rates of ALL mental illnesses. Yes, all mental illnesses - shocking, I know. There has been much improved training for healthcare professionals over the past year. But we need to see more accurate awareness of the early signs, symptoms and risks of eating disorders, and we need to see more prioritisation of early detection and treatment, especially in men and boys and before medical treatment become necessary.

As someone with lived experience, I strongly believe any related deaths are preventable if people get the right care early enough. Recovery from eating disorders is possible, but getting the right treatment early is key for the sufferer and the increasing strain on our health care system. Eating disorders are a severe mental illness and shouldn’t be underestimated.

And if you could take anything away from my story, it would be the following: “All the advice in the world won’t help, until you are willing to help yourself”. You can and will get better!

If you feel affected by the content you have read, please see our get help page for support.

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A-z topic: eating disorders, a-z topic: anorexia nervosa.

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• Eating Disorders

Stop People-Pleasing to Combat Disordered Eating

Tuning into your wants and desires can help combat disordered eating..

Posted April 17, 2024 | Reviewed by Lybi Ma

• What Are Eating Disorders?
• Find counselling to heal from an eating disorder
• People with eating disorders often work hard at remaining small, figuratively.
• Breaking out of the pattern of shrinking away positively affects eating disorder recovery.

In working with eating disorders, it is hard to miss the inherent goals of “getting and remaining small.” Sometimes this is a literal small and clients begin dieting to change their bodies but what tends to be universal is the unconscious desire for folks with eating disorders to remain small— figuratively.

What does it mean to stay small in a figurative manner? This can look like choosing not to ask for a sick day, not sharing that today is your birthday when your friends made plans, and remaining quiet instead of asking what your salary is before starting a new job. There is a tremendous amount of withholding when we stay small. I have heard each of these scenarios in my work as an eating disorder therapist and I have found it helpful to classify these experiences as “remaining small.” A goal within the eating disorder work I do with clients is to help them work toward taking up space. Assertiveness can help break out of the pattern of remaining small.

Often assertiveness does not come with a positive connotation, especially for women. The sense of sticking up for one’s self is scary and aggression can be confused with assertiveness. Historically, women have contended with limiting gender roles that promote remaining quiet and complacent. Additionally, people-pleasing , knowing your own inherent value, and fears of coming across as entitled are barriers to assertiveness.

Ending the people-pleasing and believing you are worthy of asking for things in life that you need and desire is a huge challenge. How does one begin to chip away at these obstacles of taking up space and becoming more assertive?

I often talk to my clients about building awareness around the urge to remain small (figuratively). Asking questions about when this happens most is a good starting point. Folks will often describe the difficulty in taking up space in their relationships. I advocate for testing out the dialectical behavioral therapy skill “ opposite action ,” which suggests we engage in the opposite behavior of what we typically would do with trusted people around us. This experience could look like noticing that you feel ashamed in a certain moment and working on not hiding but remaining engaged in the conversation. The ultimate goal is slowly building towards staying present and not shrinking away.

Additionally, I often talk to my clients about the paradox of healthy entitlement . Those with eating disorders can be exceptionally fearful of coming across as anything other than amenable to people and their needs. Because people-pleasing is so central to the fear of sharing your own opinions—it can be worth sitting with the idea that as humans we are all entitled to have our thoughts and feelings and we get to choose how to present these. If we are intentional and mindful of others we do not have to fear being seen as rude or entitled. While becoming disrespectful is never the goal, internalizing the paradox of healthy entitlement can help build assertiveness skills, for example, the message becomes, “I am entitled to be respected, seen, and heard.”

The more one can reduce the barriers to assertiveness, the more one can take up space and move through eating disorder recovery.

Linehan, M. (2014.). Opposite action skill . Dialectical Behavior Therapy (DBT) Tools. https://dbt.tools/emotional_regulation/opposite-action.php

What is a people pleaser? . Medical News Today. (2023). https://www.medicalnewstoday.com/articles/people-pleaser

Vanessa Scaringi, Ph.D., CEDS-C, is an Austin, TX-based licensed psychologist.

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