“Anorexia nervosa” is characterized by reduction to a body weight that is less than 85 percent of that expected for height and age; intense fear of weight gain; body image disturbance; and, in postmenarcheal females, the absence of menstruation for three consecutive months.
“Bulimia nervosa” is characterized by episodes of binge eating; inappropriate compensatory behavior (such as self-induced vomiting, fasting, misuse of laxatives and/or excessive exercise); binging and inappropriate compensatory behavior occurring, on average, at least twice a week for three months; and a self-evaluation that is strongly tied to body weight and shape.
“Eating disorder not otherwise specified” is a diagnostic category clinicians use when some, but not all, criteria for a specific eating disorder are met (e.g., in females, all of the criteria for anorexia nervosa are met except that the individual continues to have regular menses). Binge eating disorder (also referred to as compulsive overeating) is included in this category. Binge eating disorder involves the consumption of large portions of food during discrete time periods and a sense of lacking control over food. Binge eating usually includes a preference for eating alone, eating more rapidly than normal and eating to the point of feeling uncomfortable, even sick.
The above diagnostic categories and criteria were provided by the American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders IV-TR, Fourth Edition, Text Revision. Washington, D.C.
Although eating-related pathology has been traced back to the Middle Ages (1), never before in history has such symptomology generated so much interest and concern. Behaviors now commonly referred to as “eating disorders” seem to be on the rise in recent years and some consider the problem to have reached almost epidemic proportions. (2)
As those who work with eating disorders well know, these diagnostic descriptions are often inadequate; many eating-disorder sufferers do not fit neatly into any of the categories. The current classification system also fails to capture the internal world of the eating disorder sufferer. The shame, self-loathing, and intense preoccupation with food and weight can be devastating, even in cases in which the criteria for a formal diagnosis are not met. Moreover, eating disorders often co-occur with other psychiatric disorders, including depression, anxiety, obsessive-compulsive disorder and substance abuse. (3) Eating disorders are serious, often chronic, conditions that cause psychosocial impairment, serious health risks, even death. (4)
According to the National Eating Disorders Association, as many as 10 million females and one million males are fighting life and death battles with an eating disorder, such as anorexia nervosa or bulimia nervosa, while another 25 million are believed to be struggling with binge eating. (5) Eating disorders are believed to be highly prevalent at colleges and universities in the United States. In a summary of several studies, Hoyt and Ross reported estimates that one to four percent of female college students meet criteria for a formal diagnosis of anorexia nervosa or bulimia nervosa, and 30 to 75 percent of students report various symptoms of disordered eating. (6) Certain sub-groups, such as college athletes, and students in the performing arts, may be at even greater risk due to a number of factors including emphasis on weight and physicality in general, perfectionism and a high achievement orientation.
In general, adolescence and early adulthood appear to be periods of significant risk for developing an eating disorder. Young, white, females, from affluent and high-achieving backgrounds, have traditionally been considered the most at-risk group, but current research is now challenging such assumptions. Eating disorders may be more common among women of color than was originally believed. The National Eating Disorders Association reports increasing evidence of disordered eating among racial and ethnic minorities in the U.S. (7) Older women may also be at greater risk than once believed. In 2007, Carolyn Costin, founder of a Southern California treatment program and a recovered anorexic, reported an increase in women seeking treatment in their 30s, 40s and 50s. (8) Men are also vulnerable. It is estimated that about 10 percent of those who seek help for an eating disorder are male. (9)
The development of an eating disorder is complex, with no single explanation for why they occur. Most sufferers report that the problem began with concerns about weight and dieting but, as ironic as it may sound, eating disorders are not really about food. Themes that commonly underlie the symptoms include a search for identity and an attempt to control one’s emotions and life. Intrapsychic, familial, societal and biological factors have all been implicated in the development of eating disorders.
Counseling and Psychological Services offers a number of programs and services to address eating disorders at CSULB. Efforts are designed to raise awareness and educate the campus community about the problem and serve as a preventative mechanism against the development of new eating disorders. In addition, CAPS provides short-term support to students who have concerns about their eating or body image.
On March 1, CAPS sponsored “Eating Disorders Awareness Day 2007: Be Comfortable in Your Genes.” This event is offered each spring in conjunction with National Eating Disorders Awareness Week and the National Eating Disorders Association. This day of educational programming included distribution of free literature, guest speakers, workshops, video presentations and discussion groups. Guest speakers included Rebekah Smart, Ph.D., assistant professor of psychology from California State University, Fullerton and Sarah Hewitt, M.S., R.D. (registered dietician) and CSULB alumna.
While educating the campus community serves a preventative function, the reality is that each year many students come to CSULB with a history of eating-related problems or develop a problem after they arrive. CAPS assists students by providing initial consultation and assessment, short-term intervention and referrals to specialized care in the community. Students who think they have a problem are encouraged to schedule an appointment. Students may also attend the “New Attitudes about Food” group, which meets every Monday in the Women’s Resource Center. This support group is designed to provide an informal and safe place to discuss eating-related concerns.
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