Eating Disorders
B
y the time she was 9 years old, Marya Hornbacher
developedbulimia nervosa, which is an eating disorder
characterized by binge eating along with vomiting or
other behaviors to compensate for the large number
of calories ingested. By the time she reached 15, she had
anorexia nervosa, an eating disorder characterized by being
at least 15% below expected body weight along with us-
ing various methods to prevent weight gain. For the next
5 years, she careened from one eating disorder to another.
By Hornbacher’s own account she had “been hospital-
ized six times, institutionalized once, had endless hours of
therapy, been tested and observed and diagnosed... and
fed and weighed for so long that I have begun to feel like
a laboratory rat” (Hornbacher, 1998, p. 3). At the age of
23, Hornbacher wrote Wasted: A Memoir of Anorexia and
Bulimia about her experiences with eating disorders, in
which she wonders:
Just what was I trying to prove, and to whom? This is one of the ter-
rible, banal truths of eating disorders: when a woman is thin in this
culture, she proves her worth, in a way that no great accomplishment,
no stellar career, nothing at all can match. We believe she has done
what centuries of a collective unconscious insist that no woman can
do—control herself. A woman who can control herself is almost as
good as a man. A thin woman can Have It All.”
(1998, pp. 81–82)
But as Hornbacher points out, eating disorders don’t really help any-
one have it all. An eating disorder... is an attempt to fi nd an identity, but ultimately it strips you of any
sense of yourself, save the sorry identity of “sick.” It is a grotesque
mockery of cultural standards of beauty that winds up mocking no
one more than you. It is a protest against cultural stereotypes of
women that in the end makes you seem the weakest, the most needy
and neurotic of all women. It is the thing you believe is keeping you
safe, alive, contained—and in the end, of course, you fi nd it’s doing
quite the opposite. These contradictions begin to split a person in two.
Body and mind fall apart from each other, and it is in this fi ssure that
an eating disorder may fl ourish, in the silence that surrounds this con-
fusion that an eating disorder may fester and thrive.
(1998, p. 6)
435CHAPTER
10
Chapter Outline
Anorexia Nervosa
What Is Anorexia Nervosa?
Medical, Psychological, and Social Effects
of Anorexia NervosaCriticisms of the DSM-IV-TR Defi nition
of Anorexia Nervosa
Bulimia Nervosa
What Is Bulimia Nervosa?
Medical Effects of Bulimia Nervosa
Problems With the DSM-IV-TR
Diagnostic Criteria
Eating Disorder Not Otherwise Specifi ed
Understanding Eating Disorders
Neurological Factors: Setting the Stage
Psychological Factors: Thoughts of and
Feelings About Food
Social Factors: The Body in Context
Feedback Loops in Action: Eating Disorders
Treating Eating Disorders
Targeting Neurological and Biological
Factors: Nourishing the Body
Targeting Psychological Factors:
Cognitive-Behavior Therapy
Targeting Social Factors
Feedback Loops in Treatment:
Eating Disorders
Follow-up on Marya HornbacherBulimia nervosa
An eating disorder characterized by binge
eating along with vomiting or other behaviors
to compensate for the large number of
calories ingested.Anorexia nervosa
An eating disorder characterized by being
at least 15% below expected body weight
along with using various methods to prevent
weight gain.Katherine Streeter/Frank Sturges Reps