252 Eating Disorders
explored the prevalence of death or family breakup in the families of eat-
ing disordered patients compared to controls and found no difference. This
was supported by the findings of Dolan, Lacey, and Evans (1990) and Kendler
et al. (1992). In contrast to these results, Schmidt, Tiller, and Treasure (1993)
reported an association between loss and the development of bulimia (not
anorexia) if the meaning of loss was expanded to include parental separa-
tion, death of a parent, or being sent to boarding school. Rastam and Gillberg
(1991) also reported a relationship between loss and the development of
an eating disorder, in this case anorexia, if the definition of loss was
expanded to include deaths in the immediate family, including those that
had happened prior to the onset of the disorder. The authors suggested
that the mechanism for this may be unresolved grief; however, the study
did not test this hypothesis.
Research has, therefore, addressed the extent to which childhood sexual
abuse may trigger the onset of an eating disorder, and provides no sup-
port for this association. There is some tentative support for the role of
parental loss if an expanded definition is used.
Problems with a significant events theory
There are several problems with this analysis:
- The evidence for individual triggers of eating disorders remains weak.
- This analysis cannot explain why eating disorders are a problem for
women in the West and why they are more common now. - It cannot explain why such triggers are translated into food avoidance
and the desire to be thin. - It cannot explain why many individuals experience triggers such as
sexual abuse and parental loss and do not develop an eating disorder.
Conclusion
Anorexia and bulimia nervosa have received much attention over recent
years from both the popular and academic worlds. Anorexia is character-
ized by weight loss and is associated with a high mortality rate and a range
of psychological and physical problems. Most anorexics receive help in some
form or another, as the problem is easily recognized. Bulimia is more com-
mon than anorexia, although how common is unclear since many bulimics
remain unrecognized as the behavior can be carried out in private and may