460 CHAPTER 10
P SNCASE 10.4 • FROM THE INSIDE: EDNOS
Forty-year-old Sam recounts his preoccupations with his muscles:
I would get up in the morning and already wonder whether I lost muscle overnight while
sleeping. I would rather be thinking about the day and who I was going to see, et cetera. But
instead, the thoughts always centered on my body. Throughout the day, I would think about
everything I ate, every physical movement I did, and whether it contributed to muscle loss in
any way. I would go to bed and pray that I would wake up and think about something else the
next day. It’s a treadmill I can’t get off of.
(Olivardia, 2007, pp. 125–126)FEEDBACK LOOPS IN ACTION: Eating Disorders
As we have seen, many neurological, psychological, and social factors are associ-
ated with the development and maintenance of eating disorders. Let’s look at some
theories about how these factors interact through feedback loops.
Most females in Western societies are exposed to images of thin women
as ideals in the media, yet only some women develop an eating disorder. Why?
Neurological factors (such as a genetic vulnerability) may make some individuals
more susceptible to the psychological and social factors related to eating disorders
(Bulik, 2005). For instance, researchers hypothesize that young women who are
prone to anxiety (neuroticism)—which is both a psychological factor and a neu-
rological factor—are more susceptible to the effects of a familial focus on appear-
ance, a social factor (Davis et al., 2004). In turn, these two factors are associated
with weight preoccupation, creating feedback loops: After statistically controlling
for body size, researchers found that young women who were preoccupied with
weight were more prone to anxiety and were more likely to have families that
focused on appearance. That is, twofactors—anxiety proneness and familial fo-
cus on appearance—were most associated with the young women’s preoccupation
with weight. This preoccupation in turn leads to anxiety focused on weight and
appearance.
A preoccupation with weight can also lead to dieting, which can create its
own neurochemical changes (neurological factor) that may lead to eating disor-
ders (Walsh et al., 1995). In addition, the stringent rules that people may set for a
diet can lead them to feel out of control with eating if they “violate” those rules
(psychological factor). Further, people with higher levels of perfectionism and
body dissatisfaction (psychological factors) may seek out comments about their
appearance (social factor) or pay more attention to appearance-related comments
(psychological factor) (Halmi et al., 2000). Figure 10.7 illustrates the feedback
loops for eating disorders.McCabe, 2001). However, rather than suffer from the specific sets of symp-
toms for anorexia or bulimia, males are more likely to develop EDNOS, with
symptoms that focus on muscle building, either through excessive exercise or
steroid use (Weltzin et al., 2005). Sam, in Case 10.4, is preoccupied with losing
muscle mass.