We live in an image conscious culture, which urges all of us to improve our appearance. The message sent by magazines, T.V. and other multi media include "you have to buy this, buy that, straighten and whiten your teeth, get rid of your wrinkles or pimples, and most commonly lose weight and you will be happy." The recent and reoccurring debate concerning the unhealthy, thin models used in the modeling industry is a perfect example of how strongly rooted our notion of the motto "thinness equals happiness" has become. Although many of us would benefit from eating a bit less and exercising more in order improve our health and fitness, simply watching what you eat is NOT an eating disorder. Eating Disorders are potentially life-threatening illnesses which are simultaneously psychological and physical in nature. They are characterized by a range of abnormal and harmful eating behaviors which are accompanied and motivated by unhealthy beliefs, perceptions and expectations concerning eating, weight, and body shape. As a general characterization, individuals with eating disorders tend to have difficulty accepting and feeling good about themselves. They tend to think of themselves as "fat" and "ugly" because of their body size and shape, even when this self-judgment is objectively inaccurate and false. Identifying and defining themselves according to their perceived "fatness", eating disordered people tend to conclude that they are unacceptable and undesirable, and as a result, feel quite insecure and inadequate, especially about their bodies. For them, controlling their eating behaviors is the logical pathway in their quest for thinness.

Eating disorders have existed for a long time, and have been documented worldwide. The frequency of self-starvation and purging behaviors vary greatly across certain periods of history, indicating that certain combinations of social and economic factors often ease or prevent these behaviors. Historical evidence suggests that anorexia and bulimia have existed since the at least the first century (Cook-Cottone, 2006). In the scholarly article written by Walter Kaye he explains, that during the time of Caesar (700 B.C.), rich ancient Romans spoiled themselves at lavish banquets and then relieved themselves by vomiting so they could return to the feast and continue eating. Ancient Egyptians drew hieroglyphics that portrayed their use of monthly purges to avoid illness. In the book, 100 Midlife Women with Eating Disorders, Zina Kelly and Edward J. Cumella described European women of the renaissance period, who punished their bodies by fasting to reach a higher plane of spirituality and closeness to God. Holy anorexia was respected by medieval societies as a sound method for cleansing a woman's spirit. Medical symptoms of bulimia were not widely discussed until the early 1900's. This disorder was first described in medical terms in 1903 in "Obsessions et la Psychasthenie", where Pierre Janet discusses Nadia, a woman who engaged in compulsive binges in secret. As the previous information suggests, anorexia and bulimia were originally thought to be physical diseases due to a medical condition. Researchers attributed these disorders to hormone imbalances and deficiencies. A controversial and widely known example in the book is Catherine of Sienna (1347-1380) a Catholic Italian woman who was idolized in 1461 by Pope Pius II. In 1978, Hilde Bruch's The Golden Cage, was one of the first books to suggest that eating disorders were becoming a serious problem. "The Best Little Girl in the World," a movie released in 1985, gave the average person a glimpse of what it was like to have an eating disorder. During that same year, the high profile pop singer at the time Karen Carpenter died from heart failure brought on by her anorexia nervosa. In the 1990's, binge eating disorder was first recognized as a formal diagnosis (Kaye, 2008). Prior to 1992, when binge eating disorder was officially "introduced" at the International Eating Disorders Conference, individuals with this type of behavior were labeled emotional overeaters, obsessive overeaters, and food addicts. 

It wasn't until the 1930's that the medical community began to understand that the causes of these troubling eating disorders were in part psychological and emotional rather than wholly physical. The first formal description and diagnosis of anorexia as a medical condition occurred in England during the 1680's. Historical documents show that Dr. Richard Morton of London described his twenty-year-old patient in 1686 as "a skeleton clad with skin". In his work, "A Treatise of Consumption" he suggested that her sadness literally ate away at her. She reportedly died two years later. Louis-Victor Marce is also widely known for describing a similar patient in 1859. Sir William Gull, a physician to England's royal family, was the first to characterize anorexia as a disease different from religious hysteria or biological eating problems. Although he felt that the disease developed from a mental state, he did not believe that patients suffering should be treated as mentally insane. He treated the young women who came to him by prescribing them force feeding, moral teaching and a change of scene (Walter, 2008). In 1873, he presented his ideas in "Anorexia Hysterica" to his colleagues in the Clinical Society of London, and named the malady anorexia nervosa, meaning loss of appetite. 

There is more to eating disorders than inherited genetics, personality and coping deficits. These factors interact in a way with various family/environmental issues to play an important role in creating and maintaining eating disorders. Much of the research on eating disorders has focused on the development of emotional boundaries in families. Researchers have found that, in some cases, families are over-involved with an individual who has an eating disorder ("Life Transitions Can Trigger Eating Disorders"). Teenagers in a trapped relationship may feel so powerless to develop a separate identity from an over-involved parent that they try to find independence by controlling what happens to their bodies. For example, an adolescent girl who wants to join her high school cheerleading squad, which would require her to be away from home after school for daily practices (Noring, 1997). This separation may be emotionally threatening to an over-involved parent, who balances by sharing the cheerleading identity with her daughter via attendance at daily practices, games and any related social gatherings. The daughter is unable to develop an identity separate from her mother, so she tries to exert control the only way she knows how, by controlling her food intake. This type of behavior can slowly develop into an eating disorder. Research also indicates that families of individuals with eating disorders tend to be overprotective, strict, and focused on success. They have high, sometimes unreasonable expectations for achievement and may place attention on external "rewards". Many children from these kinds of families try to achieve the appearance of success by being thin and attractive, even if they do not feel successful. If children perceive that they are failing to live up to family expectations, they may turn to something that seems more easily controlled and at which they may be more successful, such as food restriction or weight loss. Pathology within the family may also contribute to eating disorders. Some individuals with eating disorders live in or came from families that exhibited dysfunctional or negative behaviors, such as alcohol and drug use. Divorce and domestic violence are also not uncommon family issues for those suffering with an eating disorder. 

Mass media provides a significantly influential context for people to learn about body ideals and the value placed on being attractive. According to statistics, over 80% of Americans watch television daily. On average, these people watch over three hours per day. American children engage in increasing amounts of media use, a trend fueled largely by the growing internet access through phones and laptops.  On a typical day, eight to eighteen-year-olds are engaged with some form of media about seven and a half hours. Most of this time is spent watching television, though children play video games more than an hour per day and are on their computers for more than an hour per day. Even media aimed at elementary school age children, such as animated cartoons and children's videos, emphasize the importance of being attractive. Sexually objectified images of girls and women in advertisements are most likely to appear in men's magazines. Yet the second most common source of such images is the advertisements in teen magazines directed at adolescent girls. Currently we live in a media-saturated world and no one is doing anything to control the message. There is no single cause of disordered eating, but, research is clear that media does indeed contribute and bring exposure and pressure to people by the media increase the chances of an eating disorder. Numerous experimental studies have linked exposure to the thin ideal in mass media to body dissatisfaction of the thin ideal, and disordered eating among women. The effect of media on women's body dissatisfaction, thin ideal internalization, and disordered eating appears to be stronger among young adults than children and adolescents. This may suggest that long-term exposure during childhood and adolescence sets the foundation for the negative effects of media during early adulthood. Black-oriented television shows may serve a protective function; Hispanic and Black girls and women who watch more Black-oriented television have higher body satisfaction. Pressure from mass media to be muscular also appears to be related to body dissatisfaction among men.  This effect may be smaller than among women but it is still significant. Young men seem to be more negatively affected by the media images than adolescent boys are. Facebook, Instagram, and other social media technology may be inadvertently worsening the struggles of those suffering from eating disorders. "The Internet and social media have brought us amazing things. The downside, specifically related to the clients -- with Facebook and Instagram, in particular -- is it floods us with images that are very often unrealistic," said Dr. Constance Quinn, New York site director of the Renfrew Center, an institute for the treatment of eating disorders in women. It's no surprise that viral Internet body challenges are kryptonite for people who suffer from eating disorders. Most revoltingly popular was (is) the "thigh gap," in which women post "inspirational" photos showing the growing gaps between their thighs and encourage other women to make their legs skinnier in a similar fashion. Seeing an endless display of your peers' successes -- whether it's how thin they look in a bikini on the beaches or how happy they look with their family at Christmas around the perfect holiday dinner -- may encourage the harsh self-comparisons that are "the most salient factor" in developing eating disorders, said Adrienne Ressler, the vice president of professional development for the Renfrew Center Foundation. 

As most eating disorders start in adolescence, parents have the best shot at helping to prevent them from occurring. Fortunately, many things can be done to prevent the development of eating disorders. One prevention approach involves providing education via the Internet and/or in person training to physicians, schools, clergy and sports organizations. By teaching adults to be aware of the most vulnerable individuals and the symptoms, eating disorders can be caught early and treated. Educating both male and female children about healthy eating and body image is also an important primary prevention task. Health classes in school should teach children about different body types, nutrition, the importance of exercise, recognizing hunger and the dangers of dieting. Children also need to be taught about critical thinking  --  how to recognize when media images are unrealistically perfect and to not use those images as comparisons for themselves. Teaching kids strategies to reject peer pressure to succumb to the lure of trying to be thin and perfect might help too. In addition, parents can be big advocates in building healthy body images, self-esteem and lifestyles for their children. In fact, one of the most important things that parents can do is be strong role models for their children - demonstrating what a balanced and healthy adult looks like. Model eating a balanced diet with fruits and vegetables, exercising in moderation, and participating in fun family activities, even if you are self-conscious of your weight, your abilities, or your appearance. Avoid criticizing your own body, especially in front of your children. 

In addition, we are not isolated but are part of a global culture. The trends cross the entire developed world are consistent in their glamorization of skinniness and youth as a feminine, and increasingly a masculine ideal. The media would find it hard to convince the national psyche, therefore, that thinness is not a desirable ideal. Eating disorders are a very serious problem among teenage girls, vulnerable from the puberty hormone changes, and self-image distorted. Good news is that years of research has narrowed the causes down somewhat to the six main areas that potentially explain just why it is that people yield to anorexia or bulimia: biological, psychological, family, social, cultural, and media reasons, and in doing that, families and friends of people with anorexia and bulimia can do their best to get to the root of the problem/cause and give their friend or family member who is suffering hopefully another chance at a healthy, productive, fulfilling life.

