Eating and Body Dysmorphic Disorders: Crash Course Psychology #33
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Eating and Body Dysmorphic Disorders: Crash Course Psychology #33

August 16, 2019


When Lauren was fifteen years old, her family
moved across the country and she started going to a new school. Already shy, Lauren suffered
from low self-confidence and had a hard time transitioning; nothing felt right and soon
her changing body became a source of insecurity. Eventually, she began thinking that maybe
if she lost weight and focused on fitness, she’d make more friends and feel better about
herself and life would get better. Soon she became obsessed with dieting and it quickly
spiraled into her subsisting only on rice cakes and apples and candy corn and celery. She like this new feeling of control every
time she stood on the scale and saw a lower number. She was achieving something, and that made
her feel good. Soon, she thought of nothing else. But what Lauren couldn’t see was that she
was no longer healthy. Even when her hair started falling out and her skin grew dry and cracked,
and when she could never get warm. When she looked in the mirror, she still saw
a chubby girl. Her family, though, did notice, and yet, at a visit
to the doctor, she was just told to eat more. She didn’t. One day while jogging, she had a heart attack
and collapsed. As a teenager, she was 5’7″ and weighed eighty-two pounds. Lauren was
finally admitted to a psychiatric hospital where she was treated for anorexia nervosa.
She was put on bed rest, saw a therapist twice a week, joined a support group and slowly
began eating small amounts of food again. Her recovery was slow but, with the support
of her family and doctors, she was released eight months later. Though Lauren suffered a few
relapses over the years, she is now healthy. Ultimately, she was lucky. Anorexia, bulimia, and other
eating and body dysmorphic disorders can kill. Eating disorders are among the deadliest psychological
disorders, with some of the highest rates of death directly attributable to the illness.
They slowly ruin the body, but, in order for these conditions to be recognized and treated
successfully, they have to be understood as disorders of the mind. Here’s some scary figures: According to the
National Eating Disorder Association, forty-two percent of first to third grade girls want
to be thinner; eighty-one percent of ten year olds are afraid of being fat; over half of
teenage girls and nearly a third of teenage boys have used troubling weight control methods
like fasting, skipping meals, smoking, vomiting, or taking laxatives. The rate of new cases of eating disorders
in Western culture has been increasing since the 1950’s, and today in the US, an estimated
twenty million women and ten million men have suffered from a clinically significant eating
disorder at some point in their lives. But get this straight: we’re not talking about
fad diets or lifestyle choices spurred by vanity. Eating disorders are psychological
illnesses that often come with serious consequences. These disorders tend to fall into three main categories:
anorexia, bulimia, and binge eating disorders. Those suffering from anorexia nervosa, most
often adolescent females, essentially maintain a starving diet and, eventually, and abnormally
low body weight. As in Lauren’s case, anorexia can begin as a diet that quickly spirals out
of control as a person becomes obsessed with continued weight loss, all while still feeling
overweight. Our old friend, the DSM V, actually delineates
two sub types of the disorder. The first involves restriction, which usually consists of an
extremely low-calorie diet, excessive exercise, or purging, like vomiting or the use of laxatives.
The second type is the binge/purge sub type, which involves episodes of binge eating combined
with the restriction behavior. As you can easily imagine, the physiological
effects of this psychological condition can be devastating. As the body is denied crucial
nutrients, it slows down to conserve what little energy it has, often resulting in abnormally
slow heart rate, loss of bone density, fatigue, muscle weakness, hair loss, severe dehydration,
and an extremely low body mass index. And it’s that low body mass that’s the defining
characteristic of anorexia nervosa – a refusal to maintain a weight at or above what would
normally be considered minimally healthy. If this condition persists, of course, it
can be deadly, which is why anorexia has what’s often estimated to be the highest mortality
rate of any psychiatric disorder. That might surprise you, given the host of
troubling disorders we’ve already covered here on Crash Course Psychology, but mortality
rates associated with, say, major depression or PTSD or schizophrenia tend to be the result
of secondary behavior, like suicide. But with anorexia, the mortality rate is especially
high because people can die as a direct result of extreme weight loss and physiological damage. Another common eating disorder is bulimia
nervosa. While anorexia is characterized primarily
by the refusal to maintain a minimal body weight, bulimia is not. People with bulimia
tend to maintain an apparently normal, or at least minimally healthy, body weight, but
alternate between binge eating, followed by fasting or purging, often by vomiting or using
laxatives. A bulimic body may not be as obviously underweight
as an anorexic one, but that addictive cycle of binging and purging can seriously damage
the whole digestive system, leading to irregular heartbeat, inflammation of the esophagus and
mouth, tooth decay and staining, irregular bowel movements, peptic ulcers, pancreatitis,
and other organ damage. Sometimes the two diagnoses can be difficult
to discern, especially because someone may shift back and forth between anorexic diagnostic
features and bulimic diagnostic features. The DSM V recently added a third category
called binge-eating disorder, which is marked by significant binge-eating, followed by emotional
distress, feelings of lack of control, disgust, or guilt, but without purging or fasting. Although sometimes triggered by stress or
a need for, or lack of, control, the presence of an eating disorder is not a tell-tale sign
of childhood sexual abuse, as was once commonly thought. Instead, these disorders are often
predictive indicators of a person’s feelings of low self-worth, need to be perfect, falling short of
expectations, and concern with others perceptions. Although the prevalence of bulimia and binge-eating
is similar among ethnic groups in the United States, anorexia is is much more common among
white women, often of higher socioeconomic status. But the prevalence of these disorders is rising
in males, too. Today, between ten and twenty percent of people diagnosed with eating disorders
are men who feel the same pressure to attain what they imagine is physical perfection,
and that’s worth noting. These disorders have strong cultural and gender
components; the so-called “ideal standard of beauty” varies wildly across cultures and
time, and thinness is far from a universal desire, especially in countries where malnutrition
and starvation are problems. But in the Western world, and increasingly
in other countries, thinness is a common pursuit. And being bombarded with images of unrealistically
slender models and jacked celebrities has increased many people’s dissatisfaction, or
even shame and disgust, with their own bodies. These are all attitudes that can contribute
to eating disorders. Some people have even had plastic surgery to
look more like Beyonce, or J-Lo, or…Barbie. When taken to extremes, this kind of behavior starts
inching into the realm of body dysmorphic disorder. Body dysmorphic disorder is another psychological
illness, one that centers on a person’s obsession with physical flaws – either minor or just
imagined. Those suffering from this disorder often obsess over their appearance, often
staring into mirrors for hours, and feel distressed or ashamed by what they see. Although it’s often lumped in with the eating
disorders, our growing understanding of body dysmorphia suggests that it actually shares
some traits with obsessive-compulsive disorder, particularly the obsession with some imagined
bodily perfection and the compulsion to check oneself over and over to discern perceived
flaws. Not surprisingly, BDD and OCD may share some
similar neurophysiological features, although that’s still being researched. People suffering from BDD may exercise excessively,
groom themselves excessively, or seek out extreme cosmetic procedures, but, unless treated,
they usually remain critical and unsatisfied with their looks, to the point of fearing
that they have a deformity. People with BDD may suffer from anxiety and
depression, start avoiding social situations, and stay home for fear that others will notice
and judge their appearance negatively. Obviously, this causes a lot of emotional
distress and dysfunction. Some bodybuilders suffer from a particular type of BDD called
muscle dysmorphia, sort of the opposite of anorexia, where they become obsessed with
the notion that they aren’t muscular enough, even if they’re ripping shirts like the Hulk. And again, this isn’t mere vanity; people
suffering from body dysmorphia disorder look in the mirror and often see a distorted, even
grotesque, image in their reflection. So, how do these disorders come about? Well, to be honest, we still have a lot of
dots to connect. Neurologically, there are a few compelling
clues. In the case of eating disorders, for example, research has long suggested that
neurotransmitters like serotonin and dopamine may play a role. Dopamine is involved in regions of the brain
connected to hunger and eating, like the hypothalamus and nucleus accumbens, and some research has
found that binge eating appears to alter the regulation of dopamine production in a way
that can reinforce further binging. The result is a neurological pattern that
can resemble drug addiction, although the addiction comparison is still pretty controversial. Genetics appear to play a role, too, as there
seems to be increased risk among genetic relatives with eating disorders as compared to controls. But a lot of attention is also being paid
to environmental and familial factors, particularly the behavioral modeling and learning processes
that shape how we think about ourselves and our bodies. Specifically, children who grow
up observing problematic or unhealthy eating behavior in parents may be at higher risk
for developing an eating disorder. And explicitly learning unreasonable or unhealthy values
about your weight or your shape from your family, and definitely from your peers, can
have a powerful effect. Eating and body dysmorphic disorders are serious
business, but they are treatable — and perhaps even preventable. If cultural learning contributes to how we
eat and how we want to look, then maybe education can help increase our acceptance of our own
appearance, and be more accepting of others. Today, you learned about the symptoms and
sub types of anorexia, bulimia, and binge-eating disorder, as well as various types of body
dysmorphic disorder, and some of the physiological and environmental roots of these conditions. Thank you for watching, especially to all
of our Subbable subscribers. This episode of Crash Course Psychology was co-sponsored
by Subbable subscriber Matthew Woolsey and by Rich Brown of Beach Ready Auto Repair in
Outer Banks, North Carolina. To find out how you can become a co-sponsor
for one of our videos, just go to subbable.com/crashcourse. This episode was written by Kathleen Yale,
edited by Blake de Pastino, and our consultant is Dr. Ranjit Bhagwat. Our director and editor
is Nicholas Jenkins, the script supervisor and sound designer is Michael Aranda, and
the graphics team is Thought Café.

Only registered users can comment.

  1. The problem really is that eating disorders are seen as disease of the body even though it clearly is only a symptom of the underlying mental struggle. Personally, I have been yo-yoing around with my weight for years but the mental triggers are always the same, no matter at which weight I am.

  2. It's crazy to me that he says they still haven't proven that OCD and BDD are related; i have both and i've never even considered them to be separate.

  3. I feel like medical school should give GPs more of a basic understanding of nutrition, digestion and weight. "Just eat more (or just eat less)" is massively unhelpful to anybody.

  4. it's sad that when skinny people have eating disorders it's treated more seriously but when fat people or even healthy weight people develop eating disorders people praise them. even if they know how they got there, it's better to have starved yourself than to be fat. noone worries for the whale.

  5. it's sad that when skinny people have eating disorders it's treated more seriously but when fat people or even healthy weight people develop eating disorders people praise them. even if they know how they got there, it's better to have starved yourself than to be fat. noone worries for the whale.

  6. My mom would tell me if I didn't lose the weight, I'd never find a husband. If I wasnt being reminded of my weight, it's because I had done something more offensive 😣

  7. A doctor telling someone with an eating disorder to just “eat more” as the simple solution to their complex problem are the same as a therapist who tells someone with depression to just “feel better”.
    Gee, I never thought of that! Wow, so easy! No wonder nobody dies from eating disorders or depression, they’re so easy to fix!
    😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑😑

  8. So is body dysmorphia a side effect of an eating disorder? Or is that what causes eating disorders. (Ik there is no sole cause for eating disorders but is it a main component?)

  9. I had an eating disorder bulimia to be exact. It was hard for me because when I looked at myself I saw someone who wasn't worth loving. I thought I was ugly, I thought I was repulsive and disgusting. I was coughing blood and it always hurt me. Then one day I got the most horrible burning stomach pain and my best friend finally convinced me that I needed to get help. He convinced me that the burning feeling in my chest, throat, and stomach wasn't worth it. So now im better although the temptation is always there.

  10. Losing weight for your health is okay but that should be your only goal. You're never going to be perfect, but you are loved exactly as you are.

    It's me. I love you just as you are.

  11. Damn, until I was about 11 I had no concept of what fat is at all, and I rarely even looked in mirrors

  12. I think it's really great that Hank mentioned stuff about cultural influences and eating disorders in men. I've always loved Crash Course and this video just solidifed that more.

  13. I remember last year when i went to my family the first time, after i lost a lot of weight from starving myself over and over again
    At some point they talked about my weight loss and my one aunt seemed really happy about it. She was one of the main reasons too why i got anorexia, cause she body shamed me since i was like 5. So my whole family was a bit worried about my weight loss and then my aunt just said: “ well there isn't a problem. She isn't underweight, so she cant be anorexic“. After that my family didnt seem to worry about it anymore.
    Having to listen to her say this was quite a shock to me ·-·

  14. A poem of my heart…
    More than life itself, I love you.
    Beyond your wildest dreams, I love you.
    When you feel nothing, I love you.
    When you are depressed and suicidal, I love you.
    When you cannot face another day, I love you.
    When you are all alone, I love you.
    When no one else loves you, I love you.
    When no one seems to care, I love you.
    When the tears will not stop flowing, I love you.
    When there is no hope left, I love you.
    When you need a friend, I love you.
    When you need your best friend, I am here.
    I will never leave you.
    I will never forsake you.
    I will forgive every wrong that you have done.
    I will overlook all of your mistakes.
    I will help turn your sorrow into joy.
    I will embrace you and hold you.
    …If you will simply receive Me.
    Yes, it's that simple my friend.
    -The Lord Jesus Christ

  15. Anorexia shouldn’t be characterized by low weight. Plenty of suffers are at a healthy weight or are overweight

  16. I do good all day with my diet then at night i eat so much and i hate my self cus im fat and i juzt wanna be skinny

  17. Does anyone have any tips for talking to your parents about BDD?

    I’m 5’4 and I weigh 122 lbs. I would consider myself a confident person, but I have started to become obsessed with my lower stomach. I’ve been doing ab workouts, eating very healthy and exercising so much, and really just doing anything I can to make my lower belly be flat. I can’t do it. I look at my lower stomach in the mirror at least 3 times a day if not way more. I don’t think I have BDD, but I have no way of knowing.

  18. does anyone else already picked on their scar then scratch it with something abrasive because it looks terrible? cuz I did THAT. And I'm obsessively looking at it in the mirror and feel sad and depressed every time.

  19. i don’t think of food as a necessity. sometimes i’ll be starving & still be sick just by looking at food. i’m almost 25 & weigh 90 something, and i’m aware that i’m really small, and i don’t see myself big, i don’t binge either but idk my relationship with food sucks… ARFID?

  20. It's annoying when people tell you to not judge them and try to make you look bad based on their own insecurities. AKA "I'm overweight and It's rude for people not to be with me because of my weight"

  21. I was living on 800 calories a day, weighing myself twice a day, occasionally throwing up if I ate anything over that (that rarely happened), exercising to purge my body of calories, avoided social nights out because gasp I might gain weight…

    But because I wasn't underweight, when I opened up to someone about it, they looked at me and went 'You look healthy enough' and the conversation just drifted off. I remember feeling like a liar or attention seeker after it. =

  22. I used to starve myself, I fasted, I skipped meals. Now I eat very healthy and I’m trying to eat way more calories since I’m a competitive swimmer and lift very often. I don’t think I’m eating enough because whenever I get up my vision turns black and my head starts to hurt for like 10 seconds. I would like to say I don’t have an eating disorder but I think I might have restriction and I’m trying to fix it. I’m female, 5’8, 123 Ibs, which is considered underweight for my BMI 🙁

  23. I over eat, but don't fall into the classification of binge-eating. I tend to over eat, and feel anxious or discomfort if I don't eat all of my food. I also take free food back to my locker during events at work. Needless to say, I was starved as a child.

  24. it would've been good to mention OSFED, which includes orthorexia (obsession with eating only "healthy" foods/safe foods etc) and atypical anorexia (basically the same as anorexia nervosa except doesn't include the weight factor)

  25. this will prolly get no attention but my friend (by that i mean me) literally forcefully and intentionally throws up everything she eats. would it be bulimia or something else?

  26. I was underweight from my
    childhood. But now I am 25 and I was very tensed about my weight. I took
    various allopathic products, but the improvement was until in their continuing.
    One day my friend told me about Planet Ayurved, I searched for it and ordered
    medicine for anorexia nervosa, which contains Sanjivani vati, Digestion
    support, etc. Now I look very healthy and beautiful and my weight is also
    improving

  27. I have BDD, I avoid mirrors and when I happen to look into one i get an awful sick feeling like I'm about to throw up. I constantly try to pick, fix and camouflage what I hate about myself. From what my loved ones say, I see my flaws very drastically and over exaggerated

  28. I was so proud of myself today when I only had two coffees and a handful of bran flakes until dinnertime, even though having caffeine without eating makes me shaky and faint. I'm about 5'0 and I weigh about 140 lbs. I hate looking in the mirror, I hate going swimming because bathing suits are so revealing, I hate wearing form-fitting or short clothes because I don't want other people to see what and ugly fat creature I am. I want to fix it any way I can…

  29. I'm so terrified for my best friend, she recently told me about the EDs
    that I suspected she had for the last six years. She has gotten better
    but I'm still so scared. She said that she has Anorexia, Bulimia and
    Binge eating disorder, Along with a few EDNOS habits.

  30. I'm so terrified for my best friend, she recently told me about the EDs
    that I suspected she had for the last six years. She has gotten better
    but I'm still so scared. She said that she has Anorexia, Bulimia and
    Binge eating disorder, Along with a few EDNOS habits.

  31. I had anorexia ever since I had 7 year's old until 2017 and my adoptive parents didn't know anything about my disorder especially my mom. She would watch me eat until I ate the whole plate of food, she would give huge amounts and made me eat it only for it to come back up, and she would also threaten me with pictures of people who looked like skeletons and told me that I would become this if I didn't eat. None of that worked and it got worse in my 5th year in elementry school. I was 4'7 and weight under 80 pounds. When I entered 6th grade I chose to be in athletics since I was pretty good at sports and luckily I gained some weight after school ended. Now I weight around 85 to 90 pounds and grown to 4'9.

  32. It'd be great to see more content on the eating disorders that are more prevalent. There is so much content on anorexia, which is the least common eating disorder. Binge eating disorder and EDNOS are by the far the most common. I'd love to see something on those.

  33. As a male, STARVING yourself is the LAST thing you’ll want to do. You’ll LOSE MORE MUSCLE mass in the process RATHER THAN FAT. It’s a long process that takes time. Eat a well balanced-nutritious diet high in protein and carbs. DONT heavily focus on cardio. weight training and calisthenics are the way to go. Increase your caloric intake and do this for about 4 months than slowly lower your caloric intake. I’m also recovering from BDD and Binging disorder and I hated the fact of eating more but trust me it’s the best thing you can do for yourself.

  34. One of the reasons for binge/stress eating is because stress and/or anxiety cause the reptilian brain to go into survival mode which would make it so you eat as much as you can in order to store energy in case of an emergency where you might go for a long period of time without being able to eat. in this day and age we have convenience at our finger tips which means we wouldn't move as much as our ancestors in most cases. Which is why the energy reserves do not decrease or stay the same. The fat is just unused emergency energy. if you binge and/ or stress eat I suggest taking time off from what is stressing you out or giving you anxiety, do what calms you, GET SLEEP, exercise daily, and keep a journal of things you like about yourself/ are generally grateful for. (I know it's easier said than done)♥️

  35. I haven't been diagnosed yet but I'm really like %99 sure I've got BDD. I'm constantly looking in the mirror to fix my face. I've tried mewing but my face still looks horrible.

  36. I kind of wish that the beauty norms would encompass more body types including people who are over-weight so that people don't feel pressured to be under-weight which is dangerous.

  37. I've had anorexia for many years, I tried in patient a few times without any success. When I hit 27 kg with a BMI of 9.8 I nearly died and after a few weeks at the hospital I was forced in patient for over half a year. Even after that I keep relapsing, being forced to be weight restored doesn't heal the mind. I know now that I will never be free from anorexia nervosa.

  38. i know my ed is getting bad bc it’s getting really hard to breathe, my teeth are getting so thin and my digestive system is so irregular

  39. I don’t think that it’s very extreme, but I think I might be a bit dysmorphic. I don’t have any other mental disorder, but I’ve studied what I need to do to make myself have what I persisted as a perfect body. I still like to eat food, and I do it without restrictions, binging or purging. But I literally beat myself up whenever I see I’m aren’t as toned as I was the last day. But it gets to a point where I know what I’m looking at in the mirror is not me. I just look, gross. I’m scared, but trying to get help so I don’t have to fully self diagnose because I really hate doing that.

  40. If I’m “recovering” from an eating disorder, is it normal for me to feel really sick when I eat too much? Or a good amount? I don’t know. I just feel so full that I think I’m going to throw up and (tmi) I get constipated and cannot use the restroom for days unless I limit my eating. But I can’t tell if I’m binge eating or not. Until I eat less again. But I’m not trying to eat less again? It just doesn’t make me feel sick and nauseous

  41. This is THE worst piece of garbage ever done regarding eating disorders. Ever. What is wrong with you? If you want to know the truth about the many manifestations of eating disorders (which you and the DSM have no understanding of), talk to me. Honestly, This “crash course” is nothing more than a crash and burn. You should damn be ashamed of it.

  42. the bodyweight component is what makes many of those suffering from anorexia feel like they arent actually sick because they cant be admitted as an anorexic. Being labeled as an atypical anorexic can feel like a slap in the face for many suffering because they fel like they are failing at being skinny, and failing at being fat all at the same time. (failing at an eating disorder, and failing at being healthy all at the same time). truth is, there is never sick enough, and having such disordered thinking and attempting to act on it is enough to be considered ill, and in need of help but eating disorders are such a difficult topic, because some of those suffering have the disorder telling them they arent sick, and that they dont want help and that they need to hide it, unlike with some other mental disorders where you may want help, and want to stop it. (no one wants a disorder, but sometimes disordered thinking can cause some people to believe that they dont want help because it means they cant continue. often times it takes a scare, or a reality check which is difficult and overall its a very difficult topic.). not much of a comment towards the video, just a discussion and thought i had after watching it.

  43. I look like i have a eating disorder but its only beacuse my metabolism is so high that i am always underweight . I do checking monthly to make sure my weight isent too low or too high (mostly checking to see if im too low) . But i dont care if my weight goes up by a few beacuse weight always fluctuates. But i eat like a hog lol and im healthy as well since i still get my vitamins and food as well.
    It makes me sad knowing that there is a mental illness that makes people strive for bodly perfection when they were already perfect before…

  44. I had an eating disorder just last year and I didn’t even know. I wanted to be skinnier so I skipped meals but then I would crave so much food and that made me gain even more weight since my metabolism ran out of control. I’m so glad I finally stopped (somehow) and began eating three times a day and now I have an amazing metabolism. Please be careful guys

  45. I was never diagnosed with anorexia but my whole life people have always given me attention for being underweight and bony. So when I was 12 and I actually started to look normal I wasn't used to it and thought I was getting fat. Not to mention I wasn't getting attention. I only ate what I was forced to and all that and to this day I can go a couple days without eating (now it isn't from any kind of mind thing it's just because I forget to eat if nobody reminds me. I went years of only eating when people told me to) My parents and doctor thought it was just high metabolism but nah

    I look normal now thanks to my friend. I opened up to her about my issues and she basically got my brain to not see my bony body as fat anymore

  46. See I don’t check my body. I avoid it. If that makes sense. But the perception of myself isn’t the same as others

  47. Im 164cms and only weight 42kgs, i will not tell you my age but i eat well, veggies, grains and dhal (lentils)
    do i have anorexiia

  48. I don’t know what’s wrong with me or what I fall under, I eat one piece of fruit a day during the week usually and that’s all I’ll eat. Then on like Saturday I just binge then hate myself for it and will eat alittle bit more on Sunday than I usually would but not as much as the day before. But I like to stay at about 42kgs which is underweight for my body. This started out like a diet and turned into this and I am obsessive about it but I don’t think I need/I don’t want help I think I could stop if I wanted to? I don’t know maybe that sounds like I do need help I have no idea but I truly believe I’m fine..?

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