More than you can chew: Binge eating, suicide, and minority girls

Full-syndrome eating disorders like anorexia, bulimia, and binge eating disorder get the lion’s share of research money and media attention. But subthreshold disorders are often just as serious and affect more people. EDs in minority populations (where, in this case, “minority” means anything other than young, white females) also get much less attention. Again, the research data shows us that no population is immune to an ED.

Binge eating, in particular, is easily written off. It’s “periodic overindulgence,” or a “lack of willpower,” when indeed it’s anything but. Even adolescents who don’t meet criteria for full-blown binge eating disorder still have levels of impairment in social and academic functioning (Stice et al., 2009). This impairment can be significant- a recent study found that 34.4% of women with binge eating disorder and 18.3% with subthreshold BED had suicidal ideation; 15.1% of the women with BED had made a suicide attempt (Swanson et al., 2011).

The question that remains what links binge eating and suicidal thoughts and behaviors. A new study in the journal Prevention Science looks more closely at this phenomenon in a group of inner city adolescents (Musci, Hart, & Ialongo, 2013).

What they found

The researchers followed a group of 275 African-American females from inner city Baltimore, two-thirds of whom received free or reduced-priced lunches at school (it’s frequently used as a proxy measure for socio-economic status, since low income is a requirement for these lunches). During the four years of the study, the girls were given a variety of questionnaires and tests, including assessments for binge eating behavior, depression, anxiety, internalizing symptoms (your tendency to turn negative emotions and feelings inward), self-perception, body image, and suicidal thoughts and actions.

The researchers were able to categorize the girls into low (43%), moderate (42%), and high (16%) levels of internalizing symptoms. The girls with the high internalizing symptoms had greater levels of binge eating and body dissatisfaction as well as a significantly higher likelihood of suicide attempts. Even without accounting for internalization symptoms, girls who binge ate were 1.62 times more likely to attempt suicide. This relationship remained, even when the researchers controlled for body dissatisfaction.

Although body dissatisfaction was greater in the girls with higher internalization, it didn’t appear to affect the relationship between binge eating and suicide attempts. It makes me wonder whether eating disorder prevention programs would be better off looking at the emotional drivers of EDs rather than just the body image aspect.

These results also emphasize the tremendous emotional and psychological impacts of EDs. Certainly medical problems are both real and deadly, but we forget about the emotional toll.

Write the researchers:

Psychosocial impairment is common; in fact, individuals with BED tend to report more impairment in emotional well-being than in physical well-being. In comparison to individuals without an eating disorder, those with BED report significantly more impairment in their role due to emotional problems, feeling less vitality, and having more impairment in their social functioning.

In an article from the British Psychological Society, BPS member Deanne Jade had this to say about the article:

“The population displaying eating disorder symptoms and poor body image is unhappy as a result of dietary chaos and its effects on mood, low self worth – which is a predisposition and the effects of eating disordered behaviour which leads to shame and anxiety. The risk of suicide is thought to be 57 times greater at every age for people with anorexia compared to the norm. For persons with bulimia nervosa there is also a high risk of PTSD (full or partial syndrome) with a history of abuse or neglect. So these findings are not a surprise.

“I worry about the terminology in the conclusions of this research; in particular that females with depression or anxiety are “often” dissatisfied with their body image” (aren’t most females?) and of the “association” (of eating disorders and suicide risk) where deeper analysis might establish more pertinent mediating factors if any.

“It is important for prevention scientists to target body image concerns and dieting behaviours in all females (and males) by teaching emotional literacy in early life. By the time eating disorder symptoms manifest it may be too late to prevent psychiatric disturbance.”

References:

Musci RJ, Hart SR, Ialongo N. (2013). Internalizing Antecedents and Consequences of Binge-Eating Behaviors in a Community-Based, Urban Sample of African American Females. Prevention Science, doi: 10.1007/s11121-013-0411-9

Stice E, Marti CN, Shaw H, Jaconis M. (2009). An 8-year longitudinal study of the natural history of threshold, subthreshold, and partial eating disorders from a community sample of adolescents. Journal of Abnormal Psychology, 118(3):587-97. doi: 10.1037/a0016481.

Swanson, S. A., Crow, S. J., Le Grange, D., Swendsen, J., & Merikangas, K. R. (2011). Prevalence and correlates of eating disorders in adolescents: Results from the National Comorbidity Survey Replication Adolescent Supplement. Archives of General Psychiatry, 68, 714–723. doi:10.1001/archgenpsychiatry.2011.22.

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3 Responses to “More than you can chew: Binge eating, suicide, and minority girls”

  1. “It makes me wonder whether eating disorder prevention programs would be better off looking at the emotional drivers of EDs rather than just the body image aspect.”

    Absolutely. 100%. YES. (I think) Body image is a “symptom” of these emotional drivers. Eating disorders don’t discriminate, like you pointed out here and without dealing with those emotional issues, it is nearly impossible to develop a healthy relationship with food.

  2. The continued lack of misunderstanding about BED, and the continued, subtle conflation of BED with non-pathological “obesity” or normal overeating is really disturbing to me. Without specifying names, I found this really striking in a fairly widely-shared article published by a major ED advocacy organization just a day or two ago, in which the “recovered” (I question that, but it’s a separate matter) author first states that she has struggled with an ED/severely disordered eating since early childhood – age 8 or so – and just paragraphs later states that the catalyst for her “real” EDs (i.e. BN and AN) was in large part body dissatisfaction due to weight gain caused by her “poor eating habits.” Reading it I thought, “Well, which was it? BED or a poor (but WNL) diet?”

    In this case it was clearly as much an issue of poor editorial control as the author’s own internalized assumption that if one is overweight by societal measures, this must be partly volitional even if one has a known ED. But I was disappointed that this slip was let through into such a widely-disseminated piece. We’re not going to get very far in changing conceptions about BED – helping the public to believe that it is every bit as “real” and unchosen as other EDs – without actively countering these beliefs that clinically-significant binge eating is NOT the same as normal overeating and certainly not the presumed underlying reason why all fat people are fat.