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Personality Predisposition

Yes, believe it or not, there are personality traits that can predispose one to disordered eating and/or eating disorders. And our personalities are molded by both the genes we inherit and our individual life experiences.

Eating disorders have traits that are specific to them, but there are those that are applicable to all. Perfectionism is one such trait, and is frequently correlated with increased risk. Those with a perpetual and intense need to be perfect have a higher chance of falling prey to and suffering longer from these disorders. This self-imposed and dangerous trait (often a learnt behavior) significantly influences how a person behaves and predisposes them to obsession surrounding how they manage their weight and their eating. Our overall culture makes falling prey to perfectionism almost encouraged and applauded. Often perfectionist people thrive for external validation, ultimately separating their behaviors from their authentic self, giving them the harmful feeling that no one truly knows them.

In the Jewish orthodox culture this need for perfection is especially pervasive. There are pressures placed on the girls for perfection that extend to so many areas of their lives. The ideal that a girl should be able to get everything done and do all that is expected of her successfully, can place an unrealistic expectation that sets her up to fail. The example set by mothers is often one of the “superwoman ideal”, able to have many children, take good care of them, work, cook, have guests over often, and never need to take a break. A daughter seeing all of this may perceive standards that are impossible to live up to. Sadly, there is no endgame for perfectionists. There is no sense of attained fulfilment as they tend to look for additional challenges and areas within which to excel. This can lead to sadness and dissatisfaction as the affected person is never able to be happy with who they are and what they have achieved, as they are in constant need of a more ambitious and aggressive challenges.

Temperament is another aspect of personality that can affect risk. Those with greater level of negative emotionality, including higher levels of anger, fear, and sadness, have greater propensity to develop an eating disorder. This is also true for those with lower levels of self-control since they have reduced self-regulatory abilities. These specific temperament traits lead to negative self-body evaluation and body size perception, both recognized as risk factors for and precursors to disordered eating and eating disorders. Individuals who struggle with poor interpersonal relationships or who tend to be shy and inhibited are also at increased risk. Some other character traits include impulsive, novelty seeking, high levels of persistence, extreme harm avoidance, as well as those who are rule-driven and inflexible. Of course, not everyone with these character or personality traits will develop an eating disorder, however, the presence of them does indeed increase risk and factors into a person’s overall risk for them.

In my research, the “superwoman ideal” and the risk of perfectionism were highly prevalent and recurring themes and thus merit more in depth posts in the future.

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Social Stressors

We have covered a little about family and religion vis a vis disordered eating and eating disorder risk. I’d like to turn now to social and societal factors, as they also contribute to risk. Thin body ideals and unrealistic body expectations cultivated from media exposure often create higher incidence of body image concerns that influence inappropriate dieting and food behaviors. This is especially relevant to young adolescent females, who are inherently more susceptible to these pressures, as they are a primary focus of media attention. This is done in order to shape a young and impressionable girl’s awareness and cognition regarding physical beauty and is achieved by highlighting what is important and valuable to society, and, at the same time, what is not. These mostly unrealistic expectations and unattainable standards can create self-imposed pressure for the adolescent girl and lead to increased disordered eating and eating disorder risk and behaviors.

Additionally, adolescents are very highly invested in and motivated by what their peers think of them. If an adolescent does not feel a sense of belonging to or acceptance by her desired social circles, disordered eating and/or eating disorders can ensue. There are many of these types of pressures experienced by girls, including the pressure of belonging to certain social circles, the pressure of fitting in with and being accepted by their friends, perfectionistic pressure, appearance pressure, academic pressure, as well as the overall pressure to be thin. The weight of these demands is taxing and can be destructive to a girl’s self-esteem, body-image, and overall body acceptance and further, is also a documented source of anxiety for them.

Social network sites, another significant source of social pressure, are documented to increase disordered eating attitudes for those who already possess negative attitudes about themselves and can nudge others towards the development of a negative self-image as well. Interestingly, disordered eating has been adopted as a self-soothing tool used by those affected from these negative attitudes and is described as helping to alleviate the negative or unpleasant social media feedback experience. However, even though this coping method may at first appear calming and/or pacifying to those who use it, ultimately it leads to more dangerous and destructive eating behaviors down the road.

There is much to be said about social influence and its powerful impact on young girls. So much so, it simply cannot be adequately covered in one post. Nevertheless, it is critical that we monitor how our daughters are experiencing and internalizing their social network experiences, both online and in person, so that we can detect and get help for any issues as soon as possible.

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The Quandary of Adolescence

Let’s take this concept of internalization and perception a bit further by looking specifically at the delicate and influential age of adolescence for the Jewish orthodox female. Adolescence, in general, is an age where overall there is a higher propensity for developing disordered eating and/or eating disorders. Adolescents are looking to discover who they are and where they want to go. They are the most uncomfortable with themselves, as they try to find themselves and assert their independence, but are not quite sure where they are and where they want to go. A balance must be achieved, then, between their perception of this internal struggle/conflict of what is expected of them and their own wants, needs, and desires.

Adolescence is also a time when a person develops and solidifies their relationship with G-d and yet, is also a time when spiritual growth and development are especially trying and confusing, as the adolescent struggles to balance what they have been told and what it is they believe. There are mental health and educational professionals who reveal that it is during adolescence that it is most difficult for a young girl to have a solid, intrinsic, and spiritual relationship with G-d. There is greater difficulty for the adolescent to connect with G-d at this age when the perception is that multiple rules and regulations are being demanded of them. This state of confusion or misperception that is experienced by the adolescent has been documented to express itself via cognitive bias or dissonance against one’s own weight and size, ultimately leading to food and/or eating issues.

Further, culturally in our communities, many times our daughters are expected to mature and grow up quickly, taking on more responsibilities and household duties than other secular teens their age. Girls are asked to care for younger siblings, babysit whenever possible, get summer jobs from a young age, help with housework and Shabbos prep, as well as complete hours of homework to ensure academic success. Compounded on top of these extra responsibilities, is the stress of having to get ready to enter seminary and start on the path to shidduchim. This can make the girls feel as if their own individuality or distinctiveness is compromised or worse, not allowed to develop and/or blossom. And sometimes, these expectations can lead to feelings of a lack of control in certain areas of the adolescent’s life, necessitating the need for her to take control in other areas, very possibly leading to food and eating issues.

Adolescence is undoubtedly a delicate, stressful, and complicated life stage. It is so important for parents, teachers, doctors, mental health professionals, as well as Rabbis to understand the unique issues and challenges adolescents face.

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More on Religious Risk

We discussed the religious risk factor considerations last week and so I was going to move on to the next category of risk. But, based on the response to my last post, I have decided to delve a little deeper into this topic.

The relationship between religion and eating disorders is both complex and multifaceted. One particularly difficult area pertaining to adolescent girls is the perceived focus on externals. One of the vital messages we work hard to convey to our children is that your identity as a person, as an orthodox Jew, is not tied to your appearance, rather it is based on your neshama, that internal connection between each person and G-d. However, too often the cultural norms and expectations communicated to our girls are internalized and perceived as something else entirely. For example, consider our shidduch system. Girls start talking about marriage and their shidduch prospects from a very young age along with a clear expectation that in order for a girl to get married she must be thin. In fact, often the message given over to the girls is that they should be a specific size, overshadowing any middos or academic achievements. This emphasis is the antithesis of the message we work hard to impart, and can lead to confusion and mixed message perception, thereby increasing risk.

Another example can be found with the concept of tznius. Many girls struggle to understand how tznius connects them to G-d or fulfills them spiritually, as some of the laws of tznius necessitate an external focus and specificity. While the focus is intended to support their internal connection, the message often imparted is that the external, physical look of the person is more important and relevant. So, while the intention of tznius is both positive and constructive, sometimes girls can negatively internalize its message, thereby creating negative and biased cognitions that do influence and affect disordered eating and eating disorder risk.

Sadly, for many adolescent girls the message that “in order to be good you have to look good” is what they are perceiving and internalizing. This leads to confusion around why they are being judged by their appearance, if externals are truly not significant in the way that internals are. The message communicated becomes “sure, character traits and middos are appreciated, but it is the physical, outward presentation that is truly valuable” as it gets a lot more attention, focus, and praise. And this, unfortunately, is the message the girls acquire, ultimately increasing their risk not only for disordered eating and eating disorders, but for many types of mental health issues and illness.

Clearly, it is not religion that is communicating these mixed or confusing messages. Rather, it is the way the message is imparted and how it is understood by the girls that raises risk levels for them.  

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Religious Risk

We’ve been talking about the many factors that can influence and create risk for eating disorders and disordered eating. There are religious considerations that do impact these issues. That said, religion cannot be viewed as an entirely positive or negative construct regarding eating disorder risk. This is partly because there are psychological variables as well as religious engagement considerations to consider. Studies have determined eating disorder risk is both staved off by and preserved through religious factors and considerations. Religious behaviors and beliefs have been found to lead to both positive and negative coping strategies and eating disorder outcomes. How can this be and what does this mean on a practical level? Well, while religiosity does influence eating pathology, body satisfaction, as well as image disturbances and issues, the result and outcome of that influence is not always the same.

In fact, in the scientific research on how Jewish orthodox religion affects disordered eating and eating disorders, there are conflicting conclusions. There are those studies that find strong religiosity, greater levels of spirituality, and connection to G-d to be both a protective and positive influence vis a vis eating disorders. On the other hand, however, there are also studies which find that positive religious feelings and religious coping do not reflect lower levels of eating disorders and that sometimes, a person’s attachment to G-d as well as their spiritual beliefs and practices actually grow stronger through their eating disorder experience. Ultimately, though, studies have established that religion itself is less a factor, but how an individual internalizes their religion that can be. Those with a more personal and real connection to G-d are found to have better coping skills and less overall risk, compared with those who experience a more extrinsic or socially focused motivation regarding their religious practice and observance. Those were found to be at higher eating disorder risk overall.

Religious eating disorder risk is complicated and complex, especially during adolescence as that is a time of self-discovery, transition, and transformation, which can be especially trying for someone’s spiritual growth and development. More often than not, adolescents are simply not yet ready to forge their own deep and lasting connection to G-d, especially since adolescence is also a time when teens challenge and question everything. While this is simply part of their maturity and growth process, this can make religion with its strict rules and regulations, seem overwhelming and intense. Although this is just a quick and oversimplified overview of how religion affects risk, it nevertheless, demonstrates how multi-layered and delicate eating disorder onset can be.     

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The Family Factor

What are some of the other causes of eating disorders? There are many potential causes of eating disorders with not one single issue that can be pinpointed as a sure-fire cause. Rather it is the combination of certain risk factors and how the affected person internalizes and/or perceives them, that creates the risk for them. There are those who may have experienced several or more potential risk factors and will not be develop an eating disorder, whereas for others, enduring one or two of the risk factors, may impact them far more seriously.

That said, there are several categories of proven factors regarding disordered eating and eating disorder onset. Last week we mentioned genetic factors. The next category of risk factors are familial ones. Parents are critical components in the development of both the biological and social environments of their children. These created environments influence how children learn to develop their own body attitudes, as well as their eating and weight management patterns. Perceptions by children around the expectations of their parents can lead to increased risk and while these perceptions may not seem legitimate or demonstrable, if a child perceive her parents’ expectations as unattainable or unreasonable, increased risk follows. This scenario can, in turn, lead to identity crises or deficits that leave the child feeling out of control and/or unable to fully satisfy their parent’s expectations, thus increasing risk.

The familial relationship between a mother and her daughter plays an especially significant role in body image development for girls. If a mother has her own body image or food related issues, there is a tendency for her to inadvertently pass these issues on to her daughter. In fact, in a 2014 study by Neumark-Sztainer et al., any mother dieting whatsoever was found to be significant when it comes to the use of unhealthy and extreme weight control behaviors among adolescent girls. Further, if a mother perceives her daughter’s shape as outside what is socially ideal or what is considered healthy, often times, she tries to influence her daughter to make changes she deems acceptable. Unfortunately, this frequently involves unconsciously changing and/or shaping a child’s self-perception of acceptable weight and shape, potentially leading to increased risk. Clearly, the development of healthy family relationships around food is critical for all children.

In the next post, we will discuss religious factors and how they affect this risk.

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The Struggle is Real

Eating disorders are powerful forces that can prove difficult to stop. People affected by them often don’t know how to differentiate between themselves and the disorder. And while eating disorders are all about food – whether that means controlling what you eat, bingeing, purging, or dieting chronically, the actual causes and onset of them are really not about the food itself. Rather, food becomes a strategy to manage some inner turmoil or severe stress that someone is experiencing. In fact, for some, food can feel safer than the people in their lives. Each eating disorder is unique and needs to be managed and treated as such. This is why eating disorders can be so insidious and complicated to treat.

What then are the causes an eating disorder? Well, there are many things that can trigger someone to develop an eating disorder. One category of risk is genetic as eating disorders are not only psychological, but biological in nature as well.  Specific genetic variations that change the metabolism of certain nutrients have been discovered and these can lead to a statistically higher predisposition for an eating disorder. In fact, having family members with any affective disorder or ones who experience anxiety, obsessive compulsive disorder, or depression, all hold genetic ties that are linked to increased risk. In a Harvard Health study from 2019, it was found that genes can account for between 25 to 80 percent of a person being overweight. While other studies find genetic links to other types of eating disorders such as anorexia and bulimia. It is so important then, that we not judge people for their struggle, as well as acknowledge and understand that part of a person’s struggle might be inherited. Each person’s battle is distinct.

There are many other risk factors as well, and these will be discussed in future posts.

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What is an eating disorder?

So, what is an eating disorder? Eating disorders are serious mental illnesses with numerous physical and emotional consequences. According to the Fifth Edition of the Diagnostic and Statistical Manual (DSM-5), eating disorders refer to distorted ways in which people consume or absorb their food. These behaviors can significantly impact the persons physical, psychological, and emotional health and functioning. Often people with eating disorders become so preoccupied with food and weight issues that it becomes harder and harder for them to focus on other aspects of their life.

There are several different types of eating disorders. They include; anorexia nervosa, bulimia nervosa, binge eating disorder, other specified feeding and eating disorders, pica, rumination disorders, orthorexia, avoidant/restrictive food intake disorder, and body dysmorphic disorder. Each of these will be explained and highlighted in future posts. It is common for people to only know of one or two types of eating disorders, but as you can see, there are quite a few different forms and varieties of them.

There are others who may have significant issues surrounding food, but they are not severe enough to warrant a diagnosis of an eating disorder. These people may have something called disordered eating. Disordered eating refers to any disturbed eating practices. These can be thoughts, specific behaviors, or attitudes that are related to symptoms that while similar to full-blown eating disorders, are not on the same level or scale. Some disordered eating behaviors include weight and body shape preoccupation, any behavior done to compensate for eating, such as excessive exercise and/or vomiting, or extreme dieting. Both eating disorders and disordered eating entail persistent disturbances in behaviors related to eating.

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Jewish Orthodox Female Eating Disorder Risk

Studies have established that Jewish orthodox women and girls are often at higher risk for developing disordered eating pathology and/or a clinically diagnosed eating disorder than their secular counterparts.

  • In 2004, Rayworth et al. determined that Jewish women are more than two times as likely to meet the criteria for eating disorders as those of other religious backgrounds.
  • Then, in a study conducted in 2008 by Pinhas, Jewish adolescent girls were found to be at higher risk for eating disorders as well as to have higher disordered eating levels than their non-Jewish peers.
  • In 2012, Feinson and Meir discovered women from all walks of Jewish observance to be at higher risk for eating disorders than those from other cultures.
  • And finally, in a study conducted of Jewish women from 2016 by Feinson and Hornick-Lurie, over 33% of participants responded that body shape and size does indeed influence how they feel about themselves.

These are significant and alarming statistics, warranting our attention. These studies support the critical need for prevention programs developed based on the unique conditions and circumstances of Jewish orthodox females. This will increase both the efficacy and long-term success of the programs as well as ensuring a larger, more extensive reach.

Citations available upon request

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Why Prevention is Needed

Eating disorders are often misunderstood and sometimes, even considered a lifestyle choice. The reality, however, is that eating disorders are severe psychiatric illnesses with a complex etiology, thought to be caused by a complicated interplay of biological, psychological, and environmental factors. Adolescence, the age when eating disorders tend to emerge, is a time of particular vulnerability and stress, leading to increased propensity for both disordered eating and eating disorders.

The number of clinically diagnosed eating disorder cases worldwide is between 0.5% and 3% of the general population with some experts putting the number closer to 12%. They are often chronic, debilitating, and result in a significant reduction to the affected person’s quality of life. Eating disorders have high co-morbidity with other mental disorders and significant treatment resistance. And, after all our years of studying their causes and onset, there is still not a clear understanding or treatment of them. That is why prevention of them is so critical, but also so relevant to adolescents. Prevention programs have been proven successful when tailored properly and have long-lasting effects on participants.