Young girls in developed countries are primarily affected with eating disorders. Persons with anorexia are honest, do not disobey, and hide their inner feeling, tend to be good in whatever they do and often excellent athletes. Research says that anorexia people eat less to gain a sense of control over their lives.

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Dimensions of Physical and Mental Health
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Introduction
Tania is a 23 years old female living with her parents in the metro area. Her parents are
doctors while her younger brother is also a student of law, although both the parents are working
long hours but are caring and loving. As the parents are too busy hence for last one year Tania
cooks the food for the family yet never eats with the parents. She is gaining height but losing
weight which has come down from 66kg to 40 kg in one year. The parents, being doctors
themselves, are aware of the fact that there was no history of her being engaged in self-induced
vomiting, laxative abuse are concerned with her excessive exercise and self-induced food
restrictions. She became very fussy about eating because she thinks that she must lose weight as
she has turned fat. For two month she is checked by the family general physician for any visible
gastrointestinal disturbance and also to know why she seldom faints. Tania was advised to eat
fibrous diet and have an ECG. Tania believes that her parents are worried for no reason and are
trespassing her private life style which also is causing disharmony at the home. She denies any
physical complaints. Specifically, she denies any history of fatigue, fever, appetite or weight
change. She is active and a review of symptoms is completely negative. A psychosocial
(HEADSS) screening interview shows no existence of any disagreements with her parents. On a
separate interview with her parents, you discover that they have been concerned about her losing
weight since she began "eating healthier" over the past several months.
Negative self-image is considered as typical eating disorders, which are so complex
psychiatric disorders which causes psychosocial suffering for the affected persons. This disorder
affects young girls and adolescents, at a rate which has grown in the last several decades. Science
has proved that eating disorder is not only a psychological disorder that requires psychological

3. Dimensions of Physical and Mental Health 3
treatment. “Eating disorders are not a ‘state of the mind’ or lifestyle choice (Smolak, L. 2004).
These are serious mental disorders that have severe medical complications that can be fatal. Also
there is a high risk of suicide in these patients,” Familial, biological, social and cultural factors
are usually responsible for eating disorders. Body dissatisfaction and dieting, both common
among adolescents, are recognized risk factors for eating disorders. Eating disorders were a rare
phenomenon when Gull reported it for the first time in 1873, but now the prevalence rate among
adolescent and young adult women is raising concerns; there are between 8 and 13 anorexia
cases per 100,000 persons in the United States. ED rate is much higher in females between 15
and19 years (Van Hoeken, Seidell, & Hoek, 2003).
The psychopathology of eating disorder is known by the refusal to maintain normal
weight in anorexia nervosa, and by binge eating in bulimia nervosa. Adolescents also tend to be
socially withdrawn and are in the habit of dieting (Beumont, 2002). An ED person can express
different forms of negative self-evaluation (Lask, 2000). It is evident by the compulsive attitude
of being thinner (Garner, 2002) and an attitude of self-destruction is also present (Stein,
Lilenfeld, Wildman and Marcus, 2004).
Eating disorder, past and present
Young girls in developed countries are primarily affected with eating disorders. Persons
with anorexia are honest, do not disobey, and hide their inner feeling, tend to be good in
whatever they do and often excellent athletes. Research says that anorexia people eat less to gain
a sense of control over their lives. It is always easy to eat to one's heart content, but very hard to
stop eating even when the stomach demands more (Putterman, E., & Linden, W. 2004). The

4. Dimensions of Physical and Mental Health 4
disorder primarily affects young girls in the western society and usually has its onset in
adolescence. Hypotheses of an underlying psychological disturbance in young women with the
disorder include conflicts. Controlling their weight appears to offer two initial advantages: they
can take control of their bodies and gain approval from others. It eventually becomes clear
however, that they are out of control and dangerously thin. Lower self-esteem combined with
self-image which is negative are the typical characteristics of eating disorders, studies have
acknowledged that people with ED have dangerously low levels of self-image compared to
normal persons (Jhonson, Smith & Amer, 2001).
People with eating disorders may recover still they most of the time suffer residual
characteristics of this disorder like doubts about body image and weight (Button & Warren
2002). Some people with ED experience it for a short time while the other may suffer from it for
whole life. The outcome on ED research also has a number of problems, which are logical, like
using various outcome measures has been cited as one such explanation of the variability in the
rates of outcome found in ED (Calsen, 2004)
Literature Review
The general aims of the present thesis were to estimate the prevalence and incidence of
ED according to the DSM-IV in the general population of females (18-30 years), as well as risk
factors for the development of clinical ED across the ED diagnoses. There are at present no
perfect instruments for the assessment and evaluation of many complex psychological variables
(e.g., self-esteem and body concern). In fact, criticism can be raised against all instruments, since

5. Dimensions of Physical and Mental Health 5
the constructs they are intended to measure are so immensely complex, changing or even
controversial.
An Ecological Perspective of the Eating Disorder Phenomenon Since there has not been a
consensus between researchers pinpointing the etiology of eating disorders; I propose an
ecological model as the framework for which to examine this specific societal problem.
Sociocultural pressures are present in the family, through peers, and in the media. Such messages
manifest through relationships with other people. If we can increase awareness in families to
make them conscious of these sociocultural reinforcements, then we might be able to decrease
the problem of eating disorders (Fassino et al.2002).
It is, therefore, essential to understand that the adolescent woman and her family exist at
the center of an ecological model of eating disorders. With an ecological model, the individual
experiences her social environment in layers: first as a self, second through interaction with the
family, third though social interaction with institutions and peers, fourth with the media, and
finally with sociocultural norms and the ideology of her culture (Austin, 2000). Since the family
is the closest layer to the center (the individual), the family has the most potential to influence
eating attitudes and behaviors through its influence on development (Hoek, H. W., & van
Hoeken, D. 2003).
Parents have the most influence over their children’s behavior because they are the
“primary socializing agent” (Crowther, Kichler, Sherwood, & Kuhnert, 2002, p.149) of their
children’s behaviors. The family then is the first intervening variable in the development of

6. Dimensions of Physical and Mental Health 6
eating disorders. Applying a family systems perspective allows us to consider that “eating
disorders are not only an individual illness but also a „valid diagnoses of the family system‟”
(Prescott & Le Poire, 2002, p. 62). Families therefore have the potential to curb the problem of
eating pathology by channeling their children into activities that make them feel better about
their bodies and their capabilities. Also, parental connectedness and support, which includes
praise, encouragement, and physical affection, are indicators of adolescent adaptation and
positive development in youth (Corr PA, 2002).
While there are multiple risk factors for eating disorders reported in the literature, to date,
there have not been any conclusive results as to a direct cause and effect relationship of disorder
development. Thus, from the last five decades of research, risk factors have been named from
studies as “influences that increase the likelihood that disordered eating will occur” (McVey et
al., 2002, p. 76). The ecological model is useful when examining eating disorders because it
allows the researcher to move beyond exclusively blaming the media, peer influence,
sociocultural influence, or the family environment and helps the researcher examine the eating
disorder phenomenon more broadly.
Diagnosis and Clinical features
Women, from an early age, are challenged by the sociocultural messages about how
should the look, behave, although these messages are communicated through school or college
friends, workplace friends, family members, but it is through the mass media, especially the
electronic media which puts on the pressures and increases the chances of being not so satisfied

7. Dimensions of Physical and Mental Health 7
about their bodies which leads to negative effects, like anxiety about body image and weight
(Brambilla F. 2001). As these pressures are more on women than men hence the prevalence of
ED amongst them is high.
Eating disorders were a rare phenomenon when Gull reported it for the first time in 1873.
Eating disorder research has suffered in the past due to the problems of definitions of what
actually is eating disorder. Recently Fairburn and Walsh (2002) said that ED can be said to be ' a
persistent disturbance of eating behavior intended to lose weight, which significantly impairs
physical health or psychosocial functioning’. The refusal to have normal weight, or of obesity or
about body image are the characteristics of Anorexia nervosa which is of two different types, the
restricting type, when a person is not engaged in binge eating or diuretics' use and the purging
type, when a person engages is binge eating and uses diuretics. While Bulimia nervosa is about
recurrent episodes of binge eating. Binge eating is the consumption of excess food, hence person
suffering from bulimia nervosa self-induce vomiting, indulge in excessive exercise and use
laxatives. Bulimina nervosa is also of two types, the pruging type, when a person engages in
vomiting or uses laxatives and the non-purging type where the person indulges in excessive
exercise and is afraid about body image (Machado et al.2007).
Conclusion
There is a difference between anorexia nervosa and obesity, two different pathologies
with some mechanisms which appear to be the same. Obesity is an addiction like drug, where
food serves as the natural drug. While anorexia nervosa or ED is highly distractible, it has more

8. Dimensions of Physical and Mental Health 8
common anxiety disorder malfunctioning. Because anorexia nervosa is connected with the
functioning of the brain, hence there is greater need of such controls which reduces anxiety, like
relaxation, meditation and yoga.
References
Brambilla F. (2001) Social stress in anorexia nervosa a review of immunoendocrine relationship.
Physiology and Behavior 73:365-369.
Clausen, L. (2004) Time course of symptoms remission in eating disorders. International Journal
of Eating Disorders, 36(3), 296-306.
Corr PA (2002). J.A. Gray’s reinforcement sensitivity theory: tests of the joint subsystem
hypothesis of anxiety and impulsivity, Pers and Individ Diff. 33 511–532.
Fassino SP, Daga GA, Leombruni P, Mortara P, Rovera GG.(2002) Attentional biases and
frontal functioning in anorexia nervosa. International Journal of Eating Disorders 31,
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Garner. D.M. (2002) Easurement of eating disorder psychopathology. In C.G Fairhurn and K.D.
Brownell EEds) Eating disorders and Obseity. A comprehensive handbook (2nd ed pp.
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Hoek, H. W., & van Hoeken, D. (2003). Review of the prevalence and incidence of eating
disorders. International Journal of Eating Disorders, 34, 383-396
Jhonson, P., Smith, G.J., & Amner, G. (2001). The troubled self in women with severe eating
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Lask, B. (2000). Aeitiology. In B.Bryant-Waugh & Lask, R. (Eds), Anorexia Nervosa and
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Machado, P. P., Machado, B. C., Goncalves, S., & Hoek, H. W. (2007). The prevalence of eating
disorders not otherwise specified. International Journal of Eating Disorders, 40, 212-217

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Putterman, E., & Linden, W. (2004). Apperance versus health: does the reason for dieting affect
dieting behaviour? Journal of Behavioral Medicine, 27, 185- 204.
Smolak, L. (2004). Body image in children and adolescents: where do we go from here? Body
Image, 1, 15-28.
Stein, D., Lilenfeld, L.R., Wildman, P.C., & Marcus, M.D (2004). Attempted suicide and self
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Veumont, P.J.V (2002). Clinical presentation of anorexia nervosa and bulimia nervosa. In C.G.
Fairburn ^ CK.D. Brownell (Eds), Eating Disorders and Obesity, A Comprehensive
Handbook (2nd, ed, pp. 162-171), New York: The Guilford Press.
.

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Putterman, E., & Linden, W. (2004). Apperance versus health: does the reason for dieting affect
dieting behaviour? Journal of Behavioral Medicine, 27, 185- 204.
Smolak, L. (2004). Body image in children and adolescents: where do we go from here? Body
Image, 1, 15-28.
Stein, D., Lilenfeld, L.R., Wildman, P.C., & Marcus, M.D (2004). Attempted suicide and self
injury in patients diagnosed with eating disorders. Comprehensive Psychiatry, 45 (6),
447-451.
Veumont, P.J.V (2002). Clinical presentation of anorexia nervosa and bulimia nervosa. In C.G.
Fairburn ^ CK.D. Brownell (Eds), Eating Disorders and Obesity, A Comprehensive
Handbook (2nd, ed, pp. 162-171), New York: The Guilford Press.
.