How Anorexia and Bulimia Work

Anorexia and bulimia - those twin eating disorders that seem so common and maybe even just a phase for a teenage girl – are actually the deadliest mental illnesses in America. Cultivating an eating disorder can create issues that can last a lifetime.

Learn more about your ad-choices at https://www.iheartpodcastnetwork.com

See omnystudio.com/listener for privacy information.

Episode Transcript

Speaker 1 (00:01):
Welcome to Stuff you should know, a production of My
Heart Radios How Stuff Works. Hey, and welcome to the podcast.
I'm Josh Clark, and there's Charles w Chuck Bryant, there's
Jerry over there. Um, and it's just nice and pleasant,
isn't it? Chuck and Jerry? I mean it smells in here?

(00:25):
Is that what you're referencing? Yeah, gamey, I think, Yeah,
how about this. We won't say who was in here
just before us, but it was three men from our office.
And the room smells a little gamy, a little musky.
It's warm, and Jerry's headphones are hot, and her chair's

(00:45):
lot and she's so creeped out, yeah, getting a little sweaty. Yeah. So, um,
that's the last joke I'm gonna tell for this episode.
By the way. You know, every time we say that,
we end up like making jokes. So yeah, let's say it. Yes,
this is going to be a very serious episode and
there will be no jokes whatsoever. All right, hopefully we
can work in a funnier two that is clearly not

(01:06):
at anyone's expense. Yeah, yeah, I mean, it's gotta be organic,
it's gotta be good, it's gotta be worth it, I guess,
is what I'm trying to say, and about each other. Right. So, um,
we're talking today, Chuck about anorexia and bulimia, known in
the slang as anna and mia. Did you know that?

(01:27):
I did not know that. Yeah, And um, they are
actually very closely related eating disorders, so much so that
if you went to the big Book of Eating disorders,
the d s M five, and you said, ds M five,
tell me what is the difference between anna and mia,
the d s M five would just kind of shrug me, like,

(01:48):
I don't know, man, we we are, We're not a sure.
There are some big differences, but they are clearly connected
to some underlying degree. Yeah, I mean you know they
define anorexia as restrictive restrictive as in really restrictive, severely
limited intake of food. Um, and binging and purging, which

(02:11):
is if you don't know what that term is, that
means eating and then vomiting afterward, are using laxatives to
get that poop going really quickly. Uh. That is also
under anorexia in the d s M five. But that's
also binging and purging obviously characteristic of bolimia, which is
has its own categorytion, so categorization. So it's a little um,

(02:35):
I guess confusing is the best way to say it, right, right,
So I looked into a little more and it looks
like anorexia. Like you were saying, is is the hallmark
of it is calorie restriction. But apparently some people who
suffer from anorexia every once in a while binge and purge,
so it can include that. Okay, yes, but bolimia doesn't
necessarily involve any sort of even like weight component um,

(02:58):
and it doesn't ut any kind of calorie restriction. It
is strictly binging and purging. So you've got these two
different things, but they're both related in that your relationship
with food is just not healthy in any way, shape
or form. And the other thing that really kind of
ties the two things together is that they're based on
a disturbed body image where you look in the mirror

(03:21):
and what you see doesn't reflect reality at all. You
might see yourself as maybe normal if it's on a
good day, you probably more often than not see yourself
as overweight, fat, gross, disgusting, any number of horrible things
you can say about yourself, where if someone else is
looking at you, they would be like, Wow, this person
really needs to eat fast because they're emaciated their skin

(03:42):
and bones. But the aner and arexia patient or believe me,
a patient does not see that at all. And so
that kind of continues the cycle of either calorie restriction
or binging and purging. But they're they're both after the
same goal essentially, right and included. And we're going to
talk a lot about the symptoms and behaviors of people
that suffer from both of these. But a lot of

(04:05):
scale work. Weighing yourself a lot sometimes, you know, multiple
times during a day, obsessing over like you know, half
pounds I saw, like we're digital scales are really sort
of a culprit, and you know, obsessing over like a
tenth of a pound and eighth of a pound, um,
being really upset over the gaining of any weight, even

(04:28):
if it's just a half a pound, let's say. Uh.
And like you said, the language around food and body
and self image is really important, um, because this can
often be one of the early indicators or just an
indicator for friends and family if you listen to how
people talk, because a lot, you know, most of the
stuff is done behind closed doors, and one of the

(04:50):
big components, one of the sad components is is staying
in a lot and not eating out with people and
keeping all that very private. So the words are really
really important here, Yeah, because I mean, if you have
anorexia and you're engaging in like severe calorie restriction, you
know that doesn't just stop when you go out with friends.
It's like it is a part of you. I've seen

(05:11):
a uh described akin to a relationship, like a very
intense obsessive relationship where the patient and this disorder are
super tight. It's like their life, right. So if you're
out and you're hanging out with friends and trying to
appear normal, there's all sorts of stuff you have to
do to make it look like you've eaten, hiding food,
offering other people food, um, trying to make a big

(05:34):
deal about you know what you did eat, like really
showing everybody look I ate this. Um. Just just engaging
in kind of some obvious and bizarre behavior, and that's exhausting.
So it's kind of like what you said that ultimately
results in the person just withdrawing from social activities because
it's not worth like keeping up appearances. Yeah, and as
far as beliemia goes uh you know, intentionally vomiting after

(05:57):
a meal. Um. One of the hallmarks is excuse in
yourself very quickly after a meal. And that's if you
are over the social component you are actually eating out
with friends or family. Uh. And then those laxatives taking
you know, unhealthy doses of laxatives, laxatives to induce diarrhea
as quickly as possible, um, and some other stuff you know, uh,

(06:19):
trying to sweat off additional weight. Um. You know, wearing
like a plastic suit and sitting in a sauna, like
really extreme measures or just excessive exercise to try and
get rid of the extra weight. Right. So, so what
you have then is somebody who is convinced that they're overweight,

(06:39):
first of all, even when they're not, and secondly, is
obsessed with the idea of getting rid of that additional weight. Um.
And they do it by engaging in unhealthy behaviors with food.
And depending on how they do it, you've got anorexia
or you have bulimia. And UM. There's some symptoms, some
of which we kind of just went over, but some
are are kind of obvious. UM. Some are red flags. UM.

(07:02):
You know, like if somebody starts to become very thin
to where you can see their bones. Um, that's a
big sign that they have anorexia, but they you know,
you can have anorexia and not ever necessarily become emaciated. UM.
I think the diagnosis, as far as the American Psychological
Association is concerned, is if you if a patient comes

(07:25):
to you and they weigh fifteen percent less than their
normal weight for their heightened age, you would be able
to diagnose them with anorexia, or at the very least
you should start asking them questions about whether or not
they have anorexia. Yeah, and blieve me, is very complex too,
because there's not one pattern. It's not it's not always
just binge and purge every day, although it can mean

(07:47):
that sometimes if you suffer from bolimia, you will eat um.
You won't bench, You'll just eat normal meals and then
purge those. Uh. Sometimes you will restrict eating um, just
sort of as a rule. But then occasionally you will
binge and then purge, like eat you know, a huge
enormous meal, which you know bene eating is a is

(08:09):
a whole different eating disorder that you know. All of
these are sort of related and have some overlap, but
I think for this uh, this show, we're just gonna
kind of concentrate on anorexia and bolimia, right yeah, yeah,
benj any disorder. I think it deserves its own thing
because it's so prevalent and so many people have it

(08:30):
and don't even realize it, which I suspect has to
do with the food supply. I think we've been inadvertently,
um addicted to food. Um have you I told you
about that that book, The Dorrito Effect, right, yeah, yeah, Well,
like in the premise of it is that, like, to
feed this many people, we've had to basically create frankin

(08:51):
foods and to make them taste good, we've had to
use these different additives and artificial flavors and colors and
all this stuff. And the kind of idea behind it
is that in doing this, we've accidentally created these things
that are super addictive, and people have become addicted to
foodis is a very common thing. Whether it was intentional
or unintentional. At this point, it doesn't really matter. People

(09:15):
are just addicted to terrible food that's really bad for them. Yeah.
So as far as the symptoms go, you know, if
we talked about some of them. Uh, you know, the
obvious ones that you could as a friend or family
member maybe notice, as far as the exercise, not eating
in public and stuff like that, the preoccupation with weight.
But um physically, you know, you you can lead the

(09:37):
things like brittle hair, um, difficulty thinking, fainting and passing out. Uh.
And that's you know, stuff that people might notice in public. Uh.
Something that they may not see on the inside is anemia, uh,
chronic fatigue, constipation, um, slowed pulse. Uh. And then I

(09:58):
hadn't heard of this. The growth of fine hair on
the body that lanugo that the newborn babies is one
of the most adorable little things, this little on a baby. Yeah,
Supposedly there's some waxy substance that covers the baby in
the womb and prevents them from getting chapped and chafed
by the amniotic fluid, and that lanugo hair kind of

(10:22):
grows in like this, this kind of downy fine fur
that lets that waxy substance stick to the skin. And again,
if you if you become malnourished, it triggers lenugo to
grow like later on in life. Yeah, that's a that's
a big sign. Another one is um a manorrhea, which
is the absence of um menstruation or menstrual periods. Right,

(10:45):
And that used to be like even I knew that
as like a sixth grade boy or something back in
the eighties, like that was like a huge thing. If
if a girl didn't have a period, I meant she
had anorexia. And apparently the d s M five, the
latest version, said now we're going to take that up
because it's not the case without everybody like, yes, it
definitely can lead to that. And if you have a manorrhea,

(11:06):
there's a possibility it's from anorexia. But if you have anorexia,
it doesn't mean you're going to um stop having your period. Yeah,
absolutely um. And you know, I wonder how many like
fourteen year old girls listening to this we just lost
because I said period twice. Hopefully there hanging there is
exactly who should be listening to the show. And if

(11:29):
we're talking about girls and women more, uh, and we'll
get to the stats. They suffer from anorexi and believe
me in more than men do. But that is not
to say that men don't suffer from it, and they
absolutely do. Um. I mean I might as well go
with a few of these. Have some other statistics. I
found at least thirty million people of all ages and

(11:49):
genders suffer from eating disorder in the United States. And
that's all eating disorders. Every sixty two minutes, at least
one person dies as a direct result from an eating disord.
Um the A few of these are just so sad.
Eating disorders have the highest mortality rate of any mental
illness period. Thirteen percent of women over the age of

(12:13):
fifty engage in eating disorder behaviors. I saw three and
a half percent can have UM like or have a
diagnosable eating disorder three and a half over the age
of fifty or forty. And that that midlife eating disorder
thing is like a big and growing problem right now. Yeah,
I mean, well, you know, we talked about adolescents a

(12:35):
lot in here, but it's not something restricted to uh
two young people. Um, this one is super sad as well.
Six of transgender college students have reported and eating disorder.
Uh boy, these are so sad to read out loud.
Um of the risk for either one is genetic. Uh.

(12:56):
And we'll talk about the genetics of it a little
later too, And then more and half of bolimia patients
have comorbid anxiety disorders. Yeah, I saw that too. It
was like I saw something like fifty of people with
anorexia have I think anxiety, and like percent or something
of people with bolimia have have anxiety disorder. Yeah, anxiety disorders,

(13:21):
mood disorders, substance abuse disorders. It says usually alcohol. It's
one in ten boliemia patients. So it's just, you know,
these are the worst kind of statistics to read off,
but it's important to know that it's it's across the
gender spectrum, across the age spectrum. Uh. If you think
that it's just something teenage girls go through, that's just

(13:42):
not the case. Yeah, and not just teenage girls. For
a long time, it was a teenage white girl problem.
And they're starting to realize, like, no, this is it
was like you were saying, like it it spans ethnicities, genders, nationalities, ages,
it's it's a much bigger problem than than we used
to think. And I don't know if it's become a
bigger problem or if just under awareness and understanding of

(14:03):
it has grown or something like that. But did you
mention suicide. I don't think I did, so you were
saying that this is this is one of the reasons
we're talking about this um. Anorexia and bolimia are one
of the maybe the deadliest mental disorder there is as
far as statistics go, like you were saying, and one
of the big reasons is because so many people with

(14:25):
anorexia or blieve me to die by suicide something like
two hundred times at a two hundred times greater rate
than the general population. Says here, one in five of
anorexia deaths is by suicide. And then if it's not
by suicide, there's a host of other ways that you
can die from anorexia. You can simply starve to death,

(14:45):
where your your you um, your heart can stop, your
organs can shut down, and it's from this lack of
energy that you're putting into your body. Your your body's
organs start to um kind of slow down, to metabolize
more slowly, to kind of conserve what little energy they
do have, and eventually it just doesn't work any longer.

(15:07):
Your body stops basically, and you can die just from
not eating and not because there wasn't any food. There
was plenty of food and everyone who was around you
wanted you to eat, you just wouldn't do it because
you felt fat. Yeah, And I don't even think it's
a lot of times a matter of if. I mean,
if you don't get treated and you don't get help

(15:28):
and it gets bad enough, then you will die from
oregon failure at some point. Yes, But we have to
say we don't want to get all like horribly grim,
because there are studies that are coming out now that
are saying, actually, we've been studying these people for like
twenty five years, and we're finding that over the long haul,
you can cure anorexia for good. It just takes a while.

(15:50):
And it also, from what I've seen, takes a patient
who wants to be cured absolutely. Uh. And then one
more thing here, if we do need to talk about
puberty and adolescence because it can have really um long
lasting effects if that's the time of your life where
this is happening, long term effects on your development, um
on your growth. Uh. If you I think it says

(16:12):
if you have anorexia beginning at age ten all the
way through your twenties, you can have permanent stunted growth.
You can ever do sex secondary sexual characteristics like um,
your pubic care, won't grow in your breast won't develop. Uh.
And maybe a lack of menstruation from the beginning, not
like the cessation of menstruation, Like you may never get

(16:34):
your period right and you may be infertile as a
matter of fact as an adult. That's right. So yeah,
just because of the age that it's the um, the
age that it sets on, I guess, um, it's such
an important time for the development your body. It's like
the last time you should be like time, I'm just
not gonna eat for a couple of days. Yeah. Um.

(16:55):
It has some real sweeping effects for sure. Yeah. And
bulimia too, for for its part, UH is really rough
on the teeth, um, yellowing, decaying teeth, sensitive teeth, UH,
swollen sore throat, acid reflux like all the time. Um.
And then you know electrolyte imbalances being in the bathroom
a lot because you're you're you're tricking your body essentially

(17:18):
into thinking is getting some nutrition and then getting rid
of that food really quickly, and that nutrition really quickly. Uh.
And that can lead to you know, fainting, fatigue, and
eventually heart attacks and strokes. Serious stuff. Yeah, it is
extraordinarily serious stuff, and a lot of people are like, well,
it's just you know, this is how my daughter, my sister,

(17:38):
my friend likes to look. She likes to be skinny.
And this is a really persistent problem with dealing with
anorex he is that. Um, I've seen it multiple places.
It's not a lifestyle, it's a mental health disorder, and
it has to be treated because again, it is, statistically speaking,
the deadliest mental health disorder there is. Should we take

(17:58):
a break, Yes, we're gonna take a break, and we're
gonna come back with a whole list of jokes. That's right, Okay,

(18:28):
Chuck lay us the first joke on us. All right,
I have no jokes, although I will say, uh, I
think were it's time for a great sidebar. Um. You know,
we we got one of those uh home I'm not
gonna buzz market anyone, but one of those home units
that you speak to and it tells you the weather
and stuff, like one of those robots. Yeah, like a

(18:50):
little robot you put. I've been testing it out with
my daughter lately, and those robots that talk to you
can tell jokes. Did you know that? Yes? I did,
and they some of them are kind of funny, and
they're all kind of great for four year olds. Well
what you got, oh, I mean none of I mean
some Thanksgiving jokes around this time, and they I think

(19:11):
they try to be topical topical jokes. So there's like
Christmas and Thanksgiving jokes going on right now. But you're
not going to tell us one of the I'm trying
to remember some of them. I mean, trust me, they're
they're not great jokes for adults, but four year olds
eat it up. It's they're probably like deeply copyrighted too.
Maybe I don't know if you can copyright these kind
of dumb jokes. Thanksgiving joke, you're kidding me. It's like

(19:33):
what our country has founded on, all right, but writing Thanksgiving.
So that that's been going on at our house is
a lot of joke telling. And they can make Bourbon
noises and two noises and it's uh, I'm trying to
test the limits of how blue they can go. Remember
that little handheld box we had that would make different
like fart sounds and sharking sounds. So basically this is

(19:55):
what this is is a high tech kind of robot
butler that makes fart sounds. Yeah, it's great. Is it
on wheels? Now, it's not on wheels, it's it's it
sits on your nightstand or wherever you want it. I
got you, so all right, enough, enough fun and games. Yeah,
we should talk a little bit about the causes of anorexia,
because this is one of the more confounding. Um well,

(20:17):
I mean a lot of mental health disorders are confounding
in this way, actually, but we don't know the cause
of it. Um. It is probably a lot of causes. Um.
Some of them may conflict with one another, but it
is probably a very complex bag and mix of societal pressures,
which we're gonna talk about your environment, and then genetics

(20:39):
look like they do play a part. Yeah. They they
think that it's a this get this man, this is
what they call a grab bag catch all. That there
is a bio psycho social mechanism underlying anorexia and bolimia. Yeah,
it's biological, psychological, and social. And they're probably right. I mean,
there's probably components of all of them put together there,

(21:00):
which would explain why it's so hard to understand at
this point and so hard to treat. It's very tough
because it's not like you can point to one thing
and say, correct this part of your life, and uh yeah,
and it'll be better. It's like it's there's so many prongs.
It's really really tough. Yeah, absolutely, because let me think
about it, Like if you have a person who has

(21:21):
uh anorexia and they want to get better, but the
reason that they developed anna rixie in the first place
is because they have a parent who's on them about
their weight all the time. You have to correct the
parents behavior in addition to, you know, possibly treating the
patient in the hospital for malnourishment. Like, it is a
big complex ball of stuff, but there are there are

(21:43):
studies that have kind of turned up like little little
bits here. They're like, oh, here's a here's a little
a little I don't know, like a hot a matchbox
car or something. In a pile of rocks means what's
something you want? Like a diamond in the basically, Okay,
I haven't you ever found a match box kind of

(22:04):
pil of rocks. But like, I was really glad that
I found this. I thought it was just some dumb,
boring pile of rocks. I've never I had no idea
where you're going there. Well, but I'm glad, we gotta
laugh out of this. I was being serious. Oh sorry, um,
are you talking about the study the twin study, I'm
talking about all the studies. Okay, Well, they did do

(22:24):
a twin study, and they found as in studying human twins,
not two different studies that look alike. But uh, they
found that if and this is this is sort of
helps back up evidence of a genetic component. But if
one twin has anorexia, then they're identical twin, not fraternal
um um more likely to also have that same disorder. Right,

(22:50):
But not, like you said, among fraternal twins, because so
because I mean you'd think, like, you know, you see
identical twins and and think like what did your mother
do to you too? How? How could this be allowed
to go on? But if that's not the case with
fraternal twins, then that removes that environmental component, strongly suggests
that it's a genetic component. Yeah, and maybe to some

(23:11):
degree a social component. I mean not all the time,
but I would imagine fraternal twins are generally um subjected
to this or similar social components. Yes. The only thing
that would confound that is fraternal twins can also be
like like boy and girl So I mean if the
if they tossed out the boy and girl and just

(23:33):
had like fraternal twin girls or fraternal twin boys in study,
I would say that would strongly suggest it's a genetic component.
But I mean, in in any home, a boy and
a girl are going to be treating or a son
and a daughter is going to be treated differently. Is
just the way it is, unless you live in a
skinner box. Oh gosh, that that should lighten the mood, right,
unless you're dad shocks you for studies at home. Uh,

(23:56):
they did not have not found a gene they can pinpoint.
They have found thirty I'm sorry, forty three genes that
could potentially be of use when it comes to linking
genetics to these disorders, but they haven't. It's nothing is
very clear cut at this point. Right. So that's the
that's about as far as they've gotten on the biological component. UM.

(24:17):
As far as the psychological component, like you were saying,
they found there's a lot of comorbidity with other UM.
Other behavior disorders and personality disorders like depression, anxiety disorder,
obsessive compulsive disorder UM. They bear a lot of resemblance
to one another and that um, like with with anorexia

(24:40):
or bulimia, something called ritualized food behaviors develop where um,
you cut food into small pieces first to make it
seem like there's more or make it seem like you are,
um are like eating more than you actually are. But
the what makes it ritualizes you couldn't eat food any
their way, or you have to arrange food a certain

(25:03):
way on the plate before you eat it, or even
like religiously counting and tracking calories is considered a ritualized
food behavior, and it really kind of trapes is into
the realm of something like obsessive compulsive disorder or experience
the anxiety if you're forced to eat food on a
plate that's not arranged in the way that you're used to.
So the idea is that you eat one english pi

(25:25):
at a time, you are you are taking a lot
of bites and therefore, hey, look I'm eating a lot. Yeah,
that's kind of more deceptive behavior and that would probably
be like a two fer something. I mean self deceptive
even you know, sure, sure, but also deceptive like your
parents who might be watching you like a hawk or something.
You're like, no, no, exactly, really interesting. But if you

(25:46):
couldn't eat peas any other way but that then that
would be a ritualized food behavior. Right. Uh, this statistic
as far as meeting criteria for at least one other
mental health disorder, it's fifty of anorexia patients and for bolimia. Yeah,
that is really high. Yeah, and that's and you know,

(26:08):
that's what makes it weird that the two are so overlapped,
because so you've got anorexia nervosa and bolimia nervosa, and
again they each have their own separate entries in the
d s M. But then there's a kind of a
binge and purge bolimia component to anorexia. But the personality
disorders that are even the types of personalities that engage

(26:30):
in each one are really really different. Like with anorexia
nervosa UM, the patients are usually low novelty seeking, so
they're not like trying out new things. They have a
low emotional responsiveness, decreased pleasure, and reduce social spontaneity. That's
typical someone with anorexia nervosa. With bolimia nervosa, it's like

(26:51):
kind of the opposite. They tend to be impulsive, they
look for new experiences, and they can have characteristics of
a borderline personality disorder from whatever read So they're like
two totally different types of people but engage in the
same behavior. And it's one of those things where it's like, Okay,
if you have two different types of people who are
trying to do the same thing or trying to achieve
the same end, what you know, what commonalities do they have?

(27:15):
In exploring those commonalities, maybe we'll find like the answers
to what causes eating disorders like this. Yeah, it's interesting.
I mean it does make a little bit of sense
when you look at the you know, like someone suffering
from anorexia would avoid going out to eat spontaneously with friends,
let's say at all costs. Someone with bulimia might jump

(27:39):
right in there because in their mind they they may
think that they have a solve for that behavior, which
is I'll excuse myself to the bathroom right afterward, and
I can still go out with my friends and eat
a regular sized meal. I think that's a really good point.
So either way that the regardless of how that person
is personality wise, they're going to age in trying to

(28:02):
maintain their weight. But depending on their type of personality,
they're going to choose this route or that route. Yeah, yeah,
I think I think you're onto something. Dr Chuck. Well,
the other thing too, is with these personality traits, they
found correlation with things like perfectionism, irritability, and like you
were talking about this, sometimes being impulse over, sometimes the opposite.

(28:23):
But what they found too is, uh, you know, if
you're studying adolescence in puberty, a lot of these are
normal traits of adolescence, so it's really hard to distinguish
sometimes and a lot of times these things it's a
chicken or the egg, these are caused by the eating
disorder and not the other way around. Yeah. That also
applies to differences in brain structure too, Like they found

(28:45):
things like um reduction in the gray matter and the
white matter in the brain of people with one of
the nervosas or um they have more cerebral spinal fluid,
and then other regions of the brain are smaller compared
to people who don't have disorders, but they clear up
when the um anorexia is successfully treated. Yeah, so that's

(29:07):
it's kind of it really makes you wonder like where,
you know, did it cause it or its like it doesn't.
It doesn't prove or disprove it either way. It's just
the two are related and we're not sure which causes which. Yeah.
I thought this F m R I stuff was interesting
because you know, our motto went in doubt, go into
the wonder machine and see what's lighting up. Be very instructive.

(29:30):
And they did the longest motto, every t you can
fit on the front end, back of a T shirt,
not a hat, kind of peters out down the bottom,
that's right. Uh. And then the script just you know,
like a pen like you fall asleep all writings, right, yeah, right,
So the F m R I Wonder machine has found that, uh,

(29:52):
it lights up those reward centers in the brain show
increased activity. Um, if you have intorexy and you're shown
photos of someone who is drastically underweight, So that's a
pretty obvious you know sign right there. Another one is
noticing fine details when you are shown a picture of

(30:12):
your own face, that that reward response is just lighting
up the reward center. So that that means that they
are are hyper um aware of their appearance at all
times for sure, and like they noticed things that might
not even be there, right Um. And then finally you
get to the social part of the biopsychosocial components. UM

(30:37):
and that's the environmental factors. And one of the big
ones that has kind of emerged is the idea of
sexual abuse in creating antirects the universear starting it in
in UM people. I saw that. I think John's Hawkins
said sexual abuse has been reported in twenty of individuals
with antorexts inniversa and bolimia innivosa, right, um, And it

(31:01):
doesn't necessarily have to just be sexual abuse, but there
is a consistent UM reporting of some sort of trigger.
Like the people who have bolimia and anorexia typically can
point to the moment that it started or the thing
that created this idea in their mind. It could be
apparent being overly critical of their weight. It oftentimes as

(31:24):
a parent, I think, yeah, it could be a coach
who is overly critical of their weight. Um. It can
be a bully teasing them about their way. It could
be a friend making a joke about their way. It
just depends on the moment, you know how, like how
something can bother you but it doesn't seem to bother
anybody else um and vice versa. You know something that
bothers someone else. You're like, that's not that big of

(31:45):
a deal. But it's all just based on the person,
in the context, in the setting, and maybe even just
that perfect combination of neurotransmitters that happened to be active
in their brain right then then just something got them
just right that has been on to kickstart an xi
and bolimia under a lot of circumstances. Yeah, and it's
just for parents. It's so important how they talk about

(32:09):
UH and not just to their kids, but any time
your kid can hear you speaking words, how you talk
about weight, and how you talk about your own body,
and how you talk about health and um, you know,
having a kid now, it's just it's made me realize
how unkind I can be to my own self being overweight,

(32:30):
and you you can't say those things in front of
a four year old. You have to talk about um
health and you know, daddy's exercising because daddy wants to
be healthier and stuff like that, because you'd be surprised
that you know, these little ears they hear it all.
And um, the last thing that you want is for

(32:51):
anything that you say to be UH two to have
an impact on your child, uh in an unhealthy way
about their body image. You know, it's just super super important,
and I think it's gotten much much better than than
the old days when you know, I know a lot
of women who talk about, you know, whether or not
they suffered from anorexi or not, uh, struggling with their

(33:14):
body image because um, most of the time mom talking
about it growing up. I'm sure Dad's played part two.
But I've heard a lot of anecdotal examples of women
talking about in this, you know, in the seventies, mom
talking about, you know, you can't eat this, you can't
eat that because you won't get a boyfriend, or this
won't happen or that won't happen, right, and um, that's yeah.

(33:38):
I've seen that a lot of places too for researching this.
But one of the other things I saw is like
what you were saying where you were talking about yourself.
You have to watch what you say around your daughter.
When you say disparaging things about your yourself, that's called
fat talk. And it is like a pastime in the West,
were like getting getting together with friends or just having

(33:58):
a couple of conver station around the water cooler or
something about how fat you are or how much you
ate and how much you you need to lose weight,
and that they found it can actually be a real
driver for leading to um eating disorders as well. Yeah,
I mean I make jokes all the time about that
with you and everyone I know, but I don't use
that word in my house. Uh. I have to stop

(34:21):
myself from making jokes about myself. It's just it's no
good for anyone. Know. One question I have though, is
like I was a pretty like husky boy. You were robust.
I was very like I had the Pillsbury doughboy nickname,
and like I mean like I was the fat in
class for sure, And uh it bothered me, like really

(34:41):
set the tone of my childhood in a lot of ways.
Like I had a really great childhood and I loved it,
but I also had like a real bummer childhood in
that sense too. Um But like, what do you do
when your kid is demonstrably overweight and needs to lose
weight or else they're going to spend the rest of
their life uggling with their weight, which is not fun

(35:02):
at all? Like what do you do? How do you
approach the little fragile ego of a kid and saying
we need to get some weight off you, you know,
without leading them down this path to an eating disorder.
That's got to be one of the trickiest things you
you would ever have to to talk about with your
kid in that in that situation. Yeah, and and also

(35:23):
especially now in a day where there's such a movement
to be accepting of who you are, no matter how
what size you are. Um, it's just such a fine
line to walk between good health and accepting who you are. Like,
I don't necessarily have a super poor self image, but
I want to be alive in thirty years for my daughter,
you know, right, sure, like the vanity is kind of

(35:45):
gone at this point. I'm for but I want to
be healthy. Uh and and those you know, a healthy
weight goes hand in hand with not having the stroke
in the heart attack later on exactly. But I think
a lot of people would say, like, Okay, yes, there
is health to be gained from eating better or from
exercising or doing both ideally. Um, but one of the

(36:08):
problems that we have is this ideal where it's like, well,
keep going until you have washboard abs, and until you
have like these amazing biceps, and until you just want
to do nothing but walk around in nospedo or something
like that. And the fact that like those are the
models that we see on the billboards, that drives even
that idea of health, healthiness to this kind of perverted,

(36:29):
weird place that can kind of develop eating disorders as well. Yeah,
that's not me. I have no illusions about ever having
a washboard stomach. I've given up on this. I don't
want a washboard's stomach. I want to want to see,
just to see what it's like, and then I'd be like,
all right, give me a donna. I like a little

(36:49):
softness to a body. It's nicer I hug on and
lay around with. I don't want I do too. I mean,
Emily didn't want to put her head down on a
washboard stomach, right, she doesn't want to bounce a nickel
off of the No, So I want I want to
see what it would look like on me, and then
that'd be fine. I mean, that's it. I don't really

(37:11):
have like any it's not my ideal look or anything
like that. I just want to see if I could
ever do it. Yeah, I just I just need to
get healthier and drop some weight and you know, feel
a little bit better day to day, like moving around
the world, because it has an impact on that stuff too.
That's the key is feeling better day to day, feeling
good in your clothes, feeling to the point where you're
not thinking about what you're eating or how much you're

(37:32):
exercising because you're getting enough. That's the key right there,
that's the goal. Yeah, So let's talk about social pressure
because that's kind of we're right in the middle of it.
Um well, actually, let's take a break. Okay, I'm gonna
go do some crunches, right, I'm gonna hold your feet down,
and we're gonna we're gonna talk about social pressure right
for this, So Chuck, those were pretty good. Crunches bad,

(38:19):
not bad at all. I'm gonna go with a B plus.
You know I started seeing a trainer, did you really? Yeah,
well that's pretty cool, man. I didn't know that. So,
like about a month then like like kind of cool
and supportive or like drill instructor type, like army. Well
she has former army funny enough, but she is cool
and supportive and more than anything, it's just like I

(38:39):
gotta show up at her house three days a week
and do it and I can't. You know, I can't
not do it. And that's I am one person who
will not do it if given any opportunity to not
do it. Yeah, it's so easy to just shirk on
that kind of stuff and just you know, there's always
reasons to not go or not do it or whatever.
But if you have somebody there then like, you know,

(39:00):
motivating you, that definitely helps. YEA, Thanks, good for you, man.
Thanks dude. It's she's killing me, she's kicking my butt,
but it's it's what I need right now. So one
of those two, admittedly throwing it out there, I'll give
you a number. Michelle, She's great. So, uh, social pressures
we're talking about, Uh, you know, this is from a

(39:21):
Western point of view here in the United States, uh, Canada,
some places in Europe, although that can vary pretty pretty
greatly on how they look at their bodies there, but
definitely in the United States, our culture has demonstrably said
loud and clear thin as in, you've got to be skinny,

(39:43):
whether it's TV or advertising or Instagram now or YouTube. Um,
it's starting to change a little bit more because there's
there's another whole wave that I was talking about about
accepting your accepting yourself and being happy with whatever side
you are. But that still can't counter the onslaught that
has happened for decades and decades in this country. No,

(40:06):
but it is gratifying to see it changing over time,
Like you see like plus size models everywhere, like they
don't there's not like some big right up in people
about how this daring um company clothing company used to
plus size modeling, where it's just become a normal thing. Yes,
it's becoming normalized. I think that's a big, big component
because a lot of people point to the mass media

(40:27):
in the West as the main driver for eating disorders
because they say this is the ideal weight, body mass index, UM,
body fat percentage, go attained to this, do whatever you
need to do to get here, and if you don't,
you're an ug face. Right. What I think is super
interesting about this um because everyone knows that it's like yeah, sure,

(40:50):
ads and models and and Instagram like that's that's stuff
you should know, chump change. But what's really interesting is
I mean, you know, we're not enlightening anyone as to
that's not breaking news. Oh, I got what you meant,
But uh, what's really interesting to me is to look
at all, right, if it is media, what about pre television,

(41:14):
like has this stuff increased? Or what about non Western cultures?
What about if someone were to move over here from
another country where Antorexi isn't very prevalent um, how would
they change? And it appears that that does have an impact.
It does, but not like h Night and Day kind
of thing like you expect, Like the studies aren't just

(41:36):
backing one another up left and right to where yes,
it's the mass media, and that doesn't necessarily mean it's
not the mass media. It just means that they haven't
figured out how to control for all these confounding factors
that also come along with something like moving to the
US as an immigrant um and all the things that
that come along with it in addition to being exposed

(41:57):
to Western mass media. Or you know what else changed
over time? Well, we got richer, food, got cheaper, junk
food became more abundant. Maybe that has something to do
with it and not just you know this this growing
of mass media in the middle to late twentieth century.
So there's a lot of studies that do say, yes,
there does seem to be a correlation, just there's never
been a smoking gun. It's like the same thing with

(42:19):
violence in in media or sex in media. Like the
the idea that the media just has no effect on
us whatsoever is is ridiculous to me. But I also
suspect it doesn't have quite the pronounced effect on us
that we like to think or just assume. Yeah, they're
like you said, they're just so many factors you can't
UM control all of them. But there are a couple

(42:40):
of interesting findings. This one study, they found a rate
of eating disorders UH in places like Iran, Singapore, and
Japan UM increased among women who were exposed to Western culture,
either by being there for a little while or living
there for a little while, even if it was just
a vacation, or through media. And another one found that

(43:00):
UM women who were at least one generation removed from
immigration into Canada thought about dieting more than women who
were immigrants themselves. Yeah, and and dieting behavior is UM
a very Western thing, and it's starting to spread elsewhere.
Like there's countries like Egypt and Iran and Japan and
China UM where they're studying to notice eating disorders UM

(43:22):
that are they're considered non Western cultures. But there again
they're like, well, has the Western media kind of infiltrated
those spaces more or is it people who have spent
time in the West who are now coming back home
and they've developed a neating disorder? What is it exactly?
But there's a really big point to this that I
think is easily overlooked. Is if if it is the

(43:44):
Western media and it is something like saying, here's this
ideal body image, get to it. However, you have to
a lot of people in the West engage in diets
and basically everybody in the West is exposed to that media.
And yet less than five percent of people in the
United States will ever develop an eating disorder in their lifetime.

(44:07):
Why isn't it more prevalent if it's just the media
or just trying to diet? You know, what is it
that makes that extra step? And that, I think is
where that um bio psycho component comes into the biopsychosocial thing.
I think it's just kind of like a triple whammy
that gets some people just right who may be genetically predisposed,

(44:28):
who who maybe um psychologically predisposed, and then the right
combination of social factors all converge to make somebody develop
an orrexa or bolimia. Yeah, if you're an athlete, Um,
this is interesting because you can have medical complications as
an athlete who has to drop weight. Um. Either you know,
some some sports you you have to have a lower weight,

(44:50):
like if you're a dancer or a jockey or a
gymnast or something like that. Other times, like if you're
a wrestler you have to make a certain weight or
a boxer a weight class. And this is not the
same thing. I mean that it can be unhealthy weight loss.
It's not the same thing necessarily as anorexia. But it
looks like that could be a trigger for uh, anorexia,

(45:11):
you know, after you stop your athletic career. Yeah, it's
like that part in um, what was that that Channing
Tatum Steve Carell movie set in the eighties where he's
the wrestler. Oh yeah, the Fox whatever Yeah, Fox Hawk
or something like that. Anyway, where that part where he
loses a match and he goes and just binges, and

(45:33):
I think his brother comes up and makes him like
throw up because he's gotta keep wrestling and he needs
to make that that class, that weight class. So the
idea that that some people who engage in these sports
kind of internalize that idea and that behavior and can
become anorexic or um belimic. Uh. That like that just

(45:55):
kind of makes uttering complete sense. Yeah, same with the
army too, or not just the army, but the military
where they have you know, weigh ends and fitness benchmarks.
If you miss those, you're in big trouble. So people
will engage in this this kind of eating disorder like behavior,
but they don't necessarily develop in eating disorder, although some
people go on to do just that. Yeah, it says

(46:17):
there's this there's one study that found enrolling in the
military led to an increase and eating disorders. Yeah, it's interesting,
um and true stuff. He should know. Fashion. We'll talk
about history here at the end, because I think all
the other stuff was probably more important than the history
and who first named it, but we like to cover
our bases. And Anorexia nervosa was named by Sir William Gull.

(46:42):
He was Queen Victoria's doctor, and he published a paper
and this was, well, you're just walking my past, like
one of the most interesting facts of the podcast. You
like that fact? Yes, you take it man, I was
being so generous. Oh, thank you, sir. He uh he
Sir William Gull is one of the dudes who they

(47:04):
all right, you think this is interesting? Fine? He may
or may not have been Jack the Ripper. Yes, this
guy who coined the term anorexia, was one of the
first to to describe it in a scientific paper, is
also one of the one of the people that is
liked for Jack the Ripper. Yeah, you just said it again.

(47:25):
So why did I even bother because you didn't You
didn't enjoy it enough, you didn't relish it enough. Okay,
I got you. So Jack the Ripper published a paper,
uh in eighteen seventy three, and this is after treating
young women who, by all appearances had anorexia what we
now know is anorexia, right, And you could tell it

(47:45):
was he was Jack the Ripper because the paper started
dear boss, how long have you been sitting on that one, buddy?
That just came up right now? Yeah? Why does this
say dear boss on your paper? So? Uh? He had
drawings in there. Um, eventually he had photos in there
before and after treatments, and um, just like us today,

(48:09):
he was uncertain about the nature of the disorder to
begin with. Um, what we do know historically is the
nineteen seventies here in America is where it really kind
of became a big thing. And thanks to a couple
of things. In nineteen seventy eight, there was a very
popular book published by Hilda Brutsch, the Golden Cage Colon

(48:31):
the Enigma of Anorexia Nervosa and obviously and super sad Um.
Karen Carpenter was the face of anorexia in America, and
America got to see her struggle off and on with
this for years until she died from complications from anorex
in nine eight three. Yeah, she died basically from oregon

(48:55):
failure from drinking too much ipecac over the course of
her life. It was a big deal in the United States.
I mean that really put it on the map in
a big, big way. Yeah. So there is like, if
there's a silver lining to the death of Karen Carpenter,
and there are very few of those. And if you're
too young to know who Karen Carpenters, do yourself a
favor and go look up the Carpenters right now and
have fun listening to that. Yeah. But ipocac is an

(49:17):
a medic, which means you drink it and it makes
you throw up. And for the twentieth century, maybe even
the nineteenth century, to doctors recommended parents keep that stuff
around their house. So if they're dumb little kid, you know,
rat poison under the sink, you've give them some ipocactu
they throw it up in their life would be safe. Well,
they started to realize, especially after Karen Carpenter, that this
epocac serve was being abused by UM and XIA patients

(49:41):
and believe me, A patients all over the US. And
they apparently called for a band on over the counter
sales of ipocac, and that directly came from Karen Carpenter's death.
But I didn't see that it actually ever went through.
Oh really, Yeah, as as recently as two thousand three
they were calling for a ban on non prescription epocac sales.

(50:03):
And unless over the counter and non prescription are not
the same thing, then no, they didn't get it pushed through.
Can you buy it today? Do you know at all? Yeah?
I mean I believe at the very least you could
get it from a pharmacist, but I think you might
be able to still buy it in a in a
drug store. I'm not sure. I haven't tried, and this

(50:24):
was two thousand three, but I didn't see anything about
it actually being banned. Well, I just really quickly as
you can see here two thousand eight as an article
called epochac the most dangerous over the counter drug. So um. Interesting. Yeah,
so they've basically just in to that tarnished Karen Carpenter's memory.

(50:45):
So treatment is tough because, like we said, there are
so many prongs, um, and we don't want to be
down on it, because you can overcome this. But the
obviously the end goal is is multi pronged as well.
What obviously you want just physically is um to eat
healthily again, um. But another big part of that is

(51:07):
to feel better about yourself and to have a better
self image and to overcome this mental illness that's the
underlying cause of these physical symptoms. Yeah. UM, if you
have a friend or a loved one or somebody you
care about that has anorexia UM or bulimia UM, one
of the things you can do is just be supportive

(51:29):
and non judgmental in the hopes of, like you were saying,
kind of help build their self esteem because it is
definitely a crisis of self esteem is a big component
of it. But what you don't want to do is
make them feel bad or shameful for not eating. Um.
You don't want to focus on the food because it's
really not the food. The food is almost like a
convenient UM. Basically, the food is the one thing that, say,

(51:54):
a teenage girl can control in her life in some
cases how much she eats or doesn't eat, and this
becomes manifested in interacts the nervosa. So the idea that
that no, just eat the food. What's your problem with food?
It really doesn't have much to do with the food.
The food is just this um kind of red herring
in the whole thing. Yeah, the food is almost like
the drug, except the ideas to not take the drug.

(52:18):
If that makes any sense. It does not. I thought
that was making sense as it was coming out of
my mouth. I started to realize it didn't. Right up
to the end. Uh, treating it is can be done
on an outpatient basis. UM. They have high calorie supplements,
dietary recommendations. Obviously, UM, if you have serious medical complications,

(52:39):
you might have to have a hospital stay. But they
have shown that just putting someone in the hospital has
no improvement on the outcome of their mental health. Like
you've you've really have to attack it from all angles. Yeah,
and that's a big problem too. Is like when you
have a medical like medical issues like a low pulse
UM and you you are say emaciated, like they're going

(53:02):
to take you the hospital, and the doctors are not
necessarily psychologists or psychiatrists. Their doctors who are going to
try to treat your emaciation or treat your low pulse UM.
And that's good, you need that kind of treatment, but
it doesn't actually heal the anorexia at all. UM. So
there has to be a multi pronged approach. And in particular,

(53:23):
if you do need to be nourished, like you're at
death store because you haven't eaten and too long and
your body has become malnourished in your organs are starting
to fail um, you have to go to a specialist
in this because I think we talked about in the
Angus Barbieri short stuff the idea of refeeding syndrome, where
if you introduce nutrients too quickly to somebody who hasn't

(53:45):
eaten in too long, they can die basically from overdosing
on nutrients. So you have to go to a specialist
in in refeeding. It's not just something that anybody can do.
The ideally you will catch this long before you could
die from refeeding syndrome or anything like that. But it is,
it is. It is a concern in an issue that
you would want to go to a specialist physician for refeating. Yeah,

(54:07):
and it's um we were talking about parents earlier too.
It's also interesting that early on Gull and this continued
for a while, UM felt that you know, the parents
were could be a big part of the problem in
this negative influence, especially if like it's all of a
sudden it is being treated and parents like, you know,
you need to eat and need to eat this, you
need to eat that. Uh. And so they would they

(54:29):
would move kids out of the home in order to
treat them more successfully because a lot of times the
parents were contributing to the the whole cause. And to
begin with, you know, yep, they would call that a
parent ectomy. Oh really, yeah, that's what Goal called it. UM.
And so that's like one theory of treatment that the

(54:49):
parents are the problem and you need to get the
kid away from the parents, not not like get them
into foster care or anything like that, but more that
the the kids are are being oppressed in some wave
by the parents. And Hilda Brooke b r U c H.
I'm going with Brooke, Um, yeah, the one who wrote
who wrote The Golden Cage. She concluded that the reason

(55:12):
for anorexia was that the teenagers were afraid of becoming teenagers,
that they just pleased the adults in their parents their
whole life, and they were afraid to kind of venture
out on their own. Um. And so this was some
means of control. Maybe I'm not sure, but it definitely
goes in with that paran ectomy thing where if you
take the kid out and um teach them to take

(55:34):
on this disorder on their own, it can really boost
their self esteem quite a bit and potentially cure anorexia.
As it is, that's one theory. There's another that basically
is the opposite. It says, hey, family, let's let's get
together and help this. That's right, it's like a family therapy.
It's it's the Maudsley method. And this was based on
the work of psychiatrist named Salvador, not Maudsley. Salvador uh, Menuchin. Yes,

(56:02):
it's not the Manuchian method, though no one knows who
Monsley is. Maybe that was his hotel pseudonym maybe. But
this is like you said this, and this makes a
lot of sense to like getting the whole family in there,
because uh, if you go to therapy as a family
or as metallica, uh, it's gonna it's gonna bear fruit
most likely because especially with something like Interrexi and bolimia,

(56:26):
that's there may be a lot of tendrils throughout your
family that is, uh is potentially causing some of this
to begin with. So get mom and dad in there,
get brothers and sisters in there, and and I'll talk
it out. It will probably help everyone involved. Get weird
uncle al in there, oh no, never, just keep him
at Thanksgiving and keep them quiet. But one of the

(56:47):
things I saw about that family method is one of
the techniques to use is called externalizing, where they're saying
where they basically say, you have an interloper in your
family known as this eating disorder, and need to come
together as a family to get this eating disorder out
of your family. You like, you guys, gang up as
a family against the eating disorder, not against the person

(57:08):
with the eating disorder or against one another, getting up
on the eating disorder and support the person with it
to help him right, Which is great. And like we said,
you can recover from an eating disorder. JOHNS. Hopkins says
that fifty to seventy five of patients with anorexia or
bulimia will eventually recover. It's a lot. It's a really

(57:32):
great recovery rate for what is ultimately, um a chronic
mental disorder. Yeah, and can we shout out a website here? Yeah,
there is a website called alsana dot com and it
is an eating disorder Helpline of all stripes. So anorexia, bulimia, UM,

(57:53):
I imagine bench eating, any kind of eating disorders. You
can call eight eight eight eight to two eight nine
three eight at any time and someone is going to
be there and try and help you out. And you
know we talked about all the time, just that first
step super crucial. Yep, good job, thanks you too. Uh. Well,

(58:14):
if you want to know more about eating disorders like
an rexia or bulimia, you can go to where Chuck
just sent you, or you pick up the phone and
call and uh you can also just hold tight and
wait for listener mail, which is coming right now. That's right,
And yeah, we we should mention there are there are many, many,
many helplines and many organizations. But again, everything I've seen

(58:35):
is if you suspect that your friend or loved wine
or sister or son or daughter has a eating disorder,
like you need to confront it. They don't just clear
up on their own. And it's not just a lifestyle choice. Yeah,
that's right. The National Eating Disorder Helpline is another one
E two to seven. N's to put that in our
in our slogan or motto on the T shirt. Well,

(58:58):
how about this, UH have a great listener mail today.
So let's just encourage everyone to look out for their
friends and family. And if you have someone in your
family that you think may be suffering from one of
these disorders, then UH reach out to them with compassion.
And if you have one of these disorders, call one
of those numbers and just take that first step toward

(59:19):
getting some help. Yeah, very nice, Chuck, Thanks. I think
that was even better than any listener mail. Of course,
I've heard a lot of listener mail. Anything is better
than listener mail. Tops. We're just kidding. We love listener
mail And if you want to get in touch with us,
you can go onto stuff you Should Know dot com
and we've got all our social links hanging out around there,
and you can also send us a good old fashioned email,

(59:40):
wrap it up, spank it on the bottom, and send
it off to stuff podcast at iHeart radio dot com.
Stuff you Should Know is a production of iHeart Radios.
How stuff works for more podcasts for my heart Radio
because at the iHeart Radio app, Apple Podcasts, or wherever
you listen to your favorite shows,