fear of gaining weight in anorexia: an optional symptom?

Sometimes symptoms we think are the central, causative symptoms of a disorder aren’t. For example, in big chunks of the Western world, anorexia involves a distorted body image and the fear of becoming fat. But in Ghana and China you see anorexia without distorted body image, without the fear of becoming fat – and instead with religious beliefs driving the restricted food intake[1][2]

This is one of many awesome things about culturally informed research: it can help point out the deeper, broader phenomenon that we’re seeing different facets of in different cultural circumstances. In this case, the theory is that most symptoms of anorexia are triggered, in susceptible people, by dropping below a certain body weight. But not all susceptible people are going to drop below their trigger body weight – just the ones who are sufficiently obsessed with body weight (in cultures that encourage that) or religion (in cultures that encourage that) or whatever.

Anyway, what it turns out looking like is: some people have a tendency to severely restrict calories and exercise a whole lot if their weight drops below a certain (unhealthy) point. Does that not sound totally stupid? Well, it does in the Western world and China and Ghana. But if you’re in and environment like Africa in the Pleistocene era, and the middle of a famine, getting a lot of exercise by migrating would be a very good idea, and not settling down and eating while you’re supposed to be migrating is also a good idea.

For reasons I’ll go into later, this is both a very good explanation and an inadequate one (in addition to being an explanation I’ve misplaced the cite for, but I will try to remedy that if I bring it up again). In the meantime I’ll just say that a phenomenon that was at least a little bit valuable for someone or their kind in an evolutionary environment can be severely detrimental to someone in a modern environment (as anorexia is theorized to be). Saying something served a purpose in a past context does not mean there is anything desirable or preservation-worthy about it outside of that context.

Edit: Found the cite I misplaced!  It was a talk Shan Guisinger gave at the Human Behavior and Evolution Society conference in 2004.  The American Psychological Association published an <a href=”http://www.apa.org/monitor/apr04/anorexia.html”>article</a&gt; on her <a href=”http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=14599241&dopt=Abstract”>2003 article</a>.

^1: Bennett, Sharpe, Freeman, & Carson, 2004 for Ghana; Lee, 1995 for China.

^2: Thanks to Michael for writing me the script for footnoting!


12 Responses to fear of gaining weight in anorexia: an optional symptom?

  1. Michael says:

    Another important source of information is when you intervene in a feedback loop at a counterintuitive point. A lot of what you’re describing also came up in the Minnesota Starvation Experiment. In the mid-40s, the US government decided that wartime shortages and famines in Europe necessitated a body of empirical knowledge about what happens when people starve, and what the best way to renourish them is. So they took some strapping young Quaker and Mennonite lads (who volunteered, because they wanted to serve but were forbidden to engage in combat) and fed them a starvation diet for most of a year, while they continued to do hard manual labor (like back on the farm).

    The crazy part is that these psychologically normal, fully masculine men, started acting like 21st-century anorexic girls. They began obsessing over food, and (if I’m recalling this correctly) some of them even started worrying about their weight and thinking they were fat. And, of course, they became very prone to binging when the starvation period ended.

    So, yes. It seems like starting to starve might trigger the slide into anorexia. That would also explain why women who start with the goal of looking thin and sexy end up starving themselves even when they’ve left sexy far behind and now look like concentration camp victims.

    Do you know if any of the same findings have arisen in people who lose weight due to cachexia or digestive problems?

  2. Michael says:

    Regarding the evolutionary reading, you might be making an error when you say “it was useful back then, but not today.” It could be that anorexia as we know it is an overextreme, pathological version of some trait that was once useful (I know you know this, but I’m saying it for the benefit of the audience). Kind of like the way that men like big breasts, and so evolution selects for women with big breasts, but that means that once in a while all the genes will line up and you’ll get someone who has triple H-cup bosoms and can’t walk upright. No one wanted that.

    What intrigues me is that if anorexia _is_ the form of the behavior that was once useful, then there should be an off switch — something that tells the person that things have changed and it’s time to stop starving. If this theory is true, then we should instruct people with anorexia to walk many miles each day, through the forest if possible. After a couple of weeks, we should arrange for them to emerge into a clearing filled with ripe fruit trees and fat bison, where all their friends throw them a party and declare “yes! This is a fertile land and we will thrive!”

  3. Michael says:

    Also, you’re welcome! It wasn’t until I saw you using the footnote script here that I realized it would break if you used it in more than one post on the same page, but fortunately you didn’t do that, and now I’ve fixed it, and you’ll never know.

  4. Michael says:

    That’s really odd! I clicked one of the footnote links in a syndicated copy of your post, and wound up here! That shouldn’t happen, because I used relative links that should just move you around whatever page they happen to be on. Something in the RSS software must be thinking it’s terribly clever, and turning all the relative links into absolute ones so that syndication won’t muck up links internal to your blog. Anyway, it should have no effect on anything.

  5. resonance says:

    1. Thanks for mentioning that study, and I don’t know about the cachexia or digestive problems but that’s a very good question;

    2. Very good point about the labeled disorder maybe being the part of the distribution that’s pathological, although I would still guess that if the evolutionary theory is accurate, the same point would still be more pathological today than than. And about the party although to make it they might need to believe that it really was about famine/migration first;

    3. Oh good;

    4. They’re definitely still relative links in the code. I’ll take a look at the css later. Thanks for letting me know.

  6. Michael says:

    In order for it to have been less pathological in the past, it would need to have either brought some reproductive benefit to the individual, or had something that stopped it from killing them. Since anorexia kills your sex hormones (and leaves you in no shape to carry a baby anyway), reproductive benefit isn’t likely. (Dev Singh has hypothesized that anorexia is adapted for that very purpose: adolescent girls postpone both their motivation to have sex and their likelihood of anyone else targeting them as a potential mate, and then they become hyperperfectionist and drive to achieve, so that later on when they refeed and get ready to reproduce again, they’ll have more going for them and be in better shape to catch a good mate).

    So there needs to be something that, at least in most cases, stops anorexic behavior. Unless you’re some kind of dirty group selectionist.

    Then again, maybe anorexia does have an off switch. The disorder is a terrible scourge if it has, say, a 25% fatality rate, but that means that 75% of people stop at some point. And it might be more if they were in a culture that didn’t make women feel ambivalent about having bodies. You can be obviously, massively underweight, but still worry that if you loosen the restraints you’ll turn into a whale… The fact that many women go from anorexia straight to bulimia or binge eating might also be a modern artifact. We’re surrounded by food, eating cues, and other stimuli that push everyone’s binge-eating buttons, and these folks have made themselves hypervulnerable. If you’re recovering from anorexia in a food-scarce hunter-gatherer environment, maybe you get your regulation back more effectively.

  7. resonance says:

    Or a dirty kin selectionist.

    I like the idea of it having an off switch we can find, and I sincerely hope that works out. (Of course, even if it doesn’t have a built-in off switch, that doesn’t mean we can’t stop it more effectively with better techniques in the future.)

  8. Harriet says:

    The Minnesota Starvation Study is fascinating. It really helped me when my daughter was in recovery from anorexia–I could understand the psychotic personality that seemed to inhabit her as a function of malnutrition and physiological processes.

    There’s a subset of people here in the U.S. who never really develop the “fear of fat” thing, for whatever reason, and there are still some docs who won’t diagnose anorexia without it in this culture. Crazy. I’d like to know more about that reference you mention–is there anything online I could look at?

    Keep up the inquiry!


  9. Harriet says:

    Sorry, Trisha, but I do not agree that eating disorders are caused by feeling a lack of control during life transitions or by any other emotional issue. If they were, the incidence rate would be MUCH higher than the 1-2% it is. Eating disorders are caused and exacerbated by genetics and physiological events. I think we look for meaning in e.d.s just as we look for meaning in a host of other illness (remember illness as metaphor?), but that is something that happens after the fact.

    And I’ve looked HARD for adult women who’ve developed e.d.s for the first time post-adolescence and never found one. Everyone I talked to had their roots in adolescence, even in a subclinical way.

  10. resonance says:

    Harriet – I’ll check for the ref after I get home tonight.

    Trisha – I’d be interested in hearing more about your research, particularly the cross-cultural aspects. Was this primarily qualitative work, or did you do anything quantitative? What cultures have you looked at? How many people did you talk to, etc. I’m interested in learning more about cross-cultural differences and similarities as well.

    The need to exert control seemed present in the religious stuff (asceticism-type stuff for religious reasons), but I’m curious as to whether it’s an initial trigger (in genetically susceptible individuals, as Harriet mentions – if lack of control were an issue far more people, especially men, would be anorexic) or whether it’s something that sustains the disorder after it’s kicked off by an initial reduction in weight.

  11. resonance says:

    Found it! It was a talk Shan Guisinger gave at the Human Behavior and Evolution Society conference in 2004. The American Psychological Association published an article on her 2003 article.

  12. Harriet says:

    Cool! Thanks, resonance. I’d seen that when it first appeared and then lost it again.

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