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Transcript Provided by YouTube:
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When Lauren was fifteen years old, her family moved across the country and she started going
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to a new school. Already shy, Lauren suffered from low self-confidence and had a hard time
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transitioning; nothing felt right and soon her changing body became a source of insecurity.
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Eventually, she began thinking that maybe if she lost weight and focused on fitness,
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she’d make more friends and feel better about herself and life would get better. Soon she
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became obsessed with dieting and it quickly spiraled into her subsisting only on rice
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cakes and apples and candy corn and celery.
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She like this new feeling of control every time she stood on the scale and saw a lower
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number. She was achieving something, and that made her feel good. Soon, she thought of nothing else.
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But what Lauren couldn’t see was that she was no longer healthy. Even when her hair
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started falling out and her skin grew dry and cracked, and when she could never get warm.
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When she looked in the mirror, she still saw a chubby girl.
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Her family, though, did notice, and yet, at a visit to the doctor, she was just told to eat more.
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She didn’t.
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One day while jogging, she had a heart attack and collapsed. As a teenager, she was 5’7″
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and weighed eighty-two pounds. Lauren was finally admitted to a psychiatric hospital
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where she was treated for anorexia nervosa. She was put on bed rest, saw a therapist twice
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a week, joined a support group and slowly began eating small amounts of food again.
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Her recovery was slow but, with the support of her family and doctors, she was released
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eight months later. Though Lauren suffered a few relapses over the years, she is now healthy.
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Ultimately, she was lucky. Anorexia, bulimia, and other eating and body dysmorphic disorders can kill.
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Eating disorders are among the deadliest psychological disorders, with some of the highest rates
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of death directly attributable to the illness. They slowly ruin the body, but, in order for
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these conditions to be recognized and treated successfully, they have to be understood as
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disorders of the mind.
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Here’s some scary figures: According to the National Eating Disorder Association, forty-two
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percent of first to third grade girls want to be thinner; eighty-one percent of ten year
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olds are afraid of being fat; over half of teenage girls and nearly a third of teenage
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boys have used troubling weight control methods like fasting, skipping meals, smoking, vomiting,
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or taking laxatives.
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The rate of new cases of eating disorders in Western culture has been increasing since
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the 1950’s, and today in the US, an estimated twenty million women and ten million men have
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suffered from a clinically significant eating disorder at some point in their lives.
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But get this straight: we’re not talking about fad diets or lifestyle choices spurred by
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vanity. Eating disorders are psychological illnesses that often come with serious consequences.
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These disorders tend to fall into three main categories: anorexia, bulimia, and binge eating disorders.
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Those suffering from anorexia nervosa, most often adolescent females, essentially maintain
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a starving diet and, eventually, and abnormally low body weight. As in Lauren’s case, anorexia
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can begin as a diet that quickly spirals out of control as a person becomes obsessed with
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continued weight loss, all while still feeling overweight.
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Our old friend, the DSM V, actually delineates two sub types of the disorder. The first involves
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restriction, which usually consists of an extremely low-calorie diet, excessive exercise,
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or purging, like vomiting or the use of laxatives. The second type is the binge/purge sub type,
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which involves episodes of binge eating combined with the restriction behavior.
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As you can easily imagine, the physiological effects of this psychological condition can
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be devastating. As the body is denied crucial nutrients, it slows down to conserve what
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little energy it has, often resulting in abnormally slow heart rate, loss of bone density, fatigue,
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muscle weakness, hair loss, severe dehydration, and an extremely low body mass index.
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And it’s that low body mass that’s the defining characteristic of anorexia nervosa – a refusal
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to maintain a weight at or above what would normally be considered minimally healthy.
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If this condition persists, of course, it can be deadly, which is why anorexia has what’s
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often estimated to be the highest mortality rate of any psychiatric disorder.
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That might surprise you, given the host of troubling disorders we’ve already covered
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here on Crash Course Psychology, but mortality rates associated with, say, major depression
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or PTSD or schizophrenia tend to be the result of secondary behavior, like suicide. But with
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anorexia, the mortality rate is especially high because people can die as a direct result
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of extreme weight loss and physiological damage.
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Another common eating disorder is bulimia nervosa.
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While anorexia is characterized primarily by the refusal to maintain a minimal body
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weight, bulimia is not. People with bulimia tend to maintain an apparently normal, or
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at least minimally healthy, body weight, but alternate between binge eating, followed by
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fasting or purging, often by vomiting or using laxatives.
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A bulimic body may not be as obviously underweight as an anorexic one, but that addictive cycle
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of binging and purging can seriously damage the whole digestive system, leading to irregular
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heartbeat, inflammation of the esophagus and mouth, tooth decay and staining, irregular
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bowel movements, peptic ulcers, pancreatitis, and other organ damage.
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Sometimes the two diagnoses can be difficult to discern, especially because someone may
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shift back and forth between anorexic diagnostic features and bulimic diagnostic features.
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The DSM V recently added a third category called binge-eating disorder, which is marked
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by significant binge-eating, followed by emotional distress, feelings of lack of control, disgust,
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or guilt, but without purging or fasting.
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Although sometimes triggered by stress or a need for, or lack of, control, the presence
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of an eating disorder is not a tell-tale sign of childhood sexual abuse, as was once commonly
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thought. Instead, these disorders are often predictive indicators of a person’s feelings
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of low self-worth, need to be perfect, falling short of expectations, and concern with others perceptions.
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Although the prevalence of bulimia and binge-eating is similar among ethnic groups in the United
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States, anorexia is is much more common among white women, often of higher socioeconomic status.
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But the prevalence of these disorders is rising in males, too. Today, between ten and twenty
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percent of people diagnosed with eating disorders are men who feel the same pressure to attain
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what they imagine is physical perfection, and that’s worth noting.
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These disorders have strong cultural and gender components; the so-called “ideal standard
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of beauty” varies wildly across cultures and time, and thinness is far from a universal
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desire, especially in countries where malnutrition and starvation are problems.
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But in the Western world, and increasingly in other countries, thinness is a common pursuit.
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And being bombarded with images of unrealistically slender models and jacked celebrities has
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increased many people’s dissatisfaction, or even shame and disgust, with their own bodies.
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These are all attitudes that can contribute to eating disorders.
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Some people have even had plastic surgery to look more like Beyonce, or J-Lo, or…Barbie.
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When taken to extremes, this kind of behavior starts inching into the realm of body dysmorphic disorder.
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Body dysmorphic disorder is another psychological illness, one that centers on a person’s obsession
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with physical flaws – either minor or just imagined. Those suffering from this disorder
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often obsess over their appearance, often staring into mirrors for hours, and feel distressed
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or ashamed by what they see.
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Although it’s often lumped in with the eating disorders, our growing understanding of body
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dysmorphia suggests that it actually shares some traits with obsessive-compulsive disorder,
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particularly the obsession with some imagined bodily perfection and the compulsion to check
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oneself over and over to discern perceived flaws.
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Not surprisingly, BDD and OCD may share some similar neurophysiological features, although
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that’s still being researched.
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People suffering from BDD may exercise excessively, groom themselves excessively, or seek out
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extreme cosmetic procedures, but, unless treated, they usually remain critical and unsatisfied
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with their looks, to the point of fearing that they have a deformity.
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People with BDD may suffer from anxiety and depression, start avoiding social situations,
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and stay home for fear that others will notice and judge their appearance negatively.
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Obviously, this causes a lot of emotional distress and dysfunction. Some bodybuilders
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suffer from a particular type of BDD called muscle dysmorphia, sort of the opposite of
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anorexia, where they become obsessed with the notion that they aren’t muscular enough,
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even if they’re ripping shirts like the Hulk.
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And again, this isn’t mere vanity; people suffering from body dysmorphia disorder look
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in the mirror and often see a distorted, even grotesque, image in their reflection.
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So, how do these disorders come about?
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Well, to be honest, we still have a lot of dots to connect.
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Neurologically, there are a few compelling clues. In the case of eating disorders, for
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example, research has long suggested that neurotransmitters like serotonin and dopamine
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may play a role.
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Dopamine is involved in regions of the brain connected to hunger and eating, like the hypothalamus
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and nucleus accumbens, and some research has found that binge eating appears to alter the
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regulation of dopamine production in a way that can reinforce further binging.
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The result is a neurological pattern that can resemble drug addiction, although the
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addiction comparison is still pretty controversial.
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Genetics appear to play a role, too, as there seems to be increased risk among genetic relatives
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with eating disorders as compared to controls.
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But a lot of attention is also being paid to environmental and familial factors, particularly
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the behavioral modeling and learning processes that shape how we think about ourselves and
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our bodies. Specifically, children who grow up observing problematic or unhealthy eating
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behavior in parents may be at higher risk for developing an eating disorder. And explicitly
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learning unreasonable or unhealthy values about your weight or your shape from your
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family, and definitely from your peers, can have a powerful effect.
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Eating and body dysmorphic disorders are serious business, but they are treatable —
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and perhaps even preventable.
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If cultural learning contributes to how we eat and how we want to look, then maybe education
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can help increase our acceptance of our own appearance, and be more accepting of others.
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Today, you learned about the symptoms and sub types of anorexia, bulimia, and binge-eating
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disorder, as well as various types of body dysmorphic disorder, and some of the physiological
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and environmental roots of these conditions.
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Thank you for watching, especially to all of our Subbable subscribers. This episode
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of Crash Course Psychology was co-sponsored by Subbable subscriber Matthew Woolsey and
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by Rich Brown of Beach Ready Auto Repair in Outer Banks, North Carolina.
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To find out how you can become a co-sponsor for one of our videos, just go to subbable.com/crashcourse.
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This episode was written by Kathleen Yale, edited by Blake de Pastino, and our consultant
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is Dr. Ranjit Bhagwat. Our director and editor is Nicholas Jenkins, the script supervisor
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and sound designer is Michael Aranda, and the graphics team is Thought Café.
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This post was previously published on YouTube.
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Photo credit: Screenshot from video.