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Taylor Swift Reveals Eating Disorder

— Pop singer speaks about her struggles in new documentary.

MedpageToday
A photo of Taylor Swift

A new documentary about Taylor Swift premiered last week on Netflix. The film, entitled ," follows the singer/songwriter's life over the past several years. In one segment, Swift reveals that she struggled with an eating disorder for many years.

Spurred on by social media comments, she scrutinized the way her body looked in every paparazzi picture. "I remember how, when I was 18, that was the first time I was on the cover of a magazine," she . "And the headline was like 'Pregnant at 18?' And it was because I had worn something that made my lower stomach not look flat. So I just registered that as a punishment.... You register that enough times, and you just start to accommodate everything towards praise and punishment, including your own body."

She realizes now that undereating affected her stamina on tour: "I thought that I was supposed to feel like I was going to pass out at the end of a show, or in the middle of it. Now I realize, no, if you eat food, have energy, get stronger, you can do all these shows and not feel fatigued," she said. She's also reconciled with "the fact that I'm a size 6 instead of a size double-zero."

Lana Wilson, the director of "Miss Americana," is proud that Swift discussed the issue of her eating disorder with such candor, despite her discomfort. "That's one of my favorite sequences of the film," Wilson said. "I was surprised, of course. But I love how she's kind of thinking out loud about it. And every woman will see themselves in that sequence. I just have no doubt." In addition, , "I think it's really brave to see someone who is a role model for so many girls and women be really honest about that. I think it will have a huge impact."

Eating Disorders

There is a commonly held misconception that eating disorders are a lifestyle choice. Eating disorders are serious and potentially fatal illnesses that are associated with severe disturbances in people's eating behaviors and related thoughts and emotions. Preoccupation with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Anorexia Nervosa

Anorexia nervosa is characterized by emaciation, a relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight, a distortion of body image and intense fear of gaining weight, a lack of menstruation among girls and women, and extremely disturbed eating behavior. Some people with anorexia lose weight by dieting and exercising excessively; others lose weight by self-induced vomiting, or misusing laxatives, diuretics, or enemas.

Many people with anorexia see themselves as overweight, even when they are starved or are clearly malnourished. Eating, food and weight control become obsessions. A person with anorexia typically weighs herself or himself repeatedly, portions food carefully, and eats only very small quantities of only certain foods. Some who have anorexia recover with treatment after only one episode. Others get well but have relapses. Still, others have a more chronic form of anorexia, in which their health deteriorates over many years as they battle the illness.

According to some studies, people with anorexia are up to 10 times more likely to die as a result of their illness compared to those without the disorder. The most common complications that lead to death are cardiac arrest, and electrolyte and fluid imbalances. Suicide also can result.

Many people with anorexia also have coexisting psychiatric and physical illnesses, including depression, anxiety, obsessive behavior, substance abuse, cardiovascular and neurological complications, and impaired physical development.

Symptoms include:

  • Extremely restricted eating
  • Extreme thinness (emaciation)
  • A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
  • Intense fear of gaining weight
  • Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight

Other symptoms may develop over time, including:

  • Thinning of the bones (osteopenia or osteoporosis)
  • Brittle hair and nails
  • Dry and yellowish skin
  • Growth of fine hair over body (e.g., lanugo)
  • Mild anemia, and muscle weakness and loss
  • Severe constipation
  • Low blood pressure, slowed breathing and pulse
  • Drop in internal body temperature, causing a person to feel cold all the time
  • Lethargy

Risk Factors

Eating disorders can affect people of all ages, racial/ethnic backgrounds, body weights, and genders. Eating disorders frequently appear during the teen years or young adulthood but may also develop during childhood or later in life. These disorders affect both genders, although rates among women are higher than among men. Like women who have eating disorders, men also have a distorted sense of body image.

Researchers are finding that eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological, and social factors. They are using the latest technology and science to better understand these conditions.

One approach involves the study of human genes. Eating disorders run in families. Researchers are working to identify DNA variations that are linked to the increased risk of developing eating disorders.

Brain imaging studies are also providing a better understanding of eating disorders. For example, researchers have found differences in patterns of brain activity in women with eating disorders in comparison with healthy women. This kind of research can help guide the development of new means of diagnosis and treatment of eating disorders.

Statistics

According to the National Institute of Mental Health:

  • Based on diagnostic interview data from the National Comorbidity Survey Replication, median age of onset was 21 years-old for binge eating disorder and 18 years-old for both bulimia nervosa and anorexia nervosa.
  • The lifetime prevalence of anorexia nervosa in adults was 0.6%, with females being three times more likely than males (0.9% vs 0.3%).
  • More than half (56.2%) of respondents with anorexia nervosa, 94.5% with bulimia nervosa, and 78.9% with binge eating disorder met criteria for at least one of the core DSM-IV disorders assessed in the NCS-R.
  • All three eating disorders had the highest comorbidity with any anxiety disorder.
  • The lifetime prevalence of eating disorders among U.S. adolescents aged 13 to 18 years. was 2.7%.
  • Eating disorders were more than twice as prevalent among adolescent females (3.8%) than males (1.5%).

Treatments and Therapies

It is important to seek treatment early for eating disorders. Sufferers are at higher risk for suicide and medical complications and can often have other mental disorders (such as depression or anxiety) or problems with substance use. Complete recovery is possible.

Treatment plans are tailored to individual needs and may include one or more of the following:

  • Individual, group, and/or family psychotherapy
  • Medical care and monitoring
  • Nutritional counseling
  • Medications

Psychotherapies

Psychotherapies such as a family-based therapy called the , where parents of adolescents with anorexia nervosa assume responsibility for feeding their child, appear to be very effective in helping people gain weight and improve eating habits and moods.

To reduce or eliminate binge-eating and purging behaviors, people may undergo cognitive behavioral therapy, which is another type of psychotherapy that helps a person learn how to identify distorted or unhelpful thinking patterns and recognize and change inaccurate beliefs.

Medications

Evidence also suggests that medications such as antidepressants, antipsychotics, or mood stabilizers may also be helpful for treating eating disorders and other co-occurring illnesses such as anxiety or depression.

Sources: , ,

Michele R. Berman, MD, and Mark S. Boguski, MD, PhD, are a wife and husband team of physicians who have trained and taught at some of the top medical schools in the country, including Harvard, Johns Hopkins, and Washington University in St. Louis. Their mission is both a journalistic and educational one: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.