Monday, February 22, 2016

Why do smart girls develop eating disorders?

Parents of gifted girls might wonder how "smart" girls could develop an eating disorder. Doesn't their intelligence, insight and maturity somehow insulate them from developing these devastating problems?

And are they more or less likely than others to have a problem with their eating?

It's National Eating Disorders Awareness Week, a time to spread the word about identification and treatment. The hallmark features of eating disorders, such as anorexia, bulimia and binge eating disorder include:

  • a preoccupation with food, weight and body image
  • an unhealthy change in eating patterns, such as restrictive eating, compulsive overeating, or a cycle of binge eating and compensatory attempts to prevent weight gain through the use of purging behaviors or excessive exercise
  • psychological effects, such as obsessive thinking, anxiety, low self-esteem, depression, a distorted body image, and shame and secrecy about the disorder
  • medical complications, including extreme weight loss (or gain), cessation of menstrual periods, gastrointestinal disturbances, electrolyte imbalance

Eating disorders tend to emerge during middle school and high school, but symptoms may start much earlier, or can develop later in life. It is estimated that the prevalence of anorexia is 1% and bulimia is 4%. Men also can be diagnosed with an eating disorder (approximately 5-10% of individuals with anorexia and 10-20% with bulimia are male). And although much more common among white middle-class society, where young women's self-esteem is battered by pop culture's images of unattainable thinness, most women do not develop eating disorders. Similarly, dieting often triggers the onset of eating disordered symptoms; however, cutting calories rarely progresses to a serious problem for the millions of women who diet (despite its known failure rate and the emotional toll of the weight loss/weight gain cycle - but that's another topic). In fact, one study noted that 91% of college women reported dieting at least once.

So then, why do smart girls develop eating disorders?

They cannot help it. They don't choose to have an eating disorder - just as no one chooses depression, alcoholism or diabetes. Recent research has linked eating disorders to genetic, heritable causes, and differences in brain chemistry. Responses to hunger and satiety are different for some girls with anorexia, and once malnutrition sets in, judgment and decision-making become impaired. And factors such as traumatic stress and developmental transitions are necessary triggers for symptoms to emerge. But intelligence and giftedness play no role in either preventing or warding off symptoms.
They may have had traumatic experiences that prime them to develop an eating disorder. While a genetic/biochemical predisposition may be necessary, many individuals with eating disorders have a history of sexual abuse or severe physical abuse, often accompanied by depression, anxiety and post-traumatic stress disorder. Although counterintuitive, gaining control over eating is often an attempt to manage memories of abuse and achieve mastery over feelings of helplessness.
They may have traits in common with individuals who also have eating disorders. Some gifted girls and those with eating disorders may be intensely sensitive and emotional; they also may be overthinkers, driven and perfectionistic. If there is a genetic/biochemical predisposition to develop an eating disorder, along with life event triggers, these "gifted" traits may get channeled into obsessive thoughts about food and a drive to achieve an unrealistic weight. Some may feel overwhelmed by their heightened sensitivity and reactivity, and eating disorder symptoms might seem to provide temporary relief.
They may have coexisting mental health problems, such as depression, anxiety, obsessive-compulsive disorder, drug or alcohol problems, or self-harming behaviors. They did not choose these either. But struggling with additional psychological distress, as well as possible family, peer or relationship crises, makes it more likely that an eating disorder might develop. Sometimes the obsessive focus on restrictive eating and weight loss, or the almost addictive-like feel of the binge-purge cycle, can be a relief, a distraction and an outlet from even more overwhelming life stressors and emotions.
They may feel like outliers and misfits, excluded and isolated from their peers, sometimes subject to teasing and bullying. In an effort to gain popularity and fit in, some gifted girls resort to dieting or restrictive eating to achieve an idealized appearance. For some, dieting transitions into more serious eating disordered behavior. 
One writer suggested that a high proportion of individuals with eating disorders also may be gifted. The author based this statement on her clinical impressions as a psychologist, but acknowledged that there was no research to back up her claim. Without additional research, it may be premature to speculate on the prevalence of women with eating disorders who are gifted. 

However, what seems more relevant is to question how eating disorders affect gifted people and how their giftedness affects their treatment and recovery.

  • How do social and emotional characteristics of giftedness, such as heightened sensitivity, asynchronous development, or perfectionism play a role?
  • How do childhood experiences, such as difficulty finding like-minded peers, feeling misunderstood, and possibly being bullied contribute to their symptoms? 
  • Are they using the eating disorder, for example, as a defense against fear of taking academic risks, underlying existential depression, or indecision over which career path to take? 
  • Are gifted individuals better able to "outsmart" treatment professionals so they can remain entrenched in their disorder?

Just as in every other area of their lives, their giftedness impacts who they are. And it will play a role in treatment and recovery. An understanding of giftedness is essential for family, friends, and treatment professionals in order to help any gifted individual struggling with an eating disorder.

How can you help your child (or friend, student or family member) if she has an eating disorder?

1. Insist that she get help. Don't take no for an answer. The sooner the eating disorder is treated, the less entrenched it will become, and the sooner she will be on her road to recovery. Outpatient treatment typically involves individual and family therapy, nutrition counseling, group support, and medical monitoring with a physician. If outpatient therapy is not enough, sometimes inpatient or day treatment programs are helpful for quickly intervening with symptoms and offering a jump start on recovery.

2. Find a comprehensive treatment team that includes a licensed therapist, registered dietitian and physician who specialize in eating disorders. Check with your pediatrician, school counselor, spiritual leader or other trusted sources for referrals. There are also some sites online, such as EDReferral, that may provide some direction. Your insurance company may be the worst referral source, since they frequently offer random recommendations without regard to your specific needs. Trust your child's and your own instincts about a therapist, even if the referral comes from someone you trust. This is an investment in your child's health, and all of you need to feel comfortable with whomever you choose.

3. Develop a plan if your child refuses therapy. If you have concerns about her health (e.g., weight loss, purging behaviors), take her to her pediatrician, who can evaluate her symptoms and inform her about the importance of treatment. If she still refuses, she might be more open to meeting with a registered dietitian, who can work with her collaboratively to develop a healthy meal plan. If she cannot follow the meal plan, then you have more authority in your claim that she needs treatment. See if other trusted adults in her life can speak with her about going to therapy. As a last resort, you could stage a form of intervention where you and other loved ones challenge her about your concerns and the need for treatment.

4. Get support for yourself.  While it is important to respect your child's privacy, ask her if you may speak with your closest family members and friends so that you can also receive support. When your child is struggling, you suffer as well.  If you need additional guidance, sometimes therapy, eating disorders support groups, or even online groups can be helpful. As difficult as it is, know that your involvement and concern sends a powerful message of support and encouragement to your child and aids in her eventual recovery.

Websites filled with helpful information and resources about eating disorders:

Gurze Books (eating disorders books)

In addition to my work with gifted individuals, I have specialized in women's issues and eating disorders for over 30 years. This blog post is one in a series about gifted girls and women.

Other posts about gifted girls and women include:

Key relationship dilemmas for women
Difficult passage: Gifted girls in middle school
Gifted women, gifted girls and mental health
Gifted or pretty: What do parents want for their daughters?
What stops girls from learning math?


  1. Gail. I'm working with a client dealing with these issues right now. This post was great timing. Thanks so much.

  2. I really appreciate this post, I wish it was around for me to send to my mom when I first started struggling. What if they've been through treatment and it doesn't help? I'm identified as gifted (>99%ile)and I've also had an eating disorder and depression for about 8 years now. I've been hospitalized for the its medical complications three times, and twice for suicide attempts. I already knew the health risks of eating disorders when I first started using behaviours. In fact, my main goal was to lose my period and any other "adult" characteristics. To my dismay, this never occurred, and I eventually tended towards a bulimic pattern rather than one that was solely restrictive.

    After I had had enough, I got a referral to and went to the "leading" Pediatric Eating disorder clinic in my province. I spent hours driving to and from every week. They told me I had amazing insight into my condition, and an amazing knowledge of the medical complications and overall function of the human body. One time, I wrote them a letter when I was on the inpatient unit which persuaded them to discharge me instead of keeping me for symptom interruption. They did save my life multiple times and I am grateful for that. At the same time, they were incredibly invalidating and refused to listen to anything that slightly conflicted with their ideas. A lot of the things they did under the guise of "eating disorder treatment" made no sense. They also completely ignored the research I presented them with on the neurobiology of food addiction and hyper-palatable foods. I tried the "all foods fit" model and it didn't work for me. They also refused to give me a meal plan or any sort of guidance around meals. All that being said, it's not just about food and weight, either, which they seem to forget about. So I'm stuck. I'm stable medically and psychiatrically, but I'm stuck.Admittedly, my presentation of an eating disorder is atypical, as I don't have an "ED voice" in my head, and I don't feel controlled by my eating disorder. When I decide to do something, I do it. I have water fasted for 5 days on multiple occasions. I have binged because I decided to, and fasted afterwards because I decided to. I suppose the issue is more for me one of motivation. If I don't care for losing weight, I don't, and I don't compensate after binging. I just don't have any intrinsic motivation to get "better" or to stop my behaviours.


  3. Same anon. Thinking about my comments, I should add that I have tried 3 SSRIs, one SNRI, and olanzapine at a very low dose. Olanzapine was a disaster, made me really incredibly hungry, and very very tired (not good for someone with bulimia). The antidepressants didn't help.

    1. Anonymous, I hope that you continuing to get the help you need through therapy and support groups. If you are looking for online organizations that might offer more information, check out NEDA ANAD, and Something-Fishy for support. Good luck.