Monday, February 20, 2023

Eating disorders among the gifted: Are they more at risk?

The convergence of giftedness and eating struggles is like a perfect storm. Gifted individuals, with their propensity toward overthinking, perfectionism, heightened sensitivities, and overexcitabilities may be at risk for developing eating disorders. Young women and men are bombarded with societal messages that idealize thinness and muscularity, an even more difficult challenge in a world where foods high in sugar, simple carbohydrates, salt, and fats are so readily available.

The list of what triggers eating-disordered behaviors is long, and a full overview is beyond the scope of this brief article. However, some known risk factors include depressionanxietydietingtraumabody image dissatisfaction, an idealization of thinness, peer influences, and perfectionism.  Culbert and colleagues, for example, used a biopsychosocial model as a lens for understanding these triggers. In their review of the literature, they summarized that eating-disordered symptoms are more likely to arise when personality traits of negative emotionality (anxiety, sadness, anger, and mood swings), perfectionism, and "negative urgency" (a tendency to act impulsively when distressed) are combined with sociocultural pressures and an idealization of thinness. 

Despite an upsurge in research over the past 30 years, it is not always clear why some individuals - even those with predisposing traits, such as perfectionism or anxiety - develop an eating disorder and others do not. 

Many investigations of eating disordered symptoms are qualitative. Many use a small sample size. A wide range of populations have been studied (ranging from high school students to clinical populations within treatment settings), and some research includes "disordered eating" (rather than clearly defined diagnoses), complicating any comparisons across studies. And hallmark features of anorexia nervosa, such as rigid and controlling behaviors, are difficult to compare with characteristics of impulsivity and emotional dysregulation commonly found in bulimia nervosa or binge eating disorder. In fact, a study (based on my dissertation - yes, a gazillion years ago!), found significant differences even among subtypes of bulimic adolescents.

Are gifted individuals more at risk for developing an eating disorder? 

The overlap between traits seen among the gifted and those with eating disorders is striking, even though most gifted people do not develop an eating disorder. In my clinical practice, I have specialized in eating disorders as well as giftedness, and have seen clients struggling with eating disorders or obesity in residential, inpatient, outpatient, and private practice settings. Most of these clients were exceptionally bright and likely gifted - something not necessarily as common among other mental health conditions. 

It makes sense that gifted overthinkers, individuals with perfectionistic strivings, and those with low self-esteem and harsh self-expectations might develop an eating disorder. It also seems reasonable to assume that highly sensitive gifted individuals or those struggling with emotional dysregulation and the challenges of impulsivity or ADHD might gravitate toward eating-disordered behaviors in an unhealthy attempt to regulate their strong emotions. 

Yet, very little research has been conducted that might lend support (or refute) the assumption that eating disorders are prevalent among the gifted. 

Recently, though, Beiser and Gillespie studied a group of gifted teens in the US and reported that 20% admitted to negative body image and problematic eating behaviors. However, a national poll of adolescents found that approximately two-thirds of teens experience body image concerns (although the criteria used to define eating dysregulation or body image concerns differs across these studies, making any comparison difficult). Studies of eating disorders and high achievers (not necessarily gifted, but there may be some overlap here with gifted students) have identified predictors such as stressful life events and academic stress, There is also an association between eating disorders and ADHD (common among twice-exceptional individuals), as highlighted in a recent ADDitude article. Again, it seems clear that further investigation of an association between giftedness and eating disorders is needed.

What you can do

If you or your child are struggling with an eating disorder, compulsive overeating, restrictive eating, orthorexia (a preoccupation with only eating "healthy" foods), compulsive exercising, or anxiety about body image, seeking support is the first step. This is National Eating Disorders Awareness Week - designed to highlight the challenges faced by individuals with eating disorders and the importance of finding help when needed. More information about the causes of eating disorders and available treatment can be found on the NEDA and ANAD websites. 

Psychotherapy with a licensed mental health professional (see this guide about what to expect) and counseling with a registered dietitian who specializes in eating disorders is essential. Steer clear of advice from a personal coach or unlicensed nutritionist or fitness trainer who lack training in the field and may offer advice that could worsen the condition. For example, dietary "cures" sometimes touted by those untrained with eating disorders can backfire and add fuel to the fire. Family involvement is also necessary to treat the problem, along with group support and medical monitoring. Both addressing the underlying cause and taking active behavioral steps to change are essential. The sooner the problems are addressed, the easier the path to recovery. 

** For more insights about parenting gifted children, please see my book, The Gifted Parenting Journey. Available through the publisher and the usual bookseller sites, this book addresses a previously neglected topic in the literature: the needs and emotional life of parents of gifted children. For more information about this book, snippets from editorial reviews, and upcoming workshops and book events, please see this link.**

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