An eating disorder is not usually a phase, and it is not necessarily indicative of madness. It is quite maddening, granted, not only for the loved ones of the eating disordered person, but also for the person herself. It is, at the most basic level, a bundle of contradictions: a desire for power that strips you of all power. A gesture of strength that divests you of strength. A wish to prove that you need nothing, that you have no human hungers, which turns on itself and becomes a searing need for the hunger itself. It is an attempt to find an identity, but ultimately it strips you of any sense of yourself, save the sorry identity of "sick." It is a grotesque mockery of cultural standards of beauty that ends up mocking no one more than you. It is a protest against cultural stereotypes of women that in the end makes you seem the weakest, the most needy and neurotic of all women. It is the thing you believe is keeping you safe, alive, contained—and in the end, of course, you find it is doing quite the opposite. These contradictions begin to split a person in two. Body and mind fall apart from each other, and it is in this fissure that an eating disorder may flourish, in the silence that surrounds this confusion that an eating disorder may fester and thrive. — Marya Hornbacher, Wasted: A Memoir of Anorexia and Bulimia (New York: HarperCollins, 1999)
That diet and appetite are closely linked to psychological health and emotional well-being is well known. Psychological factors often influence eating habits. Many people overeat when they are bored, stressed, angry, depressed, or anxious. Psychological distress can aggravate weight problems by triggering impulses to overeat. Emotional discomfort drives many people to overeat as a way to relieve anxiety and improve mood. Some people revert to the "comfort foods of their youth"—the meals or treats offered to them when they were sick or foods that evoke memories of the carefree days of childhood. Others rely on chocolate and other sweets, which actually contain chemicals known to have a soothing effect on mood. Over time the associations between emotions, food, and eating can become firmly fixed.
Emotional arousal also may sabotage healthy self-care efforts such as resolutions to diet and exercise. Anxiety and depression can produce feelings of helplessness and hopelessness about efforts to lose weight that undermine the best intentions, prompt detrimental food choices and inactivity, and over time cause many people to give up trying entirely. Because overweight and obesity often contribute to emotional stress and psychological disorders, a cycle develops that couples increasing weight gain with progressively more severe emotional difficulties.
Emotional disturbance alone is rarely the causative factor of overweight or obesity. However, for persons with a genetic susceptibility or predisposition to obesity and exposure to environmental factors that promote obesity, emotional and psychological stress can trigger or exacerbate the problem. Even efforts to lose weight can backfire—serving to increase rather than alleviate emotional stress. For example, persons who fail to lose weight or those who succeed in losing weight only to regain it may suffer from frustration and diminished feelings of competence and self-worth. Similarly, being overweight or obese and feeling self-conscious about it or suffering from weight-based discrimination or prejudice can be ongoing sources of stress or frustration. Feelings of helplessness, frustration, and continuous emotional stress can cause or worsen such mental health problems as anxiety and depression.
Many mental health and medical professionals view overweight as both a cause and consequence of disturbances in physical and mental health. Although it may be important to determine whether a metabolic disturbance caused an individual to become overweight or resulted from excessive weight gain or whether depression triggered behaviors leading to obesity or resulted from problems associated with obesity, it is often impossible to distinguish whether overweight is a symptom of another disorder or the causative factor.