Eating Disorders

Skylar Hom

February recognized National Eating Disorders Awareness Week (NEDAwareness Week) this year from February 24th to March 1st. NEDA is a week recognized in the United States that aims to bring attention to the prevalence of eating disorders.

Eating disorders are mental and physical illnesses that are characterized by abnormal eating or exercise habits that interfere with one’s functioning in daily life. They are treatable conditions with no one cause; there are many psychological, cultural, social, and personal factors that could contribute to the development of an eating disorder. Eating disorders are indiscriminate, and affect people from all walks of life.
While eating disorders can affect everyone, there are a range of circumstances that can make a person more likely to develop one.

One large risk factor is when someone has a person in their life who has an eating disorder. Relatives, particularly first-degree relatives, with eating disorders can play a contributing role to the development of eating disorders in people. Predilections for mental health conditions can be passed down both socially and biologically.

Having certain personality traits can also put one at risk of developing an eating disorder. Perfectionism and a pre-existing dissatisfaction with one’s body are examples of this, but there are many others. Comorbid conditions, such as anxiety disorders or depression, may also play a role.

Additionally, there are environmental factors, including the weight and body stigmas that exist around us. Acculturation can also affect this. For expats who visit or begin life in Japan, this can be particularly challenging, as the body standards in Japan often differ from one’s country of origin.

Types of Eating Disorders

There are many types of eating disorders.
The most commonly known eating disorder is anorexia nervosa, which is chiefly characterized by weight loss and a restrictive eating pattern. Purging behavior is also common in those with anorexia.

Some physical symptoms of anorexia include weight loss, dizziness, loss of hair on one’s head, dental erosion, and fainting. One hallmark symptom of many eating disorders is the presence of constant thoughts about food, weight, and calories to the point where it interferes with daily life. This can manifest itself into food regulation rituals and a need for control.

Bulimia nervosa is recognized by its cyclical behavior of binge eating and purging. Binge eating is the act of eating significant amounts of food in a short period of time. Oftentimes, binge eating is also associated with a sense of being out of control. Purging is induced because it is thought to reverse the act of binge eating. This is oftentimes done through the act of vomiting, but it is also commonly performed through over-exercise and the overuse of laxatives. 

Bulimia symptoms include many similar symptoms of anorexia nervosa, as well as swelling of the cheeks and jaws, discolored teeth, and marks or scrapes on the knuckles of one’s hands. Binge eating episodes often involve the individual disappearing for hours at a time. If the person also engages in vomiting or other purging behavior, frequent trips to the bathroom after eating may be another common symptom.

One of the most common eating disorders, particularly in Americans, is binge eating disorder (BED), which involves frequent episodes of binge eating. Many of those with binge eating disorder feel shame or guilt after a binge eating session. The difference between BED and bulimia nervosa is that those with BED do not perform a compensatory act after the episode.

There are many other disordered eating behaviors that don’t necessarily fall under a specific category. These are called Otherwise Specified Feeding or Eating Disorders (OSFED), or previously, Eating Disorder Not Otherwise Specified (EDNOS). The concept of OSFED is to be a diagnosis for those whose behaviors do not necessarily fit into a specific eating disorder. A person who is diagnosed with OSFED may have symptoms from anorexia nervosa, bulimia nervosa, and others. It is considered just as severe as other eating disorders.

A diagnosis of OSFED may include many different types of symptoms. One example is atypical anorexia nervosa, where an individual has a significant amount of symptoms relating to anorexia nervosa but is considered clinically of normal weight. Another is binge eating disorder of low frequency or duration. In this case, a person has all the clinical criteria for BED, but is not as frequent or has not had the illness for as long as the usual diagnostic criteria.

Eating Disorder Misconceptions
As with many types of illnesses, the general perception of what an eating disorder entails is often confused with myths. Despite common belief, eating disorders are not the choice of the person who has it. They are considered diseases that are influenced by many factors, including sociocultural, interpersonal, and societal.

Another common misconception about eating disorders is that they only affect girls and women. In reality, boys and men make up a significant portion of eating disordered individuals. However, due to stigma and a reluctance to seek help, men are often misdiagnosed and go without treatment for longer.

Body image and standards of beauty in Japan are often different than what expats are familiar with in their own countries. The idealization of thinness is known as one of the most highly contributing factors related to eating disorders (Culbert, Racine, and Klump, 2015).

A study conducted with Japanese adolescent men found that they tend to have body dissatisfaction related to two ideals; either a thin or androgynous ideal, or one that seeks further muscular development (Yamamiya, Yuko et al., 2019). Yamamiya suggested that such a dichotomy may exist because of Western influence, where muscularity among men is most typically sought after. The thin and androgynous ideal in men may be attributed to a more traditionally Japanese mindset.

The intersectionality of such beauty standards as well as cultural differences and the stress of moving and living in an unfamiliar place often puts expats at risk of mental strain. This includes the development of eating disorders.


If you or a loved one is experiencing symptoms related to disordered eating or has been having thoughts related to disordered eating, there are many things you can do. Firstly, it helps to understand the situation at hand. Eating disorders are very serious conditions that can heavily impact one’s life.

If interested, NEDA has an online chat system, where trained volunteers offer free counseling regarding eating disorders. The chat system operates from Monday through Thursday from 9AM to 9PM EST, and on Fridays from 9AM to 5PM EST.

Tokyo Mental Health recommends that those who have concerns regarding their eating  contact us to schedule an appointment with a provider to discuss the matter. Seeking counseling is an often imperative step for many of those with eating disorders.

Eating disorders can affect all aspects of a person’s life. We believe it is extremely crucial to receive help for such a complicated situation. Please feel free to contact us at any time regarding concerns related to disordered eating.


Culbert, K. M., Racine, S. E., & Klump, K. L. (2015). “Research Review: What we have learned about the causes of eating disorders – a synthesis of sociocultural, psychological, and biological research”. J Child Psychology and Psychiatry, 56(11), 1141-1164.  doi:10.1111/jcpp.12441

Yamamiya, Yuko et al. “An exploration of the psychometric properties of the SATAQ-4 among adolescent boys in Japan.” Eating behaviors vol. 32 (2019): 31-36. doi:10.1016/j.eatbeh.2018.12.001

National Eating Disorder Awareness (