1990; Brewerton et al., 1989; Bruch, 1973, 1977; Garner et al., 1982; Halmi et al., 1991; Pike and Rodin, 1991; Rosman et al., 1977; Strober, 1981; White and Boskind-White, 1981). Eating disorders may develop as the result of developmental processes that cause the individual to place an undue importance on physical appearance as a way to obtain love and to feel in control (Bruch, 1978). This emphasis on appearance is part of modern Western culture, and it is often reinforced by parents. The need to obtain love may be exaggerated by a rigid or nondemonstrative family of origin. The need for control may be exaggerated by the emphasis on control in a rigid family or by the inability to control other aspects of life (Bruch, 1973).
The resulting focus on appearance leads to a fear of becoming fat. Along with this fear a distorted body image may develop, so that people with eating disorders perceive themselves to be fatter than they really are (Crisp and Kalucy, 1974; Warah, 1989). The fear of fat and body image distortion usually lead to dieting, which may lead to binging. Binging may lead to obesity with binging (binge eating disorder) or to a more normal weight with binging and purging (bulimia nervosa). Some dieters may be able to achieve a state of self-starvation, either with or without some binging (anorexia nervosa).
Thus, while objective criteria for diagnosis remain observable eating and purging behaviors, the dynamics of the disorders involve self-esteem and body image. To complicate matters, the pathological behaviors may alter physiological functions, which in turn may affect emotional and cognitive functioning (Garfinkel and Garner, 1982; Mitchell et al., 1991). Therefore, both the diagnostic criteria and the dynamics of the eating disorder should be taken into account simultaneously so that the behavioral, cognitive, affective, and social manifestations of the disorder can be put into a conceptual whole.
The eating disorder that will be emphasized here is anorexia nervosa, since the dynamics of anorexia nervosa most closely resemble the reduced energy intake manifested by military troops in field operations. The symptoms of anorexia nervosa may be experienced by ''normal" individuals but to a less serious degree and only for short periods of time. For example, most Americans have a fear of becoming fat or fatter and have a desire to feel in control of their eating. Most women and many men wish they were thinner. To the extent that normal troops have some of the same dynamics, a study of anorexia nervosa may provide lessons for preventing self-inflicted undernutrition in field situations.
Eating disorders vary in the criteria required for diagnosis; however, there are several common psychological themes. These include: