The tech sector and anorexia nervosa: A perfect storm?
What makes for a productive career in the tech sector? A stellar background of academic excellence? A keen eye for even the most intricate details while completing projects? Unwavering standards of excellence in how one approaches work? An ability to forego short-term rewards or distractions in favor of the pursuit of a larger overarching goal? All of the above?
Indeed, these characteristics are often observed in those who excel in the tech sector, and surprisingly, these are also the very same traits and characteristics of those who are the most vulnerable to anorexia nervosa (AN).
AN is a psychiatric, brain-based disorder that is characterized by a profound fear of weight gain, an ability to override basic appetitive drives (i.e., starvation) in the relentless pursuit of thinness, low weight and an obsessional preoccupation with weight and shape. Interestingly, those with AN most typically demonstrate academic excellence, an achievement-oriented and perfectionistic personality structure, highly detailed information processing, and a propensity for the rigid pursuit of goals. These traits are neurally encoded in the unique, yet remarkably homogenous and enduring neurobiology of those with AN, and it is these very same traits that often propel those who recover from AN into rapid career ascension in industries that rely on these traits, such as the tech industry.
Importantly, however, the traits and the biological mechanisms that underpin AN cannot simply be “turned off” after treatment, and ongoing vigilance is crucial.
Reflecting this, more than 50 percent of persons afflicted with AN experience an illness course that extends to more than two decades, despite specialized and often intensive treatment. Strikingly high rates of relapse are also evident among those who do recover, with as many as 50 percent of those who recover relapsing within 18 months of treatment discharge. Moreover, the substantial increase in the incidence of AN over each decade since the 1930s suggests the challenge presented by AN will likely intensify.
In further compounding these challenges, AN is unique in the sense that it is considered ego syntonic, meaning the primary symptoms (weight loss) are experienced as positive by those afflicted, and many patients are reticent to acknowledge their symptoms as an illness, and actively attempt to evade illness detection and treatment.
Why should this be of grave concern? Alongside this steadily increasing prevalence, AN is the most lethal of any psychiatric illness. More than 50 years of systematic research has consistently concluded that anorexia nervosa has the highest mortality rate of any psychiatric illness, which was recently calculated to be approximately six times higher than that of the general population.1 Alongside this, a diverse array of profound medical complications mars the functional capacity of those with AN, imparting vastly elevated rates of suicidality which are 57 times higher than that observed in the general population, and multi-systemic organ injury that spans cardiac abnormalities, reproductive system impairment, structural and functional brain impairment and irreparable bone damage.
Without question, the organ most impacted by AN is the brain. The severe dietary restraint characteristic of AN is known to cause diffuse white matter and gray matter volume depletion across an array of brain regions,5 the reparability of which, upon recovery, is unknown. The impact of starvation, in particular upon the frontal lobes — the brain’s center for executive functioning, attention and decision making — renders in impaired cognitive performance in an array of simple and complex cognitive tasks. Reflecting this, a recent Deloitte analysis of the economic impact of AN in Australia, a country with a population equaling seven percent of the U.S. population and an incidence of eating disorders 10 times lower than that in the United States, revealed an annual cost of $69.7 billion AUD, or approximately $54 billion USD.2 In specific regard to loss of work-related productivity, this amounted to an annual cost of $15 billion AUD, or approximately $11.5 billion USD.
Despite these staggering statistics, AN is entirely treatable. The greatest barriers to effective care are the stigmatization those with AN experience around what is often erroneously considered a volitional or vanity-driven “phase,” and poor illness recognition among health practitioners. As such, it is of crucial importance to address the mental health needs of those with AN, who are increasing in prevalence, at risk of premature death and a multitude of severe medical complications which impair one’s functional capacity, are likely to occupy high-functioning professional jobs in industry sectors that rely on intellect and a highly driven workforce, and experience gross deficits in work-related productivity.
References:
1. Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders. Archives of General Psychiatry 2011; 68: 724-731.
2. Butterfly Report. Paying the price: The economic and social impact of eating disorders in Australia. Butterfly Foundation for Eating Disorders 202.
3. Fichter MM, Quadflieg N, Crosby RD, Koch S. Long-term outcome of anorexia nervosa: Results from a large clinical longitudinal study. International Journal of Eating Disorders 2017; 50: 1018-1030.
4. Hoek HW, van Hoeken D. Review of the prevalence and incidence of eating disorders. International Journal of Eating Disorders 2003; 34: 383-396.
5. Mehler PS, Brown C. Anorexia nervosa – medical complications. Journal of Eating Disorders 2015; 3:11.