Special thanks to Dr. Alexys Hillman who proposed the question about the connection between eating disorders and criminal activity while I was presenting at the Florida Academy of Family Physician's Winter Summit in 2021. Dr. Hillman it is physicians such as yourself who ask challenging questions and demonstrate copious care for their patients that allows us to expand our awareness to better serve humanity.
Mental illness has a complex relationship with violence and criminal behavior. There is particular interest in understanding the gender differences in relation to brutality and deviance due to the interplay of cultural norms, hormonal disparities, substance use, genetics, and societal attitudes. Research shows that females commit significantly fewer crimes, including murder, compared to males. However, there is a distinct inconsistency in how society and the legal system perceive and label women who commit homicide or attempt it. Women are often characterized as either mad, bad, or victims, in contrast to how male perpetrators are identified. Irrespective of gender, criminal behavior is driven by psychological illness and the lack of resources available to address these disabilities.
Regarding the link between criminality and individuals diagnosed with eating disorders, there is still much to be understood. Most research has focused on women with anorexia nervosa (AN) or bulimia nervosa (BN), with little information on other eating disorder subtypes or males. A study found that women with eating disorders, particularly AN and BN, had a higher likelihood of being convicted of crimes such as petty theft, which may be driven by the need to emotionally fulfill unmet needs or communicate suppressed negative emotions. The exact mechanisms by which compulsive theft satisfies emotional demands are yet to be determined, but the symbolism of "filling up" is intriguing. The association between impulsivity and eating disorders and this type of theft does have parallels, but the underlying factors driving this behavior remain to be explored. Correlations have been found between low BMI and reductions in specific parts of the brain, such as the frontoparietal system responsible for perception and integration of body stimuli. Alterations in neural activity have been observed throughout various brain regions, as well as in subcortical structures and neurotransmitter levels. However, it is important to consider multiple factors, including genetics, comorbid conditions, external environment, and gender, when understanding the reasons behind neurotic theft. Additionally, petty theft in general is more common among females than males, regardless of eating disorder status.
Interestingly, there is limited research on the prevalence of eating disorders specifically among women prisoners. However, evidence suggests that women in prison display pathological impulsive behaviors, some of which include disordered eating patterns. It is unclear whether these patterns pre-existed prior to imprisonment or what specific types of patterns are prevalent. Impulsivity in female prisoners seems to be driven by anger, as evidenced by a study that found a link between disordered eating and anger-related impulsivity. From a clinical standpoint, many women with longstanding eating disorders often have underlying complex post-traumatic stress disorder (PTSD) that manifests as symptoms of depression, anxiety, insomnia, attention deficits in concentration, mood dysregulation, anger, and impulsivity. These symptoms are often misdiagnosed as bipolar disorder or borderline personality disorder. Clients with complex PTSD frequently report a history of petty theft, substance abuse, and self-medication. Among those with a history of substance abuse, their behavior often shifts between substance abuse and eating disorder behaviors throughout the course of their illness, with rarely both occurring concurrently. It is worth considering whether incarcerated females with complex PTSD lose their previous coping mechanisms (e.g., acrimonious relationships, substance use, exercise) upon entering prison, leading to the evolution of their eating disorders. Addressing female prisoners with disordered eating behaviors can be challenging, but it is crucial to focus on treating the underlying trauma as the primary issue through appropriate therapies such as eye movement desensitization and reprocessing (EMDR), neurofeedback, or other trauma therapeutic interventions. By targeting the root cause rather than the eating behaviors and thoughts, the eating disorder can be effectively managed with minimal eating disorder-specific therapy and fewer psychotropic medications. If our legal system prioritized treating the underlying mental illnesses or other burdens driving criminality, there would likely be a significant decline in misconduct. Similar to eating disorder treatment, adequate psychological and socioeconomic care tailored to individuals who engage in illegal activities is rare.
In most cases, crimes are committed due to mental illness or the need for socioeconomic survival. By imprisoning individuals with deep-seated issues, removing their coping mechanisms, and failing to address the underlying problems, we should not be surprised when they either perpetuate the same behaviors or develop other mental illnesses such as eating disorders. Instead of focusing solely on the behavior itself, we need to center our attention on understanding the reasons for these psychologically impaired behaviors. Our current legal system is flawed, and until we adopt a new approach that addresses the chronic mental distress experienced by individuals, they will continue to engage in such coping behaviors, whether they are self-harming or detrimental to others or humanity as a whole.
References:
Milligan, Waller, Andrews. Eating Disturbance in Female Prisioners: The Role of Anger. Vol 3, Issue 2, Pages 123-132, 2002.
Steiger, H.,, Bruce, K.R.,, & Groleau, P. (2010). Neural Circuits, Neurotransmitters, and Behaviour – serotonin and Temperament in Bulimic Syndromes Behavioural Neurobiology of Eating disorders , 125-138 DOI:
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