The term "eating disorders" represents a group of severe, complex mental disorders that can seriously impair health and social functioning. Eating disorders can occur in people of any age, gender, race, and body weight, shape, and size. People with eating disorders develop an unhealthy relationship with food, their weight or appearance, often associated with anxiety about food or the consequences of eating certain foods.
Eating disorders are caused by several complex factors, including genetics, brain biology, personality, cultural and social ideals, and mental health issues. Overall, eating disorders affect up to 5% of the population, most often it develops in adolescence and young adulthood. Behaviors associated with eating disorders including restrictive eating or avoidance of certain foods, binge eating, vomiting or improper use of laxatives, or compulsive exercise. This behavior can be driven in ways that look similar to addiction. Eating disorders often co-occur with other psychiatric conditions, such as depression, substance abuse, or anxiety disorders.
Mainly, there are four subcategories of eating disorders:
Anorexia nervosa (AN)
It is a restriction of energy intake relative to need that results in significantly low body weight in the context of age, sex, developmental trajectory, and physical health. It is accompanied by an intense fear of gaining weight or becoming fat, as well as a disturbance in the way one experiences and evaluates one's body weight or shape.
There are two subtypes of AN: the restrictive type and the binge-eating/purging type.
The restrictive type describes presentations in which weight loss is achieved through dieting, fasting, and/or excessive exercise.
The binge/purging type describes manifestations in which the individual with the disorder engages in repeated episodes of binge eating and purging behaviors such as self-induced vomiting, misuse of laxatives and diuretics.
The severity of AN is determined by BMI, with a BMI of less than 15 considered the most extreme cases of the disorder. Pubertal and post-pubertal women with anorexia often experience amenorrhea, or loss of menstruation, due to the extreme weight loss these individuals face, dizziness or fainting from dehydration, brittle hair/nails, cold intolerance, muscle weakness and wasting, heartburn and reflux (in those who vomit) , Severe constipation, bloating and feeling full after eating, stress fractures caused by compulsive exercise, as well as bone loss leading to osteopenia or osteoporosis (thinning of the bones), depression, irritability, anxiety, poor concentration and fatigue. Most special programs are effective in restoring weight and normalizing eating behavior, although the risk of relapse in the first year after the end of the program remains significant.
Individuals with bulimia nervosa typically alternate diets or eat only low-calorie "safe foods" with binge eating of "forbidden" high-calorie foods. Binge eating is defined as eating large amounts of food in a short period of time coupled with a feeling of loss of control over what or how much one eats. Seizure behavior is usually secretive and associated with feelings of embarrassment or shame. Attacks can be very large and food is often consumed quickly, through fullness to nausea and discomfort.
Bulimia can lead to rare but potentially fatal complications including oesophageal tears, gastric rupture, and dangerous cardiac arrhythmias. Medical monitoring in cases of severe bulimia nervosa is important to identify and treat any possible complications. Outpatient cognitive behavioral therapy for bulimia nervosa is the treatment with the strongest evidence. It helps patients normalize their eating behavior and manage thoughts and feelings that perpetuate the disorder. Antidepressants can also be helpful in decreasing urges to binge and vomit.
Binge Eating Disorder (BED)
Binge eating episodes are associated with eating much faster than normal, eating until you feel uncomfortably full, eating large amounts of food when you are not physically hungry, eating alone because you feel embarrassed about how much you are eating, and/or feeling self-disgusted, depressed or very guilty after eating. In order to be diagnosed with BED, significant anxiety about binge eating must be present and binge eating must occur an average of once a week for 3 months. The severity of BED is determined by the number of episodes of binge eating per week.
People with binge eating disorder have episodes of binge eating in which they consume large amounts of food in a short period of time, feel a sense of loss of control over the food, and are distressed by the binge eating behavior. Binge eating is chronic and can lead to serious health complications, including obesity, diabetes, hypertension, and cardiovascular disease.
A diagnosis of binge eating disorder requires frequent binge eating (at least once a week for three months), associated with a feeling of lack of control, and three or more of the following: Eating faster than normal, Eating until uncomfortably full, Eating large amounts of food when you are not hungry, Eating alone because you feel embarrassed about how much one eats, Feeling disgusted with yourself, depressed or guilty afterwards.
The most effective treatment for binge eating disorder is cognitive behavioral psychotherapy for binge eating. Interpersonal therapy has also been shown to be effective, as have several antidepressants.
Other Specified Feeding or Eating Disorder (OSFED)
A term used when an individual exhibits symptom of an eating disorder but does not meet the threshold for a clinical diagnosis. Examples might include a person with all the symptoms of anorexia nervosa but without being underweight, or a person with bulimia nervosa who does not binge and purge as often as expected.
Unspecified feeding or eating disorder (UFED)
This category may be used to classify behaviors that cause clinically significant distress or impairment in functioning but do not meet criteria for any other eating or feeding disorders.
Pica: Pica is a diagnosis given to an individual who repeatedly consumes non-food materials, such as chalk or paper, or edible items with no nutritional value, such as ice, for more than a month.
Rumination disorder: Rumination syndrome or rumination disorder is a diagnosis in which food that a person consumes and swallows is regurgitated painlessly and effortlessly. Regurgitated food can be re-swallowed, re-chewed or spit out. Regurgitation is not caused by a gastrointestinal disorder.
Causes of Eating Disorder
Eating disorders are complex illnesses. While we don't know definitively what causes them, there are some theories. It appears that 50% to 80% of the risk of developing an eating disorder is genetic, but genes alone do not predict who will develop an eating disorder. It is often said that “genes load the gun, but environment pulls the trigger.” Some environmental factors that play a role as precipitating factors include: abuse, bullying, dieting, life transitions, mental illness, puberty, stress, weight stigma. Certain situations and events—often called "precipitating factors"—contribute to or trigger the development of eating disorders in those who are genetically vulnerable. It has also become common to blame eating disorders on the media. While media influence is recognized as a complicating factor, it is not considered to be the root cause of individuals developing eating disorders. Ultimately, a person must also have a genetic vulnerability to developing eating disorders.
Psychological factors identified include low self-esteem, feelings of inadequacy and lack of control over life, depression, anxiety, anger and loneliness. Interpersonal factors include troubled family and personal relationships, difficulty expressing emotions and feelings, a history of being teased or ridiculed based on size and weight, or a history of physical or sexual abuse.
Social factors that may contribute include cultural pressures that celebrate thinness and place value on achieving the "perfect" body, narrow societal definitions of beauty that only include people with specific body weights and shapes, or cultural norms that value people based on physical appearance and not inner qualities and strengths. Obsession with food becomes an unhealthy way to cope with painful emotions or feelings. So eating disorders are more about finding a healthy way to manage your emotions than about food.
Symptoms of Eating Disorder
The specific symptoms of eating disorders vary by type. An eating disorder can be difficult to detect because it often mimics dieting. Or a person struggling with an eating disorder may be reluctant to share their concerns about eating. If you or a loved one has an eating disorder, you may experience these general changes: mood swings, fatigue, fainting or dizziness, thinning or hair loss, frequent bathroom breaks after meals, unexplained weight changes, or drastic weight loss.
Although the symptoms of different eating disorders vary widely, some may indicate cause for further investigation. What's more, if your thoughts and/or behaviors related to food, weight, or body image are causing anxiety and affecting daily functioning, it's time to get help.
Treatment for eating disorders varies depending on the type and your specific needs. Even if you don't have a diagnosed eating disorder, a professional can help you solve and manage food-related issues. Treatment includes:
• Psychotherapy: The psychopathology of eating disorders focuses on body perception disorders, where self-esteem is too dependent on weight and shape; fear of gaining weight, even if underweight; denying the severity of symptoms and distorting the way the body experiences,many people with eating disorders improve with cognitive behavioral therapy (CBT). This form of therapy helps you understand and change the distorted thought patterns that drive behavior and emotions. The best-studied outpatient therapy for eating disorders in adults includes the following elements:
• Cognitive restructuring
• Body image exposure
• Limitation of body control
• Meal planning
• Regular meals
• Relapse prevention
• Self-monitoring via paper or apps
• Medications: Some people with eating disorders have other conditions, such as anxiety or depression. Taking antidepressants or other medications can improve these conditions. As a result, your thoughts about yourself and food will improve.
• Nutrition counseling: A registered dietitian with training in eating disorders can help improve eating habits and create nutritious meal plans. This specialist can also offer tips on grocery shopping, meal planning and preparation.
The best treatment approach is often a combination of all these professionals working together to obtain comprehensive treatment that addresses physical, mental, and behavioral aspects.
Eating disorders are potentially life-threatening, resulting in the death of up to 10 percent of those who develop them. They can also cause significant psychological distress and major physical complications. Important relationships are disrupted because an eating disorder consumes time and energy, creates self-absorption, and impairs self-esteem. Treatment should begin as soon as possible, focus on the immediate distress the individual is experiencing, and aim to help the patient and family become strong enough to overcome the eating disorder.