WHAT ARE EATING DISORDERS?
Trigger warning: The following write-up may be offensive / induce trauma/trigger
harmful past experiences or practices and or behavior.
Reader discretion advised.
Eating disorders are behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions. They can be very serious conditions affecting physical, psychological, and social function.
Eating disorders affect up to 5% of the population, most often developing in adolescence and young adulthood. Several, especially anorexia nervosa and bulimia nervosa are more common in women, but they can occur at any age and affect any gender.
Eating disorders are often associated with food, weight, or shape, or with anxiety about eating or the consequences of eating certain foods.
Behavior associated with eating disorders includes restrictive eating or avoidance of certain foods, binge eating, purging by vomiting or laxative misuse, or compulsive exercise. These behaviors can become driven in ways that appear similar to an addiction. Eating disorders often co-occur with other psychiatric disorders most commonly mood and anxiety disorders, obsessive-compulsive disorder and alcohol and drug abuse problems.
Though the causes remain unclear gastrointestinal disorders, history(s) of sexual abuse, being a dancer or gymnast are some factors may be predisposing risk factors associated with this group of disorders. Many people with eating disorders also have body dysmorphic disorder, altering the way a person sees oneself. There may be other possibilities such as environmental, social and interpersonal issues that could promote and sustain these illnesses. Numerous studies have shown a genetic predisposition towards eating disorders.
TYPES OF EATING DISORDERS
Eating disorders are specified as mental disorders in standard medical manuals, including the ICD-10 and the DSM-5
Anorexia nervosa is the restriction of the energy intake relative to requirements, leading to a significantly low body weight in context of age, sex, developmental trajectory, and physical health. It is accompanied by fear of gaining weight or becoming fat, as well as a disturbance in the way one experiences and appraises their body weight and shape.
Bulimia nervosa (BN) is characterized by recurrent binge eating followed by compensatory behaviours such as purging (self-induced vomiting, eating to the point of vomiting, excessive use of laxatives/diuretics, or excessive exercise). Fasting may also be used as a method of purging following a binge. However, unlike anorexia nervosa, body weight is maintained at or above a minimally normal level. Severity of BN is determined by the number of episodes of inappropriate compensatory behaviours per week.
Binge eating disorder (BED) is characterized by recurrent episodes of binge eating without use of inappropriate compensatory behaviours that are present in BN and AN binge-eating/purging subtype. Binge eating episodes are associated with eating much more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not feeling physically hungry, eating alone because of feeling embarrassed by how much one is eating, and/or feeling disgusted with oneself, depressed or very guilty after eating.
Pica is the persistent eating of non-nutritive, non-food substances in a way that is not developed mentally appropriate or culturally supported. Although substances consumed vary with age and availability, paper, soap, hair, chalk, paint, and clay are among the most commonly consumed in those with a pica diagnosis. There are multiple causes for the onset of pica, including iron deficiency anemia, malnutrition, and pregnancy, and pica often occurs in tandem with other mental health disorders associated with impaired function, such as intellectual disability, autism spectrum disorder, and schizophrenia.
Rumination disorder encompasses the repeated regurgitation of food, which may be re-chewed, re-swallowed, or spit out.
ARFID is a feeding or eating disturbance, such as a lack of interest in eating food, avoidance based on sensory characteristics of food, or concern about aversive consequences of eating, that prevents one from meeting nutritional energy needs. It is frequently associated with weight loss, nutritional deficiency, or failure to meet growth trajectories. Notably, ARFID is distinguishable from AN and BN in that there is no evidence of a disturbance in the way in which one's body weight or shape is experienced. The disorder is not better explained by lack of available food, cultural practices, a concurrent medical condition, or another mental disorder.
(OSFED) is an eating or feeding disorder that does not meet full DSM-5 criteria for AN, BN, or BED.
Unspecified Feeding or Eating Disorder (USFED) describes feeding or eating disturbances that cause marked distress and impairment in important areas of functioning but that do not meet the full criteria for any of the other diagnoses.
Other types of eating disorders include-
Might eating syndrome
Nocturnal sleep-related eating disorder
Food maintenance, which is characterized by a set of aberrant eating behaviors of children in foster care.
MYTHS VS FACTS
Myth: Eating disorders aren't serious illnesses.
Truth: Anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified (EDNOS) are very real and very serious mental illnesses. Each disorder has clear diagnostic criteria in the Diagnostic and Statistical Manual, the go-to diagnostic reference for mental healthcare professionals.
Myth: Eating disorders are just about food.
Truth: While eating disorders generally involve an obsession with calories, weight or shape, these illnesses are rooted in biological, psychological, and sociocultural aspects. Restriction, bingeing, purging or over-exercise behaviors usually signify an attempt to control something of substance in the individual's life.
Myth: Eating disorders are a women's illness.
Truth: While research shows that eating disorders affect significantly more women than men, these illnesses occur in men and boys as well. While males used to represent about 10 percent of individuals with eating disorders, a recent Harvard study found that closer to 25 percent of individuals presenting for eating disorder treatment are male. The widespread belief that eating disorders only affect women and girls can prevent accurate diagnosis of an eating disorder in a man or boy, even among healthcare experts.
Myth: Eating disorders don't develop until the teenage years.
Truth: Consider this—research found that up to 60 percent of girls between the ages of 6 and 12 are concerned about their weight or about becoming too fat, and that this concern endures through life.
Myth: Only very thin people have an eating disorder.
Truth: While anorexia is characterized by extremely low weight, many individuals struggling with bulimia binge eating disorder and EDNOS are normal-weighted. The misconception that an eating disorder can only occur if someone is very thin contributes to misdiagnosis or delayed diagnosis in many cases, even among those patients seeking support from medical and mental healthcare professionals.
Myth: You can tell if someone has an eating disorder by looking at them.
Truth: People who suffer from eating disorders come in all shapes and sizes. The media and other public discussions about eating disorders often focus on specific diagnoses: anorexia, wherein sufferers often display the symptom of being severely underweight. Individuals who suffer from eating disorders can be of any weight, and they can fluctuate in weight
Myth: Eating disorders are a result of dysfunctional families.
Truth: Historically, parents, especially mothers, have been blamed for mental illnesses, including eating disorders. However, parents do not cause eating disorders. Eating disorders are complex disorders and it is known that a person's risk for developing eating disorders is due in large part to genetic factors. Parents or other caretakers and supports play an integral role in helping a loved one with an eating disorder to recover.
Treatment varies according to the type and severity of the eating disorder, and usually, more than one treatment option is utilized. Family doctors play an important role in the early treatment of people with eating disorders by encouraging those who are also reluctant to see a psychiatrist. That said, some treatment methods are:
- Cognitive-behavioral therapy
-Acceptance and commitment therapy: a type of CBT
-Dialectical behavior therapy
-Family therapy including "conjoint family therapy", "separated family therapy" and Maudsley Family Therapy.
-Cognitive Emotional Behaviour Therapy
-Nutrition counseling and Medical nutrition therapy
-Self-help and guided self-help are helpful in AN, BN, and BED; this includes support groups and self-help groups. Psychoanalysis
- By Dr. Meghul Chadha