Eating Disorders

 Eating Disorders

What are eating disorders?

There is a commonly held misconception that eating disorders are a lifestyle choice. Eating disorders are serious and often fatal illnesses that are associated with severe disturbances in people’s eating behaviours and related thoughts and emotions. Preoccupation with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Eating disorders affect several million people at any given time, most often women between the ages of 12 and 35. There are several types of eating disorders. The most common are anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder (ARFID), and other specified feeding and eating disorder (OSFED).

Eating disorders often co-occur with other psychiatric disorders, most commonly mood and anxiety disorders, obsessive-compulsive disorder, and alcohol and substance use disorders. Evidence suggests that genes and heritability play a part in why some people are at higher risk for an eating disorder, but these disorders can also afflict those with no family history of the condition. Treatment should address psychological, behavioural, nutritional, and other medical complications. The latter can include consequences of malnutrition or of purging behaviours, including heart and gastrointestinal problems, as well as other potentially fatal conditions. Ambivalence towards treatment, denial of a problem with eating and weight, or anxiety about changing eating patterns is not uncommon. With proper medical care, however, those with eating disorders can resume healthy eating habits and recover their emotional and psychological health.

 Eating Disorder presents a vital perspective on a much more misunderstood subject. This book is crafted to meet your needs and will provide you with successful guidance.

Learn in detail about the different types of eating disorders, including anorexia, bulimia, and binge eating, as well as less common problems. This knowledge is essential for recognising signs and understanding the varied eating disorders on physical, emotional, and mental health.

Know the root causes of eating disorders, including psychological, social, and biological influences, and why all these conditions develop and persist—understanding effective treatment methods, from therapy and medication to holistic practices that can promote recovery and permanent cure.  This offers practical advice and guidance on how to approach the disordered problem, provide emotional support, and understand the recovery journey without judgment or stigma. This will provide and guide you with the awareness, empathy, and knowledge needed to navigate and cure this complex problem and guide and support the journey to wellness for yourself or others. The eating disorders are about more than food. They’re complex mental health conditions that often require the intervention of medical and psychological experts to alter their course.

Types of Eating Disorders

There are many types of feeding and eating disorders, and they all come with their own defining characteristics and diagnostic criteria. The eating disorders formally recognised by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) include the following.

Binge Eating Disorder (BED)

Binge eating disorder, the most recently recognised eating disorder, is the most common. It is characterised by repeated episodes of binge eating, defined as the consumption of a large amount of food accompanied by a feeling of loss of control. It is found at higher rates among people of larger body sizes. Weight stigma is commonly a confounding element in the development and treatment of BED.

Bulimia Nervosa (BN)

Bulimia nervosa involves recurrent episodes of binge eating followed by compensatory behaviours, or those designed to make up for the calories consumed. These behaviours may include vomiting, fasting, excessive exercise, and laxative use.

Anorexia Nervosa (AN)

Anorexia nervosa is characterised by the restricted intake of food, leading to a lower-than-expected body weight, fear of weight gain, and disturbance in body image. Many people are unaware that anorexia nervosa can also be diagnosed in individuals with larger bodies. Although anorexia is the eating disorder that receives the most attention, it is actually the least common.

Other Specified Feeding and Eating Disorder (OSFED)

Other specified feeding and eating disorder is a catchall category that includes a wide range of eating problems that cause significant distress and impairment but do not meet the specific criteria for anorexia nervosa, bulimia nervosa, or binge eating disorder. OSFED and unspecified feeding or eating disorder (UFED) replaced the eating disorder not otherwise specified (EDNOS) category in previous versions of the DSM.

People diagnosed with OSFED often feel invalidated and unworthy of help, which is not true. OSFED can also be as severe as other eating disorders and include subclinical eating disorders.

Research shows that many people with subclinical eating disorders will develop full eating disorders. Subclinical eating disorders can also describe a phase that many people in recovery pass through on their way to full recovery.

Avoidant/Restrictive Food Intake Disorder (ARFID)

Previously called selective eating disorder, avoidant/restrictive food intake disorder (ARFID) is an eating disorder that involves a restricted food intake in the absence of the body image disturbance commonly seen in anorexia nervosa. It is manifested by persistent failure to meet appropriate nutritional and/or energy needs.

ARFID Is More Than Just Picky Eating

Orthorexia Nervosa

Orthorexia nervosa is not an official eating disorder in the DSM-5, though it has attracted a great deal of recent attention as a proposed diagnosis for future editions. It differs from other eating disorders because the unhealthy obsession does not typically come from a desire to lose weight. Further, the focus is not on food quantity but rather food quality.

Orthorexia nervosa is an unhealthy obsession with healthy eating and involves adhering to a theory of healthy eating to the point that one experiences health, social, and occupational consequences.

Other Eating Disorders

In addition to the ones listed above, other eating disorders include:

• Night eating syndrome
• Pica
• Purging disorder
• Rumination disorder

Symptoms of an eating disorder

Although symptoms of different eating disorders vary greatly, some may indicate a reason to investigate further. What's more, if your thoughts and/or behaviours surrounding food, weight, or body image are causing distress and impacting daily functioning, it's time to seek help.

• Dietary restriction
• Frequent weight changes or being significantly underweight
• Negative body image
• Presence of binge eating
• Presence of excessive exercise
• Presence of purging, laxative, or diuretic use
• Excessive thoughts surrounding food, body image, and weight

It is common for people with eating disorders, especially those with anorexia nervosa, to not believe they are ill. This is called anosognosia.

Is My Loss of Appetite an Eating Disorder?

Mental Effects

Eating disorders often occur along with other mental disorders, most often anxiety disorders, including

• Body dysmorphic disorder (BDD)
• Generalised anxiety disorder (GAD)
• ​​Obsessive-compulsive disorder (OCD)
• Social anxiety disorder (GAD)

Anxiety disorders usually predate the onset of an eating disorder. Often, people with eating disorders also experience depression and score high on measures of perfectionism.

Physical Effects

Because sufficient intake of nutritionally balanced foods is essential for regular functioning, eating disorders can significantly affect physical and mental operations. A person does not have to be underweight to experience the medical consequences of an eating disorder. Eating disorders affect every system of the body and can lead to physical health problems like:

• Brain mass loss
• Cardiovascular problems
• Gastrointestinal issues (e.g., chronic constipation, gastroesophageal reflux)
• Dental problems
• Disrupted sleep patterns
• Fainting spells
• Hair loss or downy hair all over the body (called lanugo)
• Loss of menstrual period post-puberty (or delayed first period)
• Musculoskeletal injuries and pain
• Weakened bones

Diagnosis of Eating Disorders

Medical physicians or mental health professionals, including psychiatrists and psychologists, can diagnose eating disorders. Often, a paediatrician or primary care doctor will diagnose an eating disorder after noticing symptoms during a regular check-up or after a parent or family member expresses concern over their loved one's behaviour.

Although there is no one laboratory test to screen for eating disorders, your doctor can use a variety of physical and psychological evaluations, as well as lab tests, to determine your diagnosis, including:

• A physical exam, during which your provider will check your height, weight, and vital signs
• Lab tests, including a complete blood count, liver, kidney, and thyroid function tests, urinalysis, X-ray, and an electrocardiogram
• Psychological evaluation, which includes personal questions about your eating behaviours, binging, purging, exercise habits, and body image

There are also multiple questionnaires and assessment tools used to assess a person's symptoms, including:

• Eating Disorder Inventory
• SCOFF Questionnaire
• Eating Attitudes Test
• Eating Disorder Examination Questionnaire (EDE-Q)

Who Is Diagnosed?

Contrary to popular belief, eating disorders do not only affect teenage girls. They occur in people of all genders, ages, races, ethnicities, and socioeconomic statuses. They are, however, more commonly diagnosed in women.

Men are underrepresented in eating disorder statistics—the stigma of having a condition associated primarily with women often keeps them from seeking help and getting diagnosed. Furthermore, eating disorders may also present differently in men.

Eating disorders have been diagnosed in children as young as age 6 and in older adults and seniors. The different ways eating disorders manifest in these populations can contribute to their unrecognisable nature, even by professionals.

While eating disorders affect people of all ethnic backgrounds, they are often overlooked in non-white populations due to stereotyping. The mistaken belief that eating disorders only affect affluent white females has contributed to the lack of public health treatment for others, the only option available to many underserved and marginalised populations.

Although not well-studied, it is postulated that the experience of discrimination and oppression among transgender populations contributes to higher rates of eating and other disorders among transgender individuals.

Diagnostic Changes for Eating Disorders in the DSM-5

Causes of Eating Disorders

Eating disorders are complex illnesses. While we do not definitively know what causes them, some theories exist.

It appears that 50% to 80% of the risk for 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."⁶

Certain situations and events—often called "precipitating factors"—contribute to or trigger the development of eating disorders in those who are genetically vulnerable.

Some environmental factors implicated as precipitants include:

• Abuse
• Bullying
• Dieting
• Life transitions
• Mental illness
• Puberty
• Stress
• Weight stigma

It has also become common to blame eating disorders on the media. While media influence is recognised as a complicating factor, it isn't considered an underlying cause of eating disorder development in individuals. Ultimately, a person must also have a genetic vulnerability for eating disorders to develop.

The Different Causes of Eating Disorders

Treatment for Eating Disorders

Early intervention is associated with an improved outcome, so please do not delay seeking assistance. Life may even need to be put on hold while you focus on getting well. And once you are well, you will be in a much better position to appreciate what life has to offer. Help is available in various formats, although it is common to start treatment with the lowest level of care and progress to higher levels as needed.

Self-Help

Some people with bulimia nervosa and binge eating disorder may explore self-help or guided self-help based on cognitive-behavioural therapy (CBT) principles. The person may work through a workbook, manual, or web platform to learn about the disorder and develop skills to overcome and manage it. Self-help is contraindicated for anorexia nervosa.

Cognitive Behavioural Therapy (CBT)

CBT is the best-studied outpatient therapy for adult eating disorders and includes the following elements

• Cognitive restructuring
• Body image exposure
• Delays and alternatives
• Food exposure
• Limiting body-checking
• Meal planning
• Regular eating
• Relapse prevention
• Self-monitoring via paper or applications

Family-Based Treatment (FBT)

Family-based treatment (FBT) is the best-studied treatment for children and adolescents with eating disorders.⁸ Essentially, the family is a vital part of the treatment team. Parents commonly provide meal support, which allows the young person to recover in their home environment. Another important element of FBT is externalising the eating disorder.

Nutritional Therapy

A registered dietitian can help you learn (or relearn) the components of a healthy diet and motivate you to make the needed changes.

Weekly Outpatient Treatment

Weekly outpatient treatment is the usual starting point for those who have access to treatment and typically includes treatment by a team of professionals, including a therapist, a dietitian, and a medical doctor. Other successful outpatient therapies for adult eating disorders include:

• Dialectical behaviour therapy
• Cognitive remediation therapy
• Interpersonal psychotherapy

Intensive Treatment

For people needing a higher level of care, treatment is available at multiple levels, including intensive outpatient, partial hospitalisation, residential, and hospital levels of care. In these settings, a multidisciplinary team almost always provides treatment.

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Coping with an eating disorder

Caring for your physical and mental health will go a long way toward helping you cope with an eating disorder. In addition to talking to a therapist or joining a support group (like Eating Disorders Anonymous), seek support from a trusted friend or family member who can be there for you along your path to recovery.

Beyond self-care, it’s also essential to identify a few healthy distractions you can turn to when you find yourself obsessing about food and weight or experiencing the urge to turn to disordered eating or behaviours. Here are a few to consider:

• Explore a new hobby, like photography, painting, or knitting
• Invest in an adult colouring book
• Practice mindfulness meditation
• Take a leisurely walk
• Try a yoga class or DVD
• Write in a journal

It is common for people with eating disorders, especially those with anorexia nervosa, to not believe they are ill. This is called anosognosia.

Is My Loss of Appetite an Eating Disorder?

Mental Effects

Eating disorders often occur along with other mental disorders, most often anxiety disorders, including

• Body dysmorphic disorder (BDD)
• Generalised anxiety disorder (GAD)
• ​​Obsessive-compulsive disorder (OCD)
• Social anxiety disorder (GAD)

Anxiety disorders usually predate the onset of an eating disorder. Often, people with eating disorders also experience depression and score high on measures of perfectionism.

Physical Effects

Because sufficient intake of nutritionally balanced foods is essential for regular functioning, eating disorders can significantly affect physical and mental operations. A person does not have to be underweight to experience the medical consequences of an eating disorder. Eating disorders affect every system of the body and can lead to physical health problems like:

• Brain mass loss
• Cardiovascular problems
• Gastrointestinal issues (e.g., chronic constipation, gastroesophageal reflux)
• Dental problems
• Disrupted sleep patterns
• Fainting spells
• Hair loss or downy hair all over the body (called lanugo)
• Loss of menstrual period post-puberty (or delayed first period)
• Musculoskeletal injuries and pain
• Weakened bones

What are the risk factors for eating disorders?

Eating disorders can affect people of all ages, racial/ethnic backgrounds, body weights, and genders. Eating disorders frequently appear during the teen years or young adulthood but may also develop during childhood or later in life.

Researchers are finding that eating disorders are caused by a complex interaction of genetic, biological, behavioural, psychological, and social factors. Researchers are using the latest technology and science to better understand eating disorders.

One approach involves studying human genes. Eating disorders run in families. Researchers are working to identify DNA variations that are linked to the increased risk of developing eating disorders.

Brain imaging studies are also providing a better understanding of eating disorders. For example, researchers have found differences in patterns of brain activity in women with eating disorders in comparison with healthy women. This kind of research can help guide the development of new means of diagnosis and treatment of eating disorders.

How are eating disorders treated?

It is important to seek treatment early for eating disorders. People with eating disorders are at higher risk for suicide and medical complications. People with eating disorders can often have other mental disorders (such as depression or anxiety) or problems with substance use. Complete recovery is possible.

Treatment plans are tailored to individual needs and may include one or more of the following:

• Individual, group, and/or family psychotherapy
• Medical care and monitoring
• Nutritional counselling
• Medications

Psychotherapies

Family-based therapy, a type of psychotherapy where parents of adolescents with anorexia nervosa assume responsibility for feeding their child, appears to be very effective in helping people gain weight and improve eating habits and moods.

To reduce or eliminate binge-eating and purging behaviours, people may undergo cognitive behavioural therapy (CBT), which is another type of psychotherapy that helps a person learn how to identify distorted or unhelpful thinking patterns and recognise and change inaccurate beliefs.

Medication

Evidence also suggests that medications such as antidepressants, antipsychotics, or mood stabilisers may also help treat eating disorders and other co-occurring illnesses such as anxiety or depression.

A Word 

Recovery from an eating disorder isn’t easy. It takes courage, but it is possible with the right support system in place.

If you are the parent of a minor with an eating disorder, then it is wise for you to seek treatment on their behalf. Supporting a child with an eating disorder is hard work, but there are resources for you. If your loved one with an eating disorder is an adult, you can still play an important role in helping them, too.

Since people with eating disorders often do not believe they have a problem. Family members and significant others play a crucial role in helping them seek assistance. Although recovery from an eating disorder can be challenging and sometimes long, it is possible.