Eating Disorders

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Eating Disorders

What is an eating disorder?

Does someone you know seem overly preoccupied with food, their body weight, or shape?  If yes, then this person may be suffering from an eating disorder. Eating disorders are behavioral conditions that cause severe disturbance in eating habits. People suffering from eating disorders usually have upsetting thoughts and emotions regarding food. The disorder may cause serious conditions affecting physical, psychological, and social outcomes that interfere with the ability to function normally.

What are different types of eating disorders? 

The most common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.

  • Anorexia nervosa is described as self-starvation and is characterized by severe weight loss for the person's ideal height and weight class. Body mass index (BMI) is typically under 18.5 in an adult. Anorexia nervosa has the highest mortality of any psychiatric illness other than opioid use disorder. There are two types of anorexia nervosa:
  1. restricting type-  individuals lose weight primarily by dieting, fasting, or excessively exercising
  2. Binge-eating or purging type- individuals engage in intermittent binge eating or purging behaviors along with their extreme diet and exercise.
  • Bulimia nervosa is described as alternating between eating low-calorie foods and then secretly indulging in high-calorie foods excessively in a short period of time- also known as binge eating. To make up for the binge eating, usually dangerous and unhealthy tactics are undergone to prevent weight gain. This may include fasting, vomiting, laxative misuse, or excessive exercise. People suffering from bulimia nervosa have varying weights- underweight, overweight, or normal weight. However, if the patient is underweight, this usually means they are anorexic. Similar to anorexia nervosa, people with bulimia nervosa are excessively preoccupied with thoughts of food, weight, or their perceived shape. This constant negativity impacts their health and self-image.
  • Binge eating is similar to bulimia nervosa in that there is indulgence in large quantities of unhealthy food in a short period. However, unlike bulimia, binge eating does not involve compensatory behavior to counteract the increased calorie intake. People may feel like they lack control over their eating habits which later results in guilt. This disorder may lead to serious medical conditions such as diabetes, heart disease, obesity, and high blood pressure.

Other types of eating disorders include:

  • Avoidant restrictive food intake disorder (ARFID) is a newer eating disorder that causes a disturbance in eating habits and receiving proper nutrition due to being an extremely picky eater.
  • Other specified feeding and eating disorder is an eating disorder that does not meet the criteria of the other disorders listed. A person may participate in extreme dieting and exercise but not considered underweight, so would not be diagnosed as anorexic.
  • Pica disorder is the consumption of things that have no nutritional value, such as hair or paper. It is common in children who have autism and has a high potential of causing intestinal blockages.
  • Rumination disorder is a constant regurgitation of food that causes malnutrition. It may be done unintentionally and is a common condition with infants.

Who suffers from this type of disorder?

5% of the American population suffers from an eating disorder. Both men and women can develop eating disorders. However, women are known to suffer from eating disorders more frequently than men. All who suffer from eating disorders appear to have a distorted view of their body image. Eating disorders appear to affect all socioeconomic, racial, and age demographics. Many eating disorders can occur at any time in life, but the average age range seems to be from 12-35 years old.

Causes

What causes eating disorders?

Currently, the cause of eating disorders is unknown. There are some theories on why eating disorders occur, such as:

  • Genetic factors:  it is believed that people with specific genes are more susceptible to develop eating disorders; however, further research is needed. People who have family members such as parents who suffer from eating disorders may also develop the illness.
  • Biological factors: there has been some research that shows brain structure (i.e., hypothalamus) may play a role in certain eating disorders regarding feeling full after a meal. Neurotransmitters- such as serotonin- also regulate mood and appetite. Therefore, irregularities in these levels may also be responsible for eating disorders.
  • Emotional factors: certain personality traits are known to be more at risk of developing eating disorders. This includes those who are perfectionists, have low self-esteem, have impulsive behavior, or have problems maintaining relationships.

What are the risk factors for developing eating disorders?

There are risks such as dieting and stress that place people more in danger of developing this mental illness. Dieting is believed to cause eating disorders since a severe reduction in calorie intake or starvation may affect the brain and mood of the person. Stress has also been linked to this mental illness as stressful life events may cause people to attempt to control their lives better. Eating habits are something that someone may feel they can better manage.

What are other mental illnesses associated with eating disorders?

Eating disorders often coexist with other mental illnesses such as:

  • Mood and anxiety disorders
  • Obsessive-compulsive disorder
  • Alcoholism
  • Drug abuse problems

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Symptoms

What are the symptoms of eating disorders?

Anorexia nervosa

Symptoms of anorexia nervosa may include:

Initial symptoms:

  • Highly restrictive eating habits
  • Extreme thinness (emaciation)
  • Unwillingness to maintain a normal or healthy weight
  • Intense fear of weight gain
  • Distorted body image
  • Excessive exercise
  • Use of laxatives or diet supplements
  • Vomiting after meals

Prolonged symptoms:

  • Thinning of the bones
  • Anemia
  • Muscle weakness
  • Disruption of menstrual cycles that may cause infertility
  • Dizziness from dehydration
  • Brittle hair and nails
  • Dry and yellowish skin
  • Growth of fine hair all over the body (lanugo)
  • Severe constipation
  • Low blood pressure and pulse
  • Heart damage
  • Brain damage
  • Multiorgan failure
  • Chronic fatigue
  • Depression, irritability, anxiety, poor concentration

Bulimia nervosa

Many times the signs and symptoms go unnoticed by family members and loved ones suffering from bulimia nervosa. This is because many of their actions are done in secret. Possible symptoms for bulimia nervosa include:

  • Chronic sore throat
  • Swollen salivary glands
  • Decaying teeth due to exposure to stomach acid
  • Acid reflux 
  • Intestinal irritation from laxative abuse
  • Severe dehydration which may cause dizziness
  • Stroke
  • Heart attack
  • Frequently going to the restroom after meals
  • Unexplained, large amounts of food missing
  • Laxative or water pill misuse
  • Recurrent diarrhea

Binge-eating disorder

There are a variety of symptoms associated with binge eating. Usually, a binge will occur at least once a week. People with this disorder will be normal or overweight.

  • Eating large amounts of food in a specific amount of time
  • Eating even when not hungry
  • Eating fast during binge episodes
  • Eating until uncomfortably full
  • Eating alone to avoid embarrassment
  • Feeling ashamed about your eating
  • Frequently dieting but without evidence of weight loss

Diagnosis

How are eating disorders diagnosed?

Proper diagnosis by a licensed healthcare professional is important with eating disorders as they usually coexist with other mental illnesses. There are no confirmed tests for eating disorders; however, a healthcare professional from TeleMed2U may help provide a proper diagnosis. Additional testing may be performed to determine if there are any medical complications resulting from the eating disorder.

Treatment

What are some helpful tips in preventing eating disorders?

  • Try to avoid dieting in front of your children. This can teach them unhealthy eating habits. Always try to encourage eating well-balanced diets.
  • Educating your children on proper nutrition may help eliminate any myths on unhealthy diets or fads.
  • Encourage healthy body image to your children no matter what size or shape they may be. This helps promote healthy self-esteem and acceptance.

What are the treatment options available for eating disorders? 

Research shows that early intervention and treatment puts those who have eating disorders at less risk for suicide and future medical complications. A major goal for treatment is to ease the anxiety associated with eating food and offer a way to consume a well-balanced diet. Treatment usually requires a team approach, including dieticians, primary care physicians, and mental health experts. Here are some treatment options available:

  • Psychotherapy is often the initial treatment option. It consists of therapist-led sessions set for individual or group settings. Psychotherapy is important with anorexia nervosa as it helps normalize eating habits and weight control behaviors to restore weight.
  •  The Maudsley approach is a popular family-based therapy approach for parents with adolescents suffering from anorexia nervosa. This therapy places feeding responsibility on the parents, which has shown to help with weight gain and improve eating habits.
  • Cognitive-behavioral therapy (CBT) is an approach shown to reduce or eliminate binge-eating and purging behaviors. It provides coping skills to learn how to identify distorted or unhelpful thinking patterns and recognize and change inaccurate beliefs.
  • Medication such as antidepressants, antipsychotics, or mood stabilizers may also help treat eating disorders. Medication can help treat underlying conditions or symptoms of depression, anxiety, or other mental illnesses.
  • In-patient treatment is reserved for severe cases when outpatient treatment has not been effective. Relapse is very common within the first year of treatment, especially with anorexia nervosa.

Are you or a loved one having trouble making healthy decisions regarding eating habits?  A licensed mental health care provider at TeleMed2U can help you and your family with the coping skills needed to better manage your eating disorder.

References

Engel, B. (n.d). Causes of Eating Disorders - Biological Factors. Gulf Bend Center. https://www.gulfbend.org/poc/view_doc.php?type=doc&id=11748&cn=46 
Guarda, A. (2021, March). What Are Eating Disorders? American Psychiatric Association.  https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders 
Mayo Clinic. (2018, February). Eating disorders.   https://www.mayoclinic.org/diseases-conditions/eating-disorders/symptoms-causes/syc-20353603 
National Institute of Mental Health. (n.d.).Eating Disorders. https://www.nimh.nih.gov/health/topics/eating-disorders/

Information

Medically reviewed by:

Dr Roy Kedem, MD

Dr Roy Kedem started his premedical studies at Harvard, and research in genetics and gene sequencing at Harvard, Beth Israel. He attended medical school in the UK at the Cambridge Overseas Medical Program in 1998.  Dr Kedem then completed his residency in Internal Medicine at Columbia College of Physicians and Surgeons in Stamford, Connecticut and his fellowship in Hospital Medicine at the Cleveland Clinic in Cleveland, Ohio.

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