Eating Disorders

What Is An Eating Disorder?

Eating disorders are serious medical and mental health conditions characterized by severely disordered eating behaviors. While many people have worries about their appearance or body weight, people with eating disorders tend to obsess over losing weight, altering the shape of their body, and exerting extreme control over their intake of food.

Eating disorders are often both chronic and severe, especially if the condition is not addressed soon enough. People with these disorders are at heightened risk of suicidal ideation and attempts, early death due to damaged health, and decreased quality of life as compared to people within the general population and even those with other psychiatric disorders. Fortunately, full recovery is possible with appropriate mental health treatment.

Symptoms Of An Eating Disorder

Multiple signs of an eating disorder can be present in the affected person. These can include any number of the following:

• Excessive and persistent vocalized concerns about weight or calorie intake
• Ongoing patterns of consuming foods low in calories
• Binge eating
• Attempting to avoid weight gain or lose weight by practicing purging behaviors such as vomiting, using laxatives, or taking diuretics or weight-loss pills
• Exhibiting self-consciousness regarding eating behaviors and sometimes avoiding eating around others to hide disordered eating patterns
• Avoiding certain types of food
• Nutritional deficiencies due to restricted or overly-selective eating behaviors
• Obsessive fear related to food, such as worries about experiencing gastrointestinal discomfort or pain
• Sensitivity to or repulsion regarding certain types of food

These symptoms, when clinically significant, can be indicative of one of numerous types of eating disorders, as described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

Types Of Eating Disorders

The DSM-5 details numerous eating disorders, including anorexia, bulimia, binge eating disorder, avoidant/restrictive food intake disorder, pica, rumination disorder, and other specified feeding and eating disorders.

Anorexia

Anorexia nervosa is characterized by the following symptoms:

• Restriction of eating, leading to a low body weight
• Worry about gaining weight and partaking in unhealthy behaviors to avoid gaining weight
• Lowered self-esteem as a result of having a distorted perception of the body
• In some cases, not understanding the health effects of the unhealthy eating behaviors

The DSM-5 states that these symptoms must have been present for at least three months for anorexia to be diagnosed.

Bulimia

Bulimia nervosa is diagnosed when the following symptoms are present:

• Eating excessive amounts of food in a period of two hours
• Inability to control food consumption
• Using methods to purge, such as vomiting, laxatives, or excessive exercising
• Connecting self-esteem to body image

According to the DSM-5, the above symptoms must have occurred for at least three months and be present once a week or more for bulimia to be diagnosed.

Binge Eating Disorder

Binge eating disorder (BED) has the highest prevalence rate of all eating disorders. This condition involves eating excessive amounts of food without the presence of purging behaviors.

Diagnosable criteria for BED are:

• Repeated instances of consuming large amounts of food
• Lack of control related to eating behaviors
• Feelings of low self-worth following binge eating

For binge eating disorder to be diagnosed, three or more of the following must be present:

• Feeling uncomfortably or painfully full after binge eating
• Consuming food in a rapid manner
• Continuing to eat even when not hungry
• Feeling upset after binge eating

Binge eating disorder often involves secrecy around these eating behaviors, such as only eating when alone.

Avoidant/Restrictive Food Intake Disorder

Avoidant/restrictive food intake disorder (ARFID) is an eating disorder that consists of a person not consuming enough food to nourish the body and keep it healthy. While similar in symptoms, ARFID is different from anorexia because those who have it do not present with body dysmorphia or a fear of gaining weight.

ARFID can lead to nutritional problems, lowered weight, and psychological and social disruption.

Criteria for avoidant/restrictive food intake disorder include some or all of the following:

• Weakened immune system
• Nutritional deficits that lead to dependence on consuming vitamins or other supplements
• Weakening of the nails and hair
• Sleep disturbances
• Gastrointestinal issues
• Difficulty eating foods of certain textures
• Avoiding eating for reasons that do not have to do with the ability to obtain food or any present medical conditions

Avoidant/restrictive food intake disorder commonly starts in childhood and is seen in those exhibiting excessively picky behaviors related to food consumption. People with ADHD and those on the autism spectrum disorder are at notably higher risk of developing this disorder.

Pica

The eating disorder pica involves a person having a craving for substances that are not food and that are devoid of any nutritional value. This can include eating paper, ice, chalk, dirt, soap, etc.

Pica is characterized by the following, as listed in the DSM-5:

• Symptoms are present for one month or longer
• Eating behaviors do not have anything to do with age, developmental level, or existing societal norms present in the person’s culture

Pica is more commonly seen in children, women who are pregnant, and those experiencing intellectual disabilities.

Rumination Disorder

Rumination disorder (also known as rumination syndrome) involves eating and then promptly regurgitating the eaten content and is followed by subsequent rechewing, repeated swallowing, or even spitting out and discarding of the content. This condition can cause significant physical, psychological, and social impairment.

Rumination disorder is commonly either misdiagnosed or completely missed by health professionals. This results in patients experiencing persistent symptoms or not receiving treatment as quickly as needed.

Other Specified Feeding And Eating Disorders

Other specified feeding and eating disorders (OSFED) were previously referred to as “eating disorder not otherwise specified (EDNOS)” in the DSM-IV. It includes the following conditions:

• Purging disorder, which involves the presence of purging behaviors without the presence of binge eating.
• Night eating syndrome, which includes the behavior of eating excessive amounts of food following waking from sleep. It is highly correlated with sleep difficulties.
• Atypical anorexia nervosa, which is similar to anorexia but does not require an unhealthily low weight.
• Subthreshold (or atypical) bulimia nervosa and binge eating disorder, which present as bulimia-like or BED-like behaviors that do not meet the full criteria of those disorders.

Atypical eating disorders consist of the same worries about weight, body shape, and eating behaviors and cause disruption in daily well-being and functioning. Many with atypical eating disorders will go on to develop a clinically diagnosable eating disorder.

Orthorexia

Orthorexia nervosa is an eating disorder that involves a person being obsessed with what they consider to be proper nutrition and healthy eating. It exhibits in some or all of the following:

• Eating behaviors that are ritualistic in nature
• Restricting food intake
• Strict avoidance of certain foods that a person perceives as being unhealthy or toxic
• Nutritional deficiencies
• Medical problems
• Social and emotional disturbances

With orthorexia, food is prepared with excessive attention to detail, with a fear of straying from the perceived elements of what is healthy versus toxic for the body. Orthorexia creates a fear that deviating from these behaviors can lead to feelings of shame, guilt, worry, and even further restriction of food intake.

What Causes Eating Disorders?

According to the American Psychiatric Association, there is not one single cause for developing an eating disorder. Like other diagnosable mental health conditions, eating disorders tend to be more commonly seen in people whose family members also have them, so genetics are highly implicated in their development. Similarly, a person’s environment and experiences during childhood and adolescence are also factors.

Other causative factors may include:

• Pressure from society to diet or achieve a certain weight
• Unhealthy coping mechanisms when faced with life stressors
• Medical conditions
• Experiencing benefits from a small amount of weight loss, as the weight loss can result in outcomes perceived as rewarding

These elements often affect eating habits as well as the decision process related to food intake behaviors.

Risk Factors Of Eating Disorders

As described above, there is not one single factor for the development of an eating disorder. Still, people diagnosed with these conditions usually have risk factors that contribute to the eating disturbance.

Risk factors include the following:

• Having another mental health condition, especially an anxiety disorder
• Going through or having gone through bullying
• A family history of severely disordered eating
• Obesity in childhood
• Pressure from peers and the media to attain a certain appearance
• Dissatisfaction with body size or shape
• Diagnosed diabetes
• Spending time with other people with eating disorders
• Participation in sports that include weight guidelines
• Distorted self-image and related dissatisfaction
• A history of dieting

These factors, compounded by genetic risk, considerably increase the likelihood of developing an eating disorder.

Complications Caused By Eating Disorders

People with eating disorders are at higher risk of experiencing adverse physical and mental complications that are disruptive to their daily lives.

Physical Side-Effects

Physical and medical complications caused by eating disorders include the following:

• Unhealthy weight loss
• Electrolyte imbalance
• Damage to teeth
• Nutritional deficiencies
• Hormonal changes
• Alterations in bone density
• Irritable bowel syndrome
• Postural orthostatic tachycardia syndrome (POTS)
• Sexual dysfunction
• Diabetes
• Kidney damage
• Chronic weakness and fatigue

Anorexia in particular, can lead to thinning of the bones, low blood pressure, dry/yellowish skin, lanugo (fine hair covering the body,) brain damage, anemia, weakness or wasting away of muscle tissue, drop in internal body temperature leading to always feeling uncomfortably cold, severe constipation, slowed breathing, lowered pulse rate, and sluggishness.

Similarly, bulimia and purging disorder can lead to damaging metabolic changes, swelling of the parotid glands, heart problems, gastrointestinal issues, and oral bleeding as a result of esophageal tearing (from induced vomiting).

In addition, there are many ob/gyn complications for women suffering from eating disorders, including:

• Miscarriage risk
• Infertility issues
• Unplanned occurrence of pregnancy
• Congenital disabilities, including small head circumference in the baby
• Complications treating gynecologic types of cancer
• Postpartum mental health issues, including anxiety and depression
• Decreased nutritional health for pregnant women

Other possible consequences for this population include polycystic ovarian syndrome resulting from bulimia, obesity from binge eating disorder, and difficulty breastfeeding as a result of anorexia.

Cognitive Side Effects

Eating disorders can lead to lasting and disruptive effects on cognition, including:

• Lowered ability to focus and pay attention
• Negatively impacted processing speed
• Worsening of social skill abilities
• Decreased reasoning skills and ability to problem-solve
• Impaired visual learning ability

These disruptions in cognitive ability can negatively affect the ability to adapt and maintain healthy interpersonal relationships.

Eating Disorder Treatment

Early detection of eating disorders alongside treatment provision are key factors in achieving recovery. Treatments shown to be most effective for eating disorders are behavioral interventions that help a person regain normal eating patterns and tackle their actions to control their weight.

Individual Treatment

Individual treatment can range from outpatient therapy to inpatient or residential treatment that may be hospital-based. These more intensive treatment modalities can be crucial for individuals with very low body weights and those who have shown an inability to gain weight by utilizing a lower level of care.

For individuals with anorexia, one of the most recurring indicators that relapse will occur after receiving treatment is a prior inability to restore their weight to a healthy level. This provides evidence that receiving around-the-clock treatment care can be especially helpful.

No matter the level of care, cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) have shown to be particularly helpful in the treatment of certain eating disorders, especially bulimia. Dialectical behavioral therapy (DBT) is also useful in treatment provision for people with eating disorders.

Group Treatment

Modalities of therapy such as CBT, IPT, and DBT can also be provided in a group therapy setting as opposed to individual sessions. Group therapy can provide a patient with camaraderie as well as increased insight regarding their eating disorder behaviors.

Receiving empathy and encouragement from others can aid in positive treatment outcomes. Group therapy can occur in several settings, including outpatient, partial hospitalization, and inpatient treatment.

Family Psychotherapy

Incorporating a person’s family in therapy may improve treatment outcomes, especially for adolescents. Family can play a key role in treatment by providing encouragement and support to the person with an eating disorder. They can also serve as a support system to both their family member with the condition and the person or team providing the treatment.

Family members can be a catalyst for the affected person to seek help for their eating disorder. Family therapy can also be very beneficial by teaching parents or caregivers to monitor their loved one’s eating habits while providing ongoing support.

Medications

Medication may help treat eating disorders, especially if a person is also experiencing depression or anxiety related to the eating disturbance. Reaching out to a healthcare provider is the best option for exploring medication options in treatment. Medication has been shown to be especially useful when administered alongside psychotherapy.

The only approved medication worldwide for bulimia is fluoxetine (Prozac).

In the United States, the FDA has approved the medication lisdexamfetamine (Vyvanse and Elvance) for binge eating disorder.

There is currently no approved prescription medication to treat anorexia, avoidant/restrictive food intake disorder, rumination disorder, or the eating disorder pica. Despite this, there is preliminary evidence that helpful medications for people with anorexia could include olanzapine (Zyprexa) and other atypical antipsychotics, as well as dronabinol (Marinol and Syndros), which is a cannabinoid receptor agonist medication.

Nutritional Counseling

Receiving nutritional counseling can be a beneficial element of the treatment plan for someone experiencing an eating disorder.

Nutritional counseling can help a person learn the skills needed to restore nutrition in their body and improve physical health. This can also help a person achieve a healthy weight if necessary. By learning skills from a nutritional counselor, a person can also learn to lessen excessive exercise in disorders where this is a concern. It can also assist in lowering or eliminating binging and purging behaviors when those symptoms are present.

How To Help Someone With An Eating Disorder

Empathy is key in helping someone with an eating disorder. Aiding them in recognizing the concerning changes in their behavior is helpful. This can be an essential first step in helping someone lessen or stop disordered behaviors and begin to overcome their anxiety regarding making healthy changes.

Assisting someone in locating treatment and accompanying them for a first therapy or medical appointment is also recommended.

Recovery often has the best results when a team approach that includes loved ones alongside healthcare professionals is employed. Along with providing compassion, it can be helpful to understand that a person suffering from an eating disorder may be worried or ambivalent about beginning their healing journey. If you are regularly around a person with an eating disorder, accompanying them while providing support during mealtimes can be effective.

It is important to remember that treatment is highly effective and that complete recovery is possible. Proper treatment will help a person lessen unhealthy eating patterns and obsessive attempts to control weight while teaching them to recognize the distorted cognitions that led to and sustained the eating disorder.

Getting Help For An Eating Disorder

Eating disorders lead to significant impairment in health and psychological well-being. If you are struggling with an eating disorder, you do not have to struggle alone. Help is available.

Contact your doctor or another health care provider who can perform an assessment and connect you to appropriate treatment options.