By: Bhaveeshika Charun
What are Eating Disorders?
Eating disorders are behavioural conditions characterised by severe and persistent disturbance in eating behaviours and associated distressing thoughts and emotions. They can be severe conditions affecting physical, psychological and social function (Guarda, 2023).
Types of Eating Disorders
The most common types of eating disorders include (Guarda, 2023):
● Anorexia Nervosa: is characterized by self-starvation and weight loss resulting in low weight for height and age. Dieting behavior in anorexia nervosa is driven by an intense fear of gaining weight or becoming fat.
★ There are two subtypes of anorexia nervosa:
➔ Restricting type, in which individuals lose weight primarily by dieting, fasting or excessively exercising.
➔ Binge-eating/purging type in which persons also engage in intermittent binge eating and/or purging behaviours.
★ The following symptoms may be related to starvation and purging behaviours: ➔ Menstrual periods cease
➔ 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 fullness after meals
➔ Stress fractures from compulsive exercise as well as bone loss resulting in osteopenia or osteoporosis (thinning of the bones)
➔ Depression, irritability, anxiety, poor concentration and fatigue
● Bulimia Nervosa: Individuals with bulimia nervosa typically alternate dieting, or eating only low calorie “safe foods” with binge eating on “forbidden” high calorie foods. Binge eating is defined as eating a large amount of food in a short period of time associated with a sense of loss of control over what, or how much one is eating. Binge behavior is usually secretive and associated with feelings of shame or embarrassment.
★ Possible signs include:
➔ Frequent trips to the bathroom right after meals
➔ Large amounts of food disappearing or unexplained empty wrappers and food containers
➔ Chronic sore throat
➔ Swelling of the salivary glands in the cheeks
➔ Dental decay resulting from erosion of tooth enamel by stomach acid ➔ Heartburn and gastroesophageal reflux
➔ Laxative or diet pill misuse
➔ Recurrent unexplained diarrhea
➔ Misuse of diuretics (water pills)
➔ Feeling dizzy or fainting from excessive purging behaviors resulting in dehydration
● Binge Eating Disorder (BED): People with binge eating disorder have episodes of binge eating in which they consume large quantities of food in a brief period, experience a sense of loss of control over their eating and are distressed by the binge behavior. Unlike people with bulimia nervosa however, they do not regularly use compensatory behaviors to get rid of the food by inducing vomiting, fasting, exercising or laxative misuse.
★ The diagnosis of binge eating disorder requires frequent binges (at least once a week for three months), associated with a sense of lack of control, and three of the following features:
➔ Eating more rapidly than normal.
➔ Eating until uncomfortably full.
➔ Eating large amounts of food when not feeling hungry.
➔ Eating alone because of feeling embarrassed by how much one is eating.
➔ Feeling disgusted with oneself, depressed or very guilty after a binge. ● Avoidant Restrictive Food Intake Disorder (ARFID): is a recently defined eating disorder that involves a disturbance in eating resulting in persistent failure to meet nutritional needs and extreme picky eating.
★ In ARFID, food avoidance or a limited food repertoire can be due to one or more of the following:
➔ Low appetite and lack of interest in eating or food.
➔ Extreme food avoidance based on sensory characteristics of foods e.g. texture, appearance, color, smell.
➔ Anxiety or concern about consequences of eating, such as fear of choking, nausea, vomiting, constipation, an allergic reaction, etc. The disorder may develop in response to a significant negative event such as an episode of choking or food poisoning followed by the avoidance of an increasing variety of foods.
● Other Specified Feeding and Eating Disorder: This diagnostic category includes eating disorders or disturbances of eating behavior that cause distress and impair family, social or work function but do not fit the other categories listed here. In some cases, this is because the frequency of the behavior does not meet the diagnostic threshold (e.g., the frequency of binges in bulimia or binge eating disorder) or the weight criteria for the diagnosis of anorexia nervosa are not met.
● Rumination Disorder: Rumination disorder involves the repeated regurgitation and re-chewing of food after eating whereby swallowed food is brought back up into the mouth voluntarily and is re-chewed and re-swallowed or spat out.
● Pica: Pica is an eating disorder in which a person repeatedly eats things that are not food with no nutritional value. The behavior persists over at least one month and is severe enough to warrant clinical attention.
● Typical substances ingested vary with age and availability and might include paper, paint chips, soap, cloth, hair, string, chalk, metal, pebbles, charcoal or coal, or clay. Individuals with pica do not typically have an aversion to food in general.
Symptoms
Symptoms vary, depending on the type of eating disorder. Anorexia, bulimia and binge-eating disorder are the most common eating disorders. People with eating disorders can have different body types and sizes (Guarda, 2023).
Causes
The exact cause of eating disorders is not known. As with other mental health conditions, there may be different causes, such as:
● Genetics: Some people may have genes that increase their risk of developing eating disorders.
● Biology: Biological factors, such as changes in brain chemicals, may play a role in eating disorders (Mayo Clinic, 2023).
Risk Factors
● Family history.
● Other mental health issues.
● Dieting and starvation.
● A history of weight bullying.
● Stress (Mayo Clinic, 2023).
Complications
The more severe or long-lasting the eating disorder, the more likely it is that serious complications may occur. These may include:
● Serious health problems.
● Depression and anxiety.
● Suicidal thoughts or behaviour.
● Problems with growth and development.
● Social and relationship problems.
● Substance use disorders.
● Work and school issues.
● Death (Mayo Clinic, 2023).
Red Flags That May Suggest An Eating Disorder
● Skipping meals or snacks or making excuses for not eating.
● Having a very limited diet that hasn't been prescribed by a trained medical professional.
● Too much focus on food or healthy eating, especially if it means not participating in usual events, such as sports banquets, eating birthday cake or dining out. ● Making own meals rather than eating what the family eats.
● Withdrawing from usual social activities.
● Frequent and ongoing worry or complaints about being unhealthy or overweight and talk of losing weight.
● Frequent checking in the mirror for what are thought to be flaws.
● Repeatedly eating large amounts of foods.
● Using dietary supplements, laxatives or herbal products for weight loss. ● Exercising much more than the average person. This includes not taking rest days or days off for injury or illness or refusing to attend social events or other life events because of wanting to exercise.
● Calluses on the knuckles from reaching fingers into the mouth to cause vomiting. ● Problems with loss of tooth enamel that may be a sign of repeated vomiting. ● Leaving during meals or right after a meal to use the toilet.
● Talk of depression, disgust, shame or guilt about eating habits.
● Eating in secret (Mayo Clinic, 2023).
Prevention
For Adults:
● Choose a healthy diet.
● Don’t use a dietary supplement.
● Get enough physical activities.
● Seek help for mental health issues.
For children:
● Avoid dieting around your child.
● Talk to your child.
● Encourage and reinforce a healthy body image (Mayo Clinic, 2023).
References:
1. Mayo Clinic Staff. (March 28, 2023) “Eating Disorders” Mayo Clinic https://www.mayoclinic.org/diseases-conditions/eating-disorders/symptoms-causes /syc-20353603
2. Angela Guarda, M.D. (February, 2023) “What are Eating Disorders?” American Psychiatric Association
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