Eating Disorders

Eating Disorders

By

Dr. David Koehn

Taken from a series of information from the internet, here is a treatise on eating disorders. Eating disorders are about more than food. Has your urge to eat less or more food spiraled out of control? Are you overly concerned about your outward appearance? If so, you may have an eating disorder.

Eating disorders are serious medical illnesses marked by severe disturbances to a person’s eating behaviors. Obsessions with food, body weight, and shape may be signs of an eating disorder. These disorders can affect a person’s physical and mental health; in some cases, they can be life-threatening. But eating disorders can be treated. Learning more about them can help you spot the warning signs and seek treatment early. Eating disorders are not a lifestyle choice. They are biologically-influenced medical illnesses.

Eating disorders can affect people of all ages, racial/ethnic backgrounds, body weights, and genders. Although eating disorders often appear during the teen years or young adulthood, they may also develop during childhood or later in life (40 years and older). People with eating disorders may appear healthy, yet be extremely ill.

The exact cause of eating disorders is not fully understood, but research suggests a combination of genetic, biological, behavioral, psychological, and social factors can raise a person’s risk. Specifically, biological factors, social pressure, and family history and dynamics are some of the factors associated with eating disorders. Culturally mediated body-image concerns and personality traits like perfectionism and obsessiveness also play a large role in eating disorders, which are often accompanied by depression and/or anxiety.

What are the common types of eating disorders?

Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder. If you or someone you know experiences the symptoms listed below, it could be a sign of an eating disorder—call a health provider right away for help.

1. Anorexia Nervosa

People with anorexia nervosa avoid food, severely restrict food, or eat very small quantities of only certain foods. Even when they are dangerously underweight, they may see themselves as overweight. (Karen Carpenter, a renowned singer, succumbed to this form of an eating disorder.) They may also weigh themselves repeatedly. There are two subtypes of anorexia nervosa: a restrictive subtype and binge-purge subtype. Restrictive: People with the restrictive subtype of anorexia nervosa place severe restrictions on the amount and type of food they consume. Binge-Purge: People with the binge-purge subtype of anorexia nervosa also place severe restrictions on the amount and type of food they consume. In addition, they may have binge eating and purging behaviors (such as vomiting, use of laxatives and diuretics, etc.).

Symptoms include:

• Extremely restricted eating and/or intensive and excessive exercise
• Extreme thinness (emaciation)
• A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
• Intense fear of gaining weight
• Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight

Over time, these symptoms may also develop:

1. Thinning of the bones (osteopenia or osteoporosis)
2. Mild anemia and muscle wasting and weakness
3. Brittle hair and nails
4. Dry and yellowish skin
5. Growth of fine hair all over the body (lanugo)
6. Severe constipation
7. Low blood pressure, slowed breathing and pulse
8. Damage to the structure and function of the heart
9. Drop in internal body temperature, causing a person to feel cold all the time
10. Lethargy, sluggishness, or feeling tired all the time
11. Infertility
12. Brain damage
13. Multiorgan failure

Anorexia can be fatal. Anorexia nervosa has the highest mortality (death) rate of any mental disorder. People with anorexia may die from medical conditions and complications associated with starvation; by comparison, people with others eating disorders die of suicide. If you or someone you know is in crisis and needs immediate help, call the toll-free National Suicide Prevention Lifeline (NSPL) at 1-800-273-TALK (8255), 24 hours a day, 7 days a week.

2. Bulimia Nervosa?

People with bulimia nervosa have recurrent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behaviors that compensate for the overeating, such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. Unlike those with anorexia nervosa, people with bulimia nervosa may maintain a normal weight or be overweight.

Symptoms include:

• Chronically inflamed and sore throat
• Swollen salivary glands in the neck and jaw area
• Worn tooth enamel and increasingly sensitive and decaying teeth (a result of exposure to stomach acid)
• Acid reflux disorder and other gastrointestinal problems
• Intestinal distress and irritation from laxative abuse
• Severe dehydration from purging
• Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium and other minerals), which can lead to stroke or heart attack

3. Binge-Eating Disorder

People with binge-eating disorder lose control over their eating. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder are often overweight or obese.

Symptoms include:

• Eating unusually large amounts of food in a specific amount of time, such as a 2-hour period
• Eating fast during binge episodes
• Eating even when full or not hungry
• Eating until uncomfortably full
• Eating alone or in secret to avoid embarrassment
• Feeling distressed, ashamed, or guilty about eating
• Frequently dieting, possibly without weight loss

Other Eating Disorders

1. Rumination disorder

Rumination disorder is repeatedly and persistently regurgitating food after eating, but it's not due to a medical condition or another eating disorder such as anorexia, bulimia, or binge-eating disorder. Food is brought back up into the mouth without nausea or gagging, and regurgitation may not be intentional. Sometimes regurgitated food is rechewed and swallowed or spit out.

The disorder may result in malnutrition if the food is spit out or if the person eats significantly less to prevent the behavior. The occurrence of rumination disorder may be more common in infancy or in people who have an intellectual disability.

2. Avoidant/restrictive food intake disorder

This disorder is characterized by failing to meet your minimum daily nutrition requirements because you don't have an interest in eating; you avoid food with certain sensory characteristics, such as color, texture, smell or taste; or you're concerned about the consequences of eating, such as fear of choking. Food is not avoided because of fear of gaining weight. The disorder can result in significant weight loss or failure to gain weight in childhood, as well as nutritional deficiencies that can cause health problems.

3. Pica

Ever heard of a reality television show called, ‘My Strange Addiction?’ Although a majority of us may believe it is scripted, many individuals who appeared on the show were addicted to eating mattresses, hair, and other non-edible items. Believe it or not, this is not a ‘fake’ condition, but those individuals have a psychological disorder known as pica. A recent episode in “Bull” illustrated the devastating impact Pica can have on a family. 

That said, pica is a psychological disorder characterized as the persistent eating of substances with no nutritional value, such as dirt, hair, ice, paper, metal, stones, glass, chalk, drywall or paint, and even feces. According to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) criteria, for a person’s eating habits to be considered pica, it must persist for more than one month at an age where eating non-edible substances is considered developmentally inappropriate and is not a cultural practice. The condition also needs to be severe enough that it requires medical attention. Pica has also been linked to other mental and emotional disorders as well, including obsessive-compulsive disorder, and can lead to a plethora of complications such as intoxication, physical and mental impairment, nutritional deficiencies, and emergency surgeries due to intestinal obstruction.

Pica is seen more in young children than adults. Up to one-third of children ages, 1 to 6 have these eating behaviors. It is unclear how many children with pica intentionally consume dirt (geophagy). Pica can also occur during pregnancy. In some cases, a lack of certain nutrients, such as iron and zinc, may trigger the unusual cravings. Pica may also occur in adults who crave a certain texture in their mouth.

1. Obesity

While technically not classified as an eating disorder, obesity is a complex disorder involving an excessive amount of body fat. Obesity isn't just a cosmetic concern. It increases your risk of diseases and health problems, such as heart disease, diabetes, and high blood pressure. Being extremely obese means, you are especially likely to have health problems related to your weight.

The good news is that even modest weight loss can improve or prevent the health problems associated with obesity. Dietary changes, increased physical activity, and behavior changes can help you lose weight. Prescription medications and weight-loss surgery are additional options for treating obesity.

Obesity is diagnosed when your body mass index (BMI) is 30 or higher. Your body mass index is calculated by dividing your weight in kilograms (kg) by your height in meters (m) squared.

For most people, BMI provides a reasonable estimate of body fat. However, BMI doesn't directly measure body fat, so some people, such as muscular athletes, may have a BMI in the obese category even though they don't have excess body fat. Ask your doctor if your BMI is a problem.

Risk factors

Teenage girls and young women are more likely than teenage boys and young men to have anorexia or bulimia, but males can have eating disorders, too. Although eating disorders can occur across a broad age range, they often develop in the teens and early 20s.

Certain factors may increase the risk of developing an eating disorder, including:

• Family history. Eating disorders are significantly more likely to occur in people who have parents or siblings who've had an eating disorder.
• Other mental health disorders. People with an eating disorder often have a history of anxiety disorder, depression, or obsessive-compulsive disorder.
• Dieting and starvation. Dieting is a risk factor for developing an eating disorder. Starvation affects the brain and influences mood changes, rigidity in thinking, anxiety, and reduction in appetite. There is strong evidence that many of the symptoms of an eating disorder are actually symptoms of starvation. Starvation and weight loss may change the way the brain works in vulnerable individuals, which may perpetuate restrictive eating behaviors and make it difficult to return to normal eating habits.
• Stress. Whether it's heading off to college, moving, landing a new job, or a family or relationship issue, change can bring stress, which may increase your risk of an eating disorder.

Seek Treatment

Unfortunately, many people with eating disorders may not think they need treatment. If you're worried about a loved one, urge him or her to talk to a doctor. Even if your loved one isn't ready to acknowledge having an issue with food, you can open the door by expressing concern and a desire to listen. Be alert for eating patterns and beliefs that may signal unhealthy behavior, as well as peer pressure that may trigger eating disorders. Red flags that may indicate an eating disorder include:

• Skipping meals or making excuses for not eating
• Adopting an overly restrictive vegetarian diet
• Excessive focus on healthy eating
• Making own meals rather than eating what the family eats
• Withdrawing from normal social activities
• Persistent worry or complaining about being fat and talk of losing weight
• Frequent checking in the mirror for perceived flaws
• Repeatedly eating large amounts of sweets or high-fat foods
• Use of dietary supplements, laxatives or herbal products for weight loss
• Excessive exercise
• Calluses on the knuckles from inducing vomiting
• Problems with loss of tooth enamel that may be a sign of repeated vomiting
• Leaving during meals to use the toilet
• Eating much more food in a meal or snack than is considered normal
• Expressing depression, disgust, shame or guilt about eating habits
• Eating in secret

It is important to seek treatment early for eating disorders. People with eating disorders are at higher risk for suicide and medical complications. Some people with eating disorders may also have other mental disorders (such as depression or anxiety) or problems with substance use.

Treatment plans for eating disorders include psychotherapy, medical care, and monitoring, nutritional counseling, medications, or a combination of these approaches. Typical treatment goals include restoring adequate nutrition, bringing weight to a healthy level, reducing excessive exercise, and stopping binge-purge and binge-eating behaviors. Complete recovery is possible.

Specific forms of psychotherapy (or “talk therapy”) and cognitive-behavioral approaches can be effective for treating specific eating disorders. For more about psychotherapies, visit https://www.nimh.nih.gov/health/topics/psychotherapies/index.shtml.

Research also suggests that medications may help treat some eating disorders and co-occurring anxiety or depression related to eating disorders. Information about medications changes frequently, so talk to your health care professional and check the U.S. Food and Drug Administration (FDA) website for the latest warnings, patient medication guides, or newly approved medications available at www.nimh.nih.gov/findhelp that may help you find a provider or treatment.

Prevention

Although there's no sure way to prevent eating disorders, here are some strategies to help develop healthy-eating behaviors:

• Avoid dieting around family members. Family dining habits may influence the relationships members of the family develop with food. Eating meals together gives you an opportunity to teach each other about the pitfalls of dieting and encourages eating a balanced diet in reasonable portions.
• Talk to your family member. For example, there are numerous websites that promote dangerous ideas, such as viewing anorexia as a lifestyle choice rather than an eating disorder. It's crucial to correct any misperceptions like this and to talk to your child about the risks of unhealthy eating choices.
• Cultivate and reinforce a healthy body image in each member of the family, whatever their shape or size. Talk to each other about self-image and offer reassurance that body shapes can vary. Avoid criticizing your own body in front of each other. Messages of acceptance and respect can help build healthy self-esteem and resilience that will carry each member of the family through the rocky periods of their development.
• Enlist the help of a multidisciplinary team of health professionals (medical, psychological, and nutrition). Their input will be able to identify early indicators of an eating disorder. They can ask pertinent questions about eating habits and satisfaction with appearance during appointments. These visits should include checks of height and weight percentiles and body mass index, which can alert you and your family member’s health team to any significant changes.