Eating Disorders

What is Eating Disorders?

Eating disorders are when a person’s eating habits are disrupted, usually due to extreme worry over their body weight, which can harm their physical health or social life. They can be serious mental health issues that often lead to severe health problems and can even be fatal. In the official manual for mental health disorders, known as the DSM-5, ‘Eating Disorders’ were replaced with ‘Feeding and Eating Disorders.’ This includes eight types:

1. Anorexia nervosa: an extreme fear of gaining weight leading to self-starvation
2. Bulimia nervosa: recurring episodes of binge eating followed by harmful behaviors to prevent weight gain
3. Binge eating disorder: frequent bouts of excessive eating
4. Avoidant or restrictive food intake disorder: limited food choices due to aversion or lack of interest in eat
5. Pica: eating non-food substances
6. Rumination: regurgitating food to re-chew, re-swallow, or spit out
7. Other specific feeding and eating disorders, including:
* Purging disorder: forced vomiting or use of laxatives for weight loss
* Night eating syndrome: excessive food consumption in the evening and night
* Atypical anorexia nervosa: all symptoms of anorexia without weight-loss

There’s also subthreshold bulimia nervosa and binge eating disorder, orthorexia, and other unspecified eating disorders.

What Causes Eating Disorders?

Eating disorders can be caused by a mix of different factors, including biological issues, psychological conditions, developmental influences, and cultural aspects.

1. Biological factors:
– Genetics: Studies involving twins and adopted children show that there’s a hereditary element to eating disorders. For example, if one twin has an eating disorder, there’s a 50% chance the other twin will develop one too.
– Neurobiology: The chemical serotonin, which helps control appetite and mood, may play a part in the development of eating disorders.

2. Psychological factors: Certain personality traits, like a tendency towards perfectionism, impulsivity, seeking out new experiences, obsessive-compulsiveness, avoiding harm, and emotional instability, can often be linked to eating disorders.

Developmental factors: Disruption in early life development, such as experiencing sexual abuse in childhood, can greatly increase the risk of developing an eating disorder.

Sociocultural factors: Cultural attitudes that prefer thinness and exposure to Western ideals which value slim bodies for women can contribute to eating disorders. Likewise, media that promotes these ideas can lead to a higher occurrence of eating disorders worldwide.

Risk Factors and Frequency for Eating Disorders

About one in eight young people might develop at least one eating disorder by the age of 20. Approximately 5 million Americans struggle with eating disorders every year. Despite the fact that these disorders can occur in individuals of all ages and genders, they are most frequently found in adolescents and young women. Specifically, about 0.3% of young females have anorexia nervosa and around 1% have bulimia nervosa. Young women generally have higher rates of eating disorders, apart from binge eating disorder, which is more prevalent among men and older individuals.

• One in eight youngsters may have an eating disorder by the age of 20.
• About 5 million people in the United States are affected by eating disorders every year.
• Eating disorders mostly affect adolescents and young women, but can develop in people of all ages and genders.
• Among adolescent females, around 0.3% have anorexia nervosa, and approximately 1% have bulimia nervosa.
• Except for binge eating disorder, the prevalence of eating disorders is generally higher in young women. Binge eating disorder is more common in men and older individuals.

Signs and Symptoms of Eating Disorders

Anorexia nervosa is a well-studied eating disorder that often starts during adolescence and is more common in women. Its features include:

• Being extremely underweight
• Fear of gaining weight
• Distortion of body image and denial of being seriously underweight
• Constant behaviors to avoid weight gain despite being underweight
• Obsession with food and weight

Anorexia can result in grave consequences, including death due to medical complications or suicide. Long-term sufferers may encounter a variety of health issues such as decreased bone density, brittle hair and nails, dry skin, low blood pressure, slow heart rate, and muscle wasting.

The disease is of two types; the restrictive type where the individual loses weight through diets or excessive exercise, and the binge eating/purging type where the person consumes large quantities of food and subsequently purges, using methods such as self-induced vomiting.

Bulimia nervosa, on the other hand, is primarily characterized by consuming large amounts of food in a short period, followed by compensatory behavior to prevent weight gain. This disorder often starts in late adolescence or early adulthood and can lead to sore throats, tooth decay, severe dehydration, and hormonal disturbances.

Binge Eating Disorder is the most common eating disorder, usually beginning in adolescence. It is characterized by excessive food consumption in a short period, lack of control during these episodes, and feelings of guilt afterward. However, individuals with this disorder do not use purging behaviors to compensate.

Avoidant or Restrictive Food Intake Disorder is a condition that usually occurs during the first seven years of life and can extend into adulthood. It can manifest through intense dislikes for specific food qualities, less interest in eating, its impact on social function, and their resulting deficiency in vitality and micronutrients.

Pica is a disorder where the individual craves non-food items. It is usually benign and can resolve itself in pregnant women and children, but it can become problematic in intellectually disabled individuals.

Rumination disorder is a condition where a person voluntarily regurgitates previously consumed food, re-chews it, and either swallows or spits it out. It can lead to weight loss or malnutrition.

The Other Specified Feeding and Eating Disorder includes the purging disorder, night eating syndrome, atypical anorexia nervosa, and subclinical bulimia nervosa/binge eating disorder. These eating disorders, excluding Rumination disorder and Pica, share the same concern about overeating, body shape, and weight with unhealthy eating behavior.

Testing for Eating Disorders

When dealing with individuals who have eating disorders, it’s important to follow a structured approach. Here’s the general process:

First, a comprehensive health history is needed. This includes questions about eating habits, whether the person tends to binge eat or purge, how they view their body, their current weight versus their desired weight, and if they use anything like laxatives, diet pills, diuretics, or emetics. It’s also important to understand their menstrual history, if applicable.

Second, a mental health review should be conducted. This involves checking for signs of substance abuse, mood disorders, anxiety, personality disorders and suicidal thoughts or behaviors.

Third, a thorough review of past medical records and family history is done to see if there are any pre-existing conditions or genetic factors that could add to the person’s risk.

Fourth, a complete physical examination is performed. This includes a psychiatric examination to evaluate mental status and cognitive state, and further checks for any signs of suicidal tendencies.

Last but not least, a number of laboratory tests are conducted. These include a complete blood count, kidney and liver function tests, and checks for electrolytes, calcium, magnesium, and phosphate levels. Lipid and cholesterol levels, as well as thyroid function, are also analyzed. Urine tests, an electrocardiogram, and a chest X-ray are also part of this thorough laboratory examination.

Treatment Options for Eating Disorders

Treating eating disorders involves a range of strategies that vary greatly depending on the individual’s needs. These strategies often include a combination of psychological counselling, medication, nutritional advice, and ongoing monitoring. The goal of treatment is to address the issues causing the eating disorder, which emphasizes the importance of early intervention.

Psychotherapy techniques have proven to be successful for many eating disorders. Cognitive Behaviour Therapy (CBT) is usually the first choice for all types of eating disorders. For children and teenagers suffering from anorexia, Family-based treatment (FBT) has been particularly successful. Other forms of therapy, like Interpersonal psychotherapy, can be used as an alternative to CBT for conditions like Bulimia or Binge eating disorder.

Other therapeutic strategies include Maudsley Anorexia Nervosa Therapy for Adults (MANTRA) and Focal Psychodynamic Therapy (FPT), often used in combination with CBT. Stimulation therapies for the brain, like repetitive transcranial magnetic stimulation and deep brain stimulation, are being researched as additional treatment options.

An important part of treating eating disorders sometimes involves using medication. Fluoxetine, for example, is an FDA-approved drug that can help treat Bulimia and Binge eating disorders. However, it’s important to note that this type of medication often has limited success in treating anorexia unless the patient also suffers from major depression. Other medications like antidepressants, antipsychotics or mood stabilizers can also be beneficial in treating associated mental health conditions like anxiety or depression.

Nutritional therapy plays a crucial role in managing all types of eating disorders. When oral feeding is not an option, tube feeding is often the next alternative, with total parenteral nutrition only being used if there’s significant digestive dysfunction. The main goal of nutritional therapy in individuals with anorexia is weight gain, with the initial focus on a slow progression of calorie intake before gradually increasing this over time.

Patients recovering from eating disorders often require ongoing monitoring and support as they are at risk of relapsing. Psychotherapy can play a crucial role in preventing relapse after recovery.

As for specific treatments of eating disorders, Anorexia often requires outpatient care, psychotherapy, and sometimes antidepressant treatment if the individual experiences severe depression. In contrast, Bulimia often requires inpatient care only in the case of severe depression, suicidal thoughts, electrolyte imbalance or abuse of laxatives, diet pills, or diuretics. As for Binge Eating Disorder, cognitive-behavioral therapy and interpersonal therapy are effective treatments.

Other conditions, such as Avoidant or Restrictive Food Intake Disorder (ARFID), Pica, and Rumination Disorder require tailored treatment strategies for successful management. In all cases, any related health issues should also be addressed alongside the eating disorder treatment.

What else can Eating Disorders be?

Many other health issues can appear similar to eating disorders. Conditions such as long-term infections, issues with digestion, cancer, weak immune system, disorders related to hormones like diabetes, overactive thyroid, or Addison’s disease must be investigated and ruled out before confirming an eating disorder. A significant fear of weight gain and a skewed perception of one’s body are the typical signs of an eating disorder, and these elements can help to distinguish it from the other health issues mentioned above.

Mental health conditions such as obsessive-compulsive disorder, mood disorders, major depression, anxiety disorders, and drug abuse are often found together with eating disorders. It’s crucial to have a high level of awareness and suspicion to identify these mental health conditions, as they often occur alongside eating disorders.

Personality disorders can also occur alongside eating disorders. For instance, Bulimia nervosa is often associated with an unpredictable or dramatic personality, while anorexia nervosa tends to occur with avoidant or anxious personality disorders.

What to expect with Eating Disorders

The future outlook for people struggling with eating disorders can vary quite a bit. For instance, long-term recovery tends to be more likely in individuals with Bulimia nervosa compared to those with Anorexia nervosa. Factors that make it harder to recover from any eating disorder include recurrent binge-eating and purging, having the disorder for over six years, a very low body weight, a lack of motivation, unstable personalities, depression, concerns about body image, and strained relationships.

One of the big problems with eating disorder treatment is that people often take a long time to seek help. This is often because they lack health knowledge, experience social stigma, struggle with the cost of treatment, or can’t access good mental health services. Recovery from bulimia nervosa typically comes earlier than from anorexia nervosa. Most individuals with bulimia nervosa recover within 9 to 10 years. However, only half the people with Anorexia nervosa recover in the same time frame. Moreover, the mortality rate is higher in Anorexia nervosa compared to other eating disorders and is the highest of any mental health disorder.

Possible Complications When Diagnosed with Eating Disorders

Eating disorders can cause acute or chronic physical issues as well as mental health problems.

Acute Complications:

• Cardiovascular problems like slow heart rate, low blood pressure, irregular heart rhythm, fluid around the heart, heart failure, heart muscle scarring and fluid in lungs
• Blood issues like anemia and weaker immunity
• Cognitive issues affecting memory and concentration
• Other problems like nerve damage, muscle weakness, hepatitis, pancreatitis, constipation
• Bad dental health due to frequent vomiting, with one-third of bulimia nervosa patients having enlarged salivary glands

Eating disorders can also cause low sodium levels from diuretic use, vomiting and excessive water intake. When starting to eat properly again, low potassium levels are common, and rapid refeeding can also trigger hypophosphatemia-induced refeeding syndrome, potentially leading to muscle breakdown, red blood cell breakdown, paralyzed gut, metabolic acidosis, low blood pressure, irregular heart rhythm, heart failure, seizures, coma, and sudden death.

Patients with eating disorders may lack important vitamins like thiamine, niacin, B6, B12, C, D, E, K and folate, and minerals like iron, zinc, magnesium, and copper. Anorexia nervosa can cause endocrine issues like missed periods due to brain changes, and high cortisol levels and resistance to growth hormone.

Chronic Complications:

• Delayed growth and development, and puberty
• Missed periods in females and impotence in males as a result of eating disorders. Pregnant women with eating disorders have higher rates of complications during pregnancy
• Decreased bone density, with a higher risk of fractures
• Binge eating can lead to obesity and type 2 diabetes

Psychiatric Coexisting Conditions:

• Anxiety disorders
• Depression with suicidal thoughts
• Compulsive behaviors like skin-picking, hair-pulling, excessive exercise
• Impulsive actions like self-harm, aggression, alcohol use, drug use
• Obsessive-compulsive personality disorder, borderline personality disorder and avoidant personality disorder are often seen in conjunction with eating disorders

The phenomenon of the body’s reaction to resuming nutrition after malnutrition, known as refeeding syndrome, can cause medical complications. This includes low phosphorous levels and fluid overload. To avoid this, the protein intake should initially be 1.2 grams per kilogram of ideal body weight per day, with a low-calorie intake of 30 kcal/kilogram/day during the first week, while ensuring phosphorus levels stay above 3.0 mg/dL. Monitoring of different health parameters and correction of electrolyte imbalances are crucial during refeeding. Feeding should begin slowly, at 10 kcal per kg/day, and gradually increased over a week.

Preventing Eating Disorders

: Eating disorder prevention is a very important public health matter. Programs that aim to benefit everyone and are implemented at a national, community, or even school level, aim to enhance overall health while decreasing the risk of developing eating disorders. These programs often involve education on subjects such as eating disorders, body image, and weight issues, and can be part of a school’s curriculum.

When someone is diagnosed with an eating disorder, it’s very important to provide education to both the patient and their family about the disease, what to expect, and how to manage it. Parents and other family members can play a vital role in managing the disorder, especially for young children or teenagers. This management can include helping plan meals or setting boundaries.