Eating Disorders

Eating disorders are serious conditions characterized by an incessant urge to eat that can have negative impacts on their physical and mental state and engaging in compensatory behaviors, like purging or excessive exercising after the binge episode.

What Are Eating Disorders?

Eating disorders are life-threatening conditions characterized by abnormal eating habits that can negatively impact an individual physically and mentally. Most eating disorders involve an extreme focus on reducing weight, excessive eating, and body shape. A research paper [mfn] National Guideline Alliance (UK). Eating Disorders: Recognition and Treatment. London: National Institute for Health and Care Excellence (UK); 2017 May. (NICE Guideline, No. 69.) 2, Introduction. Available from: https://www.ncbi.nlm.nih.gov/books/NBK533174/ [/mfn] explains the condition as “a persistent disturbance of eating behavior or behavior intended to control weight, which significantly impairs physical health or psychosocial functioning.”

Such behaviors can severely impact the body’s ability to get the appropriate amount of nutrition it requires to stay healthy. Eating disorders can also cause medical conditions related to the heart, digestive systems, bones, teeth, and mouth. For some people, exercising control overeating or excessive exercising is a way to gain control of their weight. It may begin as simply eating more than usual and gradually develop into out-of-control eating behavior.

According to a 2015 study [mfn] Sharan, P., & Sundar, A. S. (2015). Eating disorders in women. Indian journal of psychiatry, 57(Suppl 2), S286–S295. https://doi.org/10.4103/0019-5545.161493 [/mfn] , such conditions are disorders associated with eating behaviors that affect our thoughts, emotions & attitudes and involve the ensuing physiological impairments. “Eating disorders are associated with a significant burden on patients and their family members and have among the highest mortality rate one of the psychiatric disorders,” explains the study.

These disorders develop during teenage years and in young adulthood. This condition affects both genders wherein women are more affected than men. The causes of this condition are unclear but there may be genetic, environmental, and biological factors involved. Recovery is possible with treatment and medications. In extreme cases, hospitalization may be required to attend to any associated medical conditions.

Prevalence Of Eating Disorders

Eating disorders, particularly bulimia nervosa and anorexia nervosa, are typically observed in young females. A 2015 study [mfn] Arcelus, J., Witcomb, G., & Mitchell, A.. (2014). Prevalence of eating disorders amongst dancers: a systemic review and meta-analysis (Version 1). Loughborough University. https://hdl.handle.net/2134/18993 [/mfn] found that these disorders affect almost 12% of dancers. One 2010 study [mfn] Chen, L. P., Murad, M. H., Paras, M. L., Colbenson, K. M., Sattler, A. L., Goranson, E. N., Elamin, M. B., Seime, R. J., Shinozaki, G., Prokop, L. J., & Zirakzadeh, A. (2010). Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. Mayo Clinic proceedings, 85(7), 618–629. https://doi.org/10.4065/mcp.2009.0583 [/mfn] found that individuals who have experienced sexual abuse are more likely to develop this condition. A 2015 report found that anorexia affects about 0.4% and bulimia affects about 1.3% of young women in a given year.

Anorexia and bulimia occur nearly ten times more often in women than in men. A report [mfn] Smink, F. R., Van Hoeken, D., & Hoek, H. W. (2013). Epidemiology, course, and outcome of eating disorders. Current Opinion in Psychiatry, 26(6), 543-548. https://doi.org/10.1097/yco.0b013e328365a24f [/mfn] conducted to devise the expected time for recovery found that 70% of people with anorexia and 50% of people with bulimia recovered within five years. It is important to keep in mind that anorexia and bulimia have an increased risk of death.

Types Of Eating Disorders

Symptoms of eating disorders may vary according to the type of the disorder. The most common eating disorders are anorexia nervosa, bulimia nervosa, binge eating disorder, rumination disorder, pica disorder, restrictive food intake disorder, and others.

1. Anorexia nervosa

Anorexia nervosa is a type of eating disorder characterized by having an unrealistic idea about body image and an intense fear of gaining weight. Individuals with this condition are extremely focused on their weight. Due to this, they often resort to extreme measures such as excessive exercising or misusing laxatives. This can negatively impact their daily life and mental state.

In order to prevent weight gain, they also restrict their food intake to keep their calorie intake in check. A 2014 study [mfn] Universite de Montreal. (2014, October 8). Childhood eating difficulties could be a sign of underlying psychological issues. ScienceDaily. Retrieved March 21, 2021 from www.sciencedaily.com/releases/2014/10/141008083159.htm [/mfn] confirmed that it is the most common chronic condition among teens. This condition is more common in females than in males. A 2006 study [mfn] Hoek HW. Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Curr Opin Psychiatry. 2006 Jul;19(4):389-94. doi: 10.1097/01.yco.0000228759.95237.78. PMID: 16721169. [/mfn] found that the average prevalence rate of anorexia among young females is 0.3%.

The signs and symptoms of Anorexia nervosa includes:

• Restricted eating
• Thin appearance
• Abnormal blood counts
• Fatigue
• Insomnia
• Dizziness or fainting
• Bluish discoloration of the fingers
• Fear of gaining weight
• Repeated weighing and measuring your body
• Checking the mirror frequently for perceived flaws
• Complaining about being fat or having parts of the body that are fat
• Covering up in layers of clothing
• Flat mood or lack of emotion
• Social withdrawal
• Irritability
• Depressed or suicidal tendencies

Read More About Anorexia Nervosa Here

2. Bulimia Nervosa

Bulimia Nervosa is an eating disorder characterized by consuming a substantial amount of food and purging, and feeling a lack of control over the excess food intake. This condition is a life-threatening disorder since it may cause medical conditions that require immediate attention. Bulimia usually involves uncontrollable eating which may stop if the individual is interrupted or if their stomach starts to hurt.

This is followed by self-induced compensatory behavior, such as purging or using laxatives. The individual suffering from this disorder usually binges and purges in secret. According to a psychiatry report [mfn] Smink, F. R., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: incidence, prevalence and mortality rates. Current psychiatry reports, 14(4), 406–414. https://doi.org/10.1007/s11920-012-0282-y [/mfn] conducted on the incidence, prevalence, and mortality rates for eating disorders, there is also a higher risk of suicide and self-harm associated with this disorder. A 2018 study [mfn] Hail, L., & Le Grange, D. (2018). Bulimia nervosa in adolescents: prevalence and treatment challenges. Adolescent health, medicine and therapeutics, 9, 11–16. https://doi.org/10.2147/AHMT.S135326 [/mfn] found the prevalence rate of bulimia nervosa is between 1% to 5%.

The common signs and symptoms of bulimia nervosa are:

• Recurrent binge eating episodes
• Engaging in compensatory behaviors such as purging or using laxatives
• Experiencing lack of control during the binge-eating episodes
• Intense fear of gaining weight despite having the normal age and height appropriate weight
• Tooth decay
• Depleted tooth enamel
• Inflamed and sore throat
• Acid reflux
• Hormonal imbalances

Read More About Bulimia Nervosa Here

3. Binge Eating Disorders (BED)

Binge eating disorder is a condition characterized by consuming copious amounts of food and feeling a loss of control during the binge episode. People with this condition eat even when they are not hungry and can continue to eat even after they are full. A 2016 study [mfn] Brownley KA, Berkman ND, Peat CM, Lohr KN, Cullen KE, Bann CM, Bulik CM. Binge-Eating Disorder in Adults: A Systematic Review and Meta-analysis. Ann Intern Med. 2016 Sep 20;165(6):409-20. doi: 10.7326/M15-2455. Epub 2016 Jun 28. PMID: 27367316; PMCID: PMC5637727. [/mfn] reported that individuals with binge eating disorder often experience extreme distress about their overeating, body shape, and weight. Reports [mfn] Iqbal A, Rehman A. Binge Eating Disorder. [Updated 2021 Jan 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551700/ [/mfn] suggest that almost 2% of people worldwide suffer from BED and can also cause additional health issues related to diet.

Some of the signs and symptoms of binge eating disorder are:

• Consuming large amounts of food
• Eating more quickly than normal
• Eating despite not being hungry
• Often eating alone due to shame or embarrassment
• Feeling guilty for eating too much

4. Pica Disorder

Pica disorder is an eating disorder characterized by consuming things that are not considered food. Individuals with this condition often crave non-food items such as ice, chalk, dirt, soil, soap, hair, pebbles, and others. Children or individuals experiencing this may be at an increased risk of poisoning, infections, gut injuries, and nutritional deficiencies. In accordance with the substance consumed, pica may also be fatal. The exact prevalence rate [mfn] Al Nasser Y, Muco E, Alsaad AJ. Pica. [Updated 2020 Dec 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532242/# [/mfn] of pica can be challenging. A German prevalence study [mfn] Murray HB, Thomas JJ, Hinz A, Munsch S, Hilbert A. Prevalence in primary school youth of pica and rumination behavior: The understudied feeding disorders. Int J Eat Disord. 2018 Aug;51(8):994-998. doi: 10.1002/eat.22898. Epub 2018 Sep 2. PMID: 30175409. [/mfn] of 804 children found that 99 children (12.6%) have engaged in pica behaviors at some point in their lives.

The most common signs and symptoms of pica disorder are:

• Stomach upset
• Stomach pain
• Blood in the stool that can be a sign of ulcer
• Bowel problems such as constipation
• Teeth injuries

5. Rumination Disorder

Rumination disorder is an eating disorder wherein an individual regurgitates food they previously consumed and then re-chews and re-swallows it or spits it out. This condition occurs within the first 30 minutes of eating the meal. Regurgitation usually occurs when ingested food rises to the esophagus, throat, and mouth but it is not involuntarily forced out of the mouth as it is done while vomiting. Rumination, also known as regurgitation is a digestive function in animals with compartmentalized stomachs such as cows and sheep. But it is believed to be a rare condition in humans. A 2012 study [mfn] Rajindrajith, S., Devanarayana, N. M., & Crispus Perera, B. J. (2012).

Rumination syndrome in children and adolescents: a school survey assessing prevalence and symptomatology. BMC gastroenterology, 12, 163. https://doi.org/10.1186/1471-230X-12-163 [/mfn] found the prevalence rate was 5.1 percent in males and 5 percent in females. Surveys also showed a prevalence rate among infants to be 6 to 10 percent [mfn] Mimidis, K., & Papadopoulos, V. (2007). The rumination syndrome in adults: A review of the pathophysiology, diagnosis and treatment. Journal of Postgraduate Medicine, 53(3), 203. https://doi.org/10.4103/0022-3859.33868 [/mfn] of the population.

The signs and symptoms of this disorder are as follows:

• Regurgitating food within 10 mins of consuming it
• Abdominal pain or pressure relieved by regurgitation of food
• Weight loss
• Chapped lips
• Digestive problems
• Dental problems

6. Avoidant/Restrictive Food Intake Disorder (AFRID)

Avoidant/restrictive food intake disorder is a new term replaced by “feeding disorder of infancy and early childhood”. AFRID is a serious condition that drives people to undereat.

This condition develops during infancy or early childhood and can also continue during adulthood. It’s a common condition among men and women. People tend to experience disrupted eating patterns due to a lack of interest in eating or distaste in certain smells, tastes, colors, textures, or temperatures. A 2018 study [mfn]Thomas, J. J., Lawson, E. A., Micali, N., Misra, M., Deckersbach, T., & Eddy, K. T. (2017). Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment. Current psychiatry reports, 19(8), 54. https://doi.org/10.1007/s11920-017-0795-5 [/mfn] found that the prevalence rate of this condition is 3.2%.

Common signs and symptoms include:

• Prevents the person from eating sufficient calories or nutrients
• Eating habits that interfere with normal social functions
• Weight loss or poor development for age and height
• Nutrient deficiencies or dependence on supplements or tube feeding

Children are found to be picky eaters. In the case of adults, they have a lower food intake. It is important to keep in mind that this condition doesn’t include the avoidance or restriction of foods due to lack of availability, religious or cultural practices.

7. Other Eating Disorders

Along with the above-mentioned eating disorders, there are other eating disorders that also exist. They are:

• Compulsive overeating
• Diabulimia
• Drunkorexia
• Night eating syndrome
• Nocturnal sleep eating disorder
• Purging disorder
• Orthorexia Nervosa

Causes Of Eating Disorders

The exact cause of eating disorders is still unknown. However, there may be other factors involved in developing this condition.

1. Genetic Factors

Experts believe that genetics may be a contributing factor in developing eating disorders. Twin and adoption studies [mfn] Klump, K. L., Suisman, J. L., Burt, S. A., McGue, M., & Iacono, W. G. (2009). Genetic and environmental influences on disordered eating: An adoption study. Journal of abnormal psychology, 118(4), 797–805. https://doi.org/10.1037/a0017204 [/mfn] found that twins who were separated at birth and adopted by different parents found evidence that eating disorders may be hereditary. This 2015 study [mfn] Culbert KM, Racine SE, Klump KL. Research Review: What we have learned about the causes of eating disorders – a synthesis of sociocultural, psychological, and biological research. J Child Psychol Psychiatry. 2015 Nov;56(11):1141-64. doi: 10.1111/jcpp.12441. Epub 2015 Jun 19. PMID: 26095891. [/mfn] found that if one of the twins develops this disorder, there’s a 50% chance for the other twin to develop it too.

2. Personality Traits

Another cause of this condition may be personality traits. A report found that neuroticism, perfectionism, and impulsivity are the three most common personality traits linked to an increased risk of developing this disorder.

Read More About Big 5 Personality Traits Here

3. Biological factors

Experts believe that differences in brain structure and biology may play a role in the development of eating disorders. Studies [mfn] Marsh, R., Stefan, M., Bansal, R., Hao, X., Walsh, B. T., & Peterson, B. S. (2015). Anatomical characteristics of the cerebral surface in bulimia nervosa. Biological Psychiatry, 77(7), 616-623. https://doi.org/10.1016/j.biopsych.2013.07.017 [/mfn] found that hormonal imbalances in the brain may trigger the urgency to consume copious amounts of food to an extent that can have life-threatening and negative impacts on an individual.

Read More About Causes of Eating Disorders Here

Comorbid Conditions Associated With Eating Disorders

There may be several comorbid conditions associated with these conditions. They include

• Anxiety disorders
• Mood disorders
• Compulsive Behaviors
• Impulsive behaviors

Complications Associated With Eating Disorders

There may be certain complications associated with this condition that can include:

• Cardiovascular effects such as low heart rate, lower blood pressure, or poor peripheral circulation.
• Hematological effects due to reduction in bone marrow activity and the quantity and quality of blood cells.
• Metabolic effects such as electrolyte abnormalities, vitamin or iron deficiencies.
• Muscular effects such as muscle weakness, pain in skeletal muscles and joints.
• Growth and development issues in children.
• Amenorrhoea in females and loss of potency in males.
• Depleted bone mineral density.
• Weight gain and obesity.

Treatment For Eating Disorders

Treatment for eating disorders depends on the severity of the symptoms. People with this condition are at a higher risk for suicidal and medical complications. Patients may also suffer from underlying mental disorders or problems with substance use. It is possible to recover from this condition with therapy and medications.

Read More About Treatment of Eating Disorders Here

Recovery From Eating Disorders

Most people with eating disorders recover with therapy, medications, or nutritional counseling. It can negatively impact an individual’s body if left untreated. There is no definite way to prevent these disorders. It is important to seek professional help in case you are experiencing the symptoms.

Eating Disorders At A Glance

1. Eating disorders are life-threatening conditions characterized by abnormal eating habits that can negatively impact an individual physically and mentally.
2. This condition affects both genders wherein women are more affected than men.
3. These disorders develop during the teenage years and in young adulthood.
4. Eating disorders, particularly bulimia nervosa and anorexia nervosa, are typically observed in young females
5. Recovery is possible with treatment and medications.