Understanding Eating Disorders: Types, Symptoms, Causes, and Treatment
Eating disorders are considered some of the the most dangerous of mental disorders.
Eating disorders, characterized by disturbances in eating, pose a significant risk on physical health and other aspects of life, such as personal relationships and professional life.
- Understanding Eating Disorders
- How Are Eating Disorders Diagnosed?
- What Are The Common, Core Elements Across Eating Disorders?
- Why Does It Matter Whether Someone Has An Eating Disorder?
- How Do You Know If You Or Someone You Care About Has An Eating Disorder?
- What Causes Eating Disorders?
- Can Eating Disorders Be Prevented?
- What Could Make An Eating Disorder Better Or Worse?
- Eating Disorder Treatment and Recovery
Understanding Eating Disorders
How Are Eating Disorders Diagnosed?
The Diagnostic and Statistical Manual of Mental Disorders (DSM), a publication of the American Psychiatric Association (APA), describes the signs and symptoms of eating disorders.
The DSM-5, the fifth and current edition published in 2013, list the following eating disorders:
- Anorexia nervosa,
- Bulimia nervosa,
- Binge-eating disorder,
- Avoidant/restrictive food intake disorder (arfid),
- Rumination disorder, and
- other specified feeding andeating disorders (OSFED).
1. Anorexia Nervosa
Anorexia nervosa, often referred to simply as anorexia, is carachterized by a reduced consumption of calories that results in:
- an abnormally low weight for adults or a failure for children and teens to grow as they should,
- a fear of weight gain or of becoming fat, and
- a distorted perception of body weight and shape.
Although, people with anorexia place a high value on controlling their weight and shape, nearly 50% of adults with anorexia binge eat and/or purge regularly.
Purging is an unhealthy behavior that aim to get rid of food consumed or compensate for binge eating. It usually involves self-induced vomiting, fasting, exercising, or misuse of medicines like laxatives, diuretics, or enemas.
2. Bulimia Nervosa
Bulimia nervosa, commonly called bulimia, is a serious, potentially life-threatening eating disorder.
People with bulimia engage in repeated episodes of binge eating and purging, at least once weekly over a 3-month time frame.
When it comes to discussing eating disorders, binge-eating refers to feelingout of control while eating an amount of food that most people would agree is large given the circumstances.
As with anorexia nervosa, people with bulimia nervosa are very concerned with and focused on their body weight and shape.
3. Binge-Eating Disorder
People with binge-eating disorder regularly engage in binge-eating episodes, but they do not purge.
Their binge-eating episodes, commonly involve:
- Eating faster than usual,
- Eating until they are very full,
- Eating when they are not hungry, and
- Eating alone, because they feel ashamed about how much they eat.
The experience of binge eating can cause sever unhappiness.
4. Avoidant/Restrictive Food Intake Disorder (ARFID)
ARFID, oftentimes characterized as “extreme picky eating,” is an eating disorder impacting thousands of individuals, particularly children.
Unlike individuals with anorexia nervosa, those with ARFID avoid certain foods not because of concern about getting fat, body shape, or weight, but because of fears related knowing they must eat, when they have no interest in eating, fearing the temperature might not be what they like, fear of choking or becoming sick or fear of eating a new food.
Pica refers to the persistent phenomenon of eating substances such as dirt or paint, or paper that have no nutritional value.
A toddler or an individual living in famine would not be considered to have pica if non-food substances were repeatedly eaten.
6. Rumination Disorder
Rumination disorder is characterized by repeatedly and unintentionally regurgitating (bringing food that has just been swallowed back up into the mouth) undigested or partially digested food from the stomach, rechewing it, and then either reswallowing it or spitting it out.
7. Other Specified Feeding And Eating Disorders (OSFED)
The DSM-5 briefly describes a set of other specified feeding and eating disorders (OSFED). These disorders are considered “other” simply because relatively little is known about them.
Examples of OSFED described in DSM-5 are as follows:
- Atypical anorexia nervosa
- Subthreshold bulimia nervosa
- Subthreshold binge-eating disorder
- Purging disorder
- Night eating syndrome
Orthorexia is an unhealthy obsession with healthy eating, including being very concerned with a food’s quality, origins, or preparation.
Orthorexia per se is not an eating disorder. But it makes it hard to maintain a healthy weight or lead to medical problems, a diagnosis of anorexia nervosa or of ARFID may apply.
If the highly restrictive eating behavior growing out of orthorexic attitudes results in reactive binge-eating, a diagnosis of bulimia nervosa, binge-eating disorder, or OSFED may apply.
Obesity is not considered an eating disorder because a range of factors—biological, behavioral, and environmental— that vary across people contribute to its development.
What Are The Common, Core Elements Across Eating Disorders?
1. Aberrant eating behavior – is the core, common feature across distinct eating disorders. These behabiors might include:
- Skipping meals
- Limited variety in diet
- Eating in isolation
- Inducing vomiting after eating
- Binge-purge behaviors
2. Mental distress underlying, accompanying, or resulting from disturbances in eating behavior – such as low self-esteem, concerns about appearance (body shape, weight, or both), perfectionism, etc.
Once the change in eating behavior becomes routine, guilt and shame feelings about eating, and loss of control feeling intensify.
Why Does It Matter Whether Someone Has An Eating Disorder?
1. Eating Disorders Take A Toll Physically.
Anorexia nervosa, for example, is considered the most fatal mental disorder with 10% mortality rate.
Remaining at too low a body weight than what the body needs to function normally has significant consequences, including Abnormal heart rhythms, called arrhythmia, low blood pressure and decreased heart size.
The underweight state can also cause poor bone health, even in young people, and disrupts menstrual functioning and fertility in women.
Purging, be it vomiting or misuse of medicines like laxatives and diuretics (water pills), is a symptom common to anorexia nervosa binge-purge subtypen bulimia nervosa, and purging disorder.
Such behavior can result in dehydration and loss of crucial electrolytes (salts such as potassium and sodium) from the body. Moreover, frequent vomiting can cause dental erosion and tears in the esophagus.
Frequent binge-eating episodes characteristic of bulimia nervosa and binge-eating disorder may result in excessive weight gain over time, which may contribute to an array of medical problems, such as heart disease, type 2 diabetes, high blood pressure, Sleep apnea and breathing problems, etc.
2. Eating Disorders Take A Toll Psychologically.
Individuals with eating disorders often feel depressed and anxious, but this is not just because they’re worried about their body weight and shape.
In fact, individuals with anorexia nervosa are eight times more likely to attempt suicide than those in the general population and around one-third of adults with bulimia nervosa have had thoughts of suicide, with 25–30% having made attempts.
It is important to identify the emotional problems associated with eating disorders.
Individuals with eating disorders may:
- feel unworthy and hopeless.
- have a distorted sense of reality and battle with disordered thoughts.
- be malnourished and not thinking clearly.
How Do You Know If You Or Someone You Care About Has An Eating Disorder?
Eating disorders are sometimes easier to recognize in someone else than in oneself. Individuals with eating disorders can develop rules and ideas about food that are all-or-nothing and extreme.
While dietary changes and weight loss do not indicate the presence of an eating disorder, unusual and frequent eating behaviors can cause significant trouble.
An evaluation is appropriate in the following cases:
* Dramatic change in the foods eaten,
* No longer eating favorite foods or following strict food rules,
* Eating in patterns that appear unusual—consuming large amounts of food followed by frequent trips to the bathroom, for example.
* Their social life is changing because of the suffering experienced around eating (avoiding meals in social settings including in front of family, eating in one’s room, etc)
If and when you become concerned that your eating behaviors might include unhealthy patterns, you may ask your primary care provider whether an eating disorder is present.
You can also seek evaluation by an eating disorder specialist.
To find an eating disorder specialist in your local area, you can ask your current healthcare provider or your insurance company, or consult national professional organizations with referral resources, including those available through the National Eating Disorders Association (NEDA) and Academy for Eating Disorders (AED).
The evaluation process may vary for different individuals, but there will be usually questions about thoughts and feelings about food, weight, and body shape.
Individuals undergoing an evaluation may be asked to a questionnaire, such as the Eating Attitudes Test (EAT-26) or the Eating Disorders Assessment for DSM-5 eating disorders (EDA-5).
There should be also discussions about eating behavior, weight history, family history of eating and eating disorders, and past and current menstrual functioning for girls and women.
Clinicians may also look for physical signs of an eating disorder such as:
- body-checking (i.e., a pattern of touching, pinching, or measuring body parts, including one’s wrists, ribs, hip bone, etc.),
- visible dental erosion, or
- calluses on the back of the hand resulting from repeatedly using it to self-induce vomiting.
To provide more information about the existence of eating disorder and how seriously it has affected the body, other tests could take place such as:
- a physical exam (with attention to vital signs such as heart rate, blood pressure, and temperature),
- an electrocardiogram, and
- blood tests (with attention to serum electrolytes such as sodium and potassium) and blood cell counts.
What other conditions resemble eating disorders?
This is another reason why you need a professional evaluation.
Other illnesses that affect eating behaviors and /or weight could resemble eating disorders such as cancer, HIV, hyperthyroidism.
Hormone disturbances such as Cushing’s disease or insulin-dependent diabetes, lead to increased appetite which may resemble binge-eating disorder.
Other problems may present similar symptoms to those of eating disorders. For example, someone with social anxiety disorder may avoid all social occasions because they fear interaction with others.
What other conditions may occur together with eating disorders?
Depression and anxiety disorders are the most common psychiatric disorders that can occur together with eating disorders.
Obsessive-compulsive disorder (OCD) and substance use disorders can also co-occur with eating disorders such as anorexia nervosa.
What Causes Eating Disorders?
As with most mental disorders, there is no one, simple cause for eating disorders.
Factors such as the individual’s psychological makeup, the genes inherited from parents, media exposure, and peer influence, can play a role in increasing, and decreasing, the chances of developing an eating disorder.
Can Eating Disorders Be Prevented?
In recent years, prevention-based approaches have been developed for eating disorders with growing evidence of their effectiveness, such as programs known as the Body Project and Student Bodies.
The goal from these preventive approaches is to reduce the idealization of thinness, especially among girls and young women.
What Could Make An Eating Disorder Better Or Worse?
Eating disorders are complicated because some of the typical behaviors of the disorders are acceptable or even encouraged in people who do not have eating disorders.
Skipping a meal – Skipping a meal from time to time is okay for a person without an eating disorder, but doing so can be harmful to someone with an eating disorder.
Exercise – Similarly, while exercise is healthy for most people, it can be much more complicated for someone with an eating disorder because for him, the primary goal is to lose additional weight or prevent weight gain, and to maintain (rather than relieve) body dissatisfaction. In such case, exercise might be in and of itself be a symptom of an eating disorder.
Eating Disorder Treatment and Recovery
Eating disorder is a treatable illness.
The treatment of an eating disorder typically emphasizes the importance of normalizing all eating (and related) behavior, such as eating three meals and a snack or two daily in order to normalize hunger cues.
It also aims to create a structure that helps limit time spent thinking about food and eating and decreases the risk of binge eating.
For younger patients, there is strong evidence that family’s support has a tremendous positive effect in helping a child, teen, or even adults (who live at home) with an eating disorder.
These changes could be achieved by working with a specialist who helps them carry out a family-based treatment approach, as it could be achieved without much or any professional help.
F.E.A.S.T. (Families Empowered and Supporting Treatment of Eating Disorders) and Project HEAL are two organizations that offer online and in-person peer support for parents, and individuals with an eating disorder.
When the disorder had just begun to take hold or when symptoms are not particularly severe. Trying anything that feels useful, including self-help can help you get better.
However, when symptoms persist, or return after a brief remission, you need to consider professional help. Keep in mind that the longer symptoms remain in place, the harder it is to change them.
Below are some self-help approaches that may help you get better
#1. Use Social Media Wisely
Several studies report that spending time looking at social media sites may increase body-shape preoccupation and decrease body acceptance. Discussing social media experiences with treatment providers is important.
But social media could also be used in recovery from an eating disorder as a way to find inspiration and validation.
#2. E-Mental Health Resources: Smartphone Apps
Using e-mental health resources can help with eating disorder treatment and overall psychological well-being.
Some of these apps are:
Recovery Record: Eating Disorder Management
This app includes:
- self-monitoring (food records, thoughts, feelings, urges to use compensatory behaviors),
- personalized coping strategies,
- a portal to connect with the user’s clinician,
- components of CBT-based interventions for eating disorders,
- assistance with goal-setting, and
- additional features including ability to set reminders, meal planning, rewards, affirmations, and the potential to connect with others.
iPhone rating: 4.9 stars
Android rating: 4.8 stars
Rise Up + Recover: An Eating Disorder Monitoring and Management Tool for Anorexia, Bulimia, Binge Eating, and EDNOS
This app includes:
- self-monitoring (food records, thoughts, feelings, urges to use compensatory behaviors),
- personalized coping strategies,
- ability to share motivational quotes, images, and affirmations,
- additional eating disorder treatment resources such as podcasts, informational articles, and a treatment directory.
- Possibility to export PDF summaries of your meal log and check-ins to share with members of your treatment team.
iPhone rating: 4.7 stars
Android rating: 4.3 stars
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- Portions of this article were adapted from the book Eating Disorders: What Everyone Needs to Know®, © 2020 by B. Timothy Walsh, Deborah R. Glasofer, and Evelyn Attia. All rights reserved.