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Eating disorders impact people of all demographics and harm physical and mental health. Read the article to understand different types of eating disorders and the available treatment options which are crucial in providing support and helping those affected by this condition.
What are food behaviors?
A person’s “food behavior” refers to their attitude towards food intake patterns. In other words, a combination of automatic reflexes and conscious choices determines the amount and type of food consumed in various situations.
The ideal food behavioral pattern is for the body to obtain all the essential nutrients and appropriate calories while the individual enjoys eating. However, it is typical for a person’s food behavior to deviate from what is considered normal, which can significantly impact their health and quality of life. In this article, we will see what criteria define normal behavior; how one can distinguish between types of eating disorders; some of the root causes of these disorders, and how they can be treated.
What is an eating disorder?
Usually, a person eats when hungry and stops when they feel full. However, when faced with stress or emotional disturbances, people may react by increasing or decreasing their food intake or changing their diet in minor or significant ways.
Disorders related to food consumption can take various forms, ranging from more common conditions like overeating, addiction to sweet food, or increased appetite at night to an almost complete refusal to eat or significant reduction in food consumption.
There are two main factors involved in eating disorders where patients consume less food than what is healthy:
- Concerns about body shape and weight. People worry about their weight, body shape, and eating habits and think poorly of themselves.
- Anxiety. Limiting food, eating only certain types of food or groups of products not due to weight concerns but to health risks. In other words, there is fear of health harm, illnesses, and death.
In some cases, both factors may be at play.
Causes of eating disorders
All causes are individual, but specialists have identified the following as common causes of eating disorders:
Genetic predisposition
Specific genes indicate a person’s predisposition to certain eating disorders, for example, anorexia nervosa or overeating. Twin studies also show that eating disorders can be hereditary; in particular, anorexia nervosa and bulimia nervosa are transmitted to children in about half of the cases, while binge eating is transmitted in 46-72% of cases.
Anorexia nervosa and major depression: shared genetic and environmental risk factors
Genetic and environmental influences on anorexia nervosa syndromes in a population-based twin sample
Understanding the Relation between Anorexia Nervosa and Bulimia Nervosa in a Swedish National Twin Sample
The Genetics of Eating Disorders
Biological factors
These can include disruptions in hormone regulation, premature birth, weight gain, type 2 diabetes, food intolerances, and infectious mononucleosis. Gut dysbiosis can also cause obesity, anxiety, and depression – all linked to eating disorders.
Gut microbiota’s effect on mental health: The gut-brain axis
Social factors
These can include bullying (for example, peer harassment), dysfunctional family relations, and the idealization of thinness within the family or society. Models, athletes, and dancers are at a higher risk of developing eating disorders, as there is a b association between physical appearance and success in these fields.
Family factors
These include affective disorders in a family member, such as depression and anxiety. Conditions such as these in an individual’s close family may be linked to developing eating disorders.
Depression, anxiety disorders
Disordered eating is often used to cope with many emotional problems and mood disorders.
Attachment disorder
In the case of children and adolescents, these include attachment issues with parents. This is one of the most significant factors contributing to the development of eating disorders. Attachments issues can occur in situations where:
- Parents ignore the child’s nutritional needs (strict feeding schedules, ignoring the child’s hunger and satiety cues).
- The child’s emotional and psychological needs are regularly ignored and devalued.
- There is psychological or physical abuse toward the child.
- One of the parents has left the family, or someone in the family has died.
- The child is raised by grandparents and then taken back into the family – this can create what is known as a double attachment disruption. The child first breaks the bond with the parent and needs to establish an attachment with the grandmother as a caregiver. Once the child has somehow processed this trauma, they must return and rebuild the relationship with their parent.
- The child frequently stays in hospitals due to health conditions; this can also disrupt attachment when the bond with one or both parents is severed.
Since there are many causes, there are also many manifestations of eating behavior disorders. Let’s examine the classification that helps diagnose and choose treatment methods.
Classification of eating disorders
It’s important to understand that eating disorders cannot be reliably self-diagnosed. To accurately determine whether you or someone close to you has an eating disorder, it is necessary to undergo a comprehensive evaluation with a qualified healthcare professional. The signs and symptoms of various eating disorders are listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
The impact of DSM-5 on eating disorder diagnoses
Let’s look closer at the most common eating disorders appearing in the DSM-5:
Anorexia Nervosa
This condition is characterized by a severe limitation in caloric intake, resulting in body weight significantly below what is expected for the person’s age, sex, development, and physical well-being. Individuals experiencing anorexia nervosa typically also experience intense anxiety about gaining weight, despite already being underweight.
Furthermore, a distorted body image often places undue emphasis on weight and shape, resulting in a negative self-evaluation or a failure to recognize the severity of the individual’s low body weight. It is important not to underestimate this disorder: anorexia nervosa can cause brain structures to shrink irreparably. In severe cases, it can also lead to death.
Eating Disorders
Brain Structure in Acutely Underweight and Partially Weight-Restored Individuals With Anorexia Nervosa: A Coordinated Analysis by the ENIGMA Eating Disorders Working Group
Bulimia Nervosa
This condition is marked by repeated episodes of binge eating, which involve consuming large quantities of food within about two hours while losing control over the eating. Following these episodes, individuals with bulimia nervosa often engage in compensatory behaviors, such as self-induced vomiting, taking laxatives or diuretics, exercising excessively, or using diet pills. Additionally, those affected by this condition may place undue importance on their body shape and weight, leading to negative self-evaluation and low self-esteem.
Binge Eating Disorder
This condition is characterized by repeated episodes of consuming large amounts of food beyond what most people would eat in comparable situations within a short period. These episodes are often marked by rapid eating, continuing to eat even when feeling full, and secret eating, which may lead to emotional distress. Individuals with binge eating disorder experience a sense of loss of control over their eating during these episodes, feeling unable to stop eating or control what or how much they consume.
Orthorexia Nervosa
This condition is not currently recognized in the DSM-5. Still, it is assumed that it will be included in future revisions as it becomes more prevalent and better researched.
Orthorexia is an eating disorder characterized by an obsessive desire for healthy and proper nutrition, leading to significant restrictions in food choices. The term was first coined by Steven Bratman, who initially adopted a vegan diet for health reasons and later a raw food diet.
He soon found that his attempts to adhere to this restrictive eating style significantly negatively impacted his social life. He became constantly stressed when unable to eat “properly.” He developed anxiety over consuming anything that could potentially damage his health. This disorder often manifests in people who work in nutrition, highlighting the importance of monitoring one’s condition and reacting appropriately to acquired knowledge.
On orthorexia nervosa: A review of the literature and proposed diagnostic criteria
How to recognize an eating disorder?
Each of the eating disorders has certain characteristic features specific to it.
Anorexia Nervosa
Anorexia is primarily characterized by the following:
- an intense craving to shed weight
- deep-seated anxiety about putting on weight
- an altered perception of one’s body shape
- body weight significantly below average
Despite being underweight, often dangerously so, those with anorexia have a marked dread of gaining weight and a relentless drive to reduce their weight further.
There are two types of anorexia:
- Restrictive involves restricting food intake, and usually, the person exercises excessively to burn calories.
- Purging, which includes vomiting, is used to lose weight. Purging anorexia is associated with much more significant potential damage to the body. It is, therefore, a more severe condition.
A person can be diagnosed with anorexia only if all the following signs are present:
- Restriction of the necessary energy intake leads to significantly low weight for a certain age, gender, and level of physical health development. The Body Mass Index (BMI) needs to be evaluated:
- BMI from 17 to 18.5 – mild degree of nervous anorexia
- BMI from 16 to 16.99 – moderate form
- BMI from 15 to 15.99 – a severe form
- BMI less than 15 – a highly severe form of anorexia
- An intense fear of weight gain or obesity, manifesting in compulsive behavior that prevents weight gain, even though the patient’s weight is lower than normal,
- An inaccurate perception of one’s weight or body shape, an overemphasis on weight and body image concerning self-worth, and a failure to comprehend the potential dangers of low body weight.
Bulimia Nervosa
People who have bulimia have specific common symptoms:
- all of them have tried to induce vomiting
- most of them exhibit dieting behavior, meaning they restrict themselves from food outside of binge episodes
- most of them maintain extreme exercise routines
- most of them have used laxatives
- some of them have used diet pills or diuretics
There is also a component of excessive concern about body weight and BMI. But the weight of those who have bulimia is usually normal and may even be slightly above average.
Two main diagnostic criteria for bulimia nervosa are:
- Recurrent episodes of binge eating.
As discussed above, binge eating is when the amount of food consumed during a short period (no more than 2 hours) is significantly higher than what other people would eat during the same period under the same conditions. During this state, the person cannot stop eating or control themselves. Overeating can include excessive consumption of healthy foods if the person is trying to follow a diet or eat healthily. However, during binge eating, they may still overeat salads, nuts, and dried fruit; if they have a lapse, they may also eat junk food.
- Periodic compensatory behavior.
This behavior is aimed at preventing weight gain. It can involve inducing vomiting and using laxatives, diuretics, certain medications, fasting, dieting, and excessive physical activity.
For a diagnosis of bulimia nervosa, these binge-eating episodes and compensatory behaviors must occur at least once per week for a minimum of three months.
Anorexia spontaneously transitions into bulimia in some individuals, and bulimia can spontaneously transition into binge eating.
Binge Eating Disorder
This disorder is characterized by overeating, loss of control, and no compensation behaviors (like vomiting, dieting, or physical activity).
Binge eating disorder is diagnosed if at least 3 of the following criteria are experienced by a person:
- episodes of loss of control over eating;
- episodes of overeating during periods of pronounced stress;
- eating abnormally large amounts of food in a short period;
- eating large amounts of food when not hungry, to the point of feeling uncomfortably full;
- eating when feeling depressed, sad, or bored;
- eating alone due to shame related to eating or a feeling of abnormality;
- feeling disgusted, depressed, or guilty after such an episode of overeating.
For a diagnosis of binge eating disorder, these episodes must occur at least once per week, on average, for a minimum of three months.
These individuals often experience a loss of appetite in the morning and before lunch but increase cravings for eating in the afternoon, especially at night.
Orthorexia Nervosa
Currently, there are no specific standards for diagnosing orthorexia, but the primary indicators of this disorder include the following:
- An individual places such a high value on healthy eating that it overshadows other activities and interests in their life, negatively impacting their social life
- one’s dietary choices are solely based on whether or not the food is deemed beneficial or harmful, with taste being irrelevant
- if an individual consumes any forbidden foods, they experience intense feelings of guilt and anxiety
Treatment of eating disorders
It is essential to seek the assistance and supervision of a qualified psychiatrist to manage any eating disorder.
Sadly, individuals frequently delay seeking help until the symptoms of an eating disorder have escalated. This results in a more complicated treatment involving multiple measures. Earlier treatment of eating disorders is preferred as it gives a greater chance of reversing the damage to the patient.
The treatment process typically involves several specialists, including psychiatrists, dieticians, psychologists, gastroenterologists, and other specialists, as necessary.
Comprehensive treatment of severe eating disorders is conducted in several stages:
- restoration of central nervous system function;
- restoration of weight;
- restoration of proper nutrition;
- rehabilitative psychotherapy.
If someone seeks advice from a nutritionist about meal planning and vitamin intake, but the consultation reveals the presence of an eating disorder, it is necessary to recommend seeing a psychiatrist to address the issues together.
The process of psychiatric treatment should begin with developing mindfulness around food choices. At times, individuals may experience a relapse in response to a crisis. Therefore, psychotherapy is essential to teach individuals to recognize when a crisis is happening and to learn how to manage emotions. Eating disorders can be a coping mechanism for managing internal psychological processes.
If you or someone you know exhibits symptoms of an eating disorder, it is crucial to seek professional help, as these disorders can pose a severe threat to one’s health and well-being.
References
Anorexia nervosa and major depression: shared genetic and environmental risk factors
Genetic and environmental influences on anorexia nervosa syndromes in a population-based twin sample
The Genetics of Eating Disorders
Gut microbiota’s effect on mental health: The gut-brain axis
The impact of DSM-5 on eating disorder diagnoses
On orthorexia nervosa: A review of the literature and proposed diagnostic criteria
