Eating Disorders
Eating Disorders are outlined by any eating pattern or habit that’s out of the realm of tradition. This might embody eating too very little or an excessive amount of food; most so that it’s the potential to begin to affect the person’s physical health.While the precise reason for this isn’t known, it will typically be attributed to a mixture of things that embody environmental and biological factors
Eating disorders have one of the highest mortality rates of all psychiatric diagnoses.
What Causes Eating Disorders
Eating disorder is a complex concept, with no single cause that can be cited behind the disorder. However several risk factors have been identified as contributing to the onset of eating disorders. Many experts believe that the interaction between biology, psychology, and social factors influences the diagnosis of an eating disorder.
Most eating disorders are diagnosed during adolescence, a time when several developmental, physical, and social changes occur. It is often the case that the onset of an eating disorder follows a precipitating stressful life event at any age, such as puberty or leaving home for college. In these stressful and emotionally overwhelming situations, eating disorder behaviors may be utilized to avoid experiencing feeling difficult emotions.
Generally speaking, the age of onset for most eating disorders is between 12-14 years of age, with some cases younger and older. Females are more vulnerable to eating disorders with a female-to-male ratio are approximately 20:1.
Eating disorder patients often present with at least one other mental health disorder. The most common comorbid diagnosis is Major Depressive Disorder. Other common comorbid disorders include:
Nearly all women in Western society diet at some point during adolescence or young adulthood, yet fewer than 1% develop anorexia. Genetic vulnerabilities increase one's risk for developing an eating disorder, while it is the environmental risk and protective factors, which influence whether or not symptoms occur. The risk of developing anorexia or bulimia, if a mother and sister have anorexia, is 12 times greater for anorexia and 4 times greater for bulimia than an individual without a family history.
Biological Factors
Researches show that disturbances in serotonin and dopamine neurotransmitter systems contribute to the risk factor for developing an eating disorder. Serotonin dysfunction is linked to behavioral inhibition, anxiety, and error prediction. Disruptions in the dopamine system help produce an altered sensitivity to reward. These biological elements potentially increase one's risk of experiencing reinforcing effects when engaging in eating-disordered behavior.
Other studies have focused on abnormalities in the structure and activities of the hypothalamus, the part of the brain responsible for regulating eating behaviors. Studies focused on the hypothalamus of bulimic patients indicated that may not trigger normal satiation may not be triggered after a meal. In other words, these individuals did not feel full.
Social and Cultural Factors
Eating behavior and attitudes are largely learned through social interaction, social influence, and individual interaction. Parents' eating habits directly correlate to the body satisfaction of their daughters, while only fathers' eating habits affect the body satisfaction of their sons. Parents who emphasize the importance of thinness and encourage dieting behaviors increase their risk of having children who develop eating-disordered behavior.
Many adult women with Anorexia report having had some eating disorder symptoms during their teenage years, suggesting a vulnerability to developing an eating disorder throughout their lifespan. These individuals may exhibit typical premorbid personality and dieting traits throughout their lives such as anxiety, perfectionism, obsessiveness, and extreme dieting but do not develop anorexia until they experience significant stress in their lives.
Overview of Anorexic Population:
It is estimated that 10% of those affected with anorexia will die of complications associated with the disorder. Suicide is the most common cause of death in adults with AN. Late-onset AN is considered an unfavorable predictor of outcome, with a longer duration of illness, lower minimal weight and body fat after recovery, and higher rates of comorbid disorders.
AN is a psychological disorder that can significantly impact one's physical health. Anorexia is a serious condition and the most fatal of all mental health disorders.
There are several psychological and emotional characteristics associated with AN. Patients suffering from anorexia tend to exhibit a paralyzing sense of perfectionism, obsessive behavior, and anxiety disorders before the onset of AN. Two-thirds of AN patients develop an anxiety disorder long before the onset of AN, while perfectionism is present in recovery, even when other symptoms dissipate.
Recurrent episodes of binge eating. An episode of binge eating is characterized by the following:
BED affects more people than any other eating disorder. Unfortunately, our society has approached this problem like many other medical conditions, with short-term solutions leading to long-term problems.
Characteristics and Population Overview:
Binge eating is often associated with poor body image. Although nobody knows for certain what causes BED, treatment is based on the biopsychosocial model. Binge eaters typically use food as a way to cope with low self-image and feelings of shame and discomfort. Unlike other eating disorders, BED occurs seems to impact men more than any other eating disorder.
Data also indicates that BED does not discriminate between race and ethnicity. Although the diagnosis criteria for BED do not include a focus on body image, research shows otherwise. Patients with BED are more dissatisfied with their bodies than normal-weight or obese individuals without an eating disorder.
Generally speaking, the age of onset for most eating disorders is between 12-14 years of age, with some cases younger and older. Females are more vulnerable to eating disorders with a female-to-male ratio are approximately 20:1.
Eating disorder patients often present with at least one other mental health disorder. The most common comorbid diagnosis is Major Depressive Disorder. Other common comorbid disorders include:
- Anxiety Disorders
- Mood Disorders
- Substance Use Disorders
- ADHD
- OCD
- Panic Disorders
- Personality Disorders
- Social Phobias, and
- PTSD
Genetic Vulnerability
Nearly all women in Western society diet at some point during adolescence or young adulthood, yet fewer than 1% develop anorexia. Genetic vulnerabilities increase one's risk for developing an eating disorder, while it is the environmental risk and protective factors, which influence whether or not symptoms occur. The risk of developing anorexia or bulimia, if a mother and sister have anorexia, is 12 times greater for anorexia and 4 times greater for bulimia than an individual without a family history.
Biological Factors
Researches show that disturbances in serotonin and dopamine neurotransmitter systems contribute to the risk factor for developing an eating disorder. Serotonin dysfunction is linked to behavioral inhibition, anxiety, and error prediction. Disruptions in the dopamine system help produce an altered sensitivity to reward. These biological elements potentially increase one's risk of experiencing reinforcing effects when engaging in eating-disordered behavior.
Other studies have focused on abnormalities in the structure and activities of the hypothalamus, the part of the brain responsible for regulating eating behaviors. Studies focused on the hypothalamus of bulimic patients indicated that may not trigger normal satiation may not be triggered after a meal. In other words, these individuals did not feel full.
Social and Cultural Factors
Eating behavior and attitudes are largely learned through social interaction, social influence, and individual interaction. Parents' eating habits directly correlate to the body satisfaction of their daughters, while only fathers' eating habits affect the body satisfaction of their sons. Parents who emphasize the importance of thinness and encourage dieting behaviors increase their risk of having children who develop eating-disordered behavior.
Not surprising, is that girls who experience more criticism from their mothers regarding appearance were at greater risk for developing an eating disorder than girls whose mothers placed less importance on appearance.
Additional risk factors for eating disorders include:
- Being female
- High body dissatisfaction
- Mother with a high drive for thinness
- Father with tendencies toward perfectionism
Girls are influenced by peers' perceptions and often believe that thinness equates to popularity and acceptance, while boys' disordered eating is more influenced by teasing from others. Peer influence continues beyond adolescence.
Cultural Pressure
The emphasis on thinness and physicality contributes to the increasing prevalence of eating disorders. One of the leading causes of bulimia in developed countries is societal pressure to be thin. Thinness and attractiveness are perceived as more favorable, and reinforced by the media’s unrealistic messages about our body shapes and sizes. These social comparisons often lead to body dissatisfaction, especially in already vulnerable individuals.
The key socio-cultural factor in the development of eating disorders is a society, which places great importance on physical appearance and equates thinness with achievement or success. The information on dieting habits, and body image concerns of adult women are staggering.
Some experts believe that we would not see an epidemic of eating disorders if we were not preoccupied with diet and constantly validating those that are thin. Cross-cultural studies reveal that when women are exposed to Western ideals of thinness, eating disorder symptoms become more prevalent. Different studies clearly show how the media-based world we live in equates thinness with attractiveness and equates fat with lazy, unattractive, self-indulgent, and out of control.
Cultural Pressure
The emphasis on thinness and physicality contributes to the increasing prevalence of eating disorders. One of the leading causes of bulimia in developed countries is societal pressure to be thin. Thinness and attractiveness are perceived as more favorable, and reinforced by the media’s unrealistic messages about our body shapes and sizes. These social comparisons often lead to body dissatisfaction, especially in already vulnerable individuals.
The key socio-cultural factor in the development of eating disorders is a society, which places great importance on physical appearance and equates thinness with achievement or success. The information on dieting habits, and body image concerns of adult women are staggering.
Some experts believe that we would not see an epidemic of eating disorders if we were not preoccupied with diet and constantly validating those that are thin. Cross-cultural studies reveal that when women are exposed to Western ideals of thinness, eating disorder symptoms become more prevalent. Different studies clearly show how the media-based world we live in equates thinness with attractiveness and equates fat with lazy, unattractive, self-indulgent, and out of control.
Types of Eating Disorders
Anorexia
Diagnosis Criteria:- Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected)
- Intense fear of gaining weight or becoming fat, even though underweight
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight
- In post-menarcheal females, amenorrhea, i.e., the absence of at least 3 consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen administration)
- The discrepancy between weight and perceived body image is key to the diagnosis of anorexia; anorexic patients delight in their weight loss and express a fear of gaining weight
- Have changes in hormone levels which, in females, resulting in amenorrhea (if the weight loss occurs before puberty begins, sexual development will be delayed and growth might cease)
- Feel driven to lose weight because they experience themselves as fat, even when at a subnormal weight
- Intensely afraid of becoming fat and preoccupied with worries about their body size and shape
- Direct all their efforts towards controlling their weight by restricting their food intake, but may also binge eat, self-induce vomiting, misuse laxatives or diuretics (purging behaviors), exercise excessively, or misuse appetite suppressants
Many adult women with Anorexia report having had some eating disorder symptoms during their teenage years, suggesting a vulnerability to developing an eating disorder throughout their lifespan. These individuals may exhibit typical premorbid personality and dieting traits throughout their lives such as anxiety, perfectionism, obsessiveness, and extreme dieting but do not develop anorexia until they experience significant stress in their lives.
Overview of Anorexic Population:
It is estimated that 10% of those affected with anorexia will die of complications associated with the disorder. Suicide is the most common cause of death in adults with AN. Late-onset AN is considered an unfavorable predictor of outcome, with a longer duration of illness, lower minimal weight and body fat after recovery, and higher rates of comorbid disorders.
AN is a psychological disorder that can significantly impact one's physical health. Anorexia is a serious condition and the most fatal of all mental health disorders.
There are several psychological and emotional characteristics associated with AN. Patients suffering from anorexia tend to exhibit a paralyzing sense of perfectionism, obsessive behavior, and anxiety disorders before the onset of AN. Two-thirds of AN patients develop an anxiety disorder long before the onset of AN, while perfectionism is present in recovery, even when other symptoms dissipate.
Depression, loneliness, low self-esteem, anger, feelings of inadequacy, and preoccupation with symmetry are also common among those with AN.
The majority of AN patients experience intense feelings of helplessness and significant dissatisfaction with their body shapes and size. AN patients often show difficulty with appropriate problem-solving, immaturity in emotional development, and limited coping skills for dealing with stressful life events.
The majority of AN patients experience intense feelings of helplessness and significant dissatisfaction with their body shapes and size. AN patients often show difficulty with appropriate problem-solving, immaturity in emotional development, and limited coping skills for dealing with stressful life events.
Researchers point out that these comorbid symptoms can arise from both environmental and genetic factors with the precise influence of each varying among individuals.
Interestingly, psychological factors are strong predictors of recovery. Those with successful interpersonal relationships show better outcomes than those with comorbid mood disorders, personality disorders, alcohol and substance abuse.
Bulimia affects both female and male populations and those as young as 8 years old as well as individuals in their 60s. 90% of the cases of bulimia are women and some statistics suggest that up to 7% of females in the developed countries have had bulimia at some time in their life. Bulimia prevalence can be as high as 10% in vulnerable populations, such as college-aged women.
Demographically, most patients with bulimia nervosa are single, college educated, and in their mid-20s. However, most patients begin experiencing bulimic symptoms during adolescence. Bulimia nervosa occurs in 2.3% of white women but in only 0.40% of black women.
Risk factors for bulimia nervosa include but are not limited to, childhood sexual abuse, male homosexuality, eating alone, living in a sorority house, diabetic poor glycemic control, low self-esteem, dieting, involvement in athletics, and occupations that focus on weight.
Although bulimia nervosa is more common than anorexia nervosa, the mortality rate is lower and the recovery rate higher than that of anorexia nervosa. Approximately 50% of patients are free from all bulimic symptoms 5 years after treatment.
Interestingly, psychological factors are strong predictors of recovery. Those with successful interpersonal relationships show better outcomes than those with comorbid mood disorders, personality disorders, alcohol and substance abuse.
Bulimia
Diagnosis Criteria:- Recurrent episodes of binge eating. An episode of binge eating is characterized by eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
- A lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
- Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise
- The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months
- Self-evaluation is unduly influenced by body shape and weight
- The disturbance does not occur exclusively during episodes of Anorexia Nervosa
- Frequent episodes of binge eating, during which they consume a large amount of food within a short period of time
- Feels overwhelmed by the urge to binge and can only stop eating once it becomes too uncomfortable to eat anymore
- Feels guilty, anxious, and depressed, because they have been unable to control their appetite and they fear weight gain
- Tries to regain control by getting rid of the calories consumed (the most common method is vomiting, but they might misuse laxatives, diuretics, or appetite suppressants, fast or excessively exercise
Bulimia affects both female and male populations and those as young as 8 years old as well as individuals in their 60s. 90% of the cases of bulimia are women and some statistics suggest that up to 7% of females in the developed countries have had bulimia at some time in their life. Bulimia prevalence can be as high as 10% in vulnerable populations, such as college-aged women.
Demographically, most patients with bulimia nervosa are single, college educated, and in their mid-20s. However, most patients begin experiencing bulimic symptoms during adolescence. Bulimia nervosa occurs in 2.3% of white women but in only 0.40% of black women.
Risk factors for bulimia nervosa include but are not limited to, childhood sexual abuse, male homosexuality, eating alone, living in a sorority house, diabetic poor glycemic control, low self-esteem, dieting, involvement in athletics, and occupations that focus on weight.
Although bulimia nervosa is more common than anorexia nervosa, the mortality rate is lower and the recovery rate higher than that of anorexia nervosa. Approximately 50% of patients are free from all bulimic symptoms 5 years after treatment.
Although outcomes research on bulimia nervosa is sparse, with limited statistical estimates, it has been shown that mortality and recovery are directly related to early intervention and treatment.
Binge Eating Disorder
Diagnosis Criteria:Recurrent episodes of binge eating. An episode of binge eating is characterized by the following:
- Eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
- A sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not feeling physically hungry
- Eating alone because of feeling embarrassed by how much one is eating
- Feeling disgusted with oneself, depressed, or very guilty afterward
- Marked distress regarding binge eating is present.
- Binge eating occurs, on average, at least once a week for three months.
- Binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.
BED affects more people than any other eating disorder. Unfortunately, our society has approached this problem like many other medical conditions, with short-term solutions leading to long-term problems.
Characteristics and Population Overview:
Binge eating is often associated with poor body image. Although nobody knows for certain what causes BED, treatment is based on the biopsychosocial model. Binge eaters typically use food as a way to cope with low self-image and feelings of shame and discomfort. Unlike other eating disorders, BED occurs seems to impact men more than any other eating disorder.
Data also indicates that BED does not discriminate between race and ethnicity. Although the diagnosis criteria for BED do not include a focus on body image, research shows otherwise. Patients with BED are more dissatisfied with their bodies than normal-weight or obese individuals without an eating disorder.
Overvaluation of shape and weight in BED is associated with increased severity of eating pathology and decreased psychological functioning (depression and low self-esteem).
Compared to the general population, patients with BED show more frequent parental depression, greater vulnerability to obesity, and greater perfectionism and negative self-evaluation. Compared to the obese population without BED, these individuals show more personality disturbance and a greater likelihood of mood/anxiety disorders, and lower quality of life.
An eating or feeding disturbance so pervasive that the person is unable to meet appropriate nutritional needs, resulting in one (or more) of the following:
Most ARFID clients have sensory issues in texture, vision, touch, and smell. Gag reflexes, nausea, and purging if trigger foods are introduced or forced are common in ARFID patients. Often these individuals will go without food when they are physically hungry to the point of pain and will justify food choices through odd reasoning such as a particular brand name. Patients with ARFID tend to be particular about the shape, size, and color of their food selections.
Avoidant Restrictive Food Intake Disorder (ARFID)
Diagnostic Criteria:An eating or feeding disturbance so pervasive that the person is unable to meet appropriate nutritional needs, resulting in one (or more) of the following:
- Significant weight loss, nutritional deficiency, and dependency on nutritional supplements or interference in social functioning.
- This problem with eating is not explained by the lack of food available.
- This is different from both anorexia nervosa and bulimia nervosa in that the problems with eating are in no way related to what the person believes about his/her size, weight, and /or shape.
- This disturbance is not caused by a medical condition or another mental disorder.
- Eating issues seen: associated with being uninterested in eating, and sensory characteristics of the food. Concern about the consequences of eating, refusal to eat anything other than liquids or soft foods, an intense fear of choking, or limited intake to only a specific brand/type of food.
- While indicating that the issues develop before age 6, there are often cases of ARFID in late childhood and adolescence and it may also persist into adulthood.
- ARFID is associated with anxiety disorders, depression, the autism spectrum, obsessive-compulsive disorder, and attention-deficit/hyperactivity disorder.
- Very little research has been done on the development, course, and treatment of ARFID.
- Higher rates of peeing problems are seen in children whose mothers suffer from an eating disorder.
Most ARFID clients have sensory issues in texture, vision, touch, and smell. Gag reflexes, nausea, and purging if trigger foods are introduced or forced are common in ARFID patients. Often these individuals will go without food when they are physically hungry to the point of pain and will justify food choices through odd reasoning such as a particular brand name. Patients with ARFID tend to be particular about the shape, size, and color of their food selections.
There are many common emotional and physical characteristics associated with ARFID as well. ARFID patients often have limited capacity for voicing opinions or appropriately asking for what they want. They present with an inability to identify emotions other than happy, sad, or angry, and avoid feeling or expressing anger.
Malnourishment, ashen skin, brittle hair, dark circles under their eyes, and glazed eyes are typical of ARFID patients. Some ARFID patients have learning disabilities, but the majority of the individuals would be classified as gifted. Many ARFIDs show perfectionist tendencies at work and school. Depression is also common among ARFID patients.
Overview of ARFID Population:
Avoidant/Restrictive Food Intake Disorder (ARFID) is a relatively new diagnosis. Many medical practitioners do not know the diagnosis exists or that is it a condition that needs intervention or treatment. Because the ARFID individual has high anxiety, and sensory issues, and often avoids social situations, other diagnoses are often assigned.
Overview of ARFID Population:
Avoidant/Restrictive Food Intake Disorder (ARFID) is a relatively new diagnosis. Many medical practitioners do not know the diagnosis exists or that is it a condition that needs intervention or treatment. Because the ARFID individual has high anxiety, and sensory issues, and often avoids social situations, other diagnoses are often assigned.
For the reasons listed above, it is very difficult to give statistics on the ARFID population. What we do know is that ARFID does not discriminate between cultures, races, gender, and/or age. Many children are in ARFID treatment because their parents notice that something is wrong with their child’s eating, far beyond being ‘picky’. The ARFID population corresponds with families that have genetic links to other sensory issues, high anxiety, and/or attachment issues.
Diagnosis Criteria:
A feeding or eating disorder that causes significant distress or impairment, but does not meet the criteria for another feeding or eating disorder. Examples include:
Other Specified Feeding or Eating Disorders (OSFED)
OSFED is characterized by disturbances in eating behavior that does not meet the specific criteria for any other eating disorder. OSFED is the most common eating disorder diagnosis.Diagnosis Criteria:
A feeding or eating disorder that causes significant distress or impairment, but does not meet the criteria for another feeding or eating disorder. Examples include:
- Atypical anorexia nervosa (weight is not below normal)
- Bulimia nervosa (with less frequent behaviors)
- Binge-eating disorder (with less frequent occurrences)
- Purging disorder (purging without binge eating)
- Night eating syndrome (excessive nighttime food consumption)
Treatment for Eating Disorders
Eating disorders are serious mental illnesses that can have a devastating impact on a person's physical and emotional health. However, with proper treatment, people with eating disorders can recover and go on to lead healthy lives.
The treatment for eating disorders typically includes a combination of psychotherapy, medical care and monitoring, nutritional counseling, and sometimes medications. The specific treatment plan will vary depending on the individual's needs and the type of eating disorder they have.
Psychotherapy is the most important component of eating disorder treatment. It involves seeing a psychologist or another mental health professional on a regular basis. Therapy can help people with eating disorders to:
- Understand the underlying causes of their eating disorder.
- Challenge negative thoughts and beliefs about food and weight.
- Learn healthy coping mechanisms for stress.
- Develop a healthy relationship with food.
Medical care and monitoring are also important parts of eating disorder treatment. A doctor will monitor the individual's physical health, including their weight, blood pressure, and heart rate. They may also order other tests, such as bloodwork or an EKG.
Nutritional counseling can help people with eating disorders to learn about healthy eating habits and how to make positive changes to their diet. A registered dietitian can provide individualized guidance on meal planning, portion control, and food choices.
Medications may be used in some cases to treat eating disorders. However, medications are not the main treatment for eating disorders and are usually used in conjunction with other forms of therapy.
The treatment for eating disorders can be long and challenging, but it is possible to recover. If you or someone you know is struggling with an eating disorder, please seek professional help. There is hope for recovery.
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