Eating Disorders

1 Eating Disorders Summary

Eating disorders refer to a group of conditions characterized by serious emotional and behavioral issues concerning food habits and body weight. People with eating disorders are often distressed or obsessed about the body weight and shape.

It is a serious and potentially life-threatening problem. It affects both males and females, but women are more commonly affected by the disorder compared to men. About 13% of women above 50 years have this disorder and is found in all races and ethnic groups.

The general statistics show that around 30 million people of all age group are affected by this disorder. Moreover, among the different mental illnesses, eating disorder has the highest mortality rate.

The disorder may affect any age group but usually, develops during teenage and in young adults. Three factors increase the risk of eating disorders – heredity, environment, and personality. The most common forms of the disorder include anorexia nervosa, bulimia nervosa, and binge eating disorder.

Anorexia nervosa – this is a mental illness characterized by an unrealistic perception about body weight and an acute fear of weight gain. They have an obsession to keep the body weight as low as possible as they consider themselves as overweight.

They have a very restricted food intake, both in quality and quantity. They weigh themselves repeatedly and often have several complications due to starvation. Many of these patients tend to have a suicidal tendency, which increases the mortality rate due to this type of eating disorder.

Bulimia nervosa – this type of eating disorder is characterized by episodes of overeating that is followed by behavior that compensates and prevents gain in body weight. This includes forced vomiting, using laxatives, or excessive exercise or a combination of these.

People with a type of eating disorder have a self-esteem that is related to the body image. They often feel guilty and out of control during periods of binge eating. Unlike anorexia nervosa, these people tend to have a healthy or normal body weight.

Binge eating disorder – this form of eating disorder is also characterized by episodes of binge eating. But unlike bulimia nervosa, the episodes are not followed by compensating behaviors. People with this disorder do feel guilty and out of control during overeating.

Many patients with this disorder often eat alone due to guilt and eat even when they are not hungry. The binge eating episode may continue even when they are uncomfortably full.

There are some other less common forms of eating disorders like purging disorder, night eating syndrome, restrictive food intake disorder, and atypical anorexia nervosa that affect many people.

These disorders can have serious effects on a person’s physical and emotional health, which call for professional help. Early detection and treatment help to have a better success rate in recovering from the symptoms of the condition.

The potentially life-threatening medical consequences of the condition result from lack of essential nutrients, chemical imbalances, and obesity. Treatment for eating disorders are individual-centered and include psychotherapy, counseling, and medications.

2 Causes

Eating disorder is a complex condition and is caused by a combination of several factors including behavioral, emotional, social, and psychological factors.

It is often thought that eating disorder is caused by peer pressure or social pressure to have a particular body image. But, the actual cause of the condition is more complex.

Many of the factors may not indicate or predict the presence of the condition, but may individually contribute to the development of the condition. Some common risk factors for eating disorders include biological, psychological, and environmental factors.

Biological factors – the actual biological or biochemical cause of eating disorder is not yet known. Imbalance in chemicals that control hunger and digestion may lead to one of the eating disorder.

Eating disorders are also found to run in families. Studies show that certain genetic factors are involved in the development of eating disorders. Studies are on to identify the genes that increase the risk of eating disorders. Some studies show a difference in the brain activity of a person with eating disorder when compared to a normal woman.

Psychological factors – negative body image is one of the most common causes of eating disorder. This often leads to poor self-esteem, which in turn affects the eating behavior.

Other common causative psychological factors include lack of control of life, depression, anxiety and stress. Certain personality characteristics like being a perfectionist, or having obsessive disorder may also cause eating disorder. 

Environmental factors – social pressures like glorifying or accepting only those with a so-called ‘perfect body’, or thin body, lead to eating disorders. A social norm in which beauty is defined as having a thin or muscular body distresses the person and changes the eating behavior.

Very often people are also stressed due to racial, ethnic, and size-based discrimination. Social norms in which only people with certain physical appearance is valued adds to the distress.

Troubled relationships, being ridiculed due to body weight or shape, and also the history of sexual or emotional abuse increase the risk of eating disorder. Stressful situations in life are also found to cause some types of eating disorders.

Certain risk factors predict the onset of eating disorders in general, while some risk factors are found to be specific for a particular type of eating disorder. For example, internalization of a perfect thin body is a risk factor for bulimia nervosa.

Similarly, social pressure to be thin, and dissatisfaction about the body image also increase the risk of bulimia nervosa. Eating conflicts and issues during childhood increase the chances of developing anorexia nervosa in adulthood. Social pressure for being thin also leads to binge eating disorder.

Factors like low self-esteem, body image dissatisfaction, female gender, high body mass index during childhood, and social problems increase the risk of eating disorder in general.

An eating disorder may be associated with a particular biological, psychological, or environmental factor. The factor may also be combined with an event that triggered the disorder. Certain other factors may be involved in maintaining the disorder.

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3 Diagnosis and Treatment

Eating disorders are often identified based on the warning signs and symptoms, given by the patient himself or by their near ones. Physical and psychological examination of the patient also helps in diagnosing the type of eating disorder.

Some common indications of eating disorder include:

  • Continuously complaining about being fat or overweight, particularly when the patient is of normal body weight
  • Extremely restricted eating
  • Intense fear of gaining body weight
  • Low self-esteem or distorted body image
  • Eating large amounts within a short time
  • Eating alone
  • Feeling guilty about eating
  • Distorted body image

Physical examination – during physical examination height, weight, and vital signs of the patient are checked. Blood pressure, breathing rate and pulse rate also help in identifying the disorder. Skin, hair, and nails reveal indications of eating disorder.

Laboratory tests – eating disorder results in many issues in the functioning of vital organs and many of these can be identified through laboratory tests. Common laboratory tests used in the eating disorders include blood count, urinalysis, and liver, kidney, and thyroid function test.

Anorexia and bulimia may result in bone loss, which is determined using imaging techniques like an x-ray. An electrocardiogram is used to identify irregularities in the functioning of the heart.

Psychological evaluation – responses to questions related to eating habits are also used in the diagnosis of specific eating disorders. The questions are framed in such a way as to understand the person’s attitude towards food, eating habits, and perception of body image.

Responses to these questions aid in the diagnosis and treatment of this disorder. Treatment of eating disorder is patient-centered and is carried out by a team of experts including physicians, psychologists, healthcare providers and dieticians. Psychotherapy, medication, and nutrition counseling are the main methods for the treatment of this disorder.

Psychotherapy – this is talk-based therapy and helps to replace unhealthy thoughts and habits on food and eating with healthy behavior.

Cognitive-behavioral therapy is a type of psychotherapy used in the treatment of bulimia nervosa and binge eating disorder. In this method, the patient is taught to trace and monitor eating habits.

It also helps them to develop healthy solutions for the problem each patient is facing. Cognitive behavioral therapy also helps in tackling mood changes that affect food habits. 

Family-based therapy is a type of psychotherapy that is particularly used for teenagers and young adults with eating disorder. In this method, the family is involved in developing healthy food habits and helping the patient to maintain a healthy body weight.

Nutritional counseling:

As eating disorder affects body weight, treatment focuses on getting the patient back on normal body mass index. Dieticians and other members of the team help in charting out a healthy diet for achieving the same. The diet is designed and executed in such a way as to normalize eating habits and body weight.

Medications:

There are no sure shot medications to control this condition. Certain medications help in controlling the urge to binge or purge. Anti-depressants and anti-anxiety medications are used to control symptoms of depression and anxiety that lead to eating disorder.

Eating disorder may lead to severe malnutrition and such patients may need to be hospitalized for prompt treatment. Nonconventional, alternative medicine also is tried in the treatment of these disorders. Any of these treatment methods should be used with caution as it may be harmful.

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