“I felt empty, so I ate. Then I felt guilty, so I got rid of it”, “Everyone lied to me about my weight. They said I was thin; I knew that wasn’t true”. “Once I started eating, I couldn’t stop, no matter what anyone said or did.”
These are the voices of eating disorders.
Although the term “Eating” is in the name, eating disorders are about more than food. They’re complex mental health conditions. Because of the physical nature of their defining symptoms, eating disorders can cause both emotional distress and significant medical complications.
Let’s begin to explore this complexity with this Nutrishilp blog –
What is an eating disorder?
Eating disorders are a range of psychological conditions that cause unhealthy eating habits to develop. Self-image, food, eating, and body weight each become a source of serious anxiety for people and they experience distorted thinking and behaviors that cause problems in their lives.
What causes eating disorders?
Experts believe that a variety of factors may contribute to eating disorders.
Genetics – People who have a sibling or parent with an eating disorder seem to be at an increased risk of developing one.
Personality traits are another factor. In particular, neuroticism, perfectionism, and impulsivity are three personality traits often linked to a higher risk of developing an eating disorder.
Cultural preferences – It does happen in our society, having preferences to people on the basis of body shape as preference to thinness. These presumptions create pressure on those not falling on the line. At times to imitate celebrities (who have experts to guide on their health) people fall prey of such disorders.
Types of eating disorders
Eating disorders are a group of related conditions involving extreme food and weight issues, but each disorder has unique symptoms and diagnosis criteria. Here are six of the most common eating disorders and their symptoms.
Anorexia nervosa is likely the most well-known eating disorder. It generally develops during adolescence or young adulthood and tends to affect more women than men.
People with anorexia generally view themselves as overweight, even if they’re dangerously underweight. They tend to constantly monitor their weight, avoid eating certain types of foods, and severely restrict their calorie intake.
Common symptoms of anorexia nervosa include
• very restricted eating patterns
• intense fear of gaining weight or persistent behaviors to avoid gaining weight, despite being underweight
• a relentless pursuit of thinness and unwillingness to maintain a healthy weight
• a heavy influence of body weight or perceived body shape on self-esteem
• a distorted body image, including denial of being seriously underweight
However, it’s important to note that weight should not be the major focus of diagnosing someone with anorexia. They may also have difficulty eating in public and exhibit a strong desire to control their environment, limiting their ability to be spontaneous. Anorexia is officially categorized into two subtypes — the restricting type and the binge eating and purging type
Individuals with the restricting type lose weight solely through dieting, fasting, or excessive exercise. Individuals with the binge eating and purging type may binge on large amounts of food or eat very little. In both cases, after they eat, they purge using activities such as vomiting, taking laxatives or diuretics, or exercising excessively.
Anorexia can be very damaging to the body. Over time, individuals living with it may experience thinning of their bones, infertility, and brittle hair and nails. In severe cases, anorexia can result in heart, brain, or multi-organ failure and death.
Bulimia nervosa is another well-known eating disorder.
It also tends to develop during adolescence and early adulthood and appears to be less common among men than women. People with bulimia frequently eat unusually large amounts of food in a specific period of time.
Each binge eating episode usually continues until the person becomes painfully full. During a binge, the person usually feels that they cannot stop eating or control how much they are eating. Binges can happen with any type of food but most commonly occur with foods the individual would usually avoid.
Individuals with bulimia then attempt to purge to compensate for the calories consumed and to relieve gut discomfort. Common purging behaviors include forced vomiting, fasting, laxatives, diuretics, enemas, and excessive exercise.
Symptoms may appear very similar to those of the binge eating or purging subtypes of anorexia nervosa. However, individuals with bulimia usually maintain a relatively typical weight rather than losing a large amount of weight.
Common symptoms of bulimia nervosa include
• recurrent episodes of binge eating with a feeling of lack of control
• recurrent episodes of inappropriate purging behaviors to prevent weight gain
• self-esteem overly influenced by body shape and weight
• a fear of gaining weight, despite having a typical weight
Side effects of bulimia may include an inflamed and sore throat, swollen salivary glands, worn tooth enamel, tooth decay, acid reflux, irritation of the gut, severe dehydration, and hormonal disturbances.
In severe cases, bulimia can also create an imbalance in levels of electrolytes, such as sodium, potassium, and calcium. This can cause a stroke or heart attack.
Binge eating disorder is the most prevalent form of eating disorder and one of the most common chronic illnesses among adolescents.
It typically begins during adolescence and early adulthood, although it can develop later on. Individuals with this disorder have symptoms similar to those of bulimia or the binge eating subtype of anorexia.
For instance, they typically eat unusually large amounts of food in relatively short periods of time and feel a lack of control during binges. People with binge eating disorder do not restrict calories or use purging behaviors, such as vomiting or excessive exercise, to compensate for their binges.
Common symptoms of binge eating disorder include –
• eating large amounts of food rapidly, in secret, and until uncomfortably full, despite not feeling hungry
• feeling a lack of control during episodes of binge eating
• feelings of distress, such as shame, disgust, or guilt, when thinking about the binge eating behavior
• no use of purging behaviors, such as calorie restriction, vomiting, excessive exercise, or laxative or diuretic use, to compensate for the binge eating
People with binge eating disorder often consume an excessive amount of food and may not make nutritious food choices. This may increase their risk of medical complications such as heart disease, stroke, and type 2 diabetes.
Pica is an eating disorder that involves eating things that are not considered food and that do not provide nutritional value.
Individuals with pica crave non-food substances such as ice, dirt, soil, chalk, soap, paper, hair, cloth, wool, pebbles, laundry detergent, or cornstarch.
Pica can occur in adults, children, and adolescents.
It is most frequently seen in individuals with conditions that affect daily functioning, including intellectual disabilities, developmental conditions such as autism spectrum disorder, and mental health conditions such as schizophrenia .
Individuals with pica may be at an increased risk of poisoning, infections, gut injuries, and nutritional deficiencies. Depending on the substances ingested, pica may be fatal.
Rumination disorder can be described as a condition in which a person regurgitates food they have previously chewed and swallowed, re-chews it, and then either re-swallows it or spits it out …
This rumination typically occurs within the first 30 minutes after a meal.
This disorder can develop during infancy, childhood, or adulthood. In infants, it tends to develop between 3 and 12 months of age and often disappears on its own. Children and adults with the condition usually require therapy to resolve it.
If not resolved in infants, rumination disorder can result in weight loss and severe malnutrition that can be fatal. Adults with this disorder may restrict the amount of food they eat, especially in public. This may lead them to lose weight and become underweight.
Avoidant/restrictive food intake disorder consists of disturbed eating due to either a lack of interest in eating or a distaste for certain smells, tastes, colors, textures, or temperatures.
Common symptoms of ARFID include –
• avoidance or restriction of food intake that prevents the person from eating enough calories or nutrients
• eating habits that interfere with typical social functions, such as eating with others
• weight loss or poor development for age and height
• nutrient deficiencies or dependence on supplements or tube feeding
It’s important to note that ARFID goes beyond common behaviors such as picky eating in toddlers or lower food intake in older adults. Moreover, it does not include the avoidance or restriction of foods due to lack of availability or religious or cultural practices.
“How do I know if I have an eating disorder?”
And it’s kind of tricky to know, honestly. Eating is something we all do every day in our lives and thinking about food, or thinking about dieting or losing weight is kind of a normal part of life in our culture. When it crosses over to being a serious problem, it’s often when you notice that you’re thinking about it all the time. You’re getting anxious about what you’re going to eat or not eat. You’re thinking a lot about your body, how you look, wanting to look different.
It becomes an obsession, almost. Something you can’t get out of your head, something you organize your day around. When it crosses over into being really an eating disorder is when those thoughts and behaviors are really starting to impact your life, how you do things socially. Maybe you’re avoiding eating with other people.
And it can absolutely get to the point where your health is very seriously impacted.
Eating disorders take a lot of different forms. But basically, when you find yourself thinking a lot about food and your body, and changing the way you eat, you’re probably on the road to developing an eating disorder.
Treatment for Eating Disorders
Self-Help
Some people with bulimia nervosa and binge eating disorder may explore self-help or guided-self-help based on cognitive-behavioral therapy (CBT) principles. The person may work through a workbook, manual, or web platform to learn about the disorder and develop skills to overcome and manage it.
Cognitive Behavioral Therapy (CBT)
CBT is the best-studied outpatient therapy for adult eating disorders and includes elements as Cognitive restructuring, Body image exposure, Delays and alternatives, Food exposure, Limiting body-checking, Meal planning, Regular eating, Relapse prevention, Guided self-monitoring
Family-Based Treatment (FBT)
Family-based treatment (FBT) is the best-studied treatment for children and adolescents with eating disorders. Essentially, the family is a vital part of the treatment team. Parents commonly provide meal support, which allows the young person to recover in their home environment. Another important element of FBT is externalizing the eating disorder.
Nutritional Therapy
A registered dietitian can help you learn (or relearn) the components of a healthy diet and motivate you to make the needed changes.
Coping With an Eating Disorder
Caring for your physical and mental health will go a long way toward helping you cope with an eating disorder. In addition to talking to a therapist or joining a support group, seek support from a trusted friend or family member who can be there for you along your path to recovery.
Beyond self-care, it’s also essential to identify a few healthy distractions you can turn to when you find yourself obsessing about food and weight or experiencing the urge to turn to disordered eating or behaviors, as Explore a new hobby, like photography, painting, or knitting.
“One should be thoughtful about health but as an old Indian saying: atisarvtravarjyet, one should not OVER DO, accept the limitations too, thus eat to support your natural body type, do consult for an advice when you feel like burdened with your body shape, size or self-image. Learn to appreciate yourself.”
Shilpi Goel, Dietitian and Nutritionist