The Ultimate Guide to Eating Disorder

8 min


In today’s world terms like, ‘body shaming’ has become very common. People, especially youngsters and adolescents in particular are pushed into an imaginary yet dangerous world where beauty is set by physical standards rather than accepting ourselves and feeling proud to be who we are.

It is painful to accept, but the truth is these young minds are poisoned with every unnecessary set of rules that define every part of the body to be in a certain way to be termed as, ‘being perfect’ or to explain in our terms as ‘being chic or gorgeous’.

With this small but bitter introduction, let us see how this term, ‘eating disorder’ is linked with the standards of physical beauty as I explained above.

What is an Eating Disorder?

To begin with, we have to understand that eating disorders are an umbrella term that encompasses a set of different conditions and disorders within itself. It can be defined in simple words as a serious psychiatric disorder characterized by abnormal eating or weight control behavior.

In other words, it is a disabling, deadly, and costly mental disorder that impairs physical health and disrupts psychological functions.

The key role it plays is that it causes a disturbing attitude towards our body weight, shape, and maintenance.

Why is it important to know or have knowledge about eating disorders?

  • Like many other conditions, eating disorders have been on the rise for the past 50 years.
  • It is apparently easy to diagnose by a professional but it rather a subtle condition and people suffering from eating disorders generally don’t easily accept that and be open about it.
  • Usually friends or family play a major role in arriving at a diagnosis. So knowing about this condition is going to help us, in the long run, to help these people and protecting our loved ones.
  • It is a very under-researched area and a lot of data is needed before we understand this disorder completely. The pathology behind this is uncertain and the management or the treatment is limited as of now.

EPIDEMIOLOGY:

Usually, it affects all ages, genders ethnicities, etc. The onset of certain eating disorders is age-related. One major difference based on gender is men and women having different perceptions like men tend to focus more on the built of the body whereas women mainly focus on becoming lean or losing weight and other such imaging by means of looking more feminine.

FACTORS INFLUENCING EATING DISORDERS:

A lot of factors play a major role in pushing a person to fall into this dreadful condition. Some of them include,

  • Low self-esteem
  • Exhibiting or feeling out of control
  • As a response to stress
  • Inadequacy in life
  • A feeling of emptiness or purposelessness
  • Feeling like a failure
  • Sudden changes in life
  • Personal illness etc.

Apart from these, there are certainly other ways that can broadly be divided into two categories,

Interpersonal:

These are reasons that mainly involve a constrained or violated personal space, that include issues like,

  • Events like abuse (physically or sexually)
  • Difficulty in expressing emotions
  • History of being bullied or ridiculed based on one’s appearance especially weight
  • Troubled family and personal situations.

Cultural and Social Factors:

  • Like the ones we saw above, which includes very narrow and abrupt standards of beauty
  • Pressure from the society or the culture followed which venerates ‘being thin’ as being the ultimate goal
  • Valuing people based on their physical appearance rather than their talents, strengths, and qualities.

Having seen the basic definition, the various factors let’s actually try to understand the various types and some basic management.

PATHOPHYSIOLOGY:

Though the actual physiology is under research, the proposed mechanism behind eating disorders includes the interaction between environmental and genetic factors during the developmental years that may add to the complexity. Apart from those the causes have been divided into three major categories as predisposing(all the aforementioned factors), precipitating (the factors that were present at the time of illness), and perpetuating (factors that maintain and value the disease process).

TYPES OF EATING DISORDERS:

According to the ‘INTERNATIONAL CLASSIFICATION OF DISEASES’ (ICD-11), there are six main eating and feeding disorders, which includes the following,

  • Anorexia nervosa
  • Bulimia nervosa
  • Binge-eating disorder
  • Avoidant- restrictive food intake disorder
  • Pica
  • Rumination disorders.

The general picture of an eating disorder is that these people usually take extremely small portions of food or overeat severely.

Almost most of these disorders start off very mildly and leads to severe and very obvious changes.

SYMPTOMS AND PRESENTATIONS OF VARIOUS EATING DISORDERS:

ANOREXIA NERVOSA:

Anorexia nervosa can be defined as a condition in which people are very observed in becoming thin and take extreme measures to attain that desired weight loss.

obesity

They might have an intense fear of gaining weight and a disturbed body image. Might undergo severe dietary restrictions or excessive physical activities to lose bodyweight.

  • May show a dramatic weight loss
  • Sticking on to a very rigorous and extreme exercise routine
  • Avoiding situation or events that might involve food
  • Hesitation to take certain types of food
  • Lessening their social interactions and avoiding their friend circle etc.
  • They might also exhibit impaired cognitive and emotional behavior.
  • We might find them binging, purging, or using diuretics and laxatives. Despite their emancipated stage, they might find themselves feeling overweight or being in a state of anxiety to gain weight.
  • Body hair concentration especially in the back, forearm, and cheeks.
  • All the organ systems are affected mainly targeting the cardiac and skeletal systems.
  • It is also accompanied by certain depressive symptoms, causing a wide range of physiological and pathological symptoms.

Sometimes these preoccupations are intense and persuasive, and the false beliefs may be held with a conviction approaching the delusional.

DIAGNOSIS:

  • This is a condition emerging usually during the adolescent or the late adolescent period.
  • Females are commonly affected compared to men.
  • Certain other conditions have to be considered before arriving at a diagnosis
  • We arrive at a conclusion based on the fact that there is a pronounced fear of fatness despite being thin, and on the absence of an alternate cause of weight loss.
  • Certain forms of imaging can be used to confirm a pathology or arrive at a diagnosis.

BULIMIA NERVOSA:

In this condition, patients are usually at or near-normal weight but display a morbid fear of fatness associated with disordered eating behavior.

SYMPTOMS AND DIAGNOSIS :

  • Like anorexia nervosa bulimia nervosa also has a female predilection.
  • A major symptom of this disorder is binging of food in an uncontrolled manner followed by a corrective measure like self-induced vomiting, purgation, or dieting after binges.
  • Using the restroom frequently especially around mealtime
  • Excess or a rigid exercise routine
  • Avoiding friends or family
  • Certain dental conditions like ‘pitted teeth’ due to repeated vomiting and gastric acid regurgitation.
  • Calluses on the knuckles are a common finding
  • The ‘parotid gland’ which is a salivary gland located in the front of the ears is enlarged.
  • Electrolyte abnormalities, cardiac arrhythmias, and renal problems are very common.
  • Stomach rupture and menstrual irregularities are also common

BINGE EATING DISORDER:

As the name suggests, it is characterized by excessive eating in a given period of time. But the major difference between binge eating disorder and bulimia nervosa is that these people do not vomit after binging.

SYMPTOMS:

  • A simple way of identifying this is empty covers, food wrappers and containers indicating consumption of a large amount of food.
  • These people tend to eat around the day with no controlled or planned meal time
  • Overweight for their age or height
  • They make repeated efforts to diet and feel desperate to control food intake.

Certain health risks associated with binge eating disorder include

  • High blood pressure and cholesterol
  • Gall bladder diseases
  • Diabetes and heart diseases
  • Certain types of cancers rarely.

AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER:

This type of eating disorder can be mistaken for a very picky or a choosy eating.

The symptoms include low weight, inability to grow along their normal growth trajectory which might lead to eating disorders. The medical complications of avoidant restrictive food intake disorder are almost the same as that of anorexia nervosa. Comorbidities with neuronal development or anxiety disorders often occur.

PICA:

This has not yet been identified and classified as a specific eating disorder.

This eating disorder involves consuming non-nutritive or non-food/edible substances for a period of a month or more.

It is common to observe pica in individuals with autism, intellectual disability, schizophrenia, or any other particular physical disorders and various somatic disorders.

Pica is almost always associated with certain triggers like the taste of a particular substance, boredom, curiosity, and psychological tension.

The commonly consumed items might include dirt, sand, chalks, hair, ice, and chemicals. Pica is commonly observed in pregnant women, children, and people with autism.

RUMINATION:

It is a type of eating disorder in which people tend to regurgitate or bring back the food to the mouth re-chew it and either swallow or spit it out.

It is a psychogenic disorder characterized by purging, vomiting, and various somatic disorders. Regurgitation of food is seen after eating with the absence of vomiting or nausea. But,  involuntary retching and feeling of disgusts are common.

TREATMENT AND MANAGEMENT:

Treatment for eating disorders is not so simple due to the fact it takes a meticulous process to analyze and arrive at a perfect diagnosis. It is also one of the few disorders that do not occur individually and is always associated with one or more psychological disorders like depression, stress, and schizophrenia. Certain genetic conditions are also common in these patients. Not alone the person affected by this disorder but the caretaker, parents, or guardian in case of infants or kids need to be counseled.

The clinical presentation of eating disorders is diverse. A huge number of factors go into the planning of the treatment and prognosis in these patients like whether the patient is a child or an adult, whether the condition is acute or chronic, whether it’s a comorbid condition or a simple presentation of eating disorder, whether the patient is moderately or severely malnourished.

Till date certain forms of psychological, pharmacological and behavioral forms of therapy have been followed.

Treatment of Anorexia nervosa:

  • For an adolescent age group, family intervention and counseling are suggested as the first line of treatment, however, it’s necessary to understand the outcome and betterment of the patient depends on the amount of care, observing their behavior, and the time spent on them.
  • The caretakers and the parental intervention have shown a lot of positive outcomes on both the patient and the caretaker’s side.
  • In-patient care includes providing nutrition through nasogastric tubes and intravenous lines. However, there was a tremendous improvement in the nutritional condition of the patient relapses were common.
  • Immediate intervention is needed to improve the malnourished status of the patient.
  • Oral nutritional supplements and micronutrients are also provided to improve the overall condition of the patient.
  • Cognitive-behavioral therapy (CBT) has shown good results in improving this condition
  • 10 mg of olanzapine showed a significant weight gain and many positive outcomes in the patient.
  • Maintaining bone health in these patients is a challenging task though. Physiological doses of transdermal estrogen were given in females around the pubertal age with chronic illness and a bone age less than 15 years to mimic pubertal estrogen and to prevent osteoporosis in the later stages.

BINGE EATING DISORDER TREATMENT:

  • Cognitive behavior therapy combined with guided self-care, family-based therapy showed rapid treatment.
  • Certain forms of third-wave behavioral therapies like dialectical behavioral therapy, compassion-focused therapy, mindfulness-based therapy, acceptance and commitment therapy, and schema therapy have been adapted to treat these kinds of eating disorders.
  • Pharmacological means include the usage of fluoxetine, anti-depressants, CNS stimulants, anti-convulsant, and lisdexamfetamine.

AVOIDANT-RESTRICTIVE FOOD INTAKE DISORDER, PICA, AND RUMINATION DISORDER:

  • Family-based therapy, cognitive behavioral therapy, and drugs like cefproheptadine along with mirtazapine and olanzapine have been shown to improve avoidant restrictive food intake disorder.
  • Treatment for pica and rumination disorder is still under research.

EMERGING TREATMENT MODALITIES:

  • CRT (Cognitive remediation therapy) has shown to improve neurological and psychological insufficiencies along with exercises and cognitive flexibility.
  • Cognitive and emotional remediation and various brain directed treatment reduce eating disorders and promote learning.

Thus, we can conclude that eating disorders may not be that simple to diagnose and treat but having an idea will help us and people around us avoid falling into this dreadful condition.


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Dr Kavitha M

I am an undergraduate degree holder in dentistry. I have a great interest in music and reading. I am a linguaphile. My areas of interest lie in psychology, medical imaging, diagnostics, and oncology. I am a person who focuses more on the emerging areas of forensics.

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