27 February to 5 March 2017 is Eating Disorder Awareness week, so I’m aiming to write a post a day on eating disorders. Today I’m going to briefly explain what an eating disorder is, and talk about the common types of eating disorder.
An eating disorder is defined as a psychological disorder characterised by abnormal or disturbed eating habits. A 2015 report commissioned by Beat estimates more than 725,000 people in the UK alone are affected by an eating disorder, and Anad.org claims that at least 30 million people suffer from an eating disorder in the United States. Every 62 minutes at least one person dies as a direct result from an eating disorder, and they have the highest morality rate of any mental illness. Despite this, eating disorders aren’t always understood or taken seriously.
The latest version of the DSM (Diagnostic Statistic Manual of Mental Disorders) identified the main eating disorders as anorexia, bulimia and binge eating disorder (BED). Before the latest changes in diagnostic criteria, it was estimated that 10% of people with an eating disorder were anorexic, while 40% were bulimic and the rest fell into the EDNOS (Eating Disorder Not Otherwise Specified) category (which at the time included BED sufferers), which is (now) a diagnosis given to someone who has an eating disorder that does not meet the criteria for anorexia, bulimia, or BED.
Anorexia Nervosa is an eating disorder where a person keeps their body weight as low as possible. People with anorexia usually do this by restricting the amount of food they eat, making themselves vomit, and exercising excessively. The condition often develops out of an anxiety about body shape and weight that originates from a fear of being fat or a desire to be thin, but can have a variety of causes.
The exact causes of anorexia nervosa are unclear, but most specialists believe that it is likely down to a combination of factors, whether they be psychological, environmental, or genetic. Restricting eating can be a way to manage emotions or stress and feel a sense of control, especially while processing a difficult life event like bereavement. Other factors, such as difficult family relationships, or a history of abuse, may contribute towards anorexia. It has been suggested that changes in brain function or hormone levels may also have a role in anorexia, and the risk of someone developing the disorder is also thought to be greater in people with a family history of eating disorders, depression, or substance misuse, which implies that genes may also be an important factor.
Anorexia most commonly affects girls and women, although it has become more common in boys and men in recent years. On average, the condition first develops at around the age of 16 to 17. Around 1 in 5 anorexia sufferers commit suicide.
Bulimia Nervosa is an eating disorder characterised by binge eating followed by purging. Binge eating refers to eating a large amount of food in a short amount of time, and purging refers to the attempts to get rid of the food consumed, which may be done by vomiting or taking laxatives. This behaviour can dominate daily life and lead to difficulties in relationships and social situations, and sufferers can experience mood swings as well as feeling anxious and tense.
Like anorexia, there is no simple answer to the question of what causes bulimia, but the condition is linked to a fear of getting fat, with more complex emotions usually contributing, which the act of binging and purging are often a way of dealing with.
Low self-esteem may lead to bulimia, as sufferers often have a low opinion of themselves and might see losing weight as a way of gaining self-worth. Binging and purging may also be a way of coping with stress or depression. The disorder can also occur in victims of abuse, or individuals who have experienced a difficult childhood. Also, research shows that bulimia is more common in people who have anxiety disorders, Obsessive Compulsive Disorder (OCD), Post-Traumatic Stress Disorder (PTSD), or personality disorders. Some people suggest that the media industry creates pressure for people to aspire to low body weights, which may lead to an eating disorder, while others may feel that bulimia can seem like a way for them to take control of their lives. Genetic factors can also contribute to an eating disorder, which is suggested by research that shows that people who have a close relative who has or has had bulimia are four times more likely to develop it than those who do not have a relative with the condition.
The effects of bulimia are detrimental to an individual, and can include damage to relationships with loved ones, infertility, internal bleeding, self-injury behaviour, and even death.
Binge Eating Disorder
Binge Eating Disorder (BED) is an illness that causes people to regularly overeat. The word binge describes an episode of excessive eating or drinking; people who binge eat consume large quantities of food in a short space of time, even if they don’t feel hungry. Binges are often planned in advance and the person may buy “special” binge foods, and during a binge they may feel in a “dazed state” and out of control of what they are eating, and may not remember what they ate afterwards.
Like most eating disorders, the causes of BED are not clear, but it is seen as a way of coping with feelings on unhappiness and low esteem.
Low self-esteem and depression of anxiety are factors that may increase your risk of binge eating, and feelings of stress and anger may also contribute to it. Dissatisfaction with your body, past trauma, and a family history of eating disorders may also contribute to the development of BED. Binge eating can also sometimes develop following a strict diet, especially if someone has skipped meals or not eaten enough food. Biological abnormalities can also contribute to binge eating, and studies have shown that they hypothalamus (the part of your brain that controls appetite) may not be sending correct messages about hunger and fullness. Research have also found a genetic mutation that appears to cause food addiction.
BED affects three times the number of people diagnosed with anorexia and bulimia combined; it is more common that breast cancer, HIV, and schizophrenia. It is slightly more common in women than men, and it first tends to develop in early adulthood. It is estimated that each individual has a 1 in 30 to 1 in 50 chance of developing BED at some point in life. BED can result in many health complications, including those associated with obesity, such as high cholesterol and blood pressure, heart disease, and osteoarthritis. People with BED can also suffer from anxiety and depression, which can greatly affect quality of life.
The DSM-IV includes a classification of disordered eating that falls outside the criteria of anorexia, bulimia, and BED- this category is referred to as EDNOS (Eating Disorders Not Otherwise Specified), and it represents a majority of those with eating disorders. Because EDNOS covers those who don’t meet all guidelines for other eating disorders, there is no specific set of characteristics for the disorder. Individuals with EDNOS usually fall into one of three groups: sub-threshold symptoms of anorexia or bulimia, mixed features of both disorders, or extremely atypical eating behaviours that are not characterised by either of the other established disorders. For example, someone with anorexia who weighs 87% of their ideal body weight (IBM) will likely be diagnosed with EDNOS, because the guidelines say that someone should weigh no more than 85% of their IBW to be considered anorexic. A person who binges and purges once a week may also be diagnosed with EDNOS, as the guidelines say that the individual should binge and purge at least twice a week to be considered bulimic. A person who combines symptoms of anorexia and bulimia, but does not meet all of the medical criteria for either disease would be classified as having an EDNOS. Up to 70% of eating disorders fall into the EDNOS category.
Pica is a compulsive craving for eating, chewing, or licking non-food items, such as paint chips, chalk, or cigarette ashes. It is thought that the most common reason for Pica behaviour is the absence or lack of important minerals, such as iron or zinc. Some professionals also believe that some people engage in this activity simply because they like the taste, texture, or smell of the things they consume. The ongoing consumption of inedible items activates the rewards circuit in the brain, causing the individual to crave the substances even more, but eating the objects can be very dangerous.
Items such as paint chips may contain toxic substances such as lead, the consumption of which can lead to brain damage or death, especially in childhood. Some objects can also cause harm to the teeth and often break them, as well as causing blockages in the digestive tract. In addition to this, sharp objects can pierce the intestines. Bacteria and parasites present on some objects can also cause infections. The number of people suffering with Pica is unknown, because it often goes unreported. However, it is most commonly diagnosed in women (particularly those in the first trimester of pregnancy) and children, especially those with developmental issues.
Night Eating Syndrome
Night Eating Syndrome is characterised by a delayed daily pattern of food intake. Those with NES typically eat little or nothing during the day, then binge during the evening. NES is not the same as BED, although individuals with the condition are often binge eaters. It differs from BED in that the amount of food consumed in the evening at night is not always large, or a loss of control over necessary food intake.
Night Eating Syndrome is usually caused by a variety of contributing factors. Sometimes students pick up the habit of eating at night, and are unable to break the habit when they become working adults. Similarly, high achievers may work through lunch breaks, then overcompensate by eating more at night. The disorder may also be a response to dieting; if someone restricts their intake of calories through the day, the body signals the brain that it needs food, and the individual may overcompensate at night. Night eating can also be a response to stress.
Individuals with night eating syndrome feel like they have no control over their eating patterns, and often feel shame and guilt over their condition. NES can have a serious impact, including making people susceptible to health problems caused by being overweight, and people with the disorder are often overweight or obese. Individuals with NES often have a history of substance abuse and depression, and typically report feeling more depressed at night. Sleep disorders are also a common effect of NES. According to the National Institute of Mental Health, NES affects around 1.5% of the population.
Bigorexia is also known as muscle dysmoprhia or reverse anorexia; individuals with Bigorexia worry that they are too small, and go to great lengths to increase their muscle mass. The disorder can affect anyone, but is common among body-builders, and Rob Wilson, chair of the Body Dysmorphic Disorder Foundation has said that “about 10% of men in the gym may have muscle dysmorphia”.
The NHS says bigorexia may be a genetic disorder, or a chemical imbalance in the brain could also cause someone to develop it. Life experiences may also be a factor, as bigorexia may be more common in people who were abused in their youth. Social pressure placed on men to look a certain way could also have a role. The disorder can use to steroid use and extreme high-protein diets, which can lead to kidney failure and other ailments. Rob Wilson also said that “sometimes individuals can become very depressed and hopeless and that can even lead to suicide.” Many cases of Bigorexia may be going undiagnosed because there is little awareness of the disorder.
Although Orthorexia Nervosa is not recognised as an eating disorder by the American Psychiatric Association, and is not mentioned as an official diagnosis in the DSM, it is something that I still wanted to mention. Orthorexia is a condition that includes symptoms of obsessive behaviour in pursuit of a healthy diet. It is commonly described as “an unhealthy obsession with eating healthy food.” It can be caused by fear of poor health, compulsion for complete control, waning to be thin to improve self-esteem, or searching for spirituality through food. Sufferers of the disorder often display symptoms of anxiety disorders that frequently co-occur with anorexia and other eating disorders. Someone with orthorexia may find that their food obsessions begin to hinder everyday activities; their strict rules about food may lead them to become socially isolated, and deviating from them can cause feelings of guilt and worthlessness.
Maintaining an obsession with healthy food may cause a restriction of calories in situations where available food isn’t considered to be good enough. This can cause many sufferers to reach the point of being seriously underweight. If their dietary restrictions are too severe, malnutrition can result, and in rare cases, this malnutrition can become very severe and lead to death.
Although this post in no way perfectly explains every eating disorder, I hope that it has helped even a few people to understand what an eating disorder is, their severity, and the types of eating disorder. Posts later on this week will discuss the signs of eating disorders, misconceptions about them, and how to help someone with an eating disorder.
Thank you for reading! I hope you have found this post helpful and I wish you the best of luck in your recovery. Keep growinggg!