2.5: Eating Disorders
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Define the four main types of eating disorders.
List the health professionals on an eating disorder treatment team.
What are eating disorders? (1,2)
There is a commonly held misconception that eating disorders are a lifestyle choice. Eating disorders are serious medical illnesses marked by severe disturbances to a person’s eating behaviors and related thoughts and emotions. Obsessions with food, body weight, and shape may be signs of an eating disorder. These disorders can affect a person’s physical and mental health; in some cases, they can be life-threatening. But eating disorders can be treated. Learning more about them can help you spot the warning signs and seek treatment early. Common eating disorders include anorexia nervosa, bulimia nervosa, binge-eating disorder, and other specified feeding and eating disorders (OSFED).
Remember: Eating disorders are not a lifestyle choice. They are biologically-influenced medical and mental health illnesses.
Who is at risk for eating disorders?
Eating disorders can affect people of all ages, racial/ethnic backgrounds, body weights, and genders. Although eating disorders often appear during the teen years or young adulthood, they may also develop during childhood or later in life.
Remember: People with eating disorders may appear healthy, yet be extremely ill. You cannot tell if someone has an eating disorder by looking at them.
The exact cause of eating disorders is not fully understood, but research suggests a combination of genetic, biological, behavioral, psychological, and social factors can raise a person’s risk. Leading eating disorder researcher, Dr. Walter Kaye, sums this up by saying, "Genetics loads the gun, and environment pulls the trigger." (3)
What are the common types of eating disorders?
Eating disorders are diagnosed as mental health disorders, based on the Diagnostic and Statistical Manual of Mental Disorders, which at the time of this publication is the 5th edition (DSM-V). Common eating disorders include anorexia nervosa, bulimia nervosa, binge-eating disorder and other specified feeding and eating disorders (though there are others as well). If you or someone you know experiences the symptoms listed below, it could be a sign of an eating disorder—call a health provider right away for help.
What is anorexia nervosa?
People with anorexia nervosa avoid food, severely restrict food, or eat very small quantities of only certain foods. Even when they are dangerously underweight, they may see themselves as overweight. They may also weigh themselves repeatedly.
There are two subtypes of anorexia nervosa: a restrictive subtype and binge-purge subtype.
Restrictive: People with the restrictive subtype of anorexia nervosa place severe restrictions on the amount and type of food they consume.
Binge-Purge: People with the binge-purge subtype of anorexia nervosa also place severe restrictions on the amount and type of food they consume. In addition, they may have binge eating and purging behaviors (such as vomiting, use of laxatives and diuretics, etc.).
Symptoms include:
- Extremely restricted eating and/or intensive and excessive exercise
- Extreme thinness (emaciation), though not necessarily!
- A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
- Intense fear of gaining weight
- Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight
Over time, these symptoms may also develop:
- Thinning of the bones (osteopenia or osteoporosis)
- Mild anemia and muscle wasting and weakness
- Brittle hair and nails
- Dry and yellowish skin
- Growth of fine hair all over the body (lanugo)
- Severe constipation
- Low blood pressure, slowed breathing and pulse (which may lead to sudden cardiac death)
- Damage to the structure and function of the heart
- Drop-in internal body temperature, causing a person to feel cold all the time
- Lethargy, sluggishness, or feeling tired all the time
- Infertility
- Brain damage and cognitive distortions
- Multi-organ failure
Anorexia can be fatal. Anorexia nervosa has the highest mortality (death) rate of any mental disorder. People with anorexia may die from medical conditions and complications associated with starvation or suicide.
What is bulimia nervosa? (2)
People with bulimia nervosa have recurrent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behaviors that compensate for the overeating, such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. Unlike those with anorexia nervosa, people with bulimia nervosa may maintain a normal weight or be overweight.
Symptoms include:
- Chronically inflamed and sore throat
- Swollen salivary glands in the neck and jaw area
- Worn tooth enamel and increasingly sensitive and decaying teeth (a result of exposure to stomach acid)
- Acid reflux disorder and other gastrointestinal problems
- Intestinal distress and irritation from laxative abuse
- Severe dehydration from purging
- Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium and other minerals), which can lead to stroke or heart attack
What is binge-eating disorder? (2)
People with binge-eating disorder lose control over their eating. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder are often overweight or obese, though they may be at a normal weight. Binge-eating disorder is the most common eating disorder in the U.S.
Symptoms include:
- Eating unusually large amounts of food in a specific amount of time, such as a 2-hour period
- Eating fast during binge episodes, perhaps even feeling disassociated from their body while doing it
- Eating even when full or not hungry
- Eating until uncomfortably full
- Eating alone or in secret to avoid embarrassment
- Feeling distressed, ashamed, or guilty about eating
- Frequently dieting, possibly without weight loss
What is Other Specified Feeding and Eating Disorders (OSFED)? (4)
People with OSFED experience eating disorder behaviors or outcomes that do not fit neatly into the other categories. OSFED can look very similar to the other disorders, or can be a very specific type of behavior that has just not been given its own clinical diagnosis yet.
OSFED may include:
- Restricting intake, but not meeting all the diagnostic criteria for anorexia nervosa
- Binging and purging, but not frequently enough to meet the diagnostic criteria for bulimia nervosa
- Binge eating, but not frequently enough to meet the diagnostic criteria for binge eating disorder
- Orthorexia; eating only what the person deems to be "healthy," which can be anything from a fixation on local/organic food, to vegan/vegetarian for the reason of trying to manipulate their body, to eating only certain kinds of foods/being obsessed with macronutrients
- Night-eating; which is waking in the night to eat when not physically hungry, on a regular basis
- Sleep-related eating disorder; when the person is sleep-walking and eating unaware they are doing so
- Diabulimia; type-1 diabetics dangerously manipulating insulin to lose weight. This leads to diabetic ketoacidosis
- Drunkorexia; "saving" calories for alcohol
- Pregorexia; restricting intake when pregnant to avoid weight gain
- Chewing and spitting out food
- ...and many other eating behaviors
OSFED is just as serious as the other eating disorders, though many health care providers may miss diagnosing it, as they are not as clear-cut as the other disorders.
How are eating disorders treated?
It is important to seek treatment early for eating disorders. People with eating disorders are at higher risk for suicide and medical complications. Some people with eating disorders may also have other mental disorders (such as depression or anxiety) or problems with substance use.(2) Often blood work looks perfectly normal in people with eating disorders until very late in the disorder, making the individual think they are not "that sick."(4)
Treatment plans for eating disorders include psychotherapy, medical care and monitoring, nutritional counseling, medications, or a combination of these approaches. Typical treatment goals include restoring adequate nutrition, bringing weight to a healthy level, reducing excessive exercise, and stopping binge-purge and binge-eating behaviors. Complete recovery is possible.(2)
Treatment plans are tailored to individual needs and may include one or more of the following:(1)
- Individual, group, and/or family psychotherapy by a mental health professional.
- Medical care and monitoring by a medical provider.
- Nutritional counseling by a registered dietitian
- Medications, prescribed by a psychiatrist or medical provider.
References:
1) Eating Disorders. National Institutes of Health. <https://www.nimh.nih.gov/health/topi...rs/index.shtml> Revised Feb. 2016. Accessed 11/26/2020.
2) Eating Disorders: About More Than Food. National Institutes of Health. <https://www.nimh.nih.gov/health/publ...rs/index.shtml> Revised 2018. Accessed 11/26/2020.
3) Kaye, Walter, MD. Brain Imaging and Eating Disorders. Vimeo, vimeo.com/1678383. Accessed 11/26/2020.
4) Parker, MS, RD, Libby. 11/26/2020.