Eating Disorders: About More Than Food

What are eating disorders?

Eating disorders are serious, biologically influenced medical illnesses marked by severe disturbances to one's eating behaviours. Although many people may worry about their health, weight, or appearance occasionally, some individuals become fixated on weight loss, body weight or shape, and controlling their food intake. These may indicate an eating disorder.

Eating disorders are not a choice. They can affect a person's physical and mental health and may be life-threatening. However, with treatment, people can recover completely. These complex conditions often co-occur with other mental health disorders, such as depression, anxiety, or obsessive-compulsive disorder.

The most common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder. Each presents unique symptoms and challenges. Anorexia nervosa is characterised by an intense fear of gaining weight, leading to severe food restriction and often excessive exercise. Bulimia nervosa involves cycles of binge eating followed by compensatory behaviours such as self-induced vomiting or laxative misuse. Binge-eating disorder is marked by recurrent episodes of consuming large quantities of food, often accompanied by distress and lack of control.

The causes of eating disorders are multifaceted, involving a combination of genetic, environmental, and psychological factors. Research suggests that biological factors, including changes in brain chemistry, may contribute to their development. Additionally, societal pressures, cultural beauty ideals, and personal experiences can play significant roles in their onset and progression.

Who is at risk for eating disorders?

Eating disorders are complex mental health conditions affecting individuals from all walks of life. Contrary to common misconceptions, these disorders do not discriminate based on age, race, ethnicity, body weight, or gender. Even those who appear outwardly healthy, such as athletes, can be susceptible to the devastating effects of eating disorders.

It is crucial to understand that an individual's physical appearance does not necessarily reflect the presence or absence of an eating disorder. Individuals with eating disorders can be underweight, normal weight, or overweight. Therefore, one cannot rely solely on visual cues to determine if someone is struggling with this condition.

The underlying causes of eating disorders are not fully understood, but research suggests a complex interplay of genetic, biological, behavioural, psychological, and social factors that contribute to an individual's risk. These factors can vary greatly from person to person, making it essential to approach each case with a nuanced and comprehensive understanding.

Societal pressures and cultural ideals surrounding body image and appearance can exacerbate the risk of developing an eating disorder. The pervasive influence of media, including social media platforms, can contribute to unrealistic beauty standards and heightened body dissatisfaction, particularly among young people.

It is important to recognise that eating disorders are not merely about food or weight, but rather complex psychological conditions that often serve as coping mechanisms for underlying emotional distress. They can manifest in various forms, including anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding or eating disorders (OSFED).

Early intervention and professional treatment are crucial for individuals struggling with eating disorders. A multidisciplinary approach, involving mental health professionals, nutritionists, and medical doctors, is often necessary to address the physical, psychological, and nutritional aspects of these conditions. Treatment plans should be tailored to the individual's specific needs and may include psychotherapy, nutritional counselling, and medical monitoring.

What are the common types of eating disorders?

The most common types of eating disorders include anorexia nervosa, bulimia nervosa, binge-eating disorder, and avoidant restrictive food intake disorder. Each of these disorders is associated with distinct but occasionally overlapping symptoms. Individuals exhibiting any combination of these symptoms may have an eating disorder and should be evaluated by a healthcare professional.

Anorexia nervosa is characterised by an intense fear of weight gain, a distorted body image, and severe food restriction leading to dangerously low body weight. Bulimia nervosa involves recurrent episodes of binge eating followed by compensatory behaviours such as purging, excessive exercise, or misuse of laxatives. Binge-eating disorder is marked by recurrent episodes of uncontrolled overeating without compensatory behaviours. Avoidant restrictive food intake disorder is a feeding or eating disturbance that leads to significant weight loss or nutritional deficiency, but does not involve body image disturbance or compensatory behaviours.

It is important to note that eating disorders are complex mental health conditions that require professional diagnosis and treatment. Individuals exhibiting symptoms of any eating disorder should seek guidance from a qualified healthcare provider.

What is anorexia nervosa?

Anorexia nervosa is a condition where people avoid food, severely restrict food, or eat very small quantities of only certain foods. They also may weigh themselves repeatedly. Even when dangerously underweight, they may see themselves as overweight.

There are two subtypes of anorexia nervosa: a restrictive subtype and abinge-purge subtype.

Restrictive: People with the restrictive subtype of anorexia nervosa severely limit the amount and type of food they consume.

Binge-Purge: People with the binge-purge subtype of anorexia nervosa also greatly restrict the amount and type of food they consume. In addition, they may have binge-eating and purging episodes, eating large amounts of food in a short time followed by vomiting or using laxatives or diuretics to get rid of what was consumed.

Symptoms of anorexia nervosa include:

• Extremely restricted eating and/or intensive and excessive exercise
•  Extreme thinness (emaciation)
• A relentless pursuit of thinness and unwillingness to maintain a normal or
• healthy weight   
• Intense fear of gaining weight
• Distorted body or self-image that is heavily influenced by perceptions of body
• weight and shape
• Denial of the seriousness of low body weight 

Over time, anorexia nervosa can lead to numerous serious health consequences, including:

• Thinning of the bones (osteopenia or osteoporosis)
• Mild anaemia
• 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
• 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
• Multiple organ failure

Anorexia nervosa can be fatal. It has an extremely high death (mortality) rate compared with other mental disorders. People with anorexia are at risk of dying from medical complications associated with starvation. Suicide is the second leading cause of death for people diagnosed with anorexia nervosa.

What is bulimia nervosa?

Bulimia nervosa is a condition where people have recurrent episodes of eating unusually large amounts of food and feeling a lack of control over their eating. This binge eating is followed by behaviours that compensate for the overeating to prevent weight gain, such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviours. Unlike those with anorexia nervosa, people with bulimia nervosa may maintain a normal weight or be overweight.

Symptoms and health consequences of bulimia nervosa include:

• Chronically inflamed and sore throat
• Swollen salivary glands in the neck and jaw area
• Worn tooth enamel and increasingly sensitive and decaying teeth from
• exposure to stomach acid when vomiting
• 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?

Binge-eating disorder is a condition where people lose control of their eating andhave reoccurring episodes of eating unusually large amounts of food. 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.

Symptoms of binge-eating disorder include:

• Eating unusually large amounts of food in a short amount of time, for example,
  within two hours
• Eating rapidly during binge episodes
• 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
• Frequent dieting, possibly without weight loss

What is avoidant restrictive food intake disorder?

Avoidant restrictive food intake disorder (ARFID), previously known as selective eating disorder, is a condition where people limit the amount or type of food eaten. Unlike anorexia nervosa, people with ARFID do not have a distorted body image or extreme fear of gaining weight. ARFID is most common in middle childhood and usually has an earlier onset than other eating disorders. Many children go through phases of picky eating, but a child with ARFID does not eat enough calories to grow and develop properly, and an adult with ARFID does not eat enough calories to maintain basic body function.

Symptoms of ARFID include:

• Dramatic restriction of types or amount of food eaten
• Lack of appetite or interest in food
• Dramatic weight loss
• Upset stomach, abdominal pain, or other gastrointestinal issues with no other known cause
• Limited range of preferred foods that becomes even more limited (“picky eating” that gets progressively worse)

How are eating disorders treated?

Eating disorders can be treated successfully. Early detection and treatment are important for a full recovery. People with eating disorders are at higher risk for suicide and medical complications.

A person’s family can play a crucial role in treatment. Family members can courage the person with eating or body image issues to seek help. They also can provide support during treatment and can be a great ally to both the individual and the health care provider. Research suggests that incorporating the family into treatment for eating disorders can improve treatment outcomes, particularly for adolescents.

Treatment plans for eating disorders include psychotherapy, medical care and monitoring, nutritional counselling, medications, or a combination of these approaches. Typical treatment goals include:

• Restoring adequate nutrition
• Bringing weight to a healthy level
• Reducing excessive exercise
• Stopping binge-purge and binge-eating behaviours

People with eating disorders also may have other mental disorders (such as depression or anxiety) or problems with substance use. It’s critical to treat anyco-occurring conditions as part of the treatment plan.

Specific forms of psychotherapy (“talk therapy”) and cognitive-behavioral approaches can treat certain eating disorders effectively. 

Research also suggests that medications may help treat some eating disorders and co-occurring anxiety or depression related to eating disorders. Information about medications changes frequently, so talk to your health care provider.