An eating disorder affects both the mind and the body. Anorexia and bulimia affect people's eating habits significantly. Their thoughts and emotions are abnormally focused on food and body weight. Excessive conduct and warped thoughts become uncontrollable. "Eating disorders are not a choice," says Dr. Evelyn Attia, a psychiatry professor and head of Columbia University Irving Medical Center in New York City's Columbia Center for Eating Disorders. "They aren't a way of life. They are severe psychiatric disorders with the potential to kill, yet they are completely curable if properly recognized."
According to the National Eating Disorders Association, 30 million Americans will suffer from an eating disorder at some point in their life. Women will make up about 20 million of the total, while men will make up the remaining 10 million. Dr. Jason Nagata, a pediatrician and researcher in the division of adolescent and young adult medicine at the University of California, San Francisco, and an assistant professor of pediatrics at the UCSF School of Medicine, says that eating disorders can affect people of all sizes, ethnicities, and sexual orientations. "We're increasingly finding that both boys and girls can suffer from eating problems. They may impact people from many walks of life. As a result, it's critical not to have preconceived assumptions about how someone suffering from an eating problem appears."
Adults of all ages can acquire eating problems. Dr. Terri Griffith, clinical coordinator of the intense outpatient treatment at The Center for Eating Disorders at Sheppard Pratt in Baltimore, says, "I've seen patients from 7 years old to 75 years old." She claims to have encountered people of various races, ethnic origins, and genders seeking therapy for their eating problems. "I've seen people who are technically fat as well as individuals who are very underweight," Griffith continues. "As a result, we see a wide range of patients."
Types
The American Psychiatric Association's newest version of the Diagnostic and Statistical Manual of Mental Problems, or DSM-5 — an authoritative guide used by health professionals to diagnose mental health disorders – recognizes the following feeding and eating disorders:
Anorexia nervosa is a kind of anorexia. Anorexia is characterized by considerable weight loss or, in the case of growing children, a failure to gain weight as expected, as well as difficulties maintaining a healthy weight in accordance to one's age, height, and body type. A common symptom is a distorted body image.
Food avoidance/restrictive eating disorder. ARFID, like anorexia, involves restricting the amount and kind of food consumed. Those with ARFID, on the other hand, are usually unconcerned with their physical size or form, or their dread of getting obese. Nagata explains, "It's characterized by someone being an extremely fussy eater."
Bulimia nervosa is an eating disorder. The characteristic of bulimia is a cycle of binge eating followed by purging to compensate for the episode and avoid weight gain. Purging habits include self-induced vomiting and the abuse of medicines such as laxatives and diuretics. Excessive exercise is also a possibility.
Binge eating is a type of eating disorder. Binge eating episodes are characterized by fast consumption of huge amounts of food until discomfort is reached, followed by emotions of shame, guilt, or anxiety. Unlike bulimia, people seldom purge after eating. These episodes must occur at least once a week, on average, for at least three months to be classified as binge eating disorder.
Pica. Pica refers to the practice of consuming non-food items on a regular basis (except among children under 2 years old, for whom this behavior is common). Pica sufferers eat clay, paper, paint chips, and dirt, among other things. Pica is more frequent in young children, although it may also affect adults. Pica and strange nonfood desires are common during pregnancy.
Rumination. Rumination is the act of re-chewing, re-swallowing, or spitting out food that has been regurgitated from the stomach. People with rumination problem frequently appear to regurgitate without meaning to or without displaying any symptoms of pain or disgust. Rumination is a recurring pattern of thought that occurs shortly after each meal.
Associated Symptoms
Despite the fact that these illnesses are not eating disorders, they are connected to them and have some characteristics:
Body dysmorphic disorder (BDD) is a kind of body dysmorphic disorder Body dysmorphia is the inability of a person to stop worrying about perceived faults in their appearance. People's perceptions of an actual or imagined deficiency in a certain body area are twisted or exaggerated. Because of shame or humiliation, they may shun social situations.
Dysmorphia of the muscles. Men are more likely to suffer from muscle dysmorphia, often known as "reverse anorexia" or "bigorexia." Despite their efforts to bulk up and gain weight, some patients never feel muscular enough. According to Nagata, there is some overlap with eating disorders, and "it's clearly a significant problem we're seeing in young people."
Orthorexia. Orthorexia is a disorder characterized by a strong desire to eat healthily. People with orthorexia, ironically, might harm their mental and physical health by obsessively checking nutritional labels, gradually eliminating whole food groups, and limiting themselves to the few "clean" items.
Causes
Eating disorder researchers are still trying to figure out what causes them. "If someone is vulnerable, we believe there are a variety of variables that lead to the development of an eating problem," Attia adds. According to Attia, evidence from brain-imaging research connected to anorexia and bulimia — the two most studied eating disorders – suggests that persons with these illnesses have neurological and metabolic abnormalities. She adds that genetic research back up a biological foundation. Certain environmental variables, according to Attia, must be present for that vulnerability to appear. People may lose weight as a result of Western culture's promotion of a slim body form as a desirable beauty ideal.
"It doesn't imply that every eating problem starts with a diet," Attia adds, "but there is a lot of dieting in our society." "We frequently hear that someone started in high school or college with a really innocent endeavor to eat a little bit healthier or shed a few pounds. For the most part, this is a transient change in behavior. They either accomplish and sustain the desired alteration, or they bounce back and eventually return to, or even exceed, their original weight. "However, according to Attia, for someone who is at risk of developing an eating disorder such as anorexia, that initial weight-loss effort might set off a vicious cycle that is difficult to escape.
Symptoms
Although there might be overlap in symptoms, each eating disorder has its own set of symptoms. What they all have in common is the frequency of associated behaviors like bingeing and purging or missing meals, as well as the persistence of these habits across months or even years. These are some of the signs and symptoms of serious eating disorders:
Anorexia
Drastic calorie restriction - considerably fewer calories consumed than required.
Significant weight reduction.
Changes in eating habits, such as an extreme avoidance of meals high in fat or carbohydrates.
In children and teenagers, there is either a loss of weight or a lack of weight increase.
Low BMI (body mass index), a calculation based on weight and height.
Weight, diets, food, calories, and fat grams are all on the mind.
Observations about feeling overweight or fat on a regular basis, regardless of weight decrease.
To hide weight loss, use layers of clothing.
Separating meals on a plate is one example of a culinary ritual.
Constipation or stomach discomfort are examples of gastric issues.
Girls who do not or do not cease to have their menstrual period.
Bulimia
Obsession with diets, weight loss, and eating management.
Meal skipping or eating only tiny quantities.
After meals, disappearing to the toilet.
There was evidence of vomiting.
Use of mouthwash, gum, or breath mints on a regular basis.
Empty laxative or diuretic packets or empty wrappers are signs of purging.
Evidence of binge eating, such as food hoarding.
Teeth that are stained, discolored, or have been shortened.
Binge Eating
Even when you're full, you should eat.
During binge episodes, eat rapidly.
When it comes to eating, there is a loss of control.
Avoiding eating in the presence of others.
Food hoarding and the concealment of empty food containers.
I've been dieting a lot but haven't been able to lose weight.
After eating, you may experience despair, anxiety, or embarrassment.
ARFID
Extreme food aversion.
Excessive dietary restrictions, such as avoiding items with a particular flavor, color, or odor.
Consumption of only one type of food (like chicken nuggets).
Weight loss and body image aren't usually a problem, unlike anorexia.
Food is difficult to digest.
Small amounts and unusually sluggish eating.
Children who are unable to acquire weight.
Dependence on dietary supplements.
DIAGNOSIS
Early detection of eating disorders is critical, both because they are simpler to treat while people are younger and because the health implications of untreated eating disorders can occur at any age. Eating disorders can sometimes go undiagnosed for years, causing irreversible harm to one's health. "If a doctor observes significant weight loss from year to year or visit to visit," Nagata adds, "they could start asking more follow-up questions and doing some screening for eating disorders." It's possible that you'll be sent to an eating disorder expert or program as a result of this. Attia recommends that clinicians, such as general practitioners, inquire about dietary habits. Eating disorder signs can be detected using evidence-based screening methods, which should be followed up on. Answering questions on eating and meal patterns, eating attitudes, body weight, and attractiveness are all part of a psychological exam. It might include a mental health evaluation for anxiety, obsessive compulsive disorder, self-harm, or despair, all of which can coexist with eating problems.
Other medical reasons for rapid or substantial weight loss can be ruled out with a physical check. Nutritional deficits induced by limited eating may be detected by lab testing. Low blood pressure or a sluggish heart rate are examples of changes in vital signs. Doctors search for symptoms of associated problems after an eating disorder has been diagnosed.
Complications
Eating disorders can impact every organ in the body, posing significant health risks. "These are potentially fatal diseases," adds Attia. "Anorexia nervosa has one of the highest death rates in psychiatry. Some of these people died as a result of the illness's consequences. Some are as a result of suicide." Malnutrition and hunger, as well as the consequences of bingeing and purging, cause physical problems in people with eating disorders. The following is a partial list of probable issues:
Effects on the bones and hormones. Adolescence and early adulthood are often times when people increase bone density. Eating disordered teenagers have significantly reduced bone density and are more prone to have fractures.
Interruptions in hormone cycles in girls and young women can cause menstrual periods to halt completely, according to Attia. "In essence, their bodies begin to act like a menopausal woman," she explains. As a result, she says, they're more likely to develop bone disorders like osteopenia (bone loss) and osteoporosis (weak or brittle bones), which doctors generally ignore until menopause.
Effects on the teeth Bulimia can cause tooth erosion and cavities due to frequent vomiting. Teeth can shorten, and even young individuals have lost all of their teeth in extreme circumstances.
Effects on the gastrointestinal tract. Irritation and inflammation of the digestive tract can also be caused by vomiting. Constipation, diarrhea, gas, and bloating are all symptoms of laxative overuse.
Electrolyte abnormalities have a negative impact on the heart. Overuse of laxatives and diuretics can lead to dehydration. This can disrupt the natural balance of electrolytes in the blood, such as sodium, potassium, calcium, and magnesium. Dangerous cardiac rhythms can develop as a result.
Effects on the kidneys Dehydration that is severe and chronic might lead to kidney failure. This may necessitate lifelong dialysis or a transplant.
Effects on the brain Concentration problems are a short-term difficulty that occurs when the brain does not receive enough energy from eating. Longer-term effects are possible. "We've even observed on scans that when someone is hungry, their brain volume decreases," Attia says.
TREATMENT
Treatment facilities address the many elements of eating disorders through a team-based approach. The interdisciplinary team includes medical doctors, mental health experts, dietitians, and nutritionists.
Inpatient
A patient with eating disorders who is medically unstable or has issues from concurrent medical conditions, or who is psychiatrically unstable, has spiraling symptoms, and is at danger of self-harm, may need to be hospitalized or admitted to an inpatient institution.
Residential
If a patient's psychiatric disorders are not responding to lesser levels of care and he or she is physically stable, has normal vital signs, and is not in need of severe medical care, he or she may benefit from 24/7 residential therapy.
Partial Hospitalization
A partial hospitalization arrangement may be required for a patient who is medically and psychiatrically stable but requires ongoing monitoring and is purging, bingeing, fasting, or drastically restricting their daily food intake. Patients stay at the hospital for up to 12 hours every day, including breakfast, lunch, and supper, before returning home at night.
Intensive Outpatient
An intense outpatient program from three to seven days a week may help a patient transitioning out of (or into) partial hospitalization or residential therapy. Intensive outpatient therapy, which lasts three or four hours each day, provides ongoing support through group, individual, and nutritional therapy.
Option for Residential Treatment
Residential treatment clinics strive to provide 24-hour care in a comfortable setting. Stephanie Kern, clinical director of the Eating Disorder Solutions treatment center in Dallas, emphasizes that residents be medically stable when they arrive.
Forms of Therapy
Cognitive behavioral therapy, dialectical behavior therapy, and family-based therapy are examples of evidence-based psychological or behavioral therapies for eating disorders. Cognitive behavioral therapy (CBT) is a first-line treatment that teaches patients how to detect harmful thought patterns that can lead to self-destructive behavior and how to replace them with more constructive and positive ones.