Eating Disorder: types, symptoms, and treatment
What is an Eating disorder:
An eating disorder is an abnormal eating behavior that risks mental and physical health. Eating disorders involve a series of disturbances in eating behavior such as extreme reduction of food intake or severe overeating and feeling of distress or extreme concern about body shape and weight. These include a range of conditions that include an obsession with food, weight, and appearance to the degree that a person’s health, relationships, and daily activities are adversely affected. Eating disorders are potentially life-threatening psychiatric disorders that require clinical treatment.
Eating disorders are related to obesity since they are a part of weight-related issues or problems. Eating disorders are serious and complex emotional and physical addictions and without treatment, it leads to mood swings, physical problems, and potential death. Most often they affect young women and teenage girls. However, people of all ages and genders can also suffer from eating disorders.
Why we should know about Eating disorders:
Eating disorders involve self-starvation and overeating. The body denies all the essential nutrients which are required to function normally, so it is forced to slow down all its processes to consume energy. This slowing down can have serious medical consequences.
The prevalence of eating disorders in India is lower than that of western countries but appears to be increasing significantly in the country. Thus a study on eating disorders is necessary after realizing the increased current prevalence, the incidence of eating disorder, its complications, and increased mortality in different age groups mainly in adolescent girls.
Eating disorders types:
- Anorexia nervosa
- Bulimia nervosa
- Binge eating disorder
Anorexia nervosa means a lack of desire to eat. Anorexia nervosa is characterized by starvation. Nervosa indicates the disorder has psychological roots. The person with anorexia has an extreme fear of gaining weight despite being underweight. They may appear skinny but they have a distorted body image.
Most cases are in women ranging in age from early teens to mid-twenties that is women aged from 15 to 24. Over 0.5% to 1% of women from late adolescence to early adulthood meet the full criteria for anorexia.
- Abnormally slow heart rate and low blood pressure, which means the risk of heart failure rises.
- Growth of a downy layer of hair.
- Reduction of bone density which results in dry, brittle bones.
- Muscle loss and weakness.
- Severe dehydration can result in failure.
- Dry hair and skin, frequent hair loss.
- Fainting, fatigue, and overall weakness.
- Loss of weight.
- Consistent excuses to avoid mealtimes or Refusal to eat certain foods.
- Anxiety about gaining weight or being fat.
- Withdrawal from friends and social gatherings.
- Preoccupation with weight, food, calories, and dieting.
There are two types of Anorexia Nervosa.
In this type, The person does not regularly engage in binge eating or purging behavior (self-induced vomiting or the misuse of laxatives, diuretics, or enemas).
In this type, The person is regularly engaged in binge eating ( lacking control of overeating) or purging behavior.
Bulimia nervosa means hunger of an ox for nervous reasons. Bulimia is characterized by cycles of binging (eating a large amount of food) and then experiencing guilt, fear or stomach pains, etc. A person with bulimia eats a lot of food in a short amount of time. This is called binging and it causes feelings of shame and guilt. So the person tries to undo the binge by getting rid of the food by throwing it up.
Bulimia nervosa affects 1 to 2 % of adolescent and young adult women. Many people struggling with bulimia nervosa recognize that their behaviors are unusual and perhaps dangerous to their health. Approximately 80% of bulimia nervosa patients are females.
- Inflammation and possible rupture of the esophagus from frequent vomiting.
- Chronic irregular bowel movements and constipation as a result of laxative abuse.
- Electrolyte imbalances can lead to irregular heartbeats and possibly heart failure and death.
- Gastric rupture is an uncommon but possible side effect of binge eating.
- Tooth decay and staining from stomach acids released during frequent vomiting.
- Unusual swelling of the cheeks or jaw area.
- Discoloration or staining of teeth.
- Evidence of binge eating including the disappearance of large amounts of food in short periods of time or the existence of wrappers and containers indicating the consumption of large amounts of food.
- Calluses on the back of hands and knuckles from self-induced vomiting.
- Creation of complex lifestyle schedules or rituals to make time for binge and purge sessions.
There are two types of Bulimia Nervosa.
In this type, The person regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics.
In this type, The person uses other compensatory behaviors, such as fasting or excessive exercise, but does not regularly engage in self-induced vomiting or misuse of laxatives.
Binge eating disorder:
Binge eating disorder is compulsive eating in a period without any control over the situation. A person having BED consumes abnormal, large amounts of food in short periods of time and eats alone because of shame about their behavior. There are also several behavioral indicators of BED including eating when not hungry and eating in secret. It is characterized by recurrent binge eating without the regular use of compensatory measures to counter binge eating.
People who struggle with binge eating disorder can be of normal or heavier than average weight. Binge eating disorder is much like bulimia, except that individuals do not use purging ( ie vomiting, laxatives, fasting, etc) following a binge. The prevalence of this disorder is estimated to be approximately 1-5% of the general population. BED affects both males and females, however, females are more likely to engage in such behavior.
The health risks of BED are most commonly those associated with clinical obesity.
Some of the potential health consequences of binge eating disorder include:
- High cholesterol levels
- Gallbladder disease
- Heart disease
- Diabetes mellitus
- High blood pressure
- Eating large amounts of food when not physically hungry.
- Dramatic weight gain or weight fluctuations.
- Eating until the point of feeling uncomfortably full.
- Feeling of depression, disgust, or guilt after eating.
- Eating much more rapidly than normal.
- Withdrawal from usual friends and activities.
An eating disorder in which non-nutritional objects are eaten. It is characterized by a compulsive craving for eating, chewing, or licking non-food items or foods containing no nutrition. The typical substances consumed vary with age and availability, including paper, soap, chalk, hair, wool, soil, cloth, paint, clay, ash, metal, gum, talcum powder, etc. The eating behavior of this disorder is not part of a culturally supported or socially normative practice. Eating substances is inappropriate to the developmental level of the individual. Pica often occurs with other mental health disorders associated with impaired functioning. It affects both sexes. Over 95% of 12-month-old infants and 2 to 3 years old toddlers placed non-nutritive substances in their mouth but seldom results in indigestion.
- Mechanical bowel problems.
- Infections such as toxoplasmosis (protozoan) and toxocariasis (worm) as a result of investing feces or dirt.
- Poisoning such as by consumption of lead-based paint.
The most famous case of pica was in 1929, a patient was found to have a total of 1446 non-food items in his stomach including 453 nails, 148 seeds, 85 small stones, 42 screws, 63 buttons, and 115 hairpins.
Eating disorder symptoms:
Anorexia Nervosa symptoms:
- Resistance to maintaining body weight at or above the minimally normal weight for age and height.
- Loss of menstrual periods in girls and women post-puberty.
- Intense fear of weight gain or being fat even though underweight.
- Disturbance in the experience of body weight or shape on self-evaluation.
Bulimia Nervosa symptoms:
- Regular intake of large amounts of food accompanied by a sense of loss of control over eating behavior.
- Extreme concern with body weight and shape.
- Regular use of inappropriate compensatory behaviors such as self-induced vomiting, laxative or diuretic abuse, fasting, and obsessive or compulsive exercise.
Binge eating disorder symptoms:
- Significant weight gain.
- Periodically does not exercise control overconsumption of food.
- Digestive problems.
- Eats when depressed or bored.
- Digestive problems
- Withdrawal from friends and social gatherings
Eating disorder treatment:
- Most individuals with eating disorders are treated successfully on an outpatient basis.
- Individuals with medical complications due to severe weight loss or due to the effects of binge eating or purging may require inpatient hospitalization or residential treatment.
- Psychological counseling must address eating disorders and the underlying psychological, interpersonal, and cultural factors that contribute to the eating disorder.
- Patients with eating disorders typically require a treatment team consisting of a primary care, physician, dietitian, and licensed mental health professional.
- The most effective and long-lasting treatment for an eating disorder is some form of psychotherapy or psychological counseling, coupled with careful attention to medical and nutritional needs. This treatment should be tailored to the individual and vary according to the severity of the disorder and the patient’s particular problems, needs, and strengths.
- Other individuals, for whom outpatient therapy has not been effective, may benefit from, an intensive outpatient program, day-hospital treatment, residential treatment, or in-patient hospitalization.
- Typically, A licensed health professional provides care, including but not limited to a psychologist, psychiatrist, social worker, and medical doctor. Care should be coordinated and provided by a health professional with expertise and experience in dealing with eating disorders.
- Eating disorders-culture bound syndromes-restricted to countries with Western culture-formative as well as the pathoplastic effect on eating disorders.
- The study of eating disorders in developing countries like India could be an illuminating unique opportunity for testing the role of culture in the etiology of eating disorders.
- The studies conducted in the management have a limitation of small sample size and short follow-up period-failed to address the optimal approach to re-nutrition.
- Newer medications affecting hunger, satiety, and energy expenditure, as well as a novel approach in behavior intervention, need to be developed and tested.