Eating disorders are not physical, but psychiatric illness. Eating disorders can be driven by social factors such as the media’s ad depictions of beauty. These disorders can also be driven by our environmental exposure as well. Environmental factors include bullying, OCD, depression, and other life stressors. Of all of the mental health disorders, ED’s have the highest mortality rate.
Our culture seems to be inundated by messages regarding images of beauty, fear of obesity, and debates about diets and exercise. With this in mind, there is no wonder more than 30 million people suffer from an eating disorder. ED’s affect women and men as well; the young and the old. ED’s are not limited by race or socioeconomic status. In other words, the rich suffer as do the poor from this mental disorder. “National surveys estimate that 20 million women and 10 million men in America will have an eating disorder at some point in their lives.” (https://www.nationaleatingdisorders.org/learn/general-information/what-are-eating-disorders)
When thinking of people with ED’s you may conjure an image of a healthy, young person who develops anorexia or bulimia as their life spins out of control. The truth is, sometimes ED’s don’t manifest until someone becomes elderly or ill. In my current job, I have had many cases of elderly anorexic patients, who refuse food and have to be hospitalized for medical treatment. In some of these cases, feeding tubes are surgically implanted to provide nutrition.
The DSM-5, which stands for Diagnostic and Statistical Manual of Mental Disorders-5th edition, lists 5 eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder, elimination disorders, pica, and rumination disorder.
Anorexia affects men and women alike. It typically presents in adolescence but could occur at any age. Anorexia Nervosa manifests as a persistent fear of weight gain; restricted caloric/energy intake; behaviors and/or actions that assist in limiting weight gain. They are in a constant state of semi-starvation. Those with anorexia nervosa have significant weight loss, fail to gain or maintain weight. People with anorexia do not recognize the dangers of their severe weight loss or frailness. They may verbally acknowledge being thin, but also have a warped view of their physical body and believe that there is body fat or weight to be lost. Other psychiatric diagnoses may be observed in those with anorexia nervosa such as depression and obsessive-compulsive behaviors. Other symptoms could include: irritability, social withdraw, weakness, dental decay, insomnia, loss of interest in activities previously enjoyed, refusal to eat around others, misuse of medication, excessive exercising. Upon closer clinical assessment, low blood pressure, low temperature and a slow heart rate are common as the body’s metabolic rate decreases. As the disease progresses, the skin can become thin, yellow and the person may bruise easily.
Bulimia Nervosa manifests as a persistent fear of weight gain, similar to anorexia nervosa. However, instead of restricting caloric/food intake by refusal or limited eating, those with bulimia eat a large amount of food (binge eating), over a limited amount of time and follow the intake by precisely planned elimination. That elimination could include induced vomiting, laxative or other medication misuse, enemas or excessive exercise to prevent or control weight gain. The cyclical nature of bulimia should be noted. The sense of loss of control, the binge eating, is followed by the behaviors of control, the elimination. This is why, I think, bulimia is more difficult to notice, at least early on in the disease. Also, unlike anorexia, bulimics are typically a normal weight. How many people do you know who are dieting and controlling their intake followed by exercise? “To qualify for the diagnosis, the binge eating and inappropriate compensatory behaviors must occur, on average, at least once per week for 3 months.” (https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm10) Similar to anorexia, there may be other associated psychiatric diagnoses such as depression, obsessive-compulsive behavior, personality disorders and Klein-Levin Syndrome. Physical symptoms of those with bulimia could include dental carries, electrolyte imbalance, heart problems, nutritional deficiencies, muscle pains, rectal prolapse, ulcers, and gastric rupture. Bulimia typically presents later than anorexia; teens to young adult. Bulimia is diagnosed in women more than men.
Binge-eating disorder manifests as a feeling of loss of control when eating large amounts of food in a short period of time. Signs of binge-eating disorder are: eating when not hungry; eating alone because of embarrassment over the amount of food ingested; eating when uncomfortably full; eating in a short period of time; feeling depressed or guilty after binge-eating. Binge-eating can be further described according to the frequency of the binge episodes, as mild (1-3 times/week), moderate (4-7 times/week), severe (8-13 times/week), or extreme (14 or more times per week). Binge-eaters are of normal, overweight, or obese weight. Like bulimia, binge-eating presents in teen and young-adult years. “Binge-eating disorder appears to run in families, which may reflect additive genetic influences.” (https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm10)
Avoidant/Restrictive Food Intake
Avoidant/Restrictive Food Intake Disorder (ARFID) is a disorder recently added to the DSM and is defined as “An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs…” (https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm10) This disorder is seen more frequently in infants than adults. People with avoidant/restrictive food intake disorder have nutritional deficiencies, significant weight loss, dependence on feeding supplementation, and impaired psychosocial functioning. Avoidant/restrictive food intake disorder, unlike anorexia and bulimia, are not associated with concerns over body weight or shape. The effect of this disorder on a person’s weight is secondary. For some, this disorder is associated with the characteristics of food, such as the smell, color or textures of some foods. I have witnessed this often in people with autism, developmental delays and in children who associate food intake with unpleasurable/painful experiences (e.g., choking, frequent vomiting). Other psychiatric disorders associated with avoidant/restrictive food intake disorder are anxiety, depression, obsessive-compulsive disorder, ADD, ADHD, and autism. Physical conditions associated with this disorder include abdominal pain, nausea, vomiting, loss of appetite, structural disorders of the mouth, and decreased muscle tone.
Pica occurs when nonfood, nonnutritive substances are ingested. People with pica can ingest anything from paper, hair barrettes, earrings, cotton balls, or baby powder, just to name a few. As you can see, people with Pica can eat just about anything. Sometimes this is done unconsciously, as seen in some people with intellectual disabilities. Pica is also seen, as a secondary diagnosis, in those with anorexia nervosa. The nonnutritive ingestion is used to prevent weight gain. Pica is most commonly seen in those with schizophrenia, autism, intellectual disabilities and obsessive disorder. If pica is suspected, the individuals should be closely monitored as surgical intervention may be needed depending on the objects ingested (think pins or other sharp objects).Other associated psychiatric diagnoses such as depression, bipolar disorder, and personality disorders.
Rumination Disorder occurs when food is regurgitated. The regurgitated food may be re-swallowed, spit out or re-chewed. Rumination Disorder is not associated with problems with any medical conditions or nausea. Those with Rumination Disorder exhibit this behavior several times during the week. I have personally witnessed this disorder in toddlers, as well as school-aged children. This can also manifest in adults. Older individuals with this disorder tend to hide their behavior by avoiding social events, covering their mouth, or covering the behavior with a cough.
NEDA has an online screening disorder tool that for people over the age of 13. It’s simple and easy to use. If you know of someone that could possibly have an eating disorder, give this tool a try.
If you know of any other resources for people with eating disorders, please leave a comment below.
The information in this article is to be used for informational purposes only. It is NOT to be used in place of, or in conjunction with, professional medical advice. Anyone with questions regarding this or other medical issues discussed on this site must consult their physician for further information and treatment.
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