Eating disorders as a group are complex illnesses that are characterized by a persistent disturbance of eating habits that can profoundly affect physical and psychosocial functioning. These disorders can be associated with high rates of mortality. The diagnosis of eating disorders is based on the American Psychiatric Association’s Diagnostic and Statistical Manual 5th Edition (DSM 5).
The DSM 5 lists six types of eating disorders, namely: Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, AFRID (Avoidant Restrictive Food Intake Disorder), Rumination and Pica.
In this article, we will discuss the first 3 disorders. As we all know our culture in the US shows an unhealthy preoccupation with thinness and weight loss. Magazines and TV ads display stories about weight management and dieting. Models and actors are shown to be thin. Computer programs alter pictures to make these models even thinner. Athletes also pursue a leaner body. It is not surprising that these obsessions can extend to affect maturing children and adolescents.
Anorexia Nervosa (AN)
AN is mostly seen in adolescent and young adult females. AN is characterized by a significant restriction of food (caloric) intake relative to the need, resulting in low body weight (given the patient’s age, sex, developmental pattern, and physical health). There is an extreme fear of gaining weight despite being underweight and a constant worry about gaining weight.
The individual has a distorted perception of body weight/shape and often believes that she/he/they are fat even when underweight. They do not understand that the low weight can cause serious harm. They feel good about themselves when loosing weight and bad when they gain weight. Even though it is mostly seen in adolescent females, males and other age groups can present with this illness.
AN can cause many problems because of the lack of nutrition: problems with the function of the brain, heart, liver, kidneys, and glands. In addition, there can be bone loss, muscle weakness, bowel trouble such as boating and constipation, hair loss, brittle nails and feeling cold. Often the illness is associated with other mental illnesses such as depression, anxiety, alcohol/drug use. Difficulty with thinking, memory, attention issues and sleep troubles.
Bulimia Nervosa (BN)
This disorder is characterized by recurrent episodes of overeating (“binging”) and unhealthy behaviors such as self-induced vomiting (“purging”), misuse of laxatives, enemas, and other medications, fasting or excessive exercise to prevent weight gain. This behavior needs to be present an average of at least once per week for 3 months
The problems that can result from BN include dehydration and electrolyte disturbances (dizziness, confusion, dark urine), fatigue, irregular menstrual periods, abdominal pain, and constipation. In addition, these patients can have damage to the esophagus, teeth, gums, and cheeks. They can also have complications with the heart, kidneys, and glands.
Binge Eating Disorder
This disorder can be difficult to detect because of the associated shame. Generally, one can suspect binge eating disorder if there is a significant amount of weight dissatisfaction and if the individual has large weight fluctuations or associated depressive symptoms. It is marked by at least 3 of the following: eating more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food without feeling hungry, eating alone (because of embarrassment of the amount of food being consumed), feeling guilty or disgusted with oneself. These episodes occur on average once per week for 3 months. Unlike BN there is no associated compensatory/unhealthy behaviors.
There is no consensus regarding the causes of eating disorders. A combination of genetic, biologic, psychological, family, environmental and social factors may contribute to the development of an eating disorder. Patients with eating disorders are best cared for by an interdisciplinary team consisting of a mental health clinician, dietitian, and a general medical provider.
Hospitalization may be needed to stabilize and recover from an eating disorder. If the patient is deemed medically stable there are several options for treatment: in patient hospitalization, partial hospital (day program) and outpatient care. In AN and BN the treatment involves nutritional rehabilitation which involves prescribing and supervising meals and preventing binging or overeating and purging. Medication may sometimes be used in acutely ill patients. The treatment for Binge Eating Disorder involves a combination of psychotherapy and medication. Many times, Binge Eating Disorder is associated with other conditions that also need to be addressed such as specific phobias, social anxiety, depression, PTSD, ADHD and alcohol use disorder.
Early recognition of eating disorders is the key. Regular yearly physical checkups can help with this. Warning signs might be difficult to detect as weight is not the only identifier. 66% of patients with eating disorders have a normal weight. 33% may be obese at the onset of the illness. AN and BN sometimes begin with dietary changes such as the adaptation of vegetarian, low fat, low carb and “healthy” eating habits. Also, there may be a change with meal rituals; for example, taking longer to complete meals, cutting food and shifting food on the plate. If purging is involved, there may be frequent bathroom trips during and after meals. The patient may avoid social eating or increase physical activity or become obsessive about physical activity.
Younger children and boys may experience delay in diagnosis. Adolescents and children with chronic disease such as Type I DM may also have a delay in diagnosis. Overweight children may initially get praised for weight loss. How the weight loss occurred matters. It is important to consider the meal plans, exercise patterns and body image. A patient whose BMI decreased from 90%ile to 50%ile may be as ill as the patient who goes from 30%ile to 5%ile
We hope this overview of eating disorders demonstrates that they are a complex group of illnesses that need comprehensive and collaborative care. Teaching children to develop a healthy relationship with food and their bodies by modeling this behavior is critical. In addition, educating and enlightening them to the subtle and obvious ways that society and media can contribute to the development of unhealthy relationships with their beautiful growing bodies is our responsibility as adults.
UpToDate : Eating disorders : Overview of prevention and treatment