eating disorders

what is an eating disorder ?

mental health conditions involving abnormal eating habits and a preoccupation with weight, body shape, or food

eating disorders most commonly affect

young women aged 13-17

but 10-25% of those with eating disorders are male

Anorexia Nervosa (AN)

low weight due to limiting intake and often excessive exercise

intense fear of gaining weight and disturbances in perception of weight

what are the 2 sub-types of AN

restricting or binge eating / purging type

how does bulimia nervosa differ from BED ?

involves compensatory behaviours

binge and purge

BED = no purge

physical effects of AN

• Amenorrhea (loss of menstrual cycle).

• Low blood pressure, fatigue, heart issues, brittle hair/nails.

• Bruising easily.

psychological signs of AN

• Preoccupation with food, weight, and appearance.

• Mood swings, anxiety, depression, self-harm/suicidal thoughts.

• Poor concentration.

behavioural signs of AN

• Extreme dieting and food rituals.

• Eating in private, avoiding social meals.

• Radical shifts in food preferences.

Bulimia Nervosa (BN)

recurrent binge eating followed by inappropriate compensatory behaviours

lack of control during episodes

DSM5 - consuming large amounts of food in a short time

physical effects of BN

• Swollen cheeks (salivary gland enlargement)

• Dental erosion, gastrointestinal problems.

• Electrolyte imbalance, heart irregularities.

psychological signs of BN

• Low self-esteem, guilt/shame.

• Distorted body image.

• Obsession with control, especially around food.

behaviour signs of BN

• Frequent bathroom visits after eating.

• Secretive eating.

• Withdrawal from social situations.

Binge Eating Disorder (BED)

• Recurrent binge eating episodes without purging.

• Lack of control during episodes and distress afterwards

as per DSM5 to be diagnosed with BED you must display 3 of what 5 behaviours ?

• Eating rapidly.

• Eating when not physically hungry.

• Eating until uncomfortably full.

• Eating alone out of embarrassment.

• Feelings of guilt, disgust, or depression

physical effects of BED

• Weight gain, obesity-related issues.

• Sleep disturbances, fatigue.

psychological signs of BED

• Emotional distress, sadness.

• Fear of others’ judgment.

behavioural signs of BED

• Impulsive or secretive eating.

• Spending excessively on food, possible shoplifting.

• Co-occurring self-harm or substance abuse.

Pica (feeding disorder)

eating non-food substances that have no nutritional value eg. paper, soap, chalk, ice

usually related to deficiency

Rumination Disorder

repetitive habitual bringing up food that is partly digested

ARFID

Avoidant/Restrictive Food Intake Disorder

restricted eating by eating smaller amounts or avoiding certain foods

without body image concern

OSFED

Other Specified Feeding/Eating Disorder – symptoms don’t fit one diagnosis

UFED

unspecified - not enough info for specific diagnosis

psychodynamic explanation for eating disorders

emphasise parent-child relationship and personality characteristics

symptoms seen as expressions of a struggling inner self

cognitive behavioural explanation of eating disorders

fear of increased weight caused by faulty cognitions

weight loss = reinforcer

cognitive distortions offer sense of safety and control

outline the treatment approach for AN

3 tiered process

• Restore weight to avoid medical complications.

• Address underlying psychological issues.

• Support long-term maintenance.

Carter et al. (2011)

no one specialist treatment for AN is superior

Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)

tries to address factors that are known to maintain anorexia

what are the 3 common treatment approaches for BN and BED ?

• Cognitive-Behavioural Therapy (CBT) - challenges body image and eating beliefs

• Interpersonal Psychotherapy (IPT) - focuses on relationship and emotional triggers

• Maudsley Family-Based Therapy (FBT)

what is the most established treatment for BED in youth ?

Maudsley Family-Based Therapy (FBT)

why is treatment for eating disorders so important ?

• Physical Health Risks: Malnutrition, heart issues, fertility problems.

• Mental Health Risks:

  • High suicide risk – AN has highest mortality rate among mental health disorders.

  • Comorbidity with anxiety, depression, and substance abuse.