Eating disorders
- They cause a lot of suffering
- Early identification and early intensification and early intervention can prevent a lot of harm
- Can teach us a lot about the interactions between physical and mental health, and the impact of society and culture on mental wellbeing.
- While media dose add pressures does not cause the actual eating disorder, may causes more vulnerable people to have an eating disorder.
What are eating disorders
- Can involve eating too little (limiting) or eating too much or becoming preoccupied with weight and body shape.
- Are shown to be higher rates in women, however this just maybe due to them reporting the disorder while males do not. And can affect both men and women of any age (Is it estimated 10-25% of those with eating disorders are male).
- Is caused by complex interactions of genetic, biological, behavioural, psychology and social factor.
- There are treatments that can help and you can recover form the disorder
DSM-5
- Eating disorders according to the DSM-5 include:
o Anorexia Nervosa (AN), this is where people are of low weight due to limiting their energy intake and may engage in lots of exercise.
o Bulimia Nervosa (BN), this is a cycle of eating large quantities of food known as binging and then trying to compensate for overeating by vomiting, taking laxatives or diuretics, fasting, or exercising excessively (purging).
o Binge eating disorder (BED), this is where people experience a loss of control and eat large quantities of food over a short period of time known as binging on a regular basis. This different from Bulimia Nervosa (BN) which involves excessive exercise and purging.
o Pica, is a feeding disorder in which someone eats non-food substances that have no nutrition value. This can include: paper, soap, paint, chalk, or ice.
o Rumination Disorder, is a repetitive habitual bringing up of food that might be partly digested.
o Avoidant/ restrictive food intake disorder, is restricted eating by eating smaller amounts of food or avoiding certain foods or food groups.
o Other specified feeding or eating disorder, this is when an individual’s symptoms don’t fit the expected symptoms for Anorexia, Bulimia, or binge eating disorder.
o Unspecified feeding or eating disorder, this is when an individual’s symptoms do not line up with those of another disorder or when there is not enough information to determine a more specific diagnosis.
Types of eating disorder
- Anorexia Nervosa, for a person to have this diagnosis by the DSM-5 they must:
o Have persistent restriction of energy intake leading to significantly low body weight.
o Either an intense fear of gaining weight or persistent behaviour that interferes with weight gain.
o Disturbances in the way one’s body weight or shape is experienced or persistent lack of recognition of the seriousness of the current low body weight .
There are also two different subtypes of Anorexia Nervosa:
o Restricting type, this is a severe restriction of food intake and can take many forms such as: maintaining very low calorie count, restricting types of food eaten or only eating one meal a day. This can allow follow obsessive and rigid rules such as only eating food of one colour.
o Binge-eating/ purging type, this is a severe restriction of food intake but also during some bouts the person has regularly engaged in binge-eating or purging.
o Symptoms can be physical, physiological, and behavioural:
Physical symptoms can include:
§ Preoccupation with food/ calories, fear of gaining weight, headaches, fainting, dizziness, mood swings, anxiety, and depression
§ Dry skin and lips, brittle nails, thin hair, burses easily, yellow complexation, growth of thin white hair over the body (lanugo) and intolerance to cold.
§ Poor circulation, irregular or slow heartbeat, very low blood pressure, cardiac arrest, and heart failure.
§ Can affect blood leading to low iron levels and leading to conditions such as Anaemia.
§ Intestines problems such as constipation, diarrhoea bloating and abdominal pain.
§ Hormone irregulation or absent periods and loss of libido or infertility
§ Kidney failure and leading to dehydration.
§ Loss of bone calcium known as Osteopenia and can lead to conditions including Osteoporosis
§ Muscles loss, weakness, and fatigue
Behavioural warning signs,
§ Dieting food, restriction or rigid eating patterns, rigid thinking (black and white so food are good or bad).
§ Repetitive or obsessive behaviours relating to body shape and weight changes in clothing style
§ Eating in private and avoiding meals with other people, secrecy around eating, social withdrawal
§ Compulsive or exercise exercising
§ Radical changes in food preferences such as eating safe low calorie foods.
§ Obsessive rituals around food preparation and eating
§ Preoccupation with preparing food for others, recipes, and nutrition
§ Self-harm such as abuse or suicide attempts
Phycological warning signs,
§ Becoming progressively obsessed with food, body shape, weight and or appearance
§ Negative or distorted body image such as perceiving self to be fat when at healthy weight/underweight.
§ Intense fear of gaining weight
§ Unable to maintain a normal weight for their age and weight
§ Depression and anxiety, mood swings, heightened anxiety around mealtimes
§ Low self-esteem such as guilt, self-criticism, worthlessness and so feeling out of control
§ Suicidal or self-harm thoughts or behaviours
§ Reduced capacity for thinking and increased difficulty concentrating so can lead to impaired schoolwork performance
- Bulimia Nervosa
o Diagnosis by DSM-5 requires:
§ Recurrent episodes of binge eating characterised by eating in discreate periods of time and eating a larger amount food then most people would during a similar period of time under similar circumstances. A sense of lack of control overeating during the episode.
§ Recurrent inappropriate compensatory behaviour in order to prevent weight gain such as self-inducing vomiting, misuse of laxatives, diuretics, or other medications, fasting or exercise.
o Symptoms can be physical, physiological, and behavioural:
Physical symptoms can include:
§ Preoccupation with food and weight, low self-esteem, anxiety, depression.
§ Erosion of dental enamel, swollen jaw, bad breath, gum disease, tooth decay.
§ Chronic sore throat, indigestion, heartburn, reflux, inflamed or rupture of oesophagus.
§ Irregular or slow heartbeat, cardiac arrest, heart failure, low blood pressure, fainting and dizziness.
§ Stomach ulcers, pain, and ruptures
§ Bowel problems, constipation, diarrhoea, and cramps
§ Hormone problems such as irregular or absent periods, loss of Liborio and infertility
§ Kidney issues including dehydration
§ Calluses on knuckles, dry skin
§ Muscle fatigue and cramp caused by electrolyte imbalance and can also lead to tiredness and lethargy.
Behavioural warning signs,
§ Eating to the point of discomfort, or other evidence of binge eating
§ Frequent trips to the bathroom during or shortly after meals (could be evidence of laxatives, vomiting)
§ Uses of enemas or appetite suppressants or diuretics
§ Eating in private and avoiding meals with other people
§ Anti-social behaviour, spending more and more time alone
§ Repetitive or obsessive behaviours relating to body shape and weight
§ Secretive/ deceptive behaviour around food
§ Compulsive or excessive exercising
§ Dieting behaviour
§ Self-harm, substance abuse or suicide attempts
Psychological warning signs,
§ Preoccupation with eating, food, body shape and weight
§ Sensitivity to comments relating to food, weight, body shape or exercise
§ Low self-esteem and feeling of shame, self-loathing, or guilt (particularly after eating)
§ Having a distorted body image
§ Obsession with food and need for control
§ Depression, anxiety, or irritability
§ Mood swings, changes in personality, emotional outburst, or depression
§ Extreme body dissatisfaction
§ Loneliness due to self-imposed isolation and a reluctance to develop personal relationships
§ Fear of the disapproval of others if the illness becomes known
- Binge eating disorder
o Diagnosis by DSM-5 requires:
§ Recurrent episodes of binge eating characterised by eating in discreate periods of time and eating a larger amount food then most people would during a similar period of time under similar circumstances. A sense of lack of control overeating during the episode.
§ Binge eating episodes can be associated with three or more of the following:
· Eating much more rapidly than normal
· Eating until feeling uncomfortably full
· Eating large amounts of food when not feeling physically hungry
· Eating alone because of feeling embarrassed by how much one is eating
· Feeling disgusted with oneself, depressed by very guilty afterwards
§ Marked distress regarding binge eating is present
§ Binge eating not associated with recurrent use of inappropriate behaviours as in bulimia Nervosa to compensate for overeating such as self-induced vomiting.
Physical symptoms include:
§ Weight gain, fatigue, lethargy
§ Low self-esteem, anxiety, depression, guilt, distressed by behaviour
§ Sleep apnoea
§ High blood pressure, high cholesterol, stokes and heart attack
§ Gallbladder disease
§ Type 2 diabetes
§ Chronic kidney problems, kidney failure
§ Osteoarthritis
Behavioural warning signs,
§ Evidence of binge eating (disappearance or hoarding of food).
§ Eating more rapidly than normal, eating when not physically hungry
§ Periods of uncontrolled, impulsive, or continuous eating whereby a person may consume many thousands of calories, often to the point of feeling uncomfortably full
§ Secretive behaviour relating to food
§ Increased isolation and withdrawal from activates previously enjoyed and avoiding social situations particularly those involving food
§ Erratic behaviour (shoplifting, spending large amounts of money on food)
§ Self-harm, substance abuse or suicide attempts
Psychological warning signs,
§ An overwhelming sense of lack of control regarding eating behaviour
§ Feeling of extreme distress, sadness, anxiety, and guilt during and after a binge episode
§ Preoccupation with eating, food, body shape and weight
§ Extreme body dissatisfaction and shame about their appearance
§ Low self-esteem and embarrassment over physical appearance
§ Depression anxiety or irritability
§ Fear of the disapproval of others
Explanations for eating disorders
- Genetic link, can run in families
Psychological factors
- Low self-esteem
- Feeling of inadequacy or lack control in life
- Depression, anxiety, anger, or loneliness
Psychodynamic theories
- Emphasise the parent-child relationships and personality characteristics.
- Full recovery involves understanding and treating the cause, adaptive function, or purpose that the eating disorder serves.
- Symptoms are seen as expressions of a struggling inner self that when addressed can aid recovery
Cognitive behavioural theories
- Propose that fear (caused by faulty cognitions) of increased weight and body-image distortion make weight loss a powerful reinforcer. An example is that patient with Bulimia have negative affect and stress principate binges that create anxiety, this is then relieved by purging.
- Function that cognitive distortions serve
o They provide a sense of safety and control
o They reinforce the eating disorder as a part of the individuals identity.
o They help provide an explanation or justification of behaviour to other people
Treatment
- Anorexia therapy is generally believed to be a three-tiered process:
1. To help the patient gain weight in order to avoid medical complications
2. To address the psychological aspects of the illness
3. The long-term maintenance of weight gain
o There no one specialist treatment that has been shown to be superior when treating adults with this condition.
o Maudsley treatment for adults, tries to address factors that are known to maintain in the individual
o Together with the client the therapist will explore the strengths, resources and goals and values of the client and develop a plan of how those factors might maintain the anorexia in their individual situation. This is very collaborative and motivational and includes monitoring of risk it also address nutrition and also families and close others if that is considered helpful. Another strength is that it takes into to account daily actives so that people can continue to study or work and so does not take away from their everyday life.
- Binge eating disorder and Bulimia Nervosa therapy
o CBT is the most well-established for the treatment of Bulimia Nervosa with Interpersonal psychotherapy demonstrating equivalent long-term effects. This focuses on questioning society’s standard for physical attractiveness, challenging beliefs that encourage severe food restriction, and develop normal eating patterns. The overall goal of treatment in bulimia is to develop normal eating patterns.
o Maudsley family-based therapy is the most established treatment for youth with Bulimia Nervosa.
Importance to seek treatment
- Eating disorders can devastate the body:
o Physical problems associated with Anorexia can lead to anaemia, constipation, osteoporosis and even result in heat and brain damage
o Bulimia can result in a sore throat and worn-away tooth enamel due to acid reflux and can result in heart attracts.
o People with binge eating disorder may develop high blood pressure, cardiovascular disease, diabetes, and other problems associated with obesity.
- Eating disorders are associated with mental health:
o Suffer higher rates of other mental disorders such as: depression, anxiety disorders and substances abuse then people without an eating disorder. However it is unknown if the eating disorder are symptoms of such problems or whether the problems develop because of the isolation, stigma and physiological changes wrought by the eating disorders themselves.
What eating disorders are not
- A choice (may be initially but not when established)
- A lifestyle
- Odd eating habits
- Picky eating
- Culturally normal preoccupation with weight or shape
- Always too thin, can be normal or overweight