Eating Disorders

EATING DISORDERS

Overview of Eating Disorders

  • Every 62 minutes, at least one person dies as a direct result of an eating disorder.

  • Eating disorders have the highest mortality rate of any mental illness.

    • At least 9% of Americans will have an eating disorder during their lifetime.

  • Definition: “Eating disorders are serious but treatable mental and physical illnesses that can affect people of all genders, ages, races, religions, ethnicities, sexual orientations, body shapes, and weights.”

    • National surveys estimate that 20 million women and 10 million men in America will have an eating disorder at some point in their lives.

  • Best-known environmental contributor to the development of eating disorders: the sociocultural idealization of thinness.

The Eating Disorder Continuum

  • Differentiation between eating disorders and disordered eating.

  • The eating disorder continuum consists of three categories with significant overlap.

Causes of Eating Disorders

  • Multifactorial Predisposition: no single cause, but rather a combination of biological, psychological, and cultural factors.

    • Biological Factors: May include neurotransmitter levels and genetic predisposition.

    • Example: Synthesis and release of leptin (satiety hormone) and orexin (appetite-stimulating hormone).

    • Psychological Factors: Issues like obsessive-compulsive disorder (OCD), depression, peer relationships, family expectations, and emotional trauma may increase risk.

    • Social Factors: Societal expectations regarding body size and shape and the appeal of extreme thinness.

TYPES OF EATING DISORDERS

Anorexia Nervosa

  • Diagnostic Criteria:

    • Body weight is less than 85% of the expected weight (BMI ≤ 17.5 kg/m²).

    • Intense fear of weight gain.

    • Distorted body image.

    • Amenorrhea (absence of menstruation).

  • Causes:

    • Psychological issues (e.g., rigid perfectionism, all-or-nothing thinking).

    • Excessive exercise.

    • Distorted body image and low self-esteem.

  • Warning Signs:

    • Denial of appetite and morbid fear of weight gain.

    • Severe weight loss along with distorted body image.

    • Ritualistic behavior around food and withdrawal from social interactions.

    • Symptoms include feeling fat despite evidence of weight loss, preoccupation with food/nutrition, compulsive exercise, and possible bingeing and purging.

    • Consequences if left untreated: May lead to death.

Treatment of Anorexia Nervosa

  • Multidisciplinary Team: No single treatment; requires collaboration across disciplines.

  • Treatment goals include stabilizing the physical condition, converting the patient into an active participant, restoring nutritional status and body weight, and returning normal menstruation.

  • Psychotherapy: Individual, group, and family therapy.

  • Restoring weight is often uncomfortable for the patient.

Side Effects of Anorexia Nervosa

  1. Cardiac Effects:

    • Loss of cardiac muscle leading to a smaller heart.

    • Abnormal heart rhythms may occur, increasing the risk of sudden death.

  2. Neuropsychiatric Effects:

    • Changes in taste sensation, depression, and impaired thought processes.

  3. Gastrointestinal Effects:

    • Delayed gastric emptying, abdominal pain, constipation, and diarrhea without control.

  4. Hematological Effects:

    • Leukopenia (abnormal decrease in white blood cells) and iron-deficiency anemia.

Refeeding Syndrome

  • Occurs when the body switches its energy usage after starvation quickly reintroduced.

    • Risks include:

    • Heart arrhythmias.

    • Respiratory issues.

    • Convulsions and potential coma or death.

  • Prevention: Slow reintroduction of food through tube feeding/fluids.

Bulimia Nervosa

  • Causes:

    • Intense desire to nurture oneself with food yet strongly influenced by societal pressures to be thin.

    • Sufferers often experience conflicting feelings of obsession with food and repulsion of fat.

    • Occasional insufficient nurturing during formative years can contribute to the disorder.

  • Warning Signs:

    • Frequent binge eating followed by purging.

    • Compensatory behaviors like strict dieting, fasting, vigorous exercise, or laxative abuse.

    • Preoccupation with body weight, dental issues, and menstrual irregularities.

Side Effects of Bulimia Nervosa

  1. Metabolic Effects:

    • Electrolyte abnormalities, particularly low blood magnesium.

  2. Gastrointestinal Effects:

    • Inflammation of salivary glands, pancreatic inflammation and enlargement, and esophageal irritation.

  3. Dental Effects:

    • Erosion of dental enamel leading to decay.

  4. Neuropsychiatric Effects:

    • Fatigue, weakness, impaired thought processes, and potential seizures related to fluid shifts and electrolyte disturbances.

Bulimia Nervosa: Treatment

  • Limited research on long-term outcomes.

  • Involves medical and nutritional components to break the cycle of binge-eating and compensatory mechanisms.

  • Psychotherapy: Cognitive Behavioral Therapy (CBT) and potential use of serotonin-enhancing antidepressants such as Prozac.

Binge Eating Disorder

  • Diagnostic Criteria:

    • Recurrent episodes of binge eating accompanied by distress.

    • No recurrent purging, absence of anorexia nervosa.

    • Stress and conflict are often triggers for binge eating.

  • Treatment:

    • Focus on psychotherapy to identify emotions separating biological hunger from emotional hunger.

    • Long-term support, antidepressant medications, and self-help groups such as Overeaters Anonymous.

Body Dysmorphic Disorder (BDD)

  • Characterized by excessive preoccupation with an imagined or slight defect in appearance.

    • Symptoms include extensive grooming rituals and anxiety regarding physical flaws.

Night Eating Syndrome

  • Involves grazing in the evening, often hidden from others.

    • Symptoms include:

    • Consuming more than half of daily calories after the evening meal.

    • Waking at least once during the night to eat, usually high-carb snacks.

    • Feelings of guilt or anxiety while eating.

    • Delaying breakfast for hours.

Related Issues in Eating Disorders

The Male Perspective

  • Males are often an overlooked population in eating disorders.

    • Lower incidence compared to females, but heightened in certain professions like sports and modeling.

    • Overeating may be viewed differently in men than women.

  • Recognition of disorders in preadolescence and young adulthood is critical.

Anorexia Athletica

  • Sports-related eating disorders that emphasize body size and shape as crucial in competition.

    • Pressures can come from coaches and peers.

Pregorexia

  • Describes a pregnant woman who excessively restricts calories and exercises to control pregnancy weight gain.

    • Physicians must be aware of background body image issues prior to pregnancy.

  • Some women may note symptom reduction during pregnancy.

Infantile Anorexia

  • A feeding disorder in infancy characterized by extreme food refusal, leading to potential malnutrition.

    • Parents may inadvertently teach their infants to ignore hunger cues, causing conflicts around feeding.

    • Symptoms include significant food refusal for more than a month, concerns about poor food intake, and overall malnutrition.

Picky Eaters vs. Infantile Anorexia

  • Differences in food refusal patterns: picky eaters have inconsistent refusal and can be coaxed into eating, while infantile anorexia leads to persistent conflicts with feeding.

    • Picky eaters are typically not malnourished and have strong food preferences.

Combating Eating Disorders

Prevention Strategies

  • Difficult to treat once established; hence prevention is critical.

  • Strategies include establishing healthy mind-body-food relationships, promoting intuitive eating, and enhancing self-esteem.

Treatment Options

  • Varying levels of care, including inpatient and intensive outpatient programs with 1:1 therapy.

Family Dynamics and Eating Disorders

  • Eating disorders can be seen as a “family disease.”

    • Family therapy may address underlying dysfunction contributing to the disorder.

    • Family influences can be both enabling and limiting in recovery, impacting outcomes significantly.

Intuitive Eating Principles

  1. Honor your hunger to rebuild trust with food.

  2. Respect body signals to ensure satisfaction and fullness are acknowledged.

  3. Discover the satisfaction factor in eating in pleasant environments.

  4. Respect your body’s genetic blueprint and ideal size.

  5. Move for enjoyment, rather than solely for calorie burning.

  6. Make healthy choices without the pressure of perfection.

  7. Acknowledge feelings without using food to cope.

  8. Reject the diet mentality that leads to cycles of failure.

  9. Make peace with food and allow for all foods in moderation.

  10. Challenge harmful thoughts about eating and body image.

Preventing Eating Disorders

  • Valuing diversity in body shapes and sizes.

  • Providing accurate nutrition and health information.

  • Discouraging restrictive eating practices and emotional eating.

  • Encouraging a focus on personal qualities over physical appearance.