Eating disorders are behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions. Symptoms of these conditions can significantly affect physical, psychological and social function negatively. Increasing awareness regarding these conditions can help increase knowledge, understanding and ultimately get help for those who are suffering symptoms of these disorders.
Types of eating disorders
Eating disorders can manifest in several ways. There are multiple types of eating disorders that includes anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder, other specified feeding and eating disorder, pica, and rumination disorder.
Anorexia Nervosa
Characterized by self-starvation and weight loss resulting in low weight for height and age. Anorexia has the highest mortality of any psychiatric diagnosis and can be a very serious condition. Body mass index or BMI, a measure of weight for height, is typically under 18.5 in an adult individual with anorexia nervosa.
Intense fear or gaining weight or becoming fat drives the dieting behavior in this disorder. Although some individuals with anorexia will say they want and are trying to gain weight, their behavior is not consistent with this intent. Some persons with anorexia nervosa also intermittently binge eat and or purge by vomiting or laxative misuse.
Two subtypes of anorexia nervosa:
- Restricting type: individuals lose weight primarily by dieting, fasting or excessively exercising
- Binge-eating/purging type: individuals engage in intermittent binge eating and/or purging behaviors
Bulimia Nervosa
Individuals with bulimia nervosa typically alternate dieting, or eating only low calorie with binge eating high calorie foods. Binge eating is defined as eating a large amount of food in a short period of time associated with a sense of loss of control over what, or how much one is eating. This behavior is usually secretive and associated with feelings of shame or embarrassment. Binges may be very large and food is often consumed rapidly, beyond fullness to the point of nausea and discomfort.
Binges occur at least weekly and are typically followed by what are called "compensatory behaviors" to prevent weight gain. These can include fasting, vomiting, laxative misuse or compulsive exercise. Persons with bulimia nervosa are excessively preoccupied with thoughts of food, weight or shape which negatively affect, and disproportionately impact, their self-worth. Individuals with bulimia nervosa can be slightly underweight, normal weight, overweight or even obese.
Binge Eating Disorder
People with binge eating disorder have episodes of binge eating in which they consume large quantities of food in a brief period, experience a sense of loss of control over their eating and are distressed by the binge behavior. Unlike people with bulimia nervosa, however, they do not regularly use compensatory behaviors to get rid of the food by inducing vomiting, fasting, exercising or laxative misuse. Binge eating disorder can lead to serious health complications, including obesity, diabetes, hypertension, and cardiovascular diseases.
The diagnosis of binge eating disorder requires frequent binges (at least once a week for three months), associated with a sense of lack of control and with three or more of the following features:
- Eating more rapidly than normal
- Eating until uncomfortably full
- Eating large amounts of food when not feeling hungry
- Eating alone because of feeling embarrassed by how much one is eating
- Feeling disgusted with oneself, depressed or very guilty after a binge
Other specified feeding and eating disorders
This diagnostic category includes eating disorders or disturbances of eating behavior that cause distress and impair family, social or work function but do not fit the other categories. In some cases, this is because the frequency of the behavior does not meet the diagnostic threshold (e.g., the frequency of binges in bulimia or binge eating disorder) or the weight criteria for the diagnosis of anorexia nervosa are not met.
Avoidant Restrictive Food Intake Disorder (ARFID)
ARFID is a recently defined eating disorder that involves a disturbance in eating resulting in persistent failure to meet nutritional needs and extreme picky eating. In ARFID, food avoidance or a limited food repertoire can be due to one or more of the following:
- Low appetite and lack of interest in eating or food
- Extreme food avoidance based on sensory characteristics of foods (e.g. texture, appearance, color, smell)
- Anxiety or concern about consequences of eating, such as fear of choking, nausea, vomiting, constipation, an allergic reaction, etc
The diagnosis of ARFID requires that difficulties with eating are associated with one or more of the following:
- Significant weight loss (or failure to achieve expected weight gain in children)
- Significant nutritional deficiency
- The need to rely on a feeding tube or oral nutritional supplements to maintain sufficient nutrition intake
- Interference with social functioning (such as inability to eat with others)
People with ARFID do not have excessive concerns about their body weight or shape and the disorder is distinct from anorexia nervosa or bulimia nervosa. ARFID does not include food restriction related to lack of availability of food; normal dieting; cultural practices, such as religious fasting; or developmentally normal behaviors, such as toddlers who are picky eaters.
Pica
An eating disorder in which a person repeatedly eats things that are not food with no nutritional value. The behavior persists over at least one month and is severe enough to warrant clinical attention. Typical substances ingested vary with age and availability and might include paper, paint chips, soap, cloth, hair, string, chalk, metal, pebbles, charcoal or coal, or clay. Individuals with pica do not typically have an aversion to food in general.
A person diagnosed with pica is at risk for potential intestinal blockages or toxic effects of substances consumed (e.g. lead in paint chips).
Rumination Disorder
Rumination Disorder involves the repeated regurgitation and re-chewing of food after eating whereby swallowed food is brought back up into the mouth voluntarily and is re-chewed and re-swallowed or spat out. Rumination disorder can occur in infancy, childhood and adolescence or in adulthood. To meet the diagnosis, the behavior must:
- Occur repeatedly over at least a 1-month period
- Not be due to a gastrointestinal or medical problem
- Not occur as part of one of the other behavioral eating disorders listed above
- Rumination can also occur in other mental disorders (e.g. intellectual disability) however the degree must be severe enough to warrant separate clinical attention for the diagnosis to be made.
Warning signs: Common symptoms of an eating disorder
Many people may normally experience being self-conscious about their weight, what they eat, and how they look. This is especially true for teenagers and young adults, who face extra pressure to fit in and look attractive at a time when their bodies are changing. To be able to tell the difference between an eating disorder and normal self-consciousness, weight concerns, or dieting, the following warning signs can be observed.
Restricting food or dieting
- Making excuses to avoid meals or situations involving food
- Eating only tiny portions or specific low-calorie foods, and often restricting entire categories of food such as carbs and dietary fat
- Obsessively counting calories, reading food labels, and weighing portions
- Developing restrictive food rituals such as eating foods in certain orders, rearranging food on a plate, excessive cutting or chewing
- Taking diet pills, prescription stimulants like Adderall or Ritalin, or even illegal drugs such as amphetamines
Bingeing
- Unexplained disappearance of large amounts of food in short periods of time
- Lots of empty food packages and wrappers, often hidden at the bottom of the trash
- Hoarding and hiding stashes of high-calorie foods such as junk food and sweets
- Secrecy and isolation; may eat normally around others, only to binge late at night or in a private spot where they won't be discovered or disturbed
Purging
- Disappearing right after a meal or making frequent trips to the bathroom
- Showering, bathing, or running water after eating to hide the sound of purging
- Using excessive amounts of mouthwash, breath mints, or perfume to disguise the smell of vomiting
- Taking laxatives, diuretics, or enemas
- Periods of fasting or compulsive, intense exercising, especially after eating
- Frequent complaints of sore throat, upset stomach, diarrhea, or constipation
- Discolored teeth
Distorted body image and altered appearance
- Extreme preoccupation with body or weight
- Significant weight loss, rapid weight gain, or constantly fluctuating weight
- Frequent comments about feeling fat or overweight, or about a fear of gaining weight
- Wearing baggy clothes or multiple layers in an attempt to hide weight
How can I support a loved one with an eating disorder?
If you notice the warning signs of an eating disorder in a friend or family member, it's important to speak up and not let your worries stop you from voicing your concerns. More often than not, people with eating disorders are often afraid to ask for help. There are those who actually want to ask for help but do not know how to get help, and there are those who have lost their self-confidence that feel they do not deserve any help.
Whatever the case, eating disorders will only get worse without treatment, and the physical and emotional damage can be severe. The sooner you start to help, the better their chances of recovery. While you can't force someone with an eating disorder to get better, having supportive relationships is vital to their recovery. Your love and encouragement can make all the difference.
It is important to understand what they are going through. Research, read reliable sources, and even ask professionals regarding information about eating disorders to help gain awareness and understanding about these disorders. When talking to a friend or family member, remember that timing your conversation in private without distractions or constraints is important. This helps them feel that you truly care for them and are not shaming them for what they are experiencing. Try to keep emotions in check always. Be level-headed, logical, and open during the conversation. Be careful to avoid lecturing or criticizing, as this may only make your loved one defensive.
Be prepared for denial and resistance
There's a good chance your loved one may deny having an eating disorder or become angry and defensive. If this happens, try to remain calm, focused, and respectful. Remember that this conversation likely feels very threatening to someone with an eating disorder. Don't take it personally.
Be patient and supportive
Don't give up if the person shuts you down at first. It may take some time before they're willing to open up and admit to having a problem. The important thing is opening up the lines of communication. If they are willing to talk, listen without judgment, no matter how out of touch they may sound. Make it clear that you care, that you believe in them, and that you'll be there in whatever way they need, whenever they're ready.
Avoid ultimatums
Unless you're dealing with an underage child, you can't force someone into treatment. The decision to change must come from them.
Avoid commenting on appearance or weight
People with eating disorders are already overly focused on their bodies. Even assurances that they're not fat play into their preoccupation with being thin. Instead, steer the conversation to their feelings. Why are they afraid of being fat? What do they think they'll achieve by being thin?
Aside from offering support, the most important thing you can do for a person with an eating disorder is to encourage treatment. A doctor can assess your loved one's symptoms, provide an accurate diagnosis, and screen for any medical problems that might be involved. The doctor can also determine whether there are any coexisting conditions that require treatment, such as depression, substance abuse, or an anxiety disorder.
How many women suffer from an eating disorder?
Globally, eating disorders affect up to 9% of the population, most often develop in adolescence and young adulthood. Several, especially anorexia nervosa and bulimia nervosa are more common in women, but they can all occur at any age and affect any gender. Specifically in the Philippines, according to the Department of Health, every year, 1% to 2% of the population will develop bulimia and around 0.3% and 1% of adolescents suffer from anorexia nervosa and bulimia nervosa, respectively.
Unfortunately, in multiple researches done more recently, eating disorders have become more prominent and are becoming a more serious problem during and after the pandemic. There are multiple factors that may lead to developing an eating disorder such as social media, advertisements that celebrate thinness, culture of fat-shaming, and attributing body image and thinness as the definition of self-worth.
How Kindred can help
In treating eating disorders, it is recommended to do a multi-disciplinary approach involving multiple medical professionals in the care of a person diagnosed with an eating disorder. Here in Kindred, we are able to treat a patient holistically with a multi-disciplinary approach with all the services that we can provide.
- Mental Health Consultations with psychologists and psychiatrists for psychotherapeutic and psychopharmacologic interventions necessary
- Nutrition consultations with our nutritionist can help in learning healthy eating habits and behaviors
- General Medicine consultations can help diagnose and treat any underlying medical conditions that may be a consequence of eating disorders
- OB-Gynecological consultations and Endocrinological consultations to help treat any hormonal changes and imbalances
- Diagnostics bundles for laboratories and diagnostics
- IV drips to help with vitamin and mineral supplementation for building up immune system
Here at Kindred, we offer a safe space to comfortably seek help without the worry of being judged or invalidated. Book a consultation with us and let us be your health partner!
RESOURCES
American Psychiatric Association
Kaplan and Saddock’s Synopsis of Psychiatry 12th ed
Department of Health
NICE CPG for eating disorders
APA CPG for eating disorders
https://www.e-chnr.org/journal/view.php?number=1689
https://newsinfo.inquirer.net/1687697/govt-asked-to-address-eating-disorders-among-youth
https://www.healthdirect.gov.au/eating-disorders#treatments
https://www.helpguide.org/articles/eating-disorders/helping-someone-with-an-eating-disorder.htm