Disorders of Eating

How Does Eating Disorders Impact Your Anatomy and Health?

Eating disorders can have profound effects on both physical and mental health. The impact on the body can be extensive and severe, depending on the type and duration of the disorder.

• Malnutrition: With conditions like anorexia, the body is deprived of essential nutrients, leading to malnutrition. This can affect every organ system in the body, causing conditions such as anaemia, weakened immune function, and heart problems.
• Cardiovascular Issues: Individuals with eating disorders, especially those who engage in purging behaviours, are at risk for electrolyte imbalances, which can lead to irregular heartbeats, heart failure, and even sudden death.
• Bone Health: Chronic undernutrition and low body weight, particularly in anorexia, can lead to osteoporosis or weakened bones due to a lack of calcium and vitamin D.
• Gastrointestinal Problems: Bulimia and binge eating disorder can lead to severe gastrointestinal issues, such as acid reflux, bloating, constipation, and, in severe cases, rupture of the stomach or oesophagus due to repeated binge-purge cycles.
• Hormonal Imbalance: Eating disorders can disrupt the balance of hormones in the body, leading to issues such as amenorrhea (loss of menstruation) in women, reduced testosterone levels in men, and thyroid problems.
• Mental Health Impact: Beyond the physical implications, eating disorders are closely linked with mental health issues, including depression, anxiety, obsessive-compulsive disorder (OCD), and an increased risk of suicidal thoughts and behaviours. The relentless focus on food, weight, and body image can lead to social withdrawal, decreased quality of life, and an inability to function in daily life.

Causes and Risk Factors of Eating Disorders

• Genetic Factors: Individuals with a family history of eating disorders, depression, or anxiety are at higher risk. Specific genes may influence traits such as perfectionism, sensitivity to reward and punishment, and emotional instability, which can contribute to the development of disordered eating behaviours.
• Psychological Factors: Psychological issues such as low self-esteem, perfectionism, and body dysmorphia (a distorted perception of one's body) are common in individuals with eating disorders. Emotional and behavioural conditions like anxiety, depression, and obsessive-compulsive disorder (OCD) can also be underlying causes, as individuals may use disordered eating as a way to cope with distressing emotions or gain a sense of control.
• Environmental Factors: Environmental influences, including family dynamics, peer pressure, and traumatic experiences such as abuse or bullying, can contribute to the development of eating disorders. A family environment overly focused on appearance, dieting, or weight can also increase the risk.
• Cultural and Societal Factors: The media's portrayal of ideal body types can create unrealistic expectations and pressure to conform, leading to disordered eating behaviours. Social media platforms can exacerbate these pressures by constantly exposing individuals to curated images of idealised body types.
• Biological Factors: Hormonal changes, especially during adolescence and puberty, can trigger the onset of eating disorders. Additionally, imbalances in neurotransmitters (chemicals in the brain that regulate mood and appetite) can influence eating behaviours and contribute to the development of eating disorders.

Symptoms of Eating Disorders

• Physical Symptoms:
• Significant weight loss or gain
• Dizziness or fainting
• Fatigue and weakness
• Dry skin and brittle nails
• Hair loss or thinning
• Irregular or absent menstrual periods in women
• Gastrointestinal issues, such as constipation or acid reflux
• Cold intolerance and wearing layers of clothing to stay warm
• Dental problems, such as enamel erosion from vomiting
• Behavioural Symptoms:
• Preoccupation with food, dieting, calories, and weight
• Refusal to eat certain foods or food groups
• Eating in secret or avoiding meals with others
• Frequent trips to the bathroom after eating (which may indicate purging)
• Compulsive exercise or excessive focus on physical activity
• Withdrawal from social activities and isolating oneself
• Ritualistic eating behaviours, such as cutting food into small pieces or eating in a specific order
• Hoarding or hiding food
• Psychological Symptoms:
• Distorted body image and dissatisfaction with appearance
• Intense fear of gaining weight or becoming overweight
• Feelings of guilt, shame, or disgust after eating
• Mood swings, irritability, and depression
• Anxiety and obsessive thoughts about food and weight
• Perfectionism and an all-or-nothing approach to eating and exercise

Preventing Eating Disorders

• Promote Healthy Body Image: Encourage positive body image by focusing on the body's functionality rather than appearance. Teach individuals to appreciate their bodies for what they can do, not just how they look.
• Educate on Media Literacy: Help individuals develop critical thinking skills about media messages that promote unrealistic body standards. Teach them to recognise photo editing, filters, and other techniques that create false representations of beauty.
• Encourage Balanced Eating Habits: Promote a balanced, flexible eating approach with various foods. Avoid labelling foods as "good" or "bad" and discourage restrictive dieting, which can lead to unhealthy eating behaviours.
• Foster Self-Esteem and Resilience: Build self-esteem by encouraging individuals to set realistic goals, recognise their strengths, and develop coping skills for dealing with stress and setbacks. A strong sense of self-worth can reduce the likelihood of developing an eating disorder.
• Create Supportive Environments: Encourage open communication and create environments where individuals feel safe discussing their concerns about food, body image, and self-esteem. Address any signs of disordered eating early and provide support and resources.
• Model Healthy Behaviours: Parents, teachers, and role models can play crucial roles by modelling healthy eating behaviours, positive body image, and self-care in front of children and adolescents. Avoid making negative comments about weight, food, or appearance.

Types of Eating Disorders

• Anorexia Nervosa: Characterised by an intense fear of gaining weight, leading to severe food restriction, extreme weight loss, and a distorted body image. Individuals with anorexia may see themselves as overweight even when they are dangerously underweight.
• Bulimia Nervosa: Involves cycles of binge eating followed by purging behaviours such as vomiting, excessive exercise, or the use of laxatives. People with bulimia often maintain a normal weight, but their behaviours can lead to serious health complications.
• Binge Eating Disorder: Marked by recurrent episodes of eating large amounts of food in a short period, often accompanied by feelings of loss of control, guilt, and distress. Unlike bulimia, binge eating disorder does not involve purging behaviours.
• Avoidant/Restrictive Food Intake Disorder (ARFID): Involves an avoidance of certain foods or food groups due to sensory sensitivities, fear of choking, or a lack of interest in eating. ARFID can lead to significant nutritional deficiencies and weight loss.
• Pica: Characterised by consuming non-food substances, such as dirt, chalk, or hair. Pica is more common in children but can occur in adults, particularly those with developmental disorders or mental health conditions.
• Rumination Disorder: Involves the repeated regurgitation of food, which is re-chewed, re-swallowed, or spit out. This behaviour is not due to a medical condition and can lead to weight loss and nutritional deficiencies.
• Other Specified Feeding or Eating Disorder (OSFED): This category includes eating disorders that do not meet the full criteria for any of the above disorders but still involve significant disordered eating behaviours and distress. Examples include atypical anorexia nervosa, where individuals meet the criteria for anorexia but are within a normal weight range, and purging disorder, where individuals purge without binge eating.

Stages of Eating Disorders

Eating disorders typically progress through several stages, each with its characteristics. Understanding these stages can help recognise the early signs and intervene before the disorder becomes more severe.

• Pre-Clinical Stage:
• Individuals may start experimenting with dieting, food restriction, or excessive exercise. These behaviours are often triggered by a desire to lose weight or meet societal or personal appearance ideals.
• Although there may be an increasing preoccupation with body image, weight, and food, these thoughts do not yet dominate the individual’s daily life.
• Although subtle changes in eating patterns and weight may occur, no significant physical health issues have developed.
• Early Stage:
• Disordered eating behaviours become more regular and entrenched. This may include consistent calorie counting, avoiding specific food groups, or engaging in binge eating or purging behaviours.
• Obsession with food, weight, and body shape intensifies, and the individual may begin to isolate themselves socially. There may also be a noticeable increase in anxiety, depression, or irritability.
• Noticeable weight loss or gain, changes in energy levels, and the onset of physical symptoms such as fatigue or gastrointestinal issues may occur.
• Acute Stage:
• Disordered eating behaviours dominate the individual’s life. Daily activities and social interactions are increasingly organised around food, exercise, and weight control.
• Severe preoccupation with food, weight, and body image. The individual may develop a distorted perception of their body and experience intense guilt or shame associated with eating.
• Significant physical symptoms may develop, including malnutrition, electrolyte imbalances, and menstrual irregularities. The individual’s overall health is at serious risk.
• Chronic Stage:
• The eating disorder is deeply ingrained, and the individual may struggle to maintain normal eating patterns even if they recognise the harm being done. There may be a reliance on disordered behaviours to cope with emotional or psychological distress.
• The individual may experience severe mental health issues, including chronic depression, anxiety, and suicidal thoughts. There is often a loss of hope or belief that recovery is possible.
• Long-term health consequences are apparent, including severe malnutrition, organ damage, bone density loss, and other life-threatening conditions.

Diagnosis of Eating Disorders

• Medical Evaluation:
• Physical Examination: A thorough physical exam assesses the individual’s overall health, including vital signs, body weight, and physical symptoms like hair loss or skin issues.
• Laboratory Tests: Blood tests, urine tests, and other lab work are often used to check for electrolyte imbalances, nutritional deficiencies, and the functioning of vital organs, such as the liver, kidneys, and heart.
• Medical History: The healthcare provider will review the individual’s medical history, including weight changes, menstrual irregularities, or gastrointestinal problems.
• Psychological Assessment:
• Mental Health Evaluation: A psychologist or psychiatrist will evaluate the individual’s mental health, looking for symptoms of depression, anxiety, obsessive-compulsive disorder (OCD), or other psychological conditions commonly associated with eating disorders.
• Behavioural Analysis: The individual’s eating habits, attitudes towards food, and behaviours related to exercise and body image will be assessed. This may include structured interviews, questionnaires, or self-reporting tools to uncover disordered eating patterns.
• Cognitive Assessment: Evaluating the individual’s thought processes, beliefs about food and body image, and cognitive distortions (e.g., all-or-nothing thinking) is crucial in understanding the severity and nature of the disorder.
• Diagnostic Criteria:
• DSM-5 Criteria: Eating disorders are diagnosed based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). This includes specific criteria for anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding or eating disorders (OSFED).

Treatment of Eating Disorders

• Medical Treatment:
• Nutritional Rehabilitation: The first step often involves stabilising the individual’s physical health through nutritional support. This may include meal planning, supervised eating, and gradually reintroducing a balanced diet.
• Medical Monitoring: Regular medical check-ups are essential to monitor weight, vital signs, and the health of organs affected by the disorder. Hospitalisation may be necessary in severe cases to address life-threatening complications.
• Psychological Therapy:
• Cognitive Behavioral Therapy (CBT): CBT is the most common form of therapy for eating disorders. It focuses on identifying and changing distorted thoughts and behaviours related to food, body image, and self-esteem.
• Family-Based Therapy (FBT): Particularly effective for adolescents, FBT involves the family in the treatment process, empowering them to support the individual’s recovery and create a healthier home environment.
• Dialectical Behavior Therapy (DBT): DBT can be beneficial for individuals with eating disorders and co-occurring conditions like borderline personality disorder (BPD). It teaches skills for managing emotions and reducing harmful behaviours.
• Interpersonal Therapy (IPT): IPT addresses the interpersonal issues that may contribute to the eating disorder, such as relationship conflicts, social isolation, or grief.
• Nutritional Counseling: A dietitian specialising in eating disorders can guide developing a balanced relationship with food, creating meal plans that meet nutritional needs, and addressing fears or misconceptions about eating.
• Medication:
• Antidepressants and Anti-Anxiety Medications: These may be prescribed to help manage co-occurring conditions like depression or anxiety, which are common in individuals with eating disorders.
• Medications for Specific Symptoms: In some cases, medications may address specific symptoms, such as gastrointestinal issues or sleep disturbances.
• Support Groups and Peer Support: Participating in group therapy or support groups can provide individuals with a sense of community and understanding, reduce feelings of isolation, and offer encouragement from others experiencing similar struggles.

What if Eating Disorders are Untreated?

If an eating disorder is left untreated, it can lead to severe and potentially life-threatening complications. The longer the disorder persists, the more difficult it can be to treat and the more damage it can cause to the individual’s body and mind.

Early recognition, diagnosis, and treatment of eating disorders are crucial for improving outcomes and preventing the severe physical and psychological consequences associated with these conditions. A comprehensive approach that includes medical care, psychological therapy, nutritional support, and family involvement offers the best chance for recovery and restoring health.