Eating disorder

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at May 31, 2016
StartDiseasesEating disorder

There are a variety of eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder, pica, and avoidant/restrictive food intake disorder. They range in exact behaviors, but all are behavior disorders also linked to mental health issues like depression, anxiety, and obsessive-compulsive disorder

Contents

Definition & Facts

Eating disorders are mental disorders that have negative effects on a person's mental, emotional, and physical health. Bulimia is a condition where a person eats a large amount of food (called binging) and then takes drastic action to avoid weight gain caused by these binges. Common strategies for bulimics include vomiting, taking laxatives, excessive exercise and restricting food (fasting).

Anorexia nervosa is a condition where a person eats very little and maintains an unnaturally low body weight. Binge eating disorder is when a person eats a large amount of food in a short time, but does not purge like bulimics. 

Symptoms & Complaints

The symptoms vary with the subset of eating disorder that a person is suffering from. In general, eating disorders are incredibly fatal and linked to suicide and other tragic outcomes.

Patients with anorexia nervosa suffer a variety of symptoms both while sick and after recovery. Low bone density can lead to broken bones or osteoporosis later in life. Anorexics complain of feeling cold, even in warm settings. Low body weight can lead to lanugo which is the growth of fine hairs all over the body in the body's attempt to stay warm.

People with bulimia can face a variety of gastrointestinal problems from forced vomiting. This can range from damage to teeth from stomach acid, to fatal esophagus tears, and stomach ruptures while binging. Repeated binging and purging can cause an imbalance of electrolytes in the body, causing fatal heart attacks.

Those with anorexia will be underweight for their height and age, while those with bulimia can be underweight, normal weight, or overweight. Obesity characterizes about half of those with binge eating disorder.

Causes

There is no single known cause of eating disorders in patients. These conditions are co-morbid with conditions like depression and anxiety, which also do not have definitive causes. Cultural factors are often cited, such as the cultural emphasis on thinness and small waistlines.

While women are often depicted as the population that deals with eating disorders, men also experience eating disorders. They are especially common among college athletes, or those participating in sports with a large emphasis on speed or light body weight.

Additionally, poor self-esteem and body image issues are a large contributor. These can stem from peer pressure, internal emotional issues, or poor parenting. Social pressure isn't the only cause. There is evidence that a propensity towards eating disorders may be genetic.

Diagnosis & Tests

There are a variety of tests used in the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose eating disorders. Due to the psychological nature of eating disorders, these diagnoses are determined primarily through the behaviors and thoughts expressed by the patients. Other mental health issues such as depression, anxiety, or substance abuse disorder are commonly diagnosed among the affected patients. 

The DSM defines bulimia as a condition where the patient consumes a large amount of food in a discrete period of time, often with a sense of being "out of control" during these episodes. This is then followed by an inappropriate compensatory behavior to avoid weight gain (purging, compulsive exercise).

The DSM criteria for anorexia nervosa includes a patient's refusal or inability to maintain an adequate body weight in the context of age and sex. Additionally, the patient will have an intense fear of gaining weight or increased body fat. Previous iterations of the DSM included a loss of menstruation for women as a diagnostic criterion; however, the most recent edition of the DSM has dropped this qualification.

Treatment & Therapy

There are a variety of treatments and therapy approaches for addressing eating disorders. Psychiatric medication is often prescribed to treat depression and anxiety. Common medications prescribed include SSRI's and MAOI anti-depressants, and a variety of anti-anxiety medications.

However, medication alone is insufficient to address the deep-seated roots of eating disorders in patients. Patients will also benefit from psychotherapy performed by a licensed therapist in a clinical setting. Treatment for intense eating disorders can be a residential treatment, where patients live at the facility for the duration of their treatment. Other options include intensive outpatient programs, known as IOP.

One form of psychotherapy used to treat eating disorders is cognitive behavioral therapy (CBT), which has a strong track record for treating conditions like depression, anxiety, and obsessive-compulsive disorder. Cognitive behavioral therapy is an approach in which therapists and patients address the interplay between thoughts, behaviors, and emotions in order to help patients develop more appropriate coping mechanisms for negative emotions.

Patients with eating disorders are not comfortable with their emotions and use food behaviors in order to avoid strong feelings. Through CBT, patients are taught that their constant negative thoughts are a symptom of their disorder, not an accurate reflection of reality. They are given methods to fight these thoughts with the goal of reducing symptoms and improving overall emotional health. 

Another therapy for treating eating disorders is mindfulness-based cognitive therapy, which incorporates aspects of CBT and mindfulness meditation. Through this approach, patients are taught to analyze their thoughts and emotions as well as to perform meditation techniques to clear their minds and remain psychologically centered. 

Prevention & Prophylaxis

Prevention of eating disorders can be difficult because of the multitude of potential genetic, psychological, biological, and cultural causes. Nevertheless, a variety of programs have been proposed to help prevent eating disorders by encouraging people to question societal norms surrounding dieting and thinness, to improve their body image, and to embrace intuitive eating.

Preventive programs may be targeted towards either a universal audience with an emphasis on societal changes and public policy goals, a specific demographic vulnerable to developing eating disorders (young girls), or specific individuals who have already exhibited behaviors that may be indicative of eating disorders. Research suggests a strong link between early intervention and positive treatment outcomes, which indicates the importance of prevention.