A quick flip through a fashion magazine, or a scroll through Instagram, reveals pages and posts of super-thin, unattainable figures that our society promotes as beautiful. While most people can relate to worrying about their weight or have trouble with their own body image acceptance, the most affected groups are often young women and, more recently, young men. This obsession with the perfect body can reach an extreme level, causing abnormal eating habits that are unhealthy and even life-threatening in certain incidences. When extreme food restriction or excessive exercise reaches unhealthy levels, the issue can progress into an eating disorder, which is considered a mental health disorder.
The American Psychiatric Association lists three main types of eating disorders: bulimia nervosa, anorexia nervosa, and binge-eating disorder. The association also lists a fourth category for all symptoms that don’t fall into one of those three categories called and “eating disorder not otherwise specified,” or EDNOS.
Research regarding exactly how many people in the United States suffer from eating disorders varies. The disorders can be difficult to pinpoint and a large percentage of those affected go untreated. In addition, the American Journal of Psychiatry published that people suffering from eating disorders may also suffer from depression about half of the time. This relationship is referred to as co-occurring disorders and can often make the diagnosis and treatment more difficult to go through. The South Carolina Department of Health estimates that around 8 million people in America struggle with an eating disorder. The National Association of Anorexia Nervosa and Associated Disorders speculate that these numbers could be closer to 24 million people.
Most research concludes that women are more affected than men by eating disorders, however, men don’t often report having an eating disorder or seek treatment due to the stigma of the disorder. Eating disorders can also span culture, age, and gender lines.
What Is an Eating Disorder?
Similar to other mental health disorders, eating disorders are often misunderstood and thought to be a choice. However, eating disorders are real illnesses that can be dangerous and life-threatening. An eating disorder is defined as an illness that is characterized by serious concern and distress regarding someone’s weight or body shape as well as irregular eating habits.
An eating disorder can be an inadequate or excessive intake of food which can cause physical and mental damage to the body. An eating disorder can develop at any age, but typically appear during the teenage or young adult stages of life. Eating disorders are treatable conditions but the consequences can be detrimental and life-threatening if left untreated. Eating disorders often co-occur with other disorders including anxiety, substance abuse, or depression.
Types of Eating Disorders
Types of eating disorders include anorexia, bulimia, and binge-eating disorder. These disorders typically involve starvation, purging, and binging using different methods.
Individuals who are diagnosed with anorexia often have a distorted body image and restrict the number of calories they consume in order to remain thin. Some people with the anorexia may also compulsively exercise, binge eat and purge by vomiting or using laxatives. The disorder typically occurs during adolescence but it’s not uncommon in children or older adults.
A common misconception about the disorder is that people who suffer from anorexia are emaciated or underweight. However, larger-bodied people and even overweight people can suffer from the disorder. Atypical anorexia is an instance when an individual exhibits all of the symptoms of anorexia but whose weight remains within a normal or above normal weight range.
Bulimia involves periods of excessive binging, or overeating, followed by purging using various methods including vomiting or laxatives. People with bulimia have a fear of gaining weight and often have a distorted body image — but that doesn’t necessarily mean they are underweight.
Someone with bulimia may purge in order to manage their current weight or to prevent additional weight gain. A person with this disorder may consume more than the recommended 2,000 calories at once and then proceed to purge — either by vomiting, using laxatives, or another method. Some of these other methods of purging may include: excessive exercise, enemas, fasting or a combination of purging methods are common alternatives to vomiting. If someone binges but doesn’t purge in any form, they are often diagnosed with a binge-eating disorder (BED).
Binge Eating Disorder
Binge Eating Disorder (BED) is a serious, life-threatening disorder that is defined as repeated occurrences of consuming large quantities of food often very rapidly and to the point of discomfort. Other characteristics of BED may include: feeling the loss of control during binge-eating, experiencing shame, distress, or guilt afterward. This type of disorder is the most common eating disorder in the country.
Before 2013, BED was not recognized as an eating disorder by The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it was previously listed as EDNOS. This change is worth mentioning become some insurance companies would not provide coverage for eating disorder treatment without a DSM diagnosis.
This eating disorder isn’t necessarily related to losing or maintaining a certain weight — Pica involves eating things that are not commonly thought of as edible and does not contain any substantial nutritional value like dirt, hair, or cotton. Diagnosis for Pica is usually made from the clinical history of the person with Pica. Once a person is diagnosed with Pica, it is suggested that additional tests for anemia, potential intestinal blockages, and toxic side effects of non-food items consumed.
This disorder is often associated with other co-occurring impaired functioning mental health disorders like schizophrenia, autism spectrum disorder and intellectual disability. Pica is often the result of an iron deficiency and malnutrition. Pica is the body’s way of trying to supplement a significant nutrient deficiency. Treatment for Pica typically involves finding the deficiency and then using medication or vitamins to balance everything out.
Rumination disorder is an eating disorder that involves the individual regularly regurgitating their food. Once regurgitated the food may be re-chewed, re-swallowed or spit out. Someone with rumination disorder doesn’t appear to purposefully, regurgitate their food, nor do they appear distressed, upset or disgusted. Treatment for rumination disorder often includes a combination of breathing exercises and habit reversal. People diagnosed with this disorder replace the regurgitation with deep breathing techniques.
Avoidant Restrictive Food Intake Disorder
This eating disorder is a newly recognized diagnosis and was previously known as Selective Eating Disorder. Avoidant Restrictive Food Intake Disorder (ARFID) is related to anorexia because both eating disorders involve limitations in the amount and types of food consumed. However, ARFID doesn’t include any feelings of distress regarding body image, size, or weight like anorexia does.
Some children are finicky eaters and could be diagnosed with ARFID because they don’t intake enough calories to properly develop and grow. Adults can be diagnosed with ARFID as well, and in addition to not developing physically, they may experience difficulty with maintaining basic bodily functions. ARFID may result in serious medical consequences because the body is being denied essential nutrients to properly function and develop.
Eating Disorders Symptoms
Eating disorders are most often caused by co-occurring mental health disorders but they cause physical conditions that can be life-threatening. The earlier an eating disorder is recognized, the better the chances for recovery. Some common emotional and behavioral signs and symptoms of most eating disorders include:
- Habits and practices that indicate weight loss, dieting and control of food
- Obsession with weight and dieting
- Becoming more picky about food choices
- Appears uncomfortable eating in front of others
- Food rituals
- Skipping meals or taking small portions of food at regular meals
- Restricting entire food groups
- Loss of interest in activities and friends they once enjoyed
- Extreme concern with body size and shape
- Extreme mood swings
Some common physical symptoms of an eating disorder include:
- Noticeable fluctuations in weight
- Stomach cramps
- Menstrual irregularities
- Difficulties concentrating
- Sleep problems
- Cuts and calluses on fingers (from inducing vomiting)
- Dental problems like enamel erosion, cavities and tooth sensitivity.
- Dry skin and hair
- Brittle nails
- Muscle weakness
- Yellow skin
- Impaired immune functioning
What Causes Eating Disorders?
Most researchers conclude that eating disorders are caused by a combination of environmental, biochemistry, genetics, and social factors similar to other mental health conditions. The National Alliance on Mental Illness reports that people are 10 times more likely to develop an eating disorder if their family member has one. Certain behaviors or characteristics may be a forewarning for eating disorders as well.
Stressful events and a dysfunctional hormonal response to them may suggest a susceptibility for developing an eating disorder. Social situations associated with sports, modeling or other enterprises concentrating on body image and weight control, could influence the development of eating disorders as well. Additional mental health disorders and substance abuse are commonly linked to eating disorders and it’s not definitive whether or not one causes the other or if they just intensify each other.
Risk Factors for Eating Disorders
Risk factors that influence eating disorders include a range of biological, psychological, and socio-cultural matters. The risk factors for an individual varies of course from person to person, but there are some general influences that affect someone’s chances of developing an eating disorder. Some biological risk factors that are applicable to people with anorexia nervosa, bulimia nervosa, and binge eating disorder include:
- Having a family member with an eating disorder
- Having a family member with a mental health disorder
- History of dieting
- Negative energy balance
Some general psychological risk factors may include:
- Body image dissatisfaction
- History of an anxiety disorder
- Behavioral flexibility
Some general social risk factors may include:
- Weight stigma
- Teasing or bullying
- Appearance ideal internalization
- Limited social networks
- Historical trauma
Eating Disorders and Substance Abuse
According to the National Eating Disorders Association (NEDA), up to 50 percent of individuals with eating disorders abused alcohol or illegal substances, a rate that’s five times higher than the general population. Additionally, up to 35 percent of people with substance use disorders also had an eating disorder, this rate is 11 times higher greater than the general population.
The most common substances abused by people with an eating disorder include alcohol, laxatives, emetics, diuretics, amphetamines, heroin and cocaine — most of which are known for their appetite-suppressing side effects.
Diagnosing an Eating Disorder
There a number of professionals that can diagnose an eating disorder, it doesn’t necessarily have to come from a medical doctor. Mental health professionals like psychiatrists and psychologists, social workers, pediatricians, and family doctors all have the authority to diagnosis someone with an eating disorder.
These professionals use a variety of questionnaires and assessments to determine whether or not someone has an eating disorder, there is no laboratory test to screen for these types of illnesses. With that being said, there are some diagnostic tools during a physical examination that can be used to determine if a person has an eating disorder and the disorder’s severity. These tools may include blood work, a bone density exam and electrocardiogram to determine if there is any development of medical conditions as a result of the eating disorder.
These professionals will also probably interview the patient and ask them about experience with exercise, current eating habits, and their views on their weight and body image. The criteria professionals most use to diagnose an eating disorder is the DSM-5.
Treatment for Eating Disorders
Treatment for an eating disorder is critical due to the possibility of further medical complications if the disorder continues. Progressive treatment and therapy, including nutrition counseling and assistance for ceasing unhealthy behaviors like excessive exercise, binging and purging, are the most common types of eating disorder recovery. Integrated treatment models are often employed for co-occurring disorders and setback prevention.
If you or someone you know struggles with a substance use disorder and an eating disorder, help can’t wait. At The Recovery Village, we treat alcohol and substance addiction as well as co-occurring disorders, like eating disorders. Call or speak with our representatives about enrolling in treatment for addiction and co-occurring disorders and start on the path to long-term recovery.