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What is an eating disorder?
In the broadest sense, an eating disorder is a disturbance of eating and eating-related behaviors that result in psychological or physical impairment. Anorexia and bulimia may be the first things that come to mind when hearing “eating disorder”.
Obesity is not classified as an eating disorder, as according to the DSM-V, obesity is due to a variety of environmental, genetic, lifestyle, and physical factors. Obesity may result as a byproduct of another mental disorder; but due to the largely physiological origins, it does not qualify as a mental disorder.
The DSM-5 lists a variety of eating disorders, but the most common is pica, avoidant/restrictive food intake, anorexia nervosa, and bulimia nervosa.
The most prominent component of pica is the consumption of something that is non-nutritive or non-edible for more than a month. Other symptoms include:
- Consumption that is inappropriate for age (e.g., a three-year-old may sample a crayon, but a 20-year-old normally wouldn’t)
- The eating behavior is not culturally significant or socially normal
- If the condition is present due to another mental or physical disorder (e.g., autism spectrum disorder, pregnancy, schizophrenia), it is severe enough to warrant additional clinical treatment
Before diagnosing someone with pica, your doctor will check for gastrointestinal problems, signs of infection or poisoning, or malnutrition. It is important to rule out underlying medical issues that would better explain the individual’s symptoms.
Pica often appears in early childhood, but can begin at any age. It is especially prevalent in individuals with neurodevelopmental disorders such as autism, or other intellectual disabilities. There is a positive correlation between the severity of the disability and the occurrence of Pica; meaning, the more severe an intellectual disorder is, the more likely that person will develop pica.
Avoidant/Restrictive food intake
This disorder is marked by a lack of interest or avoidance of food that leads to a lack of proper nutrition or energy. The symptoms must also not be due to lack of available food. Additional symptoms include:
- Significant weight loss
- Interference with psychosocial functioning (problems with social life due to psychological factors)
- Nutritional deficiency
- Avoidance or lack of interest is not experienced during episodes of Anorexia or Bulimia and does not correlate with body perception issues
- The symptoms are not better explained by another condition. If symptoms are better explained by another condition, the severity is higher than normal for said condition
Avoidant/Restrictive food intake can present itself at any time but often appears in infancy or early childhood. Infants may appear too sleepy or distressed to feed. Older babies and toddlers may not engage effectively with their caretaker to relay hunger or may ignore signs of hunger in favor of other activities, such as play. Adolescents may experience avoidant/restrictive food intake as a result of emotional issues. These emotional difficulties are more generalized and do not meet the criteria for depression, anxiety, or bipolar disorder. Instead, they are defined as a “food avoidance emotional disorder.”
Older children and adolescents may also develop sensory aversion to certain foods. Sensory aspects include food texture, color, smell, or consistency. Additionally, avoidant/restrictive food intake disorder is equally as common in males and females in early childhood. The exception is males with a comorbid (occurring at the same time) autism spectrum disorder, where the disorder becomes more common than normal.
Anorexia is perhaps one of the most recognized eating disorders. Its primary features are an intense fear of weight gain and restriction of energy intake. A more complete list of symptoms includes:
- Restriction of food and energy intake that leads to significantly low body weight, in the context of normal guidelines for age, sex, developmental trajectory, and physical health.
- Intense fear of gaining weight or being overweight
- Behavior that consistently interferes with weight gain
- Negative self-evaluation of body weight and shape
- The overwhelming focus on body weight and shape in self-evaluation
- Failure to recognize low body weight
There are varying types of severity for anorexia nervosa, all measured using BMI, or body mass index. The following are the BMI criteria for each severity:
- Mild- ≥ 17 kg/m2
- Moderate- 16-16.99 kg/m2
- Severe- 15-15.99 kg/m2
- Extreme- < 15 kg/m2
In some cases, the severity may increase based on other symptoms, degree of disability, and a need for supervision.
Some individuals with anorexia nervosa will binge and purge. Others will participate in self-induced purging but will not binge eat. This is one subtype of anorexia. Individuals who exercise excessively comprise another subtype. Oftentimes excessive exercise precedes the onset of anorexia and increases further over the course of the disorder. Increased physical activity during treatment can be hard to control and can stunt weight recovery. Fear of eating in public, low social spontaneity, a desire to control personal environment, restrained emotional expression, and misuse of medication are other common features of anorexia.
Anorexia nervosa often begins in adolescence or young adulthood. It rarely starts before puberty, or after age 40. Females are significantly more likely to develop anorexia than males. It is unknown why exactly anorexia is more prevalent in women, but studies show an approximate 10:1 female-to-male ratio.
Studies show that monozygotic twins (meaning from one zygote) are at a higher risk for both people developing anorexia than dizygotic twins (meaning form two zygotes). Likewise, being the first-generation biological relative of someone with anorexia puts you at an increased risk for developing the disorder, too. Both of these facts indicate that there is a high hereditary index for anorexia.
Bulimia is diagnosed based on the following criteria:
- Recurrent episodes of binge eating
- Recurrent episodes of purging or compensatory behaviors
- The bingeing and purging/compensatory measures occur at least once a week for three months
- Self-evaluation is predominantly influenced by body shape and weight
- The disturbance does not occur exclusively during episodes of anorexia
The three dominant features of bulimia are binging, purging, and negative self-evaluation. Binge eating is defined as the intake of an excessive amount of food in a short period of time. The amount of food consumed is significantly larger than what a person would normally eat in the same amount of time. The person must also feel a loss of control.
Purging, or compensatory behaviors, are completed in response to bingeing. The most common form of purging is self-induced vomiting but may also include the inappropriate use of laxatives, diuretics, or other medications, fasting, and excessive exercise. In some instances, purging, rather than bingeing, becomes the goal. In these cases, the individual may vomit after a small meal or may binge specifically to vomit afterward.
A negative self-image in bulimia must include a preoccupation with body weight and shape. Oftentimes individuals with bulimia are of normal weight or overweight. This differs from anorexia, where the individual will be significantly underweight. Some believe that traumatic events or poor self-confidence contribute to the presence of a negative self-image. Others believe that the shame brought on by bingeing and purging creates negative self-perception.
As with anorexia nervosa, bulimia is more prominent in females than males. Little is known about males with bulimia. However, it is known that there is a 10:1 female-to-male ratio for the disorder. It is theorized that bulimia is more prominent in young girls than boys due to cultural pressure. In modernized societies, like America and Europe, there is a large emphasis on being thin, especially for women. Studies show that models and athletes are at a higher risk for developing bulimia, which further supports the theory.
Any eating disorder can become severe, especially when nutrition and health are compromised. Treatment plans for eating disorders are catered to the individual and their disorder, but most often consist of specialized treatment in a recovery center. Therapy is also a good option for those with less severe disorders or those in remission. It is imperative to deal with any underlying emotional disturbances that could cause an eating disorder to reappear. It takes strength to realize when you or a loved one is suffering from an eating disorder, and being able to openly accept and admit to the fact will bring you one step closer to recovery.