Eating Disorders

February 1, 2017

An eating disorder is a serious mental illness, characterised by eating, exercise and body weight or shape becoming an unhealthy preoccupation of someone’s life. It’s estimated that one million Australians have an eating disorder, and this number is increasing. Eating disorders are not a lifestyle choice, a diet gone wrong or a cry for attention. Eating disorders can take many different forms and interfere with a person’s day to day life. An estimated 10 million women and 1 million men struggle with eating disorders.

Teenagers and young adults are most likely to have eating disorders, but people of all ages, including young children, can have these conditions. Unfortunately, many suffer in silence, ashamed or embarrassed to seek help, or unaware that help is even out there.

Types of Eating Disorders

There are three major types of eating disorders.

Aneroxia – People with anorexia nervosa have a distorted body image that causes them to see themselves as overweight even when they’re dangerously thin. Often refusing to eat, exercising compulsively, and developing unusual habits such as refusing to eat in front of others, they lose large amounts of weight and may even starve to death.
Bulimia – Individuals with bulimia nervosa eat excessive quantities, then purge their bodies of the food and calories they fear by using laxatives, enemas, or diuretics; vomiting; or exercising. Often acting in secrecy, they feel disgusted and ashamed as they binge, yet relieved of tension and negative emotions once their stomachs are empty again.
Binge eating disorder – Like people with bulimia, those with binge eating disorder experience frequent episodes of out-of-control eating. The difference is that binge eaters don’t purge their bodies of excess calories.

Eating disorders can be deadly. Up to 20 percent of people with anorexia die from their disorder, making it the deadliest mental illness there is.

Bulimia and other eating disorders can also lead to life-threatening complications. In addition to physical complications, eating disorders often lead to psychological and social issues like depression, anxiety, poor self-esteem, and withdrawal from family and friends. These conditions don’t only affect those that suffer from them; they affect those that care about them as well.

Causes

The factors that contribute to the onset of an eating disorder are complex. No single cause of eating disorders has been identified; however, known contributing risk factors include –

Genetic Factors – There is some evidence that eating disorders have a genetic basis. The genes that are most implicated in passing on eating disorders are within biological systems that relate to food intake, appetite, metabolism, mood, and reward-pleasure responses. It has been shown that this genetic influence is not simply due to the inheritance of any one gene but results from a much more complicated interaction between many genes and quite possibly non inherited genetic factors as well.

Psychological factors – Research into Anorexia Nervosa and Bulimia Nervosa specifically, has identified a number of personality traits that may be present before, during, and after recovery from an eating disorder. These include –

perfectionism
obsessive-compulsiveness
neuroticism
negative emotionality
harm avoidance
core low self-esteem
traits associated with avoidant personality disorder

Specific additional personality traits may be associated with each type of eating disorder. It is also important to include that prolonged starvation induces change in cognition, behaviour, and interpersonal characteristics. It can therefore be difficult to discern the psychological causes from the psychological effects of eating disorders.

Socio-cultural influences – Evidence shows that socio-cultural influences play a role in the development of eating disorders, particularly among people who internalise the Western beauty ideal of thinness. Images communicated through mass media such as television, magazines and advertising are unrealistic, airbrushed and altered to achieve a culturally perceived image of ‘perfection’ that does not actually exist. Like most other psychiatric illnesses and health conditions, a combination of several different factors may increase the likelihood that a person will experience an eating disorder at some point in their life.

Nutritional Deficiency – Different subclinical nutrient deficiencies may lead to binging symptoms or mood imbalances, as the body is craving things to make up for that which it is lacking. Urinary neurotransmitter analysis is used to direct treatments with amino acids or other nutrients and botanicals to support imbalances in –

Serotonin
Norepinephrine
Glutamate

and other neurotransmitters rather than using medications such as SSRIs (including fluoxetine and citalopram among others) unless necessary. Salivary cortisol provides information about the adrenal response, and plays a role in supporting the adrenal aspect of blood sugar regulation, as well as supporting the body in fatigue and sleep disturbances.

Risk Factors

Being female – Teenage girls and young women are more likely than teenage boys and young men to have anorexia or bulimia, but males can have eating disorders, too.
Age – Although eating disorders can occur across a broad age range — including childhood, the teenage years and older adulthood — they are much more common during the teens and early 20s.
Family history – Eating disorders are significantly more likely to occur in people who have parents or siblings who’ve had an eating disorder.
Mental health disorders – People with depression, anxiety disorder or obsessive-compulsive disorder are more likely to have an eating disorder.
Dieting – People who lose weight are often reinforced by positive comments from others and by their changing appearance. This may cause some people to take dieting too far, leading to an eating disorder.
Stress – Whether it’s heading off to college, moving, landing a new job, or a family or relationship issue, change can bring stress, which may increase your risk of an eating disorder.
Sports, work and artistic activities – Athletes, actors, dancers and models may be at higher risk of eating disorders. Coaches and parents may unwittingly contribute to eating disorders by encouraging young athletes to lose weight

Symptoms

Anorexia Nervosa – People with the eating disorder called anorexia nervosa see themselves as overweight even though they are dangerously thin. Many people with anorexia also have coexisting psychiatric and physical illnesses, including depression, anxiety, obsessive behavior, substance abuse, cardiovascular and neurological complications, and impaired physical development.

Other symptoms may develop over time –

Thinning of the bones
Brittle hair and nails
Dry and yellowish skin
Growth of fine hair over body
Mild anemia and muscle weakness and loss
Severe constipation
Low blood pressure, slowed breathing and pulse
Drop in internal body temperature, causing a person to feel cold all the time
Lethargy
Infrequent or absent menstrual periods

Bulimia Nervosa – Bulimia nervosa is characterized by recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over the eating. This binge-eating is followed by purging (vomiting, excessive use of laxatives or diuretics), fasting, or excessive exercise. And like those with anorexia, people with bulimia often have coexisting psychological illnesses such as depression, anxiety, or substance abuse problems. Many physical conditions also result from their behavior, including electrolyte imbalances, gastrointestinal problems, and oral and tooth-related problems.

Other symptoms –

Chronically inflamed and sore throat
Swollen glands in the neck and below the jaw
Worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acids
Gastroesophageal reflux disorder (GERD)
Intestinal distress and irritation from laxative abuse
Kidney problems from diuretic abuse
Severe dehydration from purging of fluids

Eating Disorder Not Otherwise Specified can include binge eating and/or compulsive eating. Binge eating is a pattern of recurrent episodes of eating large amounts of food in response to feelings rather than hunger, and a sense of lack of control over how much or when to stop eating. Binges are usually followed by guilt, self-hatred and depression, rather than purging. Compulsive eating works in much the same way in that the person often feels guilty and shameful after overeating.

Complications

Eating disorders cause a wide variety of complications, some of them life-threatening.

Significant medical problems
Depression and anxiety
Suicidal thoughts or behavior
Problems with growth and development
Social and relationship problems
Substance use disorders
Work and school issues
Death

Treatment

Medical Care and Monitoring-The highest concern in the treatment of eating disorders is addressing any health issues that may have been a consequence of eating disordered behaviors.

Nutrition – This would involve weight restoration and stabilization, guidance for normal eating, and the integration of an individualized meal plan.

Therapy – Different forms of psychotherapy, such as individual, family, or group, can be helpful in addressing the underlying causes of eating disorders. Therapy is a fundamental piece of treatment because it affords an individual in recovery the opportunity to address and heal from traumatic life events and learn healthier coping skills and methods for expressing emotions, communicating and maintaining healthy relationships.

Cognitive behavioral therapy (CBT) – CBT is commonly used in eating disorder treatment, especially for bulimia and binge-eating disorder.
Family-based therapy (FBT) – FBT is an evidence-based treatment for children and teenagers with eating disorders. The family is involved in making sure that the child or other family member follows healthy-eating patterns and maintains a healthy weight.

Medications – Some medications may be effective in helping resolve mood or anxiety symptoms that can occur with an eating disorder or in reducing binge-eating and purging behaviors.

Complementary & Alternative Treatment

Acupuncture – A traditional Chinese therapy in which small needles are inserted into the skin at specific points to relieve pain and promote healing. All acupuncture practitioners should be registered with a governing body such as the Acupuncture Society.

Aromatherapy – The therapeutic use of essential oils from plants, flowers and trees to achieve health and vitality. Often aromatherapy is incorporated into massages, facials and baths.

Homeopathy – The therapeutic use of small doses of medicines to stimulate the body’s natural defence systems in order to re-balance the body. Qualified homeopaths should be registered with the Society of Homeopaths.

Naturopathy – The therapeutic use of natural healing techniques and prescriptions of plant and flower extracts. Naturopaths should be registered with the General Council and Register of Naturopaths.

Massage Therapy – Body massage, or the rhythmic, therapeutic stroking and kneading of the muscles, relaxes and soothes the body and calms and refreshes the mind.

Meditation – A method of suspending thought and directing attention in a calm and focused manner. Classes as well as individual lessons are usually available.

A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-vitamins and trace minerals, such as magnesium, calcium, zinc, phosphorus, copper, and selenium.

Creatine, when needed for muscle weakness and wasting. There is some concern that creatine may be harmful to the liver and kidneys.

Probiotic supplement a day, for maintenance of gastrointestinal and immune health. Refrigerate probiotic supplements for best results.

5-hydroxytryptophan (5-HTP) for mood stabilization.

Coenzyme Q10 for antioxidant, immune, and muscular support. Coenzyme Q10 can potentially interfere with Coumadin (warfarin) and other blood-thinning medicines.

Omega-3 fatty acids to help decrease inflammation and improve immunity.

Ashwagandha might cause sleepiness or drowsiness. Be cautious when combining with sedative medicines.

Milk thistle for liver health.

Reference –

http://eating-disorders.org.uk/

http://www.eatingdisorders.org.au/eating-disorders/what-is-an-eating-disorder

http://www.anad.org/get-information/about-eating-disorders/general-information/

https://www.cmha.ca/mental-health/understanding-mental-illness/eating-disorders/

http://www.webmd.com/mental-health/eating-disorders/signs-of-eating-disorders

http://www.mayoclinic.org/diseases-conditions/eating-disorders/basics/definition/con-20033575

http://www.nedc.com.au/eating-disorders-explained

http://www.eatingdisorderhope.com/information/eating-disorder