Eating Disorders (Types, Age, Causes, Tx) - Explained

Eating disorders are sometimes misunderstood as poor lifestyle choices. Eating disorders are complex and serious mental health conditions that affect the body mentally and physically. There are disturbances in people’s eating behaviours and the disorder often ends up interfering with their daily routine. Eating disorders can affect people of any age, race, and gender.  It ranks second in the mortality rate because of any psychiatric illnesses. However, eating disorders are treatable with the correct help. 

Global prevalence of eating disorders:

• Globally, the prevalence of eating disorders went from 3.5% to 7.8% between the years 2000 to 2018. 
• Currently, 70 million people are diagnosed with eating disorders worldwide. (1) Out of these, eating disorders in adolescents sum up to around 22%. 

How common are eating disorders in the USA?

• In the USA, approximately 9% of the U.S. population is diagnosed with an eating disorder.  (2) 
• The prevalence of eating disorders is higher in females at 8.60% as compared to men, which is 4.07%.
• Fear of weight gain, desire for thinness, and thinking about dieting affect around 68.4% of females and 51% of males in the USA. 
• 5% of pregnant women experience an eating disorder during pregnancy. 
• The median age for the onset of binge eating disorder is 21 years old while that for Anorexia nervosa and Bulimia nervosa is 18 years old. (3)

How common are eating disorders in India?

• The range of eating disorders varies from 4% to 45.4% . 
• Obesity is observed to be highly prevalent in the Indian adolescent population. (4)
• Out of all the Eating disorders, the lifetime prevalence of Bing eating disorders is the highest at 2.22%
• At least 50% of patients with Eating disorders have a psychiatric co-morbidity like major depressive disorder, obsessive-compulsive disorder, anxiety disorders, etc (17)

Understanding Eating Disorders

What are Eating Disorders? 

Eating disorders are a group of conditions that are marked by disturbances in the individual’s eating behaviors and thoughts related to food. More simply, eating disorder meaning boils down to having an unhealthy relationship with food. It is a mental health condition that can be fatal if not treated on time. However, it must be noted that fatality in eating disorders is not due to the eating disorders itself. Starvation and malnourishment can make a person extremely weak and might be fatal.

On the other hand, suicide is the leading cause of death in people suffering from Anorexia Nervosa.  When a person has an eating disorder, it is difficult for them to perceive themselves positively. Eating disorders might make a person feel that their body is unattractive even when they appear to be normal on the outside. They might be dissatisfied with the way their body looks and easily influenced by external social factors. Wanting to look fit is a normal thing but for some people losing weight becomes an obsession and this might lead to eating disorder’s introduction in their lives.

Different Types of Eating Disorders

Types of Eating Disorders

Anorexia Nervosa (AN):

Anorexia Nervosa (AN) is one of the commonly occurring eating disorders found worldwide. This disorder is characterized by reduced food intake, fueled by an intense fear of being overweight. The individual may eat infrequently - they might eat in very small portions or sometimes, skip their meals. Even when they are underweight, they may exercise to lose more weight. Anorexia Nervose is observed to start in teens who are 15 years old or older. Mostly girls and women are affected by this disorder. Globally, 4% of women and 0.3% of males are affected by this disorder. (5)

How to know if you have an eating disorder like AN is easy. The symptoms displayed by a person are obvious and easy to diagnose. The symptoms of AN include:

1. Body-image issues
2. Lack of understanding of the severity of low body weight
3. Intense fear of gaining weight
4. Extreme thinness
5. A gradual decrease in the intake of food  
6. Excessive exercising 

Anorexia Nervosa can affect people of any race, sex, and age. To correctly diagnose the disorder, it is necessary to consult a health professional. Undernourishment caused because of these types of eating disorders is detrimental. Over time, it can lead to severe health consequences like:

1. Thinning of hair
2. Muscle and bone loss
3. Brittle nails
4. Damage to the heart
5. A drop in internal temperature leads the person to feel cold all the time
6. Multiple organ failure
7. Brain damage 
8. Ceasing of menstrual cycle

If unchecked, Anorexia Nervosa can be fatal. The high mortality rate of the disorder is associated with the health complications that are brought about by starvation. 

2. Bulimia Nervosa (BN):

Bulimia Nervosa follows a repetitive cycle of binging and purging. While binging, people eat unusually large amounts of food and feel no control over their food consumption. To compensate for overeating, the individual might purge out the food that they had consumed. Purging may be induced by purposeful vomiting, using laxatives, diuretics, or enemas, exercising excessively, or sometimes a combination of all these behaviors. 

Identifying Bulimia Nervosa might require observing an individual’s eating patterns. If somebody is displaying inappropriate compensatory behaviors frequently, there might be a possibility that they have Bulimia Nervosa. However, it must be noted that a definite diagnosis of the disorder can only be made by a healthcare professional. 

BN affects an individual to varying degrees. Depending upon their purging behaviors, the disorder is classified into mild, moderate, and severe. The health consequences associated with BN are:

1. Gastrointestinal problems
2. Dehydration because of purging
3. Bloating
4. Intestinal problems because of repeated laxative use
5. Electrolyte imbalance
6. Increased risk of heart attack.

The most important thing to note here is that people suffering from Bulimia Nervosa might appear to be of normal weight or sometimes even overweight. If you suspect you or someone you know is showing signs of Bulimia Nervosa, seeking a consultation with a psychologist is advisable. 

3. Binge Eating Disorder (BED): 

Binge eating disorder (BED) is a condition marked by consuming large amounts of food in a short amount of time. People are seen eating till they are uncomfortably full or eating alone to avoid embarrassment. They also feel guilty or depressed after binging. BED is sometimes called a “Stress eating disorder”. This is because high levels of stress have been associated with binging. 

Binge eating disorder is more prevalent than Anorexia Nervosa or Bulimia Nervosa. According to the DSM-5 criteria, the overeating and compensatory weight loss behaviors must be observed once a week for at least three months. BED is also associated with many medical and psychological complications. Globally, the prevalence of these eating disorders in children is 0.7%. An estimated 2.09% of BED is found in women aged 20-29 years of age. (21)

As mentioned earlier, BED presents itself with other medical conditions. Comorbid diabetes, hypertension, and obesity are often seen with BED. People suffering from BED are also at an increased risk of heart attacks.  Binge eating disorder results from a variety of social, psychological, and biological factors. These include:

1. Substance abuse
2. Family weight problems
3. Childhood obesity
4. Perfectionism
5. Body-image issues
6. Alteration in intestinal microbiome. (6)

4. Specified Feeding or Eating Disorder (SFED):

SFED is an eating disorder classification that is often placed separately from other disorders because they do not meet the diagnostic criteria of all the other eating disorders that are mentioned in this article. This might be because of the severity or frequency with which the eating disorders affect individuals. The primary criteria for classifying SFED is that a person must be present with clinically significant distress and impairment, but they do not meet the full criteria of other disorders.  For example, the Atypical Anorexia Nervosa is a part of Other specified feeding or eating disorders. Despite the weight loss, the weight of a person is within the normal range. This makes SFED stand out from other disorders. 

Having SFED might affect an individual's social, interpersonal, occupational, and physical functioning. 

5. Atypical Anorexia Nervosa (AAN):

Atypical Anorexia Nervosa falls under the category of Other Specified Feeding and Eating Disorders (OSFED). AAN has all the features of Anorexia Nervosa like intense fear of gaining weight or distorted perceptions of body weight. What differentiates AAn from Anorexia Nervosa is that people suffering from AAN, despite losing a significant amount of weight, their weight fall under the normal range. However, people with AAN are malnourished and require immediate medical attention. 

Studies have found that individuals with higher BMI who lose weight are at a greater risk of developing AAN. This is because the praise from friends and family regarding their weight loss acts as a positive reinforcement. It is difficult to know if it can be the onset of an eating disorder. 

The medical complications associated with AAN are similar to those of AN. They are:

1. Malnutrition
2. Myocardial atrophy (degeneration of heart muscles)
3. Bradycardia (lower than usual heart rate)
4. Hypothermia

A person must be urgently evaluated if there is a 75% weight loss, refusal to eat or drink in more than 24 hours, severe abdominal pain, and intractable vomiting. (8)

6. Avoidant/Restrictive Food Intake Disorder (ARFID):

ARFID eating disorder is a type of condition where people restrict the amount or type of food they eat. It was previously known as ‘selective food disorder’. This disorder primarily affects infants and children. The avoidant habit develops because of aversions to the smell, texture, or taste of certain foods. It might also develop because of low appetite or lack of interest in eating. In very rare cases, children avoid eating food altogether because of traumatic experiences while eating like choking, vomiting, or gastrointestinal issues like intestinal obstruction.(7)

While growing up, many children are picky eaters but with AFRID, the aversion to food is much more severe. If not treated, children might develop health complications like:

1. Poor growth
2. Low weight
3. Vitamin deficiencies
4. Dependence on high-energy supplements
5. Psychosocial impairments (For eg: avoiding eating at school or work) (7)

7. Pica:

Pica eating disorder in adults is characterized by compulsive eating of food materials that are generally not considered as food. The most typical food ingested is dirt, paint, paper, chalk, metal, charcoal, clay, etc.  

Although pica can occur at any age, most commonly, the onset is traced back to childhood. Putting random objects in the mouth is a common habit of many children and hence diagnosing Pica at a young age can be tricky. However, as the child grows, the eating habits become more visible and diagnosis becomes easier. 

For adults, Pica can be traced back to circumstances like mental retardation, pregnancy or iron deficiency. People suffering from pica must be careful as their atypical eating behavior can lead to poisoning (consuming paint)  or blockages (if solids are consumed). (9)

Causes, Risk Factors, and Treatment

What Causes Eating Disorders?

A lot of research has been carried out to understand the exact cause of the development of eating disorders. However, despite extensive research, the definite nature of the cause of eating disorders has not been fully understood. 

Risk factors play an important role in the development of eating disorders. Currently, researchers have found multiple genetic, psychological, biological, and social factors that are at play here. Research shows that a combination of these risk factors might lead to the manifestation of eating disorders. 

Risk Factors for Eating Disorders:

As mentioned above, risk factors may affect independently or work in combination to develop an eating disorder. The following factors increase the risk of developing the disorders:

Biological factors:

Studies show that there is a link between genetics and the development of eating disorders. Eating disorders are most likely to develop when there is a history of parents or siblings sharing the same condition. Researchers have found specific locations on genes that play a crucial role in developing Anorexia Nervosa in females. The heritability of Bulimia Nervosa, Binge Eating disorder, and SFED have also been studied widely. (10) Studies have revealed that the heritability of Anorexia Nervosa ranges from 0.28% to 0.74%. Heritability of Bulimia Nervosa is found to be 0.60% where it is 0.39%  to 0.45% Binge Eating Disorder. 

Neurobiology:

Serotonin plays a role in appetite as well as mood regulation. Studies have shown that altered levels of serotonin are associated with severe drops in mood and distorted images of one’s body. It indirectly affects personality and develops symptoms that are prominent in patients with eating disorders. However, it is a cycle. Starvation also alters the activity of serotonin and dopamine in the body, thus affecting the functioning of the body severely. It also leads to the development of comorbid anxiety and depression. (11)

Psychological factors:

How well does a person perceive his/her body affects their mindset. Among people with eating disorders, low self-esteem, and body dissatisfaction is common. In fact, the degree of body dissatisfaction determines the severity of the disorder. Apart from that, personality traits are also crucial for knowing the root cause. Impulsivity, stress reactivity, novelty seeking, perfectionism, harm avoidance, and other personality traits are common in patients with eating disorders.  (20)

Interpersonal  factors:

Experiencing trauma in childhood can also affect the way a person develops their relationship with food. Interpersonal factors that might pose as a risk factor are:

1. Troubled family relationships 
2. Bullied in Childhood
3. History of physical or sexual abuse

Social media:

Social media plays a crucial role in influencing people’s mindsets. It is no secret that people display their best lives on social media, even when the reality is far different from it. With the surge in usage of social media, many young children and adolescents have been influenced to attain unrealistic and impossible beauty/ body standards. Men are expected to have bulky or lean bodies while women are expected to achieve the “Size zero” figure. A study found that 52% of girls and 45% of boys have been observed to skip their meals to achieve their dream body. (12)

Do I Have an Eating Disorder? 

How do I know if I have an eating disorder? 

If you are wondering if you may have an eating disorder, you must first know about the typical behaviours that people with eating disorders display. There may be drastic changes in eating behaviours and more importantly, the actions are recurrent. A person might want to lose weight but with an eating disorder, they might do so with some unhealthy practices. 

The answer to how to know if you have an eating disorder lies in the signs and symptoms mentioned below:

Warning Signs and Symptoms:

Signs and symptoms of eating disorders might vary by the type of eating disorder and also by the severity of the disorder. The most typical signs and symptoms are:

• Reducing the amount of food intake drastically
• Intense fear of gaining weight
• Denial about the seriousness of low body weight
• Distorted body image
• Acid reflux disorder
• Repeatedly purging all the food consumed
• Consuming more than usual food in less amount of time
• Eating until you are uncomfortably full

Please note that to get a definitive diagnosis of an eating disorder, it is advisable to visit a medical or mental health professional.

Eating Disorders Across Genders

How Eating Disorders Affect Females Differently Than Males:

It is found that eating disorders are more common in females as compared to males. 

Studies show that women are thought to be more dissatisfied with the way they look. One possible reason might be the societal pressures imposed on women since childhood. Thinness is generally associated with attractiveness which compels women to achieve the “perfect body” that is often unrealistic.  According to a report released by the National Institute of Mental Health, the incidence of Bulimia Nervosa and Binge eating disorder is higher in females at 47.0% and 50.8% respectively. 

How Eating Disorders Affect Males Differently Than Females:

While the prevalence of eating disorders is higher in females it must be noted that males are also affected by eating disorders. 

Despite the popular notion that eating disorders affect women more, about one in three people suffering from an eating disorder are males. (18) However, men are less likely to seek help due to the stigma and gender bias around eating disorders only affecting only women.

According to societal standards, the ideal male body type is supposed to be “lean and muscular”. Masculinity is associated with these standards and so is the drive to achieve these standards. Exposure to unrealistic media images might also add to body dissatisfaction. Men are often found to indulge in binge eating habits to bulk up. This might lead to the onset of binge eating disorders. Body dysmorphia is also common in men, which may contribute to the development of Anorexia Nervosa and Bulimia Nervosa. 

Eating Disorders Across Age Groups

Eating Disorders in Children (Age 6-12):

The most common types of eating disorders found in children from age 6-12 are Avoidant/ Restrictive Food Intake Disorder  (AFRID) and Pica. Eating disorders in children are growing exponentially so it is important for parents to keep an eye on the signs. 

Specific Signs and Symptoms:

The signs in children are usually subtle since they do not exhibit extreme behaviours. Parents must keep a check on the following signs:

• Excessive bowel movements
• Worrying about body image
• Aversion to tastes or textures
• Fear of gaining weight
• Stunted growth Lack of growth
• Constipation
• Refraining from eating

Potential Causes and Risk Factors:

Researchers do not know the exact cause of the disorder but they have found evidence linking heritability and the disorder. Eating disorders are heritable and if a parent, sibling or relative is suffering from the disorder, there is a likelihood of the child developing the disorder as well. Apart from that, children diagnosed with medical illnesses or other mental health disorders like Obsessive-compulsive disorder, anxiety, and anger issues are also at a higher risk of developing the disorder. 

Treatment Approaches:

Restoring optimal weight is extremely important for eating disorders in children. Treating children might include behavioural  interventions that would slowly expose them to the foods that they avoid, thus forming a healthy relationship with food. A child pediatrician might be able to provide the necessary information while nutritionists can guide parents on providing their children with the right kind of food. A psychologist can help to gain healthy eating behaviour by challenging the distorted thoughts that lead to unhealthy eating practices

Eating Disorders in Teenagers (Age 13-19): 

Eating disorders in teenagers are one of the most common problems encountered by doctors. Weight obsession affects millions of teenagers and takes a toll on their physical and mental well-being. 

Increased Vulnerability due to social and developmental pressures:

Heavily influenced by social media and societal pressures, teenagers feel that they have to look a certain way to be appreciated. Majority of teens are dissatisfied with their bodies and want to change quickly so that they look “thin” or “fit”. 

Specific Types of eating disorders more common in teenagers:

Anorexia Nervosa and Bulimia Nervosa are common eating disorders found in teenagers. Usually, kids hide the signs from their caregivers. However,  Binge eating disorder is the most prevalent eating disorder found in teens. Due to psychological, biological, or socio-cultural reasons, teenagers indulge in binge eating. Unlike Anorexia and Bulimia, after eating, they do not take any measures like exercising or purging food.   

Treatment Considerations for teenagers with eating disorders:

Recovery is simpler if the disorder is diagnosed early. It is to be noted that the majority of eating disorders in teens are often accompanied by mental health disorders like depression, anxiety disorder, and substance use disorders. 

Generally, a combination of psychotherapy, medications (if necessary), and nutrition counseling is followed. Some teens might require extra medical care to stabilize the complications that may occur because of starvation. Aftercare is equally important for ensuring that teens do not follow the same patterns again. 

Eating Disorders in Adults (Age 20 and Above):

How Eating Disorders May Present Differently in adults:

Though eating disorders can occur at any age, they manifest differently in adults. Eating disorders in adults may occur due to life stressors such as workplace stress, personal relationships, financial stress, etc. 

Potential Impact on relationships, work, and overall well-being:

Eating disorders are often accompanied by changes in the mood like feeling sad, depressed, or alone. If left untreated, the effects of the disorder might intensify and potentially impact relationships, work, and the overall well-being of a person. These comorbidities become critical but complex to treat. 

Treatment Options for adults with eating disorders:

Treatment for eating disorders in adults is quite similar to those in adolescents and children. However, adults might require a more intensive form of therapy due to the complexities associated with it. Patients are at a risk of developing psychiatric disorders like anxiety, depression, and Borderline Personality disorder, as well as medical conditions including cardiac, metabolic, reproductive, and gastrointestinal issues. (19) Cognitive Behavioral Therapy (CBT), Interpersonal Therapy, Family-based Treatment, Dialectal Behavioral Therapy (DBT), and Acceptance and commitment therapy (ACT) have been introduced in clinical settings. 

Eating Disorder Treatment (eating disorder treatment, eating disorder psychologist)

 Importance of Early Intervention:

Eating disorders can be detrimental to an individual's health if not diagnosed early. This is because people with eating disorders are at a higher risk of medical complications and having suicidal tendencies. Early intervention can block the physiological and psychological effects it has on an individual and prevent the disorder from getting severe. With a combination of therapies, people can reclaim their healthy lives. 

Who is involved in the treatment team? 

The initial steps towards recovery include consulting a physician who can conduct a full body check-up to understand the severity of the disorder.  However,  people will benefit more from a referral to a team of specialists such as a psychologist trained to handle people who suffer from eating disorders. 

The team also involves a nutritionist who will guide the patient to adopt healthy eating practices.

Medical professionals like cardiologists, gastroenterologists, and physicians   might also be a part of the team to treat the medical consequences that have occurred due to the eating disorder. 

Different Treatment Options for Eating Disorders: 

Psychotherapy: 

A psychologist might help the patient trace their eating patterns and guide them towards stopping or altering those behaviors effectively. Cognitive behavioral therapy (CBT) Is used frequently by psychologists in clinical settings. It focuses on thoughts, behavior, and feelings associated with the disorder. The therapist works with the patient to challenge these patterns and form a healthy relationship with food. Apart from CBT, family-based therapy and Dialectical behavioral therapy (DBT) are also used to treat eating disorders.

Medications: 

Eating disorder treatment is best effective when therapy is combined with medications. For comorbid eating disorders with conditions like anxiety and depression,  medical professionals may prescribe antidepressants or anti-psychotic medications. There is no single medication approved for AN but one may be prescribed anti-anxiety medications along with some nutritional supplements to alleviate the pain and constipation. Fluoxetine is an approved psychopharmacological medication that is currently being used to treat BN. Lisdexamfetamine has been approved to treat Binge Eating disorder. (13)

Nutrition counseling:

A trained dietician who specializes in treating eating disorders can help to develop a healthy meal plan. They can also provide tips to manage a healthy body weight with proper meal selection, preparation, and planning. 

The treatment works best when all three are combined. For some, the severity of the disorder might not be as serious. In such cases, therapy and nutrition counseling can do the job alone. 

Mental Health Effects of Eating Disorders

How Eating Disorders Affect Mental Health

Eating disorders can impact physical as well as mental health. While physical health is affected severely by multiple medical complications, a person’s mental health also degrades severely. 

Negative Impact on Mood:

The majority of eating disorders impact on the mood of a person. It is often found that people with eating disorders like Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder have low self-esteem, anxiety, and depression. Mood dysregulation in eating disorders is also common. 

Increased Risk of Co-Occurring Conditions (depression, anxiety, OCD, substance abuse):

The co-occurrence of eating disorders along with mood disorders is a common phenomenon. 55-97% of people with an eating disorder display symptoms of mood disorders like depression, anxiety, OCD and substance use.   (15) For female patients, the co-occurrence of eating disorders with Major Depressive Disorder (MDD) is 33%. (14) 

How Malnutrition Affects the Brain (explain how poor nutrition can worsen mental health symptoms)

Macro and micronutrients are important for the proper functioning of the brain. In eating disorders like AN and BN, malnourishment can affect brain activity. Poor nourishment results in brain fog and affects the overall functioning of the brain. A restricted diet or lack of nutrition can affect the neurotransmitters (chemical messengers of the brain). It affects the levels of:

• Serotonin which is responsible for the regulation of mood and happiness
• Dopamine which regulates energy and focus
• Norepinephrine is associated with energy and alertness
• Acetylcholine helps with memory
• Melatonin is known to improve sleep
• Gamma-aminobutyric acid (GABA) calms anxiety (16)

Managing and Living With Eating Disorders

How to Control Eating Disorders?

Once you have a definite diagnosis of an eating disorder, you can seek professional help and start with your treatment immediately. Therapists, nutritionists, family, and friends, all of them can come together to help you improve your lifestyle. 

Therapists can help you develop healthy coping mechanisms that can prevent you from falling into the trap of similar patterns again. With strong support from your family and friends, overcoming eating disorders can become simpler.  

When to Call a Doctor? 

In the initial stages of the disorder, one might not realize that they have an onset of ED. However, it is crucial to look out for these signs if the relationship with food starts to change. 

• Drastic changes in diet
• Always Feeling cold, dizzy, or tired
• Not getting your period
• Heart palpitations 
• Sore throat or acid reflux because of constant forceful vomiting
• Changes in mood such as being depressed or anxious
• Spending a lot of time worrying about weight
• Dramatic weight loss
• Eating when not physically hungry

Questions to Ask Your Doctor:

It is natural to have doubts regarding the type of eating disorder you might be experiencing. As much as the internet can come to your aid, it is better to ask these questions to your doctor:

• What kind of eating disorder do I have?
• What are the available treatment options?
• How long will the treatment continue?
• Is hospitalization necessary?
• Does the treatment have any side effects?
• What kind of medical complications should I be aware of?

Conclusion: 

With comprehensive treatment and unconditional support, children, teens, and adults can recover from eating disorders. 

The most simple conclusion of eating disorders is identifying and accepting that you might have an unhealthy relationship with food. By taking the help of professionals, you can start your recovery process even faster. You ca also consider joining support groups and online forums for eating disorders. If you want to gain more information about eating disorders, you can listen to the Eating Disorder Recovery Podcast by Janean Anderson or The Recovery Warrior Show with Jessica Flint. 

At Mave Health, we understand that combating a condition like eating disorder requires immense courage and a lot of support. With an exceptional team of psychologists and a health coach, we aim to provide the best possible support to the ones who are struggling. If you or somebody you know is struggling with an eating disorder, book a consultation call with our medical professionals and start your recovery journey today. 

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