The monsters in your head
The month of March is known as Eating Disorder Awareness Month, so this article aims to shed light on eating disorders and their roots.
Elizabeth Joseph
There are more than half a dozen types of eating disorder affecting all types of people.
According to clinical psychologist Dr Anina du Toit, most eating disorders are prevalent in cultures where food is in abundance.
“A culture of abundance valuing slimness may be a background cause, but whether a person takes this valuation to a pathological extreme depends on additional factors,” says Du Toit
That would counter the misconception that eating disorders are common where there is starvation.
Categories of eating disorders
Anorexia nervosa is likely the best-known eating disorder, which generally develops during adolescence or young adulthood and tends to affect more women than men.
People with anorexia nervosa generally view themselves as overweight, even if they’re dangerously underweight. They tend to constantly monitor their weight, avoid eating certain types of foods, and severely restrict their calories.
Common symptoms of anorexia nervosa can include being considerably underweight compared with people of similar age and height, very restricted eating patterns, an intense fear of gaining weight or persistent behaviours to avoid gaining weight, despite being underweight as well as a relentless chase of thinness and unwillingness to maintain a healthy weight.
Obsessive-compulsive symptoms are also often present. For instance, many people with anorexia nervosa are often preoccupied with constant thoughts about food, and some may obsessively collect recipes or hoard food.
Anorexia nervosa is officially categorised into two subtypes — the restricting type and the binge-eating and purging type. Individuals with the restricting type lose weight solely through dieting, fasting, or excessive exercise.
“Societal disparagement of being overweight and the glorification of being underweight contributes to young women expressing dissatisfaction with their weight and shape.
“Friends and family often praise anorexic patients’ slenderness and envy the self-control and discipline required to achieve this. This reinforcement doesn’t cause the disorder, but helps perpetuate it,” Du Toit explains.
Individuals with the binge-eating and purging subtype may binge on large amounts of food or eat very little. In both cases, after they eat, they purge by vomiting, taking laxatives or diuretics, or exercising excessively.
In conjunction, people with anorexia nervosa may limit their food intake or compensate for it through various purging behaviours. They have an intense fear of gaining weight, even when severely underweight.
Another such disorder is bulimia nervosa. Similar to anorexia nervosa, bulimia tends to develop during adolescence and early adulthood and appears to be less common among men than women.
People with bulimia frequently eat unusually large amounts of food in a specific period of time. Each binge-eating episode usually continues until the person becomes painfully full. During a binge, the person usually feels that they cannot stop eating or control how much they are eating.
Binges can happen with any type of food but most commonly occur with foods the individual would normally avoid.
Individuals with bulimia then attempt to purge to compensate for the calories consumed and relieve gut discomfort.
Common purging behaviours include forced vomiting, fasting, laxatives, diuretics, enemas, and excessive exercise.
Symptoms may appear very similar to those of the binge-eating or purging subtype of anorexia nervosa. However, individuals with bulimia usually maintain a relatively normal weight, rather than becoming underweight.
Some symptoms include a self-esteem overly influenced by body shape and weight and a fear of gaining weight, despite having a normal weight.
In severe cases, bulimia can also create an imbalance in levels of electrolytes, such as sodium, potassium and calcium. This can cause a stroke or heart attack.
Binge-eating disorder
This disorder is believed to be one of the most common eating disorders. It typically begins during adolescence and early adulthood, although it can develop later on.
Individuals with this disorder have symptoms similar to those of bulimia or the binge-eating subtype of anorexia.
For instance, they typically eat unusually large amounts of food in relatively short periods of time and feel a lack of control during binges.
People with binge-eating disorder do not restrict calories or use purging behaviours, such as vomiting or excessive exercise, to compensate for their binges. Symptoms of these include eating large amounts of foods rapidly, in secret and until uncomfortably full, despite not feeling hungry, feeling a lack of control during episodes of binge eating as well as feelings of distress, such as shame, disgust, or guilt, when thinking about the binge-eating behaviour.
People with binge-eating disorder are often overweight or obese. This may increase their risk of medical complications linked to excess weight, such as heart disease, stroke and type 2 diabetes.
People with binge-eating disorder regularly and uncontrollably consume large amounts of food in short periods of time. Unlike people with other eating disorders, they do not purge.
Pica is another eating disorder that involves eating things that are not considered food.
Individuals with pica crave non-food substances, such as ice, dirt, soil, chalk, soap, paper, hair, cloth, wool, pebbles, laundry detergent, or corn starch.
Pica can occur in adults, as well as children and adolescents. That said, this disorder is most frequently observed in children, pregnant women, and individuals with mental disabilities.
Individuals with pica may be at an increased risk of poisoning, infections, gut injuries, and nutritional deficiencies. Depending on the substances ingested, pica may be fatal.
However, to be considered pica, the eating of non-food substances must not be a normal part of someone's culture or religion. In addition, it must not be considered a socially acceptable practice by a person's peers.
Individuals with pica tend to crave and eat non-food substances. This disorder may particularly affect children, pregnant women, and individuals with mental disabilities.
Rumination disorder is a newly recognised eating disorder. It describes a condition in which a person regurgitates food they have previously chewed and swallowed, re-chews it, and then either re-swallows it or spits it out.
This rumination typically occurs within the first 30 minutes after a meal. Unlike medical conditions like reflux, it’s voluntary.
This disorder can develop during infancy, childhood, or adulthood. In infants, it tends to develop between 3 and 12 months of age and often disappears on its own. Children and adults with the condition usually require therapy to resolve it.
If not resolved in infants, rumination disorder can result in weight loss and severe malnutrition that can be fatal.
Adults with this disorder may restrict the amount of food they eat, especially in public. This may lead them to lose weight and become underweight.
Rumination disorder can affect people at all stages of life. People with the condition generally regurgitate the food they've recently swallowed. Then, they chew it again and either swallow it or spit it out.
Avoidant/restrictive food intake disorder (ARFID) is a new name for an old disorder.
The term replaces what was known as a "feeding disorder of infancy and early childhood," a diagnosis previously reserved for children under seven years old.
Although ARFID generally develops during infancy or early childhood, it can persist into adulthood. What's more, it’s equally common among men and women.
Individuals with this disorder experience disturbed eating either due to a lack of interest in eating or distaste for certain smells, tastes, colours, textures, or temperatures.
Common symptoms of ARFID include avoidance or restriction of food intake that prevents the person from eating sufficient calories or nutrients, eating habits that interfere with normal social functions, such as eating with others and weight loss or poor development for age and height.
It's important to note that ARFID goes beyond normal behaviours, such as picky eating in toddlers or lower food intake in older adults.
Moreover, it does not include the avoidance or restriction of foods due to lack of availability or religious or cultural practices.
ARFID is an eating disorder that causes people to under-eat. This is either due to a lack of interest in food or an intense distaste for how certain foods look, smell, or taste.
In addition to the six eating disorders above, less known or less common eating disorders also exist. These generally fall under one of three categories.
Purging disorder.
Individuals with purging disorder often use purging activities, such as vomiting, laxatives, diuretics, or excessive exercising, to control their weight or shape. However, they do not binge.
Night eating syndrome.
Individuals with this syndrome frequently eat excessively, often after awakening from sleep.
Other specified feeding or eating disorder (OSFED). While not found in the DSM-5, this includes any other conditions that have symptoms similar to those of an eating disorder but don’t fit into any of the categories above.
One disorder that may currently fall under OSFED is orthorexia. Although increasingly mentioned in the media and scientific studies, orthorexia has yet to be recognised as a separate eating disorder by the current DSM.
Individuals with orthorexia tend to have an obsessive focus on healthy eating, to an extent that disrupts their daily lives.
For instance, the affected person may eliminate entire food groups, fearing they’re unhealthy. This can lead to malnutrition, severe weight loss, difficulty eating outside the home, and emotional distress.
Individuals with orthorexia rarely focus on losing weight. Instead, their self-worth, identity, or satisfaction is dependent upon how well they comply with their self-imposed diet rules.
Purging disorder and night-eating syndrome are two additional eating disorders that are currently not well described. The OSFED category includes all eating disorders, such as orthorexia, that don’t fit into another category.
The categories above are meant to provide a better understanding of the most common eating disorders and dismiss myths about them.
Eating disorders are mental health conditions that usually require treatment. They can also be damaging to the body if left untreated.
There are more than half a dozen types of eating disorder affecting all types of people.
According to clinical psychologist Dr Anina du Toit, most eating disorders are prevalent in cultures where food is in abundance.
“A culture of abundance valuing slimness may be a background cause, but whether a person takes this valuation to a pathological extreme depends on additional factors,” says Du Toit
That would counter the misconception that eating disorders are common where there is starvation.
Categories of eating disorders
Anorexia nervosa is likely the best-known eating disorder, which generally develops during adolescence or young adulthood and tends to affect more women than men.
People with anorexia nervosa generally view themselves as overweight, even if they’re dangerously underweight. They tend to constantly monitor their weight, avoid eating certain types of foods, and severely restrict their calories.
Common symptoms of anorexia nervosa can include being considerably underweight compared with people of similar age and height, very restricted eating patterns, an intense fear of gaining weight or persistent behaviours to avoid gaining weight, despite being underweight as well as a relentless chase of thinness and unwillingness to maintain a healthy weight.
Obsessive-compulsive symptoms are also often present. For instance, many people with anorexia nervosa are often preoccupied with constant thoughts about food, and some may obsessively collect recipes or hoard food.
Anorexia nervosa is officially categorised into two subtypes — the restricting type and the binge-eating and purging type. Individuals with the restricting type lose weight solely through dieting, fasting, or excessive exercise.
“Societal disparagement of being overweight and the glorification of being underweight contributes to young women expressing dissatisfaction with their weight and shape.
“Friends and family often praise anorexic patients’ slenderness and envy the self-control and discipline required to achieve this. This reinforcement doesn’t cause the disorder, but helps perpetuate it,” Du Toit explains.
Individuals with the binge-eating and purging subtype may binge on large amounts of food or eat very little. In both cases, after they eat, they purge by vomiting, taking laxatives or diuretics, or exercising excessively.
In conjunction, people with anorexia nervosa may limit their food intake or compensate for it through various purging behaviours. They have an intense fear of gaining weight, even when severely underweight.
Another such disorder is bulimia nervosa. Similar to anorexia nervosa, bulimia tends to develop during adolescence and early adulthood and appears to be less common among men than women.
People with bulimia frequently eat unusually large amounts of food in a specific period of time. Each binge-eating episode usually continues until the person becomes painfully full. During a binge, the person usually feels that they cannot stop eating or control how much they are eating.
Binges can happen with any type of food but most commonly occur with foods the individual would normally avoid.
Individuals with bulimia then attempt to purge to compensate for the calories consumed and relieve gut discomfort.
Common purging behaviours include forced vomiting, fasting, laxatives, diuretics, enemas, and excessive exercise.
Symptoms may appear very similar to those of the binge-eating or purging subtype of anorexia nervosa. However, individuals with bulimia usually maintain a relatively normal weight, rather than becoming underweight.
Some symptoms include a self-esteem overly influenced by body shape and weight and a fear of gaining weight, despite having a normal weight.
In severe cases, bulimia can also create an imbalance in levels of electrolytes, such as sodium, potassium and calcium. This can cause a stroke or heart attack.
Binge-eating disorder
This disorder is believed to be one of the most common eating disorders. It typically begins during adolescence and early adulthood, although it can develop later on.
Individuals with this disorder have symptoms similar to those of bulimia or the binge-eating subtype of anorexia.
For instance, they typically eat unusually large amounts of food in relatively short periods of time and feel a lack of control during binges.
People with binge-eating disorder do not restrict calories or use purging behaviours, such as vomiting or excessive exercise, to compensate for their binges. Symptoms of these include eating large amounts of foods rapidly, in secret and until uncomfortably full, despite not feeling hungry, feeling a lack of control during episodes of binge eating as well as feelings of distress, such as shame, disgust, or guilt, when thinking about the binge-eating behaviour.
People with binge-eating disorder are often overweight or obese. This may increase their risk of medical complications linked to excess weight, such as heart disease, stroke and type 2 diabetes.
People with binge-eating disorder regularly and uncontrollably consume large amounts of food in short periods of time. Unlike people with other eating disorders, they do not purge.
Pica is another eating disorder that involves eating things that are not considered food.
Individuals with pica crave non-food substances, such as ice, dirt, soil, chalk, soap, paper, hair, cloth, wool, pebbles, laundry detergent, or corn starch.
Pica can occur in adults, as well as children and adolescents. That said, this disorder is most frequently observed in children, pregnant women, and individuals with mental disabilities.
Individuals with pica may be at an increased risk of poisoning, infections, gut injuries, and nutritional deficiencies. Depending on the substances ingested, pica may be fatal.
However, to be considered pica, the eating of non-food substances must not be a normal part of someone's culture or religion. In addition, it must not be considered a socially acceptable practice by a person's peers.
Individuals with pica tend to crave and eat non-food substances. This disorder may particularly affect children, pregnant women, and individuals with mental disabilities.
Rumination disorder is a newly recognised eating disorder. It describes a condition in which a person regurgitates food they have previously chewed and swallowed, re-chews it, and then either re-swallows it or spits it out.
This rumination typically occurs within the first 30 minutes after a meal. Unlike medical conditions like reflux, it’s voluntary.
This disorder can develop during infancy, childhood, or adulthood. In infants, it tends to develop between 3 and 12 months of age and often disappears on its own. Children and adults with the condition usually require therapy to resolve it.
If not resolved in infants, rumination disorder can result in weight loss and severe malnutrition that can be fatal.
Adults with this disorder may restrict the amount of food they eat, especially in public. This may lead them to lose weight and become underweight.
Rumination disorder can affect people at all stages of life. People with the condition generally regurgitate the food they've recently swallowed. Then, they chew it again and either swallow it or spit it out.
Avoidant/restrictive food intake disorder (ARFID) is a new name for an old disorder.
The term replaces what was known as a "feeding disorder of infancy and early childhood," a diagnosis previously reserved for children under seven years old.
Although ARFID generally develops during infancy or early childhood, it can persist into adulthood. What's more, it’s equally common among men and women.
Individuals with this disorder experience disturbed eating either due to a lack of interest in eating or distaste for certain smells, tastes, colours, textures, or temperatures.
Common symptoms of ARFID include avoidance or restriction of food intake that prevents the person from eating sufficient calories or nutrients, eating habits that interfere with normal social functions, such as eating with others and weight loss or poor development for age and height.
It's important to note that ARFID goes beyond normal behaviours, such as picky eating in toddlers or lower food intake in older adults.
Moreover, it does not include the avoidance or restriction of foods due to lack of availability or religious or cultural practices.
ARFID is an eating disorder that causes people to under-eat. This is either due to a lack of interest in food or an intense distaste for how certain foods look, smell, or taste.
In addition to the six eating disorders above, less known or less common eating disorders also exist. These generally fall under one of three categories.
Purging disorder.
Individuals with purging disorder often use purging activities, such as vomiting, laxatives, diuretics, or excessive exercising, to control their weight or shape. However, they do not binge.
Night eating syndrome.
Individuals with this syndrome frequently eat excessively, often after awakening from sleep.
Other specified feeding or eating disorder (OSFED). While not found in the DSM-5, this includes any other conditions that have symptoms similar to those of an eating disorder but don’t fit into any of the categories above.
One disorder that may currently fall under OSFED is orthorexia. Although increasingly mentioned in the media and scientific studies, orthorexia has yet to be recognised as a separate eating disorder by the current DSM.
Individuals with orthorexia tend to have an obsessive focus on healthy eating, to an extent that disrupts their daily lives.
For instance, the affected person may eliminate entire food groups, fearing they’re unhealthy. This can lead to malnutrition, severe weight loss, difficulty eating outside the home, and emotional distress.
Individuals with orthorexia rarely focus on losing weight. Instead, their self-worth, identity, or satisfaction is dependent upon how well they comply with their self-imposed diet rules.
Purging disorder and night-eating syndrome are two additional eating disorders that are currently not well described. The OSFED category includes all eating disorders, such as orthorexia, that don’t fit into another category.
The categories above are meant to provide a better understanding of the most common eating disorders and dismiss myths about them.
Eating disorders are mental health conditions that usually require treatment. They can also be damaging to the body if left untreated.
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