What are eating disorders?
Eating disorders are psycho-somatic diseases that can manifest themselves in various ways. A common characteristic is the marked deviation of affected individuals from the normal way of dealing with eating. The issues of food, weight and physique distort their thoughts and influence the relationship with the own body.
Depending on the type, eating disorders can cause marked under- or overweight. Even normal weight individuals can be affected. Eating behaviour is more important than body shape in recognising an eating disorder.
In most cases, eating disorders start in adolescents or early adults. They are caused by the interplay of multiple biological, psychological, and sociocultural factors. Without treatment, these disorders can lead to severe and even life-threatening concomitant symptoms.
What are the types of eating disorders?
There are four types of eating disorders. They can Occur in parallel:
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Anorexia nervosa
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Bulimia nervosa
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Binge episodes with loss of control (binge-eating-disorder)
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Psychogenic appetite loss (in the framework of other psychiatric diseases)
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Anorexia nervosa
Affected individuals have a pathologic urge to reduce their body weight. They have panic-like fear of weight gain. They starve themselves, do excessive physical exercise, constantly count calories, and use laxatives or appetite suppressants. Due to their distorted body image, they feel too fat despite being underweight, sometimes severely so. They frequently lack the insight that they are ill.
The deficiencies caused by their eating behaviour can lead to heart and, stomach problems, kidney failure, fluid retention, bone loss, impaired growth, and absence of menstruation.
Bulimia nervosa
Bulimia, or binge-purge-syndrome, is characterised by the regular occurrence of binge episodes. Affected individuals ingest large amounts of food in a brief time and lose control of themselves in the process. Given their fear of gaining weight, they then vomit what they have eaten. These vomiting episodes lead with time to physical symptoms such as dental damage, hair loss, digestive problems and heart-rhythm disorders.
Affected individuals’ self-esteem heavily depends on their physique and weight. Their weight can be normal, high, or low. They diet frequently, which can precipitate binge episodes. After such episodes, they feel shame and guilt. Bulimia occurs frequently in combination with other mental disorders.
Binge-eating attacks with loss of control (binge-eating-disorder)
This disorder is characterised by recurrent binge episodes, frequently without being hungry. Affected individuals lose control over the amount they eat and stop only when they feel unpleasantly full. In contrast to bulimia nervosa, they do not take any weight-loss measures and are thus overweight. Their overweight state predisposes them to heart and circulatory diseases, diabetes and joint problems.
People with binge-eating disorder feel bad and hate themselves after such episodes. Frequently they suffer depression and anxiety disorders, which are exacerbated by the eating disorder.
Psychogenic appetite loss
This occurs as a co-manifestation of other mental diseases (depression, anxiety disorder). In most cases, appetite loss is associated with weight loss, leading to being underweight. Nausea and globus sensation, as expressions of fear, can be associated symptoms.
How do I recognise if I have an disorder?
- My thoughts revolve constantly around eating, my physique, and my weight
- My mood and my self-esteem are totally determined by my weight
- My eating behaviour does not feel normal to me
- I have binge episodes; I starve myself; or I diet constantly
- The thought of gaining weight scares me
- I prefer to eat alone rather than in the company of others
- My weight changes rapidly
How does a medical doctor recognise if I have an eating disorder?
Affected individuals frequently keep their disease secret out of shame, or do not believe that they are ill. They consult a doctor for other complaints that occur because of the eating disorder. Such complaints include abdominal pain, lack of menstruation, or hair loss. It is also common that a medical evaluation is prompted by the concern of someone who is close to the individual.
A key part of the medical history is a comprehensive interview in which the doctor asks questions about eating behaviour, satisfaction with body and physique, sports, medicines taken and weight-loss measures. The body-mass index showing the relationship between height and weight is the next step in the work-up.
The evaluation continues with a search for physical causes for weight change, such as diabetes or thyroid disease.
Treatment success depends on your participation. It is of critical importance to admit that you are ill. This insight is difficult, especially since an eating disorder produces shame, guilt feelings, secrecy, or self-control. Use the professional help that you receive as part of your treatment to deal in a candid way with your problems, including those that are not obviously connected with the disease.
As part of the treatment, you will learn a new approach to eating. You should support this process. The path to normal eating behaviour includes eating regularly and in an alert state of mind, recognising satiety, and relishing your food. Interaction with other affected individuals is also helpful.
Relatives frequently feel helpless, even though they would like very much to help. It is important not to put the affected person under pressure. Therapeutic assistance is most effective when they are highly motivated to seek help. The best thing relatives can do is to encourage self-motivation. It is also important not to criticise or ridicule body and eating behaviour issues, and not to reduce affected individuals to only their disease.
Given that the situation is difficult for everyone involved and relatives go through their own emotional problems, it is reasonable for them too to seek professional help.
Anorexia causes the whole body to be undernourished. The intake of nutrients, electrolytes and water is insufficient. This can lead to long-term mental and physical consequences: excessively slow heartbeat, heart and kidney disorders, osteoporosis, hormonal disturbances progressing to infertility, impotence, loss of nerve cells, anaemia, loss of heart muscle and skeletal muscle, depression, isolation and anxiety disorders. Anorexia that starts at an early age can impact development: menarche does not occur and bone growth can be impaired.
As the disease progresses, the body does not function properly. A mild bacterial infection can become lethal. Anorexia nervosa has the highest case-fatality rate of all mental diseases.
Body-mass index (BMI) shows the relationship between height and weight. The normal range is between 18.5 and 24.9. Values below 18.5 indicate underweight, and values below 14.5 are life-threatening.
Even though the BMI is not the ultimate parameter of health, it is a good indicator of extremes. Severe overweight can also have life-threatening effects, albeit less acute. A BMI of more than 30 indicates severe overweight; this should be reduced.
Bulimia nervosa rarely has a single cause. In most cases it develops from the interplay of biological, psychological, familial, and/or sociocultural factors.
A biological example is genetic predisposition for an eating disorder. Familial influence refers to the attitude towards eating in the family. Examples include families in which frequent dieting occurs, or settings where excessive attention is paid to weight, physique, or appearance.
One of the psychological factors is almost always low self-esteem, which ill individuals try to offset by good looks. They frequently have a hard time dealing with feelings; depression is also frequent.
Societal influence also plays a role. Despite some opposite trends such as body positivity, mass media and social media are dominated by the beauty ideal of slimness. Affected individuals think that their urge to pursue this ideal makes them feel better.
Binge eating is a mental disorder. This makes it difficult or downright impossible for affected individuals to control it without professional help. This is because the causes are multifactorial. Examples of causative factors include familial eating behaviour, familial conflicts, low self-esteem, a high body-mass index (BMI), or depression.
Cognitive behavioural therapy (CBT) has proved effective. The goals are to normalise the eating behaviour, to strengthen self-acceptance, and to recognise the triggers for binge episodes and find ways to deal with them.
Not every change in eating behaviour reflects an eating disorder. For instance, decreased food intake can be a reaction to stress or sadness. Pathologically reduced food intake as part of anorexia is characterised by the following:
- Excessive preoccupation with the issue of eating.
- Eating behaviour displays a high level of self-control.
- Count calories incessantly and weigh themselves daily (even more than once).
- They eat slowly.
- They drink plenty of water to fill the stomach.
- They find excuses to avoid eating in the company of others or, when that is inevitable, to avoid eating (“I have eaten already”).
- Severe weight loss.
- Excessive sports activity.
- Consider themselves fat despite obvious underweight.
- Have difficulty concentrating, lose hair and have dry skin, and feel cold.
- Develop lanugo hair (new-born facial hair).