Eating Disorders

Definition

Eating disorders are serious mental health conditions characterized by persistent disturbances in eating behavior and preoccupation with food, weight, or body image. These disorders severely impair an individual’s psychological and physiological wellbeing, disrupting the body's natural functioning and internal cycles.

According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), eating disorders are defined as “a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food.” In recent years, the prevalence of eating disorders has been rising, particularly among children and adolescents.

Over time, individuals with eating disorders may become obsessively focused on their next meal, caloric intake, dietary control, and exercise routines, often to the detriment of their health and daily functioning.

Types of Eating Disorders

a. Anorexia Nervosa:

Anorexia nervosa is marked by a significant reduction in body weight, driven by an intense fear of weight gain and a distorted perception of body image. Affected individuals may engage in extreme behaviors such as laxative misuse or self-induced vomiting to prevent weight gain. This disorder is often accompanied by a preoccupation with body image, resulting in social withdrawal and heightened self-consciousness. Suicide is the second leading cause of death in individuals with anorexia, and full recovery can be difficult, especially when treatment is delayed, leading to irreversible organ damage. It is more common in females; typical onset between ages 13–20, with a mean onset at 17 years.

Diagnostic Criteria:

  • Distorted perception of body shape or weight.
  • Maintaining a body weight significantly below what is considered minimally normal.
  • Persistent and excessive fear of gaining weight, even when underweight.
  • Subtypes:
    • Restricting Type: Weight loss achieved primarily through dieting, fasting, or excessive exercise, with no recurrent episodes of binge-eating or purging in the past three months.
    • Binge-Eating/Purging Type: Weight loss occurs through self-induced vomiting, or misuse of laxatives, diuretics, or enemas.

Symptoms:

  • Purging behaviors
  • Avoidance of eating in social settings
  • Preparing food for others without eating
  • Excessive exercise
  • Rigid control over food habits
  • Social withdrawal
  • Fatigue, disturbed sleep
  • Amenorrhea (absence of at least three consecutive menstrual cycles)

b. Bulimia Nervosa:

Bulimia nervosa involves recurrent episodes of binge eating, followed by compensatory behaviors such as purging, fasting, or excessive exercise. Unlike anorexia, individuals with bulimia typically maintain a normal or above-average body weight, making the condition harder to detect.

Bulimia is often linked more to the quantity of food consumed than to specific cravings. It is more prevalent in females, with onset generally in the early twenties. The risk of suicide is also present.

Diagnostic Criteria 

  • Repeated episodes of binge eating characterized by:
  • Lack of control during eating episode
  • Consumption of an unusually large amount of food within a 2-hour period.
  • Use of inappropriate compensatory behaviors (e.g., vomiting, laxatives).
  • Occurs at least once a week for three months.
  • Self-evaluation is unduly influenced by body shape and weight.
  • Not occurring exclusively during episodes of anorexia nervosa.

Symptoms

  • Feelings of shame or guilt about eating
  • Gastrointestinal problems
  • Fatigue
  • Excessive physical activity to avoid weight gain
  • Misjudgment of one’s body image

c. Binge Eating Disorder (BED):

Binge Eating Disorder is characterized by frequent episodes of consuming large amounts of food, often accompanied by a sense of loss of control. It is particularly common among adolescents and university students. Studies report that up to 25% of individuals with BED experience suicidal thoughts.

Diagnostic Criteria:

  • Binge eating episodes occur at least once per week for three months.
  • Episodes are not associated with anorexia or bulimia.
  • Marked distress regarding binge eating.
  • Associated with at least three of the following:
  • Eating much more rapidly than normal
  • Eating until uncomfortably full
  • Eating large amounts when not physically hungry
  • Eating alone due to embarrassment
  • Feelings of disgust, depression, or guilt afterward

Symptoms:

  • Lack of control over eating
  • Secrecy or embarrassment surrounding food
  • Larger portion sizes
  • Emotional distress related to eating habits

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

ARFID is characterized by avoidance or restriction of food intake, often due to aversions to taste, texture, or smell. It is commonly diagnosed in children and adolescents, though it may persist into adulthood. Delays in seeking treatment are not uncommon.

When co-occurring with autism spectrum disorder, ARFID is more commonly observed in males.

Diagnostic Criteria:

  • Eating disturbance associated with one or more of the following:
  • Significant nutritional deficiency
  • Dependency on supplements or feeding support
  • Marked interference with psychosocial functioning
  • Failure to achieve expected weight gain or growth
  • Not better explained by cultural norms, medical conditions, or other eating disorders.

Symptoms:

  • Weight loss or failure to gain expected weight
  • Nutritional deficiencies
  • Selective eating habits
  • Frequent stomach aches associated with eating

e. Pica:

Pica is defined as the persistent consumption of non-nutritive, non-food substances, such as chalk, paper, dirt, or stones. It most commonly occurs in childhood, but in adults, it is typically associated with intellectual disabilities or psychiatric disorders. It can also manifest during pregnancy, potentially due to nutritional deficiencies.

Diagnostic Criteria (DSM-5)

  • Persistent eating of non-food substances for at least one month.
  • Behavior is not culturally or socially sanctioned.
  • Behavior warrants clinical attention if associated with another mental disorder or developmental delay.

Symptoms:

  • Stomach discomfort or cramps
  • Tooth damage
  • Fatigue
  • Academic difficulties
  • Electrolyte imbalances

f. Rumination Disorder:

Rumination disorder involves the regurgitation of previously swallowed food, which may be re-chewed, re-swallowed, or expelled. Unlike vomiting, it is not typically associated with nausea or disgust. The behavior is often involuntary and habitual.

This condition may occur at any age, including infancy (typically between 3–12 months).

Diagnostic Criteria:

  • Recurrent regurgitation lasting at least one month.
  • Not due to a gastrointestinal condition or another eating disorder.
  • If occurring alongside another disorder, it requires separate clinical attention.

Symptoms:

  • Malnutrition
  • Digestive issues
  • Impaired social functioning
  • Tooth erosion
  • Infants may exhibit arching of the back or tilting the head during episodes

Causes of Eating Disorders

  • Genetic predisposition: A family history of eating disorders increases vulnerability.
  • Environmental and familial factors: Constant criticism about weight or eating habits can contribute to disordered eating.
  • Cultural pressure: Societal standards, particularly around thinness, can disproportionately affect women.
  • Beauty standards: Influences from Western media often glorify idealized body types.
  • Perfectionism: Many individuals with eating disorders display high levels of perfectionism and unrealistic personal standards.
  • Low self-esteem: Negative self-image makes individuals more susceptible to external pressures and media portrayals.

Treatment Options

- Inpatient Treatment:

In severe cases (especially anorexia nervosa), hospitalization may be required due to risks of organ failure or life-threatening malnutrition.

Treatment may include:

  • Medical stabilization
  • Nutritional rehabilitation
  • Supervised feeding
  • Medication (e.g., SSRIs or drugs affecting serotonin levels)
  • Intensive psychotherapy over a 2–4 month period

- Outpatient Treatment:

Suitable for less critical cases, outpatient programs typically include:

  • Regular psychotherapy sessions
  • Nutritional counseling
  • Medication management when necessary
  • Therapeutic interventions
    • Cognitive Behavioral Therapy – Enhanced (CBT-E): CBT-E is a specialized, evidence-based therapeutic approach tailored specifically for the treatment of eating disorders. 
      • CBT-E focuses on identifying and addressing the distorted thoughts and maladaptive behaviors that maintain disordered eating. 
      • The therapy helps clients challenge irrational beliefs about food, body image, and self-worth, replacing them with more adaptive and realistic perspectives. 
      • One of the defining features of CBT-E is its adaptability—it can be personalized according to the individual's symptom profile and psychological barriers, such as perfectionism, low self-esteem, or avoidance behaviors.
      • Clients are encouraged to take responsibility for their recovery by developing sustainable coping strategies and setting achievable behavioral goals.
      • CBT-E has demonstrated effectiveness across various eating disorder diagnoses and is suitable for both adolescents and adults in outpatient as well as inpatient settings.
    • Family-Based Treatment (FBT): 
      • It is also known as the Maudsley approach, is a therapeutic model particularly beneficial for children and adolescents with eating disorders. 
      • In this approach, family members, particularly parents, play a central role in restoring their child’s health by taking an active part in meal planning, monitoring food intake, and supporting the recovery process at home.
      • The therapist acts as a guide, empowering families to intervene early and consistently while fostering a sense of competence and collaboration within the family unit. 
      • Over time, the responsibility for eating is gradually handed back to the adolescent, promoting autonomy and resilience.
      • Although effective, FBT requires a high level of commitment from caregivers and may not be suitable for all families due to varying levels of availability, structure, and family dynamics.

        Conclusion: In today’s hustle culture, diet fads and peer pressure can highly influence how you perceive your eating habits and body image, often contributing to unhealthy patterns and negative self perception. Portrayals of stereotypical body images result in increased pressure to conform to these unrealistic standards. Seeking support can empower you to rebuild a healthier relationship with food and yourself.

        Related resources: If you are struggling with eating patterns that feel out of control, access these resources for help regarding eating disorders:

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