Eating Disorders

According to the American Psychiatric Association (APA) (2023), eating disorders are mental health conditions marked by severe and persistent disturbances in eating behaviours, associated thoughts, and emotions. Eating disorders can have detrimental impacts on physical, mental, emotional, and social wellbeing.

Eating disorders are often associated with intense food and weight preoccupations, restrictive eating, binge eating, purging behaviours such as self-induced vomiting, laxative and diuretic use, and/or compulsive exercise. These symptoms can vary in occurrence and severity, as eating disorders can present differently for everyone (American Psychiatric Association [APA], 2013). Additionally, because eating disorders are still largely stigmatized, some people may feel ashamed and go to great lengths to hide their symptoms, making it challenging to recognize warning signs (Rose et al., 2022). Understanding the clusters of symptoms that characterize an eating disorder can make identifying them easier.

The causes of an eating disorder are complex and multifaceted. There is no single cause; rather, eating disorders result from a combination of biological, psychological, and sociocultural factors. For individuals with a genetic predisposition, exposure to certain social pressures such as appearance standards, family influences, discrimination, or concurrent mental health challenges can trigger symptoms (Galmiche et al., 2019; Tagay et al., 2014).

Disordered Eating

Disordered eating refers to a range of distressing thoughts, attitudes, and behaviours related to food, eating, body image, and physical activity. This can include preoccupation with food, body weight or shape, dieting, eliminating certain foods or food groups, mealtime anxiety, and rigid eating attitudes or behaviours (Pereira & Alvarenga, 2007). It is not uncommon for a person to experience periods of disordered eating throughout their lives, especially during key stressful life events such entering the first year of post-secondary education, prepping for exam season, the loss of a loved one, or global events such as the COVID-19 pandemic (Simone et al., 2021). It is important to remember that individuals with an eating disorder may engage in disordered eating, but not everyone that experiences disordered eating has an eating disorder.

Although eating disorders and disordered eating both involve food and body-related distress, they are distinct. While disordered eating can vary in severity and does not meet the criteria for a clinical eating disorder as outlined in the DSM-5, it can still pose a significant risk to an individual’s health and wellbeing and should be taken seriously. Moreover, disordered eating and dieting are significant risk factors for future development of an eating disorder. Early intervention and support at this stage are crucial for prevention of eating disorders (National Eating Disorders Collaboration [NEDC], 2021).

Risk Factors

There’s no single cause of eating disorders, but some people are more likely than others to experience them. Personal risk factors include:

· Feelings of low self-esteem or self-worth

· Feeling a general lack of control, feeling powerless

· Difficult family or romantic relationships

· A history of abuse or trauma.

· Social media & diet/ fitness culture

· Weight stigma

· Food/ financial insecurity

· Big life transitions

Types of Eating Disorders (NEDIC, 2021b):

Type Description

Anorexia Nervosa (AN) Restrictive eating behaviours driven by an intense fear of gaining weight or being fat that interfere with maintaining one’s biologically-appropriate body weight. People with AN may experience disturbances in how they experience their weight and shape, or difficulties recognizing the seriousness of their condition.

Bulimia Nervosa (BN) Characterized by recurring episodes of binge-eating (consumption of an unusually large quantity of food in a relatively short period of time, in a way that feels out of control) followed by behaviours intended to get rid of the food consumed or compensate for food eaten to prevent weight gain. Common compensatory behaviours include self-induced vomiting, laxative use, intense exercise, and/or food restriction. Note that people with BN are often not significantly underweight.

Binge Eating Disorder

(BED) Recurrent episodes of binge eating accompanied by marked distress and not associated with the use of compensatory behaviours.

Avoidant Restrictive Food Intake Disorder

(ARFID) Presentations include avoidance of foods with certain characteristics (flavours, textures, or colours), and fear of eating following a highly distressing experience involving food (such as becoming physically ill after eating). A key distinction between AN and ARFID is that individuals with ARFID do not overvalue body weight or shape or experience significant body image disturbances.

Otherwise Specified Feeding or Eating Disorder (OSFED -previously called EDNOS)

EDs in this category are characterized by behavioural patterns that do not fit the criteria for AN, BN, or BED, but still compromise health and functioning (i.e., atypical anorexia, purging disorder, night eating syndrome, etc.).

Orthorexia

“A pathological obsession with proper nutrition that is characterized by a restrictive diet, ritualized patterns of eating, and rigid avoidance of foods believed to be unhealthy or impure. Although prompted by a desire to achieve optimum health, orthorexia may lead to nutritional deficiencies, medical complications, and poor quality of life.” (Koven & Abry, 2015, p. 385)

Diabulimia

A disordered pattern of behaviour in an individual with diabetes, typically type I diabetes, wherein they purposefully restrict the insulin that they need to keep their blood sugar levels within a healthy range in order to lose weight.

What types of help are available?

As mental illnesses with physical manifestations, eating disorders need to be treated with consideration of both the mental and physical health impacts. Best practices include conducting a holistic assessment of the mental and physical health concerns that an affected individual is experiencing. Treatment of the mental health aspects may include psychoeducation, cognitive behavioural therapy, and pharmacotherapy (CAMH, n.d.). Treating one side without the other will yield less successful results (NIMH, 2024).

References

American Psychiatric Association (APA). (2013). Feeding and eating disorders. https://doi.org/10.1176/appi.books.9780890425787.x10_Feeding_and_Eating_Disorder

American Psychiatric Association (APA). (2023, February). What are Eating Disorders? https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders#section_8

Centre for Addictions and Mental Health (CAMH). (n.d.). Eating Disorders. https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/eating-disorders

Galmiche, M., Déchelotte, P., Lambert, G., & Tavolacci, M. P. (2019). Prevalence of eating disorders over the 2000–2018 period: A systematic literature review. The American Journal of Clinical Nutrition, 109(5), 1402–1413. https://doi.org/10.1093/ajcn/nqy342

Koven, N. & Abry, A. (2015). The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatric Disease and Treatment, 2015(1), 385-394. https://doi.org/10.2147/NDT.S61665

National Eating Disorders Collaboration (NEDC). (2021, May). Disordered eating and dieting. https://nedc.com.au/eating-disorders/eating-disorders-explained/disordered-eating-and-dieting

National Eating Disorder Information Centre (NEDIC). (2021b). Types of eating disorders. https://nedic.ca/eating-disorders-treatment/

National Institute of Mental Health (NIMH). (2024). Eating Disorders: What You Need to Know. https://www.nimh.nih.gov/health/publications/eating-disorders

Pereira, R. F., & Alvarenga, M. (2007). Disordered eating: Identifying, treating, preventing, and differentiating it from eating disorders. Diabetes Spectrum, 20(3), 141–148. https://doi.org/10.2337/diaspect.20.3.141

Rose, K. L., Negrete, C. E., Sellinger, G., Chang, T., & Sonneville, K. R. (2022). Adolescent and emerging adult perceptions of eating disorder severity and stigma. International Journal of Eating Disorders, 55(10), 1296-1304. https://doi.org/10.1002/eat.23772

Simone, M., Emery, R. L., Hazzard, V. M., Eisenberg, M. E., Larson, N., & Neumark-Sztainer, D. (2021). Disordered eating in a population-based sample of young adults during the COVID-19 outbreak. International Journal of Eating Disorders, 54(7), 1189-1201, https://doi.org/10.1002/eat.23505

Tagay, S., Schlottbohm, E., Reyes-Rodriguez, M. L., Repic, N., & Senf, W. (2014). Eating disorders, trauma, PTSD, and psychosocial resources. Eating Disorders, 22(1), 33-49. https://doi.org/10.1080/10640266.2014.857517

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