Eating Disorders Identified by Damaging Eating Patterns

Eating disorders (EDs) are serious mental problems that are identified by damaging eating patterns. These types of disorders are relatively new; however, they appear with a troubling frequency, while also having a high mortality rate. In recent years eating disorders have progressively become the focal point of several studies because of the prevalence of EDs.

According to Herpertz-Dahlmann (2015), “most eating disorders imply a deep dissatisfaction with the subject’s own body and shape: everyday life is often unduly preoccupied with eating and weight-control practices” (p. 177). There are several types of eating disorders, which include anorexia nervosa, bulimia nervosa, and binge eating disorder (Bello & Yeomans, 2018). The aim of this paper is to describe the symptoms and causes of some eating disorders, as well as to research treatment methods.

Anorexia Nervosa

Anorexia nervosa (AN) is one of the most frequent disorders that increase the mortality rate. It can affect individuals of all ages, genders, sexual orientations, races, and ethnic origins; however, young females are particularly at risk. Zipfel (2015) characterizes this disorder by “an intense fear of weight gain and a disturbed body image, which motivates severe dietary restriction or other weight loss behaviors such as purging or excessive physical activity” (p. 1099). Anorexia nervosa (AN) is among the most difficult eating disorders when it comes to studying and treating it. The main reason for this is its high mortality rate because patients often do not see the problem with their health until it is too late, and even then, they may lack the motivation to change.

Among AN patients, their wish for a thin body and intense fear of gaining weight causes them to become involved in food-restricting activities. The most popular one is limiting their calorie intake. That type of AN is called anorexia of the restrictive type (ANR). Nevertheless, even after weight loss, patients with anorexia do not stop this destructive behavior. The reason for this is patients’ distorted body image as they still see themselves as fat.

Moreover, anorexia patients often refuse to acknowledge their problems, which leads to late diagnosis and sometimes terrible consequences. It is also worth mentioning that anorexia patients are resistant to treatment, believing it would ruin their efforts to lose weight. Furthermore, along with this psychiatric disorder, patients also demonstrate other types of cognitive dysfunction. They include cognitive inflexibility, inability to make healthy decisions, as well as a twisted sense of self-awareness.

Bulimia Nervosa

BN is another eating disorder that is defined by repeated episodes of binge eating. According to Yilmaz, Hardaway, and Bulik, C. M. (2015), “patients with BN engage in consuming an uncommonly large amount of food in a short period of time” (p. 131). During these brief periods, patients cannot restrain themselves, as if they want to, but cannot stop over-eating or control how much they consume. However, after an episode of binge eating, patients engage in purging behavior. Usually, the purging is done by self-induced vomiting or laxative abuse. Bulimia patients, similarly to anorexia patients, are also concerned with a wish for a thin body, but because of their inability to control themselves, they continue the cycle of binge eating, purging, and exercise.

Such unhealthy practices lead to serious complications which involve not only issues with body weight, but a number of other illnesses. For example, some of the consequences of excessive self-induced vomiting include persistent gastric acid reflux resulting in dysphagia (difficulty in swallowing) and dyspepsia (impaired digestion). Such conditions require immediate clinical attention. Moreover, an abrupt and severe loss of body weight may lead to the resumption of menses.

According to several researchers, patients with bulimia disorder “frequently report postprandial fullness, abdominal distension, gastric distension, early satiety, and nausea” (Sato & Fukudo, 2015, p. 258). The abuse of laxatives, which is common among bulimia patients, can cause chronic watery diarrhea, followed by dehydration. Therefore, due to the severity of medical complications, BN patients require prompt and intensive treatment.

Binge Eating Disorder

Binge Eating Disorder (BED) is identified by repeated episodes of eating extremely large amounts of food while feeling guilty about lack of self-control. That feeling is followed by great stress: however, unlike cases of bulimia nervosa, the patient does not engage in purging behavior. Extreme weight loss practices, such as self-induced vomiting, the abuse of laxatives, or extreme physical exercise, do not appear in the activities of patients with BED. They also do not restrict their food intake, unlike patients with anorexia. Nevertheless, this type of disorder is equally dangerous because it is deeply connected with obesity. As any other type of eating disorder, it occurs in younger years due to poor education on healthy eating habits. Moreover, patients with BED often demonstrate symptoms of other major mental disorders, like anxiety and depression.

Causes

While studying the main demographic of anorexia in Europe, Keski-Rahkonen and Mustelin (2016) conducted research. According to the results, anorexia nervosa is present among about 1–4% of the European population, while about 1–2% of people suffer from bulimia nervosa. At the same time, around 1–4% of the population have binge eating disorder, regarding the gender demographic, 2–3% of women in Europe experience different eating disorders. Moreover, “over 70% of individuals with eating disorders report comorbid disorders: anxiety disorders (>50%), mood disorders (>40%), self-harm (>20%), and substance use (>10%) are common” (Keski-Rahkonen & Mustelin, 2016, p. 343).

The dissatisfaction with bodyweight has been generally determined as a crucial factor of influence for the development of EDs. Patients who want to change their weight are more likely to participate in distorted eating habits such as food restriction, binge eating, and purging. They falsely believe that these practices will help them to achieve their ideal body. Perfectionism can also be a supporting reason for damaging habits since it encourages eating less, bingeing, and vomiting. In addition, a combination of these factors increases symptoms of ED, especially when ED is combined with other psychiatric problems, such as depression and low self-esteem.

Furthermore, many social and cultural elements have an impact on the development of eating disorders. For instance, parents may involuntarily promote unhealthy eating with their own body dissatisfaction. They also can forcefully impose dieting behaviors on their children. Such reasons as parental negative comments relating to weight and body shape, as well as forcing children to excessively diet and exercise, also lead to displeasure with bodyweight.

In the last few years, several studies have confirmed that genetics also contribute to the development of EDs. For example, research by Salafia et al. (2015) confirmed that “genetic contributions to the development of eating disorders have been suggested by twin studies, with heritability estimates ranging from 0.39 to 0.74, depending on the disorder” (p. 34). However, in order to determine common and different features between people without eating disorders and patients with EDs, it is crucial to study personal narratives. It should also be done while selecting treatment for the most successful outcomes.

Treatment

Medical doctors should be invested in the controlling and treating patients with eating disorders. Moreover, such types of disorders usually require the help of a specialist with knowledge in psychiatry, usually psychotherapist or psychiatrist. Moreover, a qualified dietitian can also help in getting back to healthy eating habits by selecting a diet with nutritious food. The success of treatment relies on productive communication between the patient and doctors.

In addition, in order to ensure the effectiveness of treatment, the family of a patient should be involved, too. The doctor should select treatment according to several important factors. They include the severity of symptoms, the mental state of a patient, and the availability of psychological support. A patient’s motivation for going through treatment is also a vital factor, as well as the accessibility of specialized programs.

The main goal of treatment for patients who have anorexia or bulimia is returning to healthy nutritional habits. In this case, the weight gaining plays the role of surrogate marker. In severe cases of malnutrition, feeding tubes may be needed. They are commonly used forcefully when the patient refuses to eat. Moreover, for recovering of a seriously underfed patient, a doctor should consider hospitalization. Under the surveillance of nurses and doctors, key factors such as weight, hydration, and mental state will be constantly monitored, and in cases of relapse, measures can be immediately taken.

Pharmacological Treatment

As it was mentioned earlier, eating disorders are often accompanied by other mental conditions. For this reason, the pharmacological treatment of EDs may include antidepressants. For example, selective serotonin reuptake inhibitors (SSRIs) are the most thoroughly studied medication for treating binge eating disorder (McElroy et al., 2015). McElroy et al. conducted a research on the effects of several types of medications. According to their results, fluoxetine demonstrated successful outcomes in treating bulimia nervosa. Moreover, additional investigations on SSRIs and serotonin-norepinephrine reuptake inhibitors proved their efficiency in reducing the harmful behavior of binge eating disorder. Furthermore, similar results were illustrated by tests on tricyclic agents. However, it was also suggested that the outcomes were similar with placebo effects.

Besides, the study showed that while antidepressants may help reduce symptoms of depression in patients with an eating disorder, they have little effect in improving weight restoration. However, not only antidepressants are applicable to pharmacological treatment. For instance, as for using the antiobesity agent sibutramine hydrochloride, it “demonstrated some efficacy in clinical trials; however, safety concerns led to market withdrawal (Mc Elroy et al., 2015, p. 240). That may lead to the conclusion that a number of differently-oriented medications can be implemented in treatment.

In order to ensure the effectiveness of each type of medication, more studies will be needed. It is also important to remember that in the case of using psychotropic medications, the patient should be supervised by medical staff and a psychiatrist. The addition of selective serotonin reuptake inhibitors might be useful for patients who do not cooperate with a therapist or experience a major depressive episode.

Psychological Treatment

Successful psychotherapy is essential for the treatment of an eating disorder. One of the types of therapy that can be implemented in treatment for bulimia nervosa and binge eating disorder is cognitive-behavioral therapy (CBT). The research by Grilo et al. (2016) demonstrated that patients with anorexia do moderately well with CBT. To be more specific, approximately 30% of patients who begin treatment recover by the end of out-patient therapy, and at a somewhat higher rate by the end of in-patient treatment. For normal-weight cases of EDs, cognitive-behavioral therapy proved to be more effective than interpersonal psychotherapy (IPT) and psychodynamic therapy.

In addition, cognitive behavioral therapy and/or interpersonal psychotherapy reduce purging behavior of patients with binge eating disorder. Even patients with severe symptoms and psychopathological features demonstrated great results, but the implementation of CBT has not yet been widespread.

In conclusion, it would appear that eating disorders do not have one primary cause. It would be more accurate to see the reason as a complex combination of negative self-perceptions along with biological and social factors. Poor interpersonal relationships and past trauma may also play a part in the development of EDs. Nevertheless, it is evident that a person who is suffering from any kind of eating disorder needs immediate medical attention.

Anorexia nervosa, bulimia nervosa, and binge eating have a number of medical complications connected to them. Fortunately, all these disorders are treatable with medications and therapy. There is also a clear need for further studies on this matter so that new approaches to treat eating disorders could be developed and implemented. The treatment can be considered successful if a patient’s eating patterns are returned to normal, the perception of body image is restored, and self-esteem is enhanced. Finally, the process of treatment should combine both pharmacological and psychological methods in order to ensure the productiveness.

References

Bello, N. T., & Yeomans, B. L. (2018). Safety of Pharmacotherapy Options for Bulimia Nervosa and Binge Eating Disorder. Expert opinion on drug safety, 17(1), 17-23.

Grilo, C. M., Reas, D. L., & Mitchell, J. E. (2016). Combining Pharmacological and Psychological Treatments for Binge Eating Disorder: Current Dtatus, Limitations, and Future Directions. Current psychiatry reports, 18(6), 55.

Herpertz-Dahlmann, B. (2015). Adolescent eating disorders: Update on Definitions, Symptomatology, Epidemiology, and Comorbidity. Child and Adolescent Psychiatric Clinics, 24(1), 177-196.

Keski-Rahkonen, A., & Mustelin, L. (2016). Epidemiology of Eating Disorders in Europe: Prevalence, Incidence, Comorbidity, Course, Consequences, and Risk Factors. Current opinion in psychiatry, 29(6), 340-345.

McElroy, S. L., Hudson, J. I., Mitchell, J. E., Wilfley, D., Ferreira-Cornwell, M.C., Wang, J., Whitaker, T., Jonas, J., Gao, J., Gasior, M. (2015). Efficacy and Safety of Lisdexamfetamine for Treatment of Adults with Moderate to severe Binge-eating Disorder: A Randomized Clinical Trial. JAMA psychiatry, 72(3), 235-246.

Salafia, E. H. B., Jones, M. E., Haugen, E. C., & Schaefer, M. K. (2015). Perceptions of the Causes of Eating Disorders: A Comparison of Individuals with and without Eating Disorders. Journal of eating disorders, 3(1), 32.

Sato, Y., & Fukudo, S. (2015). Gastrointestinal symptoms and disorders in patients with eating disorders. Clinical journal of gastroenterology, 8(5), 255-263.

Zipfel, S., Giel, K. E., Bulik, C. M., Hay, P., & Schmidt, U. (2015). Anorexia Nervosa: Aetiology, Assessment, and Treatment. The lancet psychiatry, 2(12), 1099-1111.

Yilmaz, Z., Hardaway, J. A., Bulik, C. M. (2015). Genetics and Epigenetics of Eating Disorders. Advances in genomics and genetics, 5, 131.