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Picture someone with a broken leg. They have a cast, and they’re walking around with crutches. People wouldn’t tell that person, “Just stand up and walk. What’re you doing?” That person clearly has an ailment they cannot control and thus it is logical to not blame or question the efficacy of their difficulties. People don’t always apply the same concreteness to mental disorders. Yet, the person with an eating disorder and the person with a broken leg are both experiencing a health affliction that needs medical attention and time to heal.
What is an eating disorder?
Eating disorders are a category of mental health disorders; specifically, eating disorders are in the DMS-5 under “feeding and eating disorders.” Eating disorders are also a physical disorder. There are many different types of eating disorders, and the speculative causes of eating disorders are vast. Some people explain eating disorders through a biopsychosocial perspective or through a family systems model (7,13).
Around 30 million people will experience an eating disorder inthe US. Ten million of those people are statistically men. There are around 12 different types of eating disorders in the DSM-5. The main three are anorexia, bulimia-nervosa, and binge eating disorder (7,12).
Anorexia is the deadliest mental health disorder. Around 5.1 people out of 1000 people with anorexia die annually. People that are diagnosed with anorexia in their twenties are statisticallyand more likely to die from anorexia than any other age group. Anorexia is loosely defined as the obsession with losing weight and reducing one’s body size (2,15).
Anorexia is an especially dangerous eating disorder, because the restriction rewires the person’s dopamine reward system. When we eat our body releases dopamine in order to reinforce the behavior of eating, because without food our body cannot function. Anorexic people’s brains learn to no longer release dopamine while eating, but, instead, the brain releases dopamine when the person abstains from eating. This reinforces restrictive eating behavior. Anorexia is also typically accompanied with severe body dysmorphia which increases the phobia of being overweight (2,6,8,12,15).
Anorexia has been around for a very long time. There are peculiar reports of people restricting their food behavior in medieval times, but those incidences were explained through extreme religious related fasting. The first case of anorexia, that was recognized as an unhealthy restrictive eating pattern, was in 1689 (2,5,15).
Bulimia Nervosa
Bulimia Nervosa is a mental health disorder that involves binging on food in a short period of time, and then purging the food after it has been consumed. The term bulimia nervosa was coined in 1979 (5,13).
Binge Eating Disorder
Binge eating disorder was first recognized by a psychiatrist, Albert Stunkard, in 1959. Binge eating disorder is a mental health disorder that involves excessive consumption of food, more than the body’s ability to comfortably digest food, in one sitting. It is estimated that 3% of all adults will experience binge eating disorder. Of the 3% it is estimated that around 57% of those people will not seek treatment. Binge eating disorder is the most common eating disorder in the US (3,4,5,8,12).
What does an eating disorder do to someone’s mental health?
The vast majority, around 97%, of people who are hospitalized due to an eating disorder have another mental health disorder. Eating disorders have high comorbidity with depression, anxiety disorders, substance use disorder, and OCD. Women with anorexia, specifically, are 57 times more likely to commit suicide than other women (2,4,8,12,15).
What does an eating disorder do to the body?
There are negative effects that happen in the throes of an eating disorder, and there are effects that persist after a long incidence of eating disorder behavior has extinguished. People experiencing an active eating disorder can experience malnutrition, hair loss, excess hair growth on the arms and legs, loss of menstruation for women, osteoporosis, stunted height, impotence for men, neuropathy, seizures, anemia, digestive issues, skin irritants, muscle degeneration, electrolyte depletion, lowered heart rate, bacterial infections, sore esophageal tissue, rupture of stomach or esophagus, sores and blistering within the mouth cavity, and even death (14,16).
The consequences of a prolonged eating disorder are vast, even after eating disorders have been resolved. A person’s metabolic system can be permanently disrupted, caused by the body assuming starvation mode. This means that the body will hold on to fat intake more readily. Osteopenia and then osteoporosis is the most persistent side effect of prolonged eating disorders, even after eating disorders have gone into remission. When the muscle tissue begins to degrade, it leads to heart problems and the inability to properly digest food. These problems might resolve after normal calorie intake, or they may continue. That is also the case for neurological issues, acid reflux, regular menstruation, and fertility, which all can be permanently damaged (14,16).
What causes eating disorders?
Eating disorders have a genetic component, psychological component, a social influence, and a family dynamic influence. Henderson et al. (2019)’s study found that kids that grow up in a family that does not engage in open communication of feelings and emotions, are more inclined to develop an eating disorder. Eating disorders often involve the desire for control, which typically develops out of the inability to regulate emotions. Grange et al. (2009)’s study credits emotionally-resistant family interactions with the explanation for eating disorders (1,11,14).
Eating disorders can also be caused by pre established mental health disorders. For instance, someone with depression might have difficulty preparing and eating food, and thus could unintentionally engage in anorexic behavior (4,14).
American culture is extremely fatphobic, and although this is not the only cause of disordered eating, it is a contributing factor. A little more than 40% of 6-to-9-year old’s say they want to be smaller. Around 81% of 10-year-olds, in America, express fear of being fat. Almost 50% of 9- and 10-year-olds report that they have been on diets. College women report that 91% claim that they are often engaging in diets (8,12).
What percentage of people experience eating disorders?
The percentage of eating disorders, worldwide, has increased from 3.4% to 7.8% in the years 2000 to 2018 (8,12).
Around 2% of people with bulimia will live with it long term, and around 1% of people with anorexia will live with it for the rest of a person’s life, and a little over 5% of people with binge eating disorder will always suffer from it (2,3,8,12,15).
What are some signs of eating disorder behavior?
Body checking is a common sign of an eating disorder. Body checking could be continually trying on clothing to see if they fitor obsessively weighing themselves. Body avoidance behavior is the practice of intentionally wearing baggy clothing to draw attention away from the body. Eating consistent small portion sizes, skipping meals, mood swings, hiding food, fearfully avoiding high calorie foods, being only able to eat only certain “safe foods,” etc. are all signs of a potential eating disorder (11,13).
What are some misconceptions around eating disorders?
Only 6% of people with eating disorders are categorized as “underweight.” The way our society measures “healthy” weight is extremely arbitrary considering what we now know about the genetic influence on weight. “Overweight” people experiencing an eating disorder are half as likely to be diagnosed with an eating disorder than people that are defined as being at a “normal” weight or “underweight”. Additionally, binge eating disorder and bulimia are both disorders that are categorized by consuming a lot of food at one time, and thus people can gain weight when engaging in bulimia and binge eating disorders (3,8,12,13).
Culturally, eating disorders are only seen as a female-related problem, but that is a huge misconception. Men experience eating disorders, as well. Around ¼ of people with anorexia are men. Men are more likely to die from an eating disorder because they’re diagnosed so much later, statistically, than women. Moore et al. (2009)’s survey-based study found that anorexia and bulimia were more common in women than in men. Binge eating has virtually the same incidence in men and women. Men and women both equally report excessive exercise for “weight control”. One in five women and one in ten men report that they did routine body checking in the last three months (2,3,13,15).
Athletes are more likely to have an eating disorder than nonathletes. Athletes are seen as being the epitome of health mentally and physically, yet there are high rates of disordered eating in athletics (13).
Eating disorders affect all ethnicities, all socioeconomic classes, all genders, all abled people, all sexual identities, etc. People with eating disorders are stereotypically assumed to be rich and white. Yet, people of color experience high rates of disordered eating. Due to this misleading stereotype, people of color are especially unlikely to be addressed by their doctor in regard to eating disorder behavior. The percentage of black teenagers that experience bulimic behavior is higher than white teenagers. Asian college students have higher reports of food restriction and bulimic behavior than white college students (10,13).
Social media has not actually significantly increased the incidence of anorexia. Although, social media does increase the negative effects of body dysmorphia and most likely increases other eating disorder behavior. Roughly, 1 to 3 % of the population, in America, experiences body dysmorphia (2,6,9,15).
What is the most effective treatment for eating disorders?
Only 10% of people with an eating disorder seek professional help, but 60% of those that seek medical assistance make a full recovery (8,12).
Family group treatments, also called “The Maudsley Method,” have been found to be widely effective in combating eating disorder behavior, according to Grange et al (2009). Having family members express their support in aiding someone in their eating disorder, has been found to be very effective. Cognitive behavioral and dialectical behavior therapy has been found to be effective. Inpatient group therapy treatment is sometimes necessary for people who are severely malnourished from their eating disorder (1,11).
It is pivotal that we, as a culture, recognize mental illness as being just as concretely real as physical ailments. One day, hopefully, we can culturally recognize that the person in the cast and the person that is unable to consume sufficient calories are both experiencing pain and should be treated with the same level of patience and respect for their difficult circumstances.
References:
1. Daniel Grange et al. (2009). Academy of eating disorders position paper: the role of the family in eating disorders.Research Gate. 43(1):1-5. DOI:10.1002/eat.20751.
2. DeNoon, Daniel. (2011). Deadliest psychiatric disorder: anorexia. WebMD.
3. Marcin, Ashley. (2016). Binge eating disorder history: A timeline. Healthline.
4. Mark Chavez and Tom Insel. (2008). Eating disorders: national institute of mental health’s perspective. U.S.national library of medicine national institutes of health. 62(3): 159–166. doi: 10.1037/0003-066X.62.3.159.
5. Muhlheim, Lauren. (2020). History of eating disorders. Very well mind
6. Muhlheim, Lauren. (2021). The connection between body image and eating disorders. Very well Mind.
7. Petre, Alina. (2019). 6 common types of eating disorders (and their symptoms). Healthline.
8. Rehman, Anis. (2021). Eating disorder statistics 2021. The Checkup.
9. Richards, Patti. (2020). How does media impact body image and eating disorder rates? Center for Change.
10. Ruth Striegel-Moore et al. (2010). Gender difference in the prevalence of eating disorder symptoms. HHS Public Access. 42(5): 471–474. doi: 10.1002/eat.20625.
11. Ziporah Henderson et al. (2019). Emotional development in eating disorders: a qualitative metasynthesis. U.S.national library of medicine national institutes of health.26(4): 440–457. doi: 10.1002/cpp.2365.
12. “Eating Disorder Statistics.” (2021). ANAD. Retrieved from https://anad.org/eating-disorders-statistics/
13. “Eating disorders.” (2021). National alliance of mental illness. Retrieved from https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Eating-Disorders.
14. “HealthConsequences.” (2021). NEDA Feeding Hope. Retrieved from https://www.nationaleatingdisorders.org/health-consequences.
15. “The Long Term Health Risks of Anorexia.” 2021. Center for Discovery Eating Disorder Treatment. Retrieved from https://centerfordiscovery.com/blog/long-term-health-risks-anorexia.
16. “What is an eating disorder: types, symptoms, risks, and causes.” (2021). Eating Disorder Hope. Retrieved from https://www.eatingdisorderhope.com/information/eating-disorder.
Contributors:
Author: Katrina Peavy
Editor: Anum Khan
Health scientist: Mercedes Martin
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