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Eating disorders are among the most prevalent and often overlooked mental health conditions today. There is no “type” of person who suffers from disordered eating—around 30 million people of all genders, ages, and ethnicities are currently diagnosed with anorexia nervosa, bulimia/diabulimia, or binge eating disorder. Eating disorders have the highest mortality rate of any psychiatric condition; one person dies every 60 minutes from complications related to their disorder. Most eating disorders begin in adolescence, around puberty, and develop throughout the person’s life. Experiencing trauma, having other mental and physical health concerns, and life stressors can all worsen the condition, and without help, it is life-threatening.
What Does An Eating Disorder Look Like?
Diagnostic criteria do overlap across the eating disorder diagnoses, however, the conditions vary greatly. Each individual with anorexia, bulimia, and binge eating disorder may look very different on the outside, and a person cannot be diagnosed or evaluated simply by body weight alone—their perception of themselves (body image) and internal messages are vitally important to understand in supporting and treating them holistically.
Anorexia nervosa is characterized as inappropriate weight loss and inability to maintain an appropriate weight for one’s age and height. The heavy restriction of nutrition or “purging” by excessive exercise, laxatives, or vomiting is also common. Intense fear of gaining any weight is also a key factor in anorexia, as well as a distorted perception in his or her body’s shape and size, called body dysmorphia. Often those struggling with anorexia will wear multiple layers of clothing, generally oversized, to hide weight loss and/or stay warm, and often create rigid rules and rituals about eating, such as cutting out whole food groups (carbohydrates, sugar, meat, etc) and often cooking for others but denying their own hunger.
Bulimia nervosa is classified by a cycle of eating large amounts of food at once, followed by purging the food via vomiting, laxatives, or excessive working out. Often food is hoarded or kept in unusual places ( under the bed and in the car are two examples), and often large amounts of money are spent on food. Drinking large amounts of water or other non-caloric beverages are also common to keep the stomach full and aid in purging. Swelling around the jaw and face often occurs, as well as dental problems from induced vomiting. People struggling with bulimia are also most at risk for other co-occurring conditions such as substance abuse and self-injury (cutting). A sub-type of bulimia is the purposeful restriction of insulin in order to lose weight; this is commonly called diabulimia.
Binge eating disorder is the most common eating disorder in the United States today– it refers to ingesting large amounts of food in a short period, feeling a loss of control over the ability to stop, with no efforts to purge. Frequently binges result in feeling uncomfortably full or ill, and an overwhelming sense of shame follows the episode, triggering subsequent binges. Eating when not physically hungry, or eating when emotionally overwhelmed are also signs of binge eating disorder. Sudden withdrawal from social support and eating alone due to the amounts eaten are additional common signs.
The enduring myth is that eating disorders are a conscious decision or choice, however, this has been disproven by medical and psychological studies. Eating disorders are a biopsychosocial disease, meaning that genetic, environmental, and social elements are all factors in their development. With all of this in mind, what are some general behaviors and warning signs to be aware of in yourself or a loved one?
- Noticeable fluctuation in body weight (up or down)
- Digestive system complaints
- Menstrual cycle issues (irregular or stopping altogether)
- Dizziness and fainting, especially on standing
- Cuts and calluses on the tops of the hands (from vomiting)
- Dry skin and hair (or losing), brittle nails
- Dental problems (enamel erosion, cavities, decay)
- Feeling cold all the time, extremities cold to touch
- Immune system impairment
- Extreme weakness and fatigue
- Preoccupation with weight loss and food, dieting
- Uncomfortable eating around others
- Extreme mood swings
- Rigid rituals about food (ex: foods can’t touch, only particular foods or groups, excessive chewing)
- Skipping meals or eating very small portions
- Excessive checking of the body via mirrors, weighing or measuring
Who Is Affected By Eating Disorders?
Eating disorders were once thought to almost exclusively affect young adult, straight, white females. However, 1/3 of those diagnosed are boys—with the pressures to “bulk up” and fit the socially accepted body type, dysmorphia exists for men as well. LGBTQ+ identifying individuals are at high risk for co-occurring substance use and body dysmorphia and are less likely to seek treatment due to stigma and feelings of rejection. Experiencing a traumatic event also increases the likelihood of developing an eating disorder
Age is also not a factor in developing an eating disorder—stressors in adulthood and into later life such as pregnancy, divorce or separation, job loss, becoming a grandparent, or other natural aging signs commonly trigger disordered eating and relapse for those who have lived with eating disorders since childhood. Treatment in older populations frequently uncovers disordered patterns and body image issues from much earlier in life that were not recognized previously.
What About Long Term Effects?
The effects of eating disorders on the body long term are widespread and serious. In restricting calories for ongoing periods, the body begins to break down its tissues for fuel to survive. Muscle is the first tissue to be broken down, including heart muscle, leading to heart abnormalities and blood pressure issues. Important substances the body uses to function called electrolytes (such as calcium, sodium, chloride, and potassium) are thrown off balance when purging and from drinking too much water, which commonly causes heart attacks and heart failure.
The digestive system is used to a regular schedule, and when it is not fed regularly it will slow down or stop entirely, causing bloating, pain, and constipation. Binging or purging frequently can cause the stomach to rupture, which is immediately life-threatening.
The brain uses 1/5 of the body’s calories, and without enough nutrition can create difficulties concentrating. Sleep is disrupted by extreme hunger or fullness as well. Electrolyte imbalances in the brain can cause seizures and cramps in muscles throughout the body. The body’s hormones are also knocked out of balance, causing bone loss, the menstrual cycle to stop, reduced metabolic rate, and the inability to raise body temperature well.
Treatment For Eating Disorders
Treatment for eating disorders involves a team of professionals working together to address the physical, mental and environmental causes, and symptoms. It is vital that those struggling with an eating disorder seek help from a professional because treatment is not one size fits all and is dangerous to attempt without support and monitoring. Simply restoring a person to a “normal” weight is not enough to fully treat their disorder, however, for dangerously underweight individuals, addressing eating patterns and weight gain is a priority.
Treatment is usually overseen in a residential setting by a physician, mental health professional, and dietitian to ensure that the client’s physical and mental health is cared for. Successful treatment should involve immediately addressing any life-threatening symptoms, discontinuing disordered eating patterns to prevent further damage, nutritional education, and healing, uncovering and confronting unhealthy behaviors and thoughts, and creating a strong relapse prevention plan.
Eating disorders and substance use disorders share many risk factors biologically, and over half of those with an eating disorder also meet the criteria for a substance use disorder. However, biology is not destiny, and recovery is always possible with the right interventions and continued care. As with addiction, eating disorder recovery is a lifelong, non-linear process that requires monitoring and commitment to change from the client, a strong support network, and assistance from professionals knowledgeable about proper treatment.
The dedicated team at Defining Wellness Centers recognizes that trauma is at the root of the behavioral health issues individuals face. Our program is structured to provide support and aid in healing, helping you to define and achieve wellness. For more information, call us today (855) 466-4146.