Eating disorders are about more than just fad diets and vanity; they are a serious mental illness that could ultimately cause the end of someone’s life. It’s estimated that as many as 30 million people in the U.S. suffer from an eating disorder. Approximately 4-10% of male and 10-20% of female college students are dealing with an eating disorder.
In spite of heightened awareness of some of the more common types of eating disorders, there are still many misconceptions. Let’s take a look at some facts to help dispel the myths of eating disorders.
What is an Eating Disorder?
Eating disorders revolve around abnormal eating habits and often include physical changes.
For some, eating disorders involve limiting the amount of food that is consumed; for others, it involves uncontrollable eating. Some people with eating disorders become obsessed with diet and exercise. Others will eat large quantities of food and then vomit.
There is no single demographic at risk for eating disorders; they’re diseases that can occur in people of any gender, race, religion, or socio-economic background.
Types of Eating Disorders
Let’s take a look at the most common types of eating disorders and discuss some of the symptoms and effects of each.
Anorexia is the most well-known eating disorder. When people think or talk about eating disorders, this is usually what they are referring to.
Anorexia is characterized by restricting food intake. This could be limiting oneself to only a particular food, for example carrot sticks, or limiting the amount of food and/or calories that are consumed.
People with anorexia are typically underweight, but this not always the case. Some people can have all the behaviors without the significant weight loss or without the appearance of losing weight. There are also those who have the binge-purge subtype. This means the person will restrict food intake most of the time but have times of eating too much food and following that with purging usually by vomiting.
Symptoms of Anorexia
The most common symptoms of anorexia include:
- Fear of gaining weight
- Distorted body image; seeing oneself as fat even when underweight
- Frequent monitoring of weight
- Restricting calories
- Being underweight comparted to people of a similar age and height
- Weight being linked to self-esteem and self-worth
Bulimia involves purging food from the body to reduce the number of calories consumed. This purging can take place through compensatory behaviors like vomiting, excessive exercise, laxatives, diuretics, or enemas.
Some bulimics eat large quantities of food in a short period of time and can become painfully full. Eating large quantities of food in a short period of time is called binging. The purging is often to reduce that painful feeling from overeating.
It is important to understand that bulimia is different from the binge purge sub-type of anorexia. Most bulimics maintain a normal body weight while most anorexics are underweight. Bulimics also do not typically restrict their food intake on a regular basis.
Symptoms of Bulimia
The most common symptoms of bulimia include:
- Eating in a short period of time an amount of food that is definitively larger than what most individuals would eat in a similar time period under similar circumstances
- Feeling of a lack of control over food and eating during an episode
- Recurring inappropriate compensatory behaviors(purging) to avoid weight gain
Those suffering from bulimia often have physical repercussions for their behaviors. Those side effects may include:
- Tooth decay and eroded tooth enamel
- Severe dehydration
- Acid reflux
- Frequent sore throats
- Intestinal distress
- Electrolyte imbalances – levels of potassium, sodium, calcium, and other minerals can be too high or too low – this can result in a heart attack or a stroke
People suffering from bulimia often also have comorbid substance abuse issues, particularly alcohol abuse, or mental health issues like depression, anxiety, or bipolar.
Diabulimia is the deliberate underuse of insulin in people with type 1 diabetes for the purpose of weight control.
Diabulimia may also be referred to as Eating Disorder-Diabetes Mellitus Type 1, which is any eating disorder that co-exists with diabetes.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not have a specific listing for diabulimia, but insulin manipulation is often viewed as a compensatory behavior or a purging behavior when discussing bulimia. The key difference and the reason there’s a need to discuss this individually is because of the serious health risks posed by this behavior. With approximately 38% of females and 16% of males with type 1 diabetes having disordered eating behaviors, and the serious health risks it poses, it is important to be aware of this type of eating disorder.
Symptoms and Warning Signs of Diabulimia
The most common symptoms and warning signs of diabulimia include:
- Secrecy about diabetes management
- Neglect of diabetes management
- Fear of low blood sugars
- Fear and/or talk of “insulin makes me fat”
- Anxiety about body image
- Strict food rules
- Avoiding eating with others
- Preoccupation with food, weight, calories, or blood sugar levels
- A1c continuously at 9.0 or higher
- Fatigue and/or increased sleep
- Increase in diabetes symptoms
As with untreated diabetes, there are a lot of significant physical issues that can occur. Those with diabulimia are at risk for retinopathy, peripheral neuropathy, kidney disease, liver disease, heart disease, coma, stroke, or even death. A 2008 study showed that diabulimia increased the risk of death threefold.
Binge Eating Disorder
When the DSM-5 was released in 2015, a new eating disorder was added, binge eating disorder.
People with binge eating disorder (BED) have lost control over his/her eating. Like the binge eating in bulimia, they tend to eat large quantities of food in a single sitting, more than an ordinary person would eat in that same situation. Unlike bulimia, however, there is no compensatory behaviors. Because of this, people with BED are often overweight.
Symptoms of Binge Eating Disorder
- The most common symptoms of binge eating disorder include:
- Eating even when full or not hungry
- Eating alone or in secret to avoid embarrassment
- Eating unusually large quantities of food in a specific period of time
- Eating much for rapidly than normal
- Eating until uncomfortably full
- Feeling disgusted or ashamed of oneself or feeling guilty after eating
- A feeling of a lack of control when it comes to food and eating
Typically, those with BED are overweight or obese. This can increase the person’s risk of medical complications like type 2 diabetes, stroke, and heart disease.
More than half of those with BED also have an anxiety and/or mood disorder.
Orthorexia, sometimes called orthorexia nervosa, falls under the category of eating disorders not otherwise specified (EDNOS). While it is not recognized in the DSM-5 as its own type of eating disorder, it is becoming more and more common.
Unlike most other eating disorders, the focus of orthorexia is not on weight. Orthorexia is an obsession with healthy eating. People suffering from orthorexia develop fixations on eating only foods they deem to be pure or healthy.
While it may start out as a person just trying to become healthier, the obsession can lead to some serious negative consequences including malnutrition.
Symptoms of Orthorexia
The most common symptoms of orthorexia include:
- An increased concern about the health of the ingredients of food
- Compulsively checking the list of ingredients and nutrition labels
- Cutting out multiple food groups (all sugar, all carbs, all meat, all animal products, all dairy, etc.)
- A refusal and inability to eat anything except a narrow group of foods deemed healthy or pure
- Spending hours a day thinking and worrying about what foods may be served at an upcoming function or meal
While it may start with good intentions of eating healthier, once the line is crossed into obsession orthorexia occurs.
Because there are no formal diagnostic criteria, it is difficult to get an accurate estimate of the number of people who suffer from orthorexia.
Another eating disorder that was first discussed in the DSM-5 is rumination disorder.
In this eating disorder, a person voluntarily regurgitates food that he/she has already eaten. The person may re-chew the food, re-swallow the food, or spit the food out. This takes place within the first 30 minutes of eating.
This disorder can develop in infants between three and twelve months old. In those cases, it often disappears on its own. When this occurs in children and adults, it is more serious and typically requires treatment. When occurring in children, it can rob the child of the nutrients needed to grow and develop correctly.
Symptoms of Rumination Disorder
The most common symptoms of rumination disorder include:
- Repeated regurgitation of food; the food may be re-chewed, re-swallowed, or spit out
- The regurgitation is voluntary and is not due to any medical conditions
- Weight loss
- Tooth decay and bad breath
- Frequent stomach aches
While this disorder is typically seen in children, it can also be seen in some adults. It is most commonly found in those with developmental disorders, intellectual disabilities, stress, or anxiety.
While thought to be uncommon, there is no real information about the number of people who suffer from rumination disorder. This may be because it happens more in children or because adults feel so much shame about this behavior.
Causes of Eating Disorders
While eating disorders typically appear in the teen years or young adulthood, eating disorders can develop in those younger or older than that. Eating disorders can occur in people of all genders. Eating disorders are not caused by vanity and fad diets alone. Biological, psychological, and societal influences can all contribute to an eating disorder.
- Genetics: Eating disorders do tend to run in families. While it is still debated if this is a situation where nature or nurture is the cause of this trend, there has been research done looking into the genetics of eating disorders. So far, the research has been promising in finding some substantial genetic influence. Currently, it is estimated that 50-80% of the risk for anorexia or bulimia is genetic.
- Type 1 diabetes: With approximately 38% of females and 16% of males with type 1 diabetes having disordered eating behaviors, including diabulimia, this becomes an important risk factor for developing an eating disorder.
- History of dieting: Sometimes a history of dieting can lead to the development of binge eating or bulimia.
- Perfectionism: As we discussed, sometimes things like perfectionism can lead to the development of an eating disorder. A need to eat only the “perfect” foods or to look “perfect” can lead to disorders like anorexia, bulimia, diabulimia, orthorexia, or even rumination disorder.
- Obsessive tendencies or a feeling of a loss of control: Obsessive tendencies and a need to feel in control can also lead to eating disorders. If a person is feeling as if he/she has no control over the things in his/her life, the person may turn to one thing that can be controlled – food.
- Poor body image: Body image is how one feels about and in his/her body. This could be from feeling as if one were born to the wrong gender, from feeling overweight or disproportionate, or just having a different idea of what someone should look like. This can lead to controlling food intake in order to reach that ideal body image one has.
- Depression and/or Anxiety: Many people with eating disorders also have depression and/or anxiety. It is also possible for the person to have other mental health issues like bipolar, obsessive-compulsive disorder, or schizophrenia. It is estimated that 33-50% of those with anorexia have a comorbid mood disorder and about 50% have an anxiety disorder.
- Teasing and bullying: Being teased or bullied about weight is becoming a common reason for people to develop an eating disorder. With an increase in cyberbullying and a need to have a picture-perfect life on social media, this is becoming a more common reason for eating disorders to develop particularly in teenagers.
- Trauma/abuse: A history of trauma or abuse can lead to the development of an eating disorder. For some, the trauma can lead to the feeling of being unworthy of food. For others, the feeling of “if I looked perfect, this wouldn’t have happened to me” takes over and leads to the development of an eating disorder.
- Lack of friendships/social support: Some people have reported turning to eating disorders, particularly binging and purging, after feeling bored. For others, they hope to be able to make friendships if they lose weight or are more attractive.
Seeking Treatment for an Eating Disorder
It is important to know, however, that eating disorders are treatable. There is help available to those suffering from an eating disorder. You can visit the National Eating Disorders Association (NEDA) website for some useful tools. You can use this screening tool to determine if you or a loved one may be suffering from an eating disorder. You an also contact the NEDA helpline for support and resources.
National Eating Disorders Awareness Week (#NE Awareness) is February 25 - March 3, 2019. We’re changing the conversation around food, body image, and eating disorders! Join the movement and #ComeAsYouAre, not as you think you should be. www.nedawareness.org.
Rebecca Encao, MSMHC is both an instructor and a team lead for Southern New Hampshire University and has taught psychology and social science courses for SNHU since 2015. Prior to that she worked with eating disorder patients at Eating Recovery Center in Denver.