Eating Disorder: Types, Symptoms, Treatment

Eating behavior is a person's attitude to food intake, a complex of unconditioned reflexes and conscious decisions that determines the amount and composition of what is eaten under various conditions. Ideally, the body should receive all the necessary nutrients and the optimal number of calories, and the person himself should enjoy food.

But often the eating behavior of a person differs from the norm, which has a serious impact on health and quality of life. What is considered normal, how to distinguish the type of eating disorder, what are the causes of violations and how to cure this condition?

What is an eating disorder (EDD)

Normally, a person takes food when he feels hungry, and eats enough to make him feel full. But in the event of stress, strong emotional upheavals, a person may try to solve problems by increasing or decreasing the amount of food taken, changing his diet.

Violations can be very diverse - from overeating, passion for sweets, increased appetite at night to almost complete refusal to eat or from a significant amount of food.

There are two cores for eating disorders:

1. Preoccupation with body shape and weight

   A person worries about his weight, body shape, gluttony, considers himself bad.

2. Anxiety

   Especially in orthorexia nervosa and some restrictive eating behaviors. The very symptomatology of limiting oneself in food, in some types and groups of products is not an experience for one's weight, beauty and evaluation by other people, but an experience around harm to health. That is, inside there is rather a fear of death, illness and damage.

   But sometimes both factors play a role.

Causes of eating disorders

All causes are individual in nature, but experts distinguish the following groups:

1. genetic predisposition.

   There are gene loci that indicate that a person has a predisposition to anorexia nervosa and obesity.

   Twin studies also show that eating disorders are inherited, in particular, anorexia nervosa and bulimia nervosa are transmitted in 40-60% of cases, binge eating disorders in 48%.

2. biological factors.

   These are serotonin dysregulation, prematurity, overweight, type 2 diabetes, food intolerances, infectious mononucleosis, and also the microbiome, for example, can cause obesity, anxiety, and depression.

   Research suggests that our microbiome, that is, the community of microorganisms that live in our gut, can cause obesity, anxiety and clinical depression, and can also change energy metabolism.

3. social factors.

   These include bullying (for example, bullying by peers), eating disorder in the family, the ideal of thinness in the family or in society. Models, athletes and dancers have a high risk of eating disorders, as there is a big connection with their qualities, such as success, achievement.

4. Family factors is an affective disorder in a family member, for example, depression, anxiety disorder.

5. Psychological factors are negative self-esteem, achievementism, perfectionism, emotional lability, a tendency to anxiety.

6. Chemical dependencies in a family create a predisposition for a child in that family to develop an eating disorder in the presence of genetic and biological dispositions.

7. Depression, anxiety disorder.

8. Attachment violation.

When in some way the child's attachment to his caregivers was broken. This is one of the most powerful factors in the development of ED.

For example:

• parents ignore the child's needs in the field of food (feeding strictly by the hour, ignoring the child's feelings in terms of hunger and satiety);

• emotional, psychological needs of the child are regularly ignored, depreciated;

• when a child is subjected to mental violence, verbal, moral or physical violence;

• when one of the parents, for example, left the family at a fairly early age of the child up to seven years, when someone died in the family of the parents;

• when a child is handed over to be raised by grandmothers, and then taken back to the family, then there is a double violation of attachment. First, the child breaks the connection with the mother, he needs to build attachment with his grandmother, as with a guardian, and as soon as the child somehow processes this trauma, then he needs to come back and re-build relationships with his mother;

• a child in hospitals for health reasons, this can also be a violation of attachment, when the connection with one of the parents is broken.

Since there are many causes, there are many manifestations of eating disorders. There is a classification that helps to make a diagnosis and choose methods of treatment.

Classification of eating disorders

Now there are two guidelines, using which psychologists, psychotherapists, psychiatrists can make one or another diagnosis.

1. "DSM-5" used in America.

2. "MKD-10" - in Europe and Russia.

As for psychogenic vomiting, it does not have an overeating attack, there is only a component of the urge to vomit, it can be as a way of emotional regulation, that is, it is a way to cope with some strong, very unpleasant emotions, it can be a symptom of other disorders

Bulimia consists of two parts: it is an attack of overeating and the second part is an attack of compensation.

Psychogenic vomiting has only a vomiting-inducing component. It may also be a way of emotional regulation and may be a symptom of other disorders. For example, in a hypochondriacal disorder, this will be only one of the symptoms, that is, it will no longer be a way to cope with emotions, but a symptom of another disease.

Many people cannot be diagnosed with anorexia nervosa or bulimia nervosa, they are more likely to be diagnosed with binge eating disorder

Psychogenic overeating is overeating, which leads to the appearance of excess weight, is a reaction to difficult events in a person's life that cause states of distress. For example, loss of loved ones, accidents, surgeries. Emotional distress can be associated with problems at work, in relationships, moving, changing residence. In order to cope with these emotions, a person begins to eat and overeat.

Overeating is of three types:

1. Restrictive overeating.

   It arises as a reaction to the restriction of certain groups or types of products. Our brain works in such a way that when it notices and realizes that some kind of food has become in short supply, then it is this food that becomes the most attractive and desirable for us, the one for which we must somehow fight, we must get it and we must to eat it for the future, until its deficiency began again, until it disappeared again.

    

1. Emotional overeating.

   It is a way to change your emotional state from minus to plus. The mechanism is this: when a person feels bad, for example, tense, tired, nervous, he feels shame, guilt, discontent, then stress hormones are produced inside us, in particular cortisol. And eating delicious food is the easiest solution to a quick boost in dopamine, the pleasure hormone. It is released, and cortisol falls.

    

2. Overeating of the external type.

   When food itself is a strong stimulus. A person with an external type of overeating is not guided by his internal feelings, the feeling of hunger, the feeling of satiety, he ignores this and does not notice how hungry or full he really is now.

    

Other eating disorders in ICD 10:

• eating inedible, non-organic food in adults, for example, chalk, clay, an iron nail to gnaw;

• eating inedible, perverted appetite in adults;

• psychogenic loss of appetite.

Wherever there is the word “psychogenic”, that is, the reason is in some mental processes and most often they are associated with emotions, something arises in the emotional sphere and overeating, vomiting and loss of appetite can occur against this background.

Unspecified eating disorders - all that did not fall under any specific diagnosis, which we have previously analyzed.

This phenomenon has not yet been included in DSM 5 and ICD 10, but there is an assumption that in the next revisions of these reference books, it will be included there, as it becomes more common.

It was first used by Stephen Bratman, who decided to stick to a vegan diet for health reasons, then a raw food diet. And he soon discovered that the very attempt to constantly adhere to this rather restrictive eating style led him to the fact that his social life suffered greatly.

He is constantly stressed when he cannot eat properly, he turns on the alarm that "I ate something bad, something that could damage my health."

Often this behavior occurs in people who fall into the field of nutrition, so it is so important to monitor your condition and reaction to the knowledge gained.

How to recognize eating disorders

Anorexia nervosa is an eating disorder characterized by significant weight loss, intentionally induced or sustained by the patient, to lose weight or to prevent weight gain.

The main component of anorexia is a pathological desire to lose weight and a strong fear of gaining weight, as well as a distorted perception of one's physical form. Although people with anorexia are very far from obese, there is a strong fear of gaining weight and a very strong desire to continue to reduce this weight.

Anorexia is of two types:

• restrictive, which is associated with a restriction in food, and usually a person still trains additionally to burn calories;

• cleansing, when another way to reduce weight is to induce vomiting.

Purging anorexia is associated with much greater damage to health, is more dangerous and more deadly. Due to the fact that the internal organs are damaged more strongly, when a girl or a young man with anorexia begins to gain weight, the internal organs, being damaged, may simply not be able to cope with their further functioning.

We can confidently say that a person has anorexia only if all of the following signs are present at the same time:

• restriction in the consumption of the necessary energy leading to a significantly low weight, for a certain age, gender, level of development of physical health, that is, it is necessary to estimate the BMI:

• BMI from 17 to 18.5 - mild anorexia nervosa

• BMI from 16 to 16.99 - moderate

• BMI from 15-15.99 - severe

• A BMI less than 15 is an extremely severe form of anorexia.

• strong fear of gaining weight or obesity, compulsive behavior that prevents weight gain despite its significantly low level;

• a distorted perception of one's weight or figure, the excessive influence of weight, figure on self-esteem and a lack of understanding of the seriousness of the problem of such a low weight.

All three of these features must be present for a diagnosis to be made.

There is also a component of over-concern with body weight and BMI, but the weight is normal. Most often there may be a little extra weight, but it is normal.

Diagnostic criteria:

1. Recurrent bouts of binge eating.

   Gluttony is when the amount of food, in a given period of time, often no more than 2 hours, is significantly higher than what other people could eat in the same period of time, under the same conditions. During this state, the person cannot stop eating and cannot control it.

   Bouts of overeating can be both healthy foods, if a person is trying to stick to a diet or proper nutrition, then in a bout of overeating, he can overeat salad, nuts, dried fruits, and if a person breaks down, he can also eat junk food.

    

2. Periodically unacceptable compensatory behavior.

   It is aimed at preventing weight gain, that is, it is vomiting, laxatives, diuretics, some drugs, fasting, dieting, excessive exercise.

   For example, there are sports bulimia, in which compensation occurs through sports activities.

   A diagnosis of bulimia nervosa can be made when binge eating, unacceptable compensatory behavior, occurs on average at least once a week for three weeks.

    

Anorexia flows spontaneously into bulimia in some people, but in about 20% of cases, bulimia spontaneously flows into binge eating.

Binge eating or compulsive overeating is when there is only a bout of overeating with loss of control but no compensation.

The ICD-10 also uses the following names: psychogenic overeating, binge eating disorder, compulsive overeating or compulsive overeating disorder, hyperphobic stress response, binge-eating.

Also listed are the following criteria by which a diagnosis is made if three or more are present:

• episodes of loss of control over the process of eating food;

• episodes of binge eating during severe stress;

• eating abnormally large amounts of food in a short period of time;

• eating large amounts of food in the absence of hunger, eating to satiety;

• food in a state of depression, sadness and boredom;

• eating alone out of shame associated with the process of eating or with one's abnormality;

• feelings of disgust, depression, or guilt after such a bout of overeating.

As with bulimia nervosa, the frequency of binge eating episodes must be once a week for three consecutive weeks to be diagnosed.

Also, these people are often characterized by circadian dysregulation, that is, they usually have a loss of appetite in the morning, in the morning and before lunch, and starting from lunch and especially in the evening, they eat a lot at night.

There is no specific attack, but all the same, a person without physiological hunger eats some kind of food, just not in such huge quantities as during an attack, not in such a short time.

As for orthorexia, at the moment there are no strict diagnostic criteria, but what are the main criteria here?

• Healthy nutrition is becoming so important for a person that concern about this issue leaves no room for any other hobbies, interests in life and interferes with a person’s social life.

• The diet is determined solely by the criterion of the usefulness or not the usefulness of food

• He doesn’t care if it tastes good to him, it doesn’t taste good, he will eat for the sake of health even if he doesn’t like it and doesn’t like something healthy and healthy.

• And when he eats forbidden foods, he will experience anxiety and a strong sense of guilt.

Eating disorders in children and adolescents

Children and adolescents with anorexia are often such excellent students, perfectionists, they are the first everywhere, they are quite serious, problem-free children for their parents, leaders.

Quite often, in adolescents, anorexia flows into bulimia, because overeating develops in order for the body to receive nutrients, but this frightens a person very much, because he does not want to get fat. He begins to induce vomiting or use some other means of compensation in order not to gain weight.

There is also a rumination disorder that usually develops in infants.

It consists in the fact that the child chews food, swallows, and then burps it back into his mouth and chews it again and swallows it again, so he does in a circle to stimulate his nervous system, children with sensory deprivation often do this. For example, in a baby house, when a baby is lying, they don’t take him in his arms, they don’t stimulate him in any way, and in this way he tries to stimulate himself. And for some adults, it persists. Often this is associated with some other mental disorders and is such a symptom of them.

A common eating disorder in children and adolescents is avoidant eating disorder. This is when people do not eat food and limit themselves very much in the choice of products, because they do not like the food, it is unpleasant in taste and texture. And because she does not like it on these grounds, a person greatly limits the types of food that he can eat.

To some extent, all children at the age of four become selective eaters. Because of this, body weight decreases and microelement deficiencies appear.

If nutrition is insufficient during pregnancy, as well as in the first three years of life, then chronic malnutrition and digestion may develop - malnutrition. It most often develops in low-income families and in regions with food supply difficulties. And also with malabsorption syndrome, that is, a violation of the digestion and assimilation of food.

Treatment of eating disorders

For any type of eating disorder, a psychiatrist should be consulted for qualified support and supervision.

Unfortunately, people rarely turn to specialists at the first symptoms that allow diagnosing eating disorders, so most often the correction requires a whole range of measures.

Several specialists are necessarily involved in the process: a psychiatrist, a nutritionist, a psychologist, a gastroenterologist and other specialists as needed.

Comprehensive treatment of eating disorders is carried out in several stages:

• restoration of the central nervous system;

• weight recovery;

• power restoration;

• rehabilitation psychotherapy.

If a person turns to a nutritionist for the selection of nutrition and vitamins. And during the consultation and questioning, it turns out that he has one of the types of ED, then it is necessary to recommend that he additionally contact a psychiatrist to jointly solve the problem.

And start working with the formation of mindfulness in nutrition.

In some crisis situations, this story can be repeated again. Therefore, psychotherapy is needed in order for a person to understand when a crisis occurs, he begins to try to cope with his emotions, because to one degree or another, any eating disorder is a way to cope with your internal mental processes.

Having found symptoms of an eating disorder in yourself or your loved ones, you should consult a specialist, because eating disorders can pose a serious danger to life and health.