Behavioral health conditions
Eating is controlled by many factors, including:
- Food availability
- Cultural practices
- A person’s own voluntary control, also known as dieting.
A person’s eating habits, or dieting, can also be influenced by outside factors such as current fashion trends, marketing and sales campaigns for any kind of product, and certain activities and professions. Eating disorders involve serious disturbances in eating behavior, such as:
- Extreme reduction of food you eat
- Extreme and severe overeating
- Feelings of distress or extreme concern about body shape or weight.
Researchers are investigating how and why initially voluntary behaviors, such as eating smaller or larger amounts of food than usual, at some point move beyond control in some people and develop into an eating disorder.
Eating disorders are not due to a failure of will or behavior. In fact they are real, treatable medical illnesses in which certain harmful patterns of eating take on a life of their own. The main types of eating disorders are:
- Anorexia nervosa
- Bulimia nervosa
- Binge-eating disorder.
Eating disorders frequently develop during adolescence or early adulthood, but sometimes their onset can occur during childhood or later in adulthood.
Eating disorders frequently co-occur with other psychiatric disorders such as depression, substance abuse and anxiety disorders. In addition, people who suffer from eating disorders can experience a wide range of physical health complications, including serious heart conditions and kidney failure which may lead to death. Therefore, recognition of eating disorders as real and treatable diseases is critically important.
Females are much more likely than males to develop an eating disorder. Only an estimated 5 to 15 percent of people with anorexia or bulimia and an estimated 35 percent of those with binge-eating disorder are male.
The 12-month prevalence of anorexia nervosa among young females is approximately 0.4 percent, much more common in females than in males, with a female to male ratio of 10:1.1,2 Symptoms of anorexia nervosa include:
- Resistance to maintaining body weight at or above a minimally normal weight for age and height
- Intense fear of gaining weight or becoming fat, even though underweight
- Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight
- Infrequent or absent menstrual periods (in females who have reached puberty).
People with this disorder see themselves as overweight even though they are dangerously thin. The process of eating becomes an obsession. Unusual eating habits develop, such as avoiding food and meals, picking out a few foods and eating these in small quantities or carefully weighing and portioning food. People with anorexia may repeatedly check their body weight, and many engage in other techniques to control their weight, such as intense and compulsive exercise, or purging by means of vomiting and abuse of laxatives, enemas and diuretics. Girls with anorexia often experience a delayed onset of their first menstrual period.
The course and outcome of anorexia nervosa vary across individuals: some fully recover after a single episode; some have a fluctuating pattern of weight gain and relapse; and others experience a chronically deteriorating course of illness over many years. A review of nearly 50 years of research confirms that anorexia nervosa has the highest mortality rate of any psychiatric disorder.3 The most common causes of death are complications of the disorder, such as cardiac arrest or electrolyte imbalance and suicide.
The 12-month prevalence of bulimia nervosa (BN) among young females is approximately 1 percent to 1.5 percent, also more common in females than in males, with a female to male ratio of 10:1.1 Symptoms of bulimia nervosa include:
- Recurrent episodes of binge eating, characterized by eating an excessive amount of food within a discrete period of time and by a sense of lack of control over eating during the episode
- Recurrent inappropriate reactive behavior in order to prevent weight gain, such as self-induced vomiting or misuse of laxatives, diuretics, enemas or other medications (purging); fasting; or excessive exercise
- The binge eating and inappropriate reactive behaviors both occur, on average, at least twice a week for 3 months
- Self-evaluation is unduly influenced by body shape and weight.
Because purging or other compensatory behavior follows the binge-eating episodes, people with bulimia usually weigh within the normal range for their age and height. However, like individuals with anorexia, they may fear gaining weight, desire to lose weight and feel intensely dissatisfied with their bodies. People with bulimia often perform the behaviors in secrecy, feeling disgusted and ashamed when they binge, yet relieved once they purge.
Binge eating disorder
A 2015 study reported that this disorder is the most common eating disorder, and that it affects 3.5 percent of females and 2 percent of males among adults, with rates in children and adolescents estimated at 2.3 percent in adolescent females and 0.8 percent in adolescent males.4 Symptoms of binge-eating disorder include:
- Recurrent episodes of binge eating, characterized by eating an excessive amount of food and by a sense of lack of control over eating during the episode
- The binge-eating episodes are associated with at least three of the following:
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not feeling physically hungry
- Eating alone because of being embarrassed by how much one is eating
- Feeling disgusted with oneself, depressed or very guilty after overeating
- Marked distress about the binge-eating behavior
- The binge eating occurs, on average, at least two days a week for six months
- The binge eating is not associated with the regular use of other inappropriate behaviors (e.g., purging, fasting, excessive exercise).
People with binge-eating disorder experience frequent episodes of out-of-control eating, with the same binge-eating symptoms as those with bulimia. The main difference is that individuals with binge-eating disorder do not purge their bodies of excess calories. Therefore, many with the disorder are overweight for their age and height. Feelings of self-disgust and shame associated with this illness can lead to bingeing again, creating a cycle of binge eating.
Eating disorders can be treated and a healthy weight restored. The sooner these disorders are diagnosed and treated, the better the outcomes are likely to be. Because of their complexity, eating disorders require a comprehensive treatment plan involving medical care and monitoring, psychosocial interventions, nutritional counseling and, when appropriate, medication management. At the time of diagnosis, the clinician must determine whether the person is in immediate danger and requires hospitalization.
Treatment of anorexia calls for a specific program that involves three main phases:
- Restoring the weight lost to severe dieting and purging
- Treating psychological disturbances such as distortion of body image, low self-esteem and interpersonal conflicts
- Achieving long-term remission and rehabilitation, or full recovery
Early diagnosis and treatment increases the treatment success rate. Use of psychotropic medication in people with anorexia should be considered only after weight gain has been established. Certain selective serotonin reuptake inhibitors (SSRIs) have been shown to be helpful for weight maintenance and for resolving mood and anxiety symptoms associated with anorexia.
The acute management of severe weight loss is usually provided in an inpatient hospital setting, where feeding plans address the person’s medical and nutritional needs. In some cases, intravenous feeding is recommended. Once malnutrition has been corrected and weight gain has begun, psychotherapy (often cognitive behavioral or interpersonal psychotherapy) can help people with anorexia overcome low self-esteem and address distorted thought and behavior patterns. Families are sometimes included in the therapeutic process.
- Nutritional rehabilitation
- Psychosocial intervention
- Medication management.
Specifically, the aim of these strategies is to:
- Establish a pattern of regular, non-binge meals
- Improve the patient’s attitudes related to the eating disorder
- Encourage healthy but not excessive exercise
- Resolve co-occurring conditions such as mood or anxiety disorders.
Therapy is encouraged, including:
- Individual psychotherapy (especially cognitive-behavioral or interpersonal psychotherapy)
- Group psychotherapy that uses a cognitive-behavioral approach
- Family or marital therapy.
Psychotropic medications, primarily antidepressants such as the selective serotonin reuptake inhibitors (SSRIs), have been found helpful for people with bulimia, particularly those with significant symptoms of depression or anxiety, or those who have not responded adequately to psychosocial treatment alone. These medications also may help prevent relapse. The treatment goals and strategies for binge-eating disorder are similar to those for bulimia, and studies are currently evaluating the effectiveness of various interventions.
People with eating disorders often do not recognize or admit that they are ill. As a result, they may strongly resist getting and staying in treatment. Family members or other trusted individuals can be helpful in ensuring that the person with an eating disorder receives needed care and rehabilitation. For some people, treatment may be long term.
This article is for your information only. It is not meant to give medical advice. It should not be used to replace a visit with a provider. Magellan does not endorse other resources that may be mentioned here.
1American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Fifth Edition DSM-5™. (2013) American Psychiatric Publishing, Washington, DC; London, England.
2American Psychiatric Association (2006). Practice Guideline for the Treatment of Patients with Eating Disorders, Third Edition. Available at: http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfm, accessed March 8, 2007.
3Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with Anorexia Nervosa and other eating disorders. Archives of General Psychiatry, 68(7), 724-731.
4Lock J and La Via, and AACAP Committee on Quality Issues (2015). Practice Parameter for the Assessment and Treatment of Children and Adolescents With Eating Disorders. J Amer Acad Child Adolesc Psych ; 54(5): 412-425.
Additional source: National Institute of Health www.nih.gov