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Disordered Eating and Eating Disorders

There are many people who develop unusual eating behaviors and beliefs about food such as eating very few calories per day or overeating and then vomiting.  These abnormal eating behaviors and beliefs, over time, threaten their psychological and physical heath, and in some extreme cases, their lives.  An individual diagnosed with an Eating Disorder has an illness that centers on distorted attitudes or behaviors in eating habits, body image, or body weight. The overwhelming majority of individuals with Eating Disorders are teenage girls and young adult females.  Yet, more males and older women are also developing Eating Disorders. Males with Eating Disorders are often adversely affected by unhealthy expectations and training practices in certain sports (e.g. wrestlers, jockeys).

There are three major types of Eating Disorders in DSM-5: anorexia nervosa, bulimia nervosa, and binge-eating disorder. Anorexia nervosa is characterized by a distorted body image which causes one to restrict one’s eating behaviors; anorexics may also develop unusual eating habits (e.g., they may refuse to eat in front of other people) that can lead to extreme weight loss or death. In contrast, bulimia is characterized by binges (i.e., periods of excessive overeating) that are then followed by the use of vomiting, enemas, laxatives, diuretics, or exercise in an attempt to rid the body of the food/calories consumed. Binge-eating disorder involves ingesting a disproportionate amount of food; however, binge-eaters do not purge their body of the food. Other types of Eating Disorders are eating disorder not otherwise specified (EDNOS) and night eating syndrome (NES).

Disordered eating (dysorexia) is eating in an atypical way.  Beyond just being “picky,” some children, teens, and adults are so selective in their eating habits that their health may be at risk. Types of disordered, selective eating habits include not eating an entire food group (e.g. fruits or vegetables), eating only certain foods (e.g. pizza), only eating foods at a certain time of day, and excluding foods with a certain texture or color. While these atypical behaviors may not be easily detected as other Eating Disorders, they still warrant attention and treatment.  Disordered eating is often found among children with autistic spectrum disorders (ASD), but is found among neurotypical individuals as well. A potentially medically dangerous form of unusual eating behavior called pica is the eating of non-food items (e.g. dirt, pencil erasers).  Swallowing hair leading to serious medical complications is sometimes found among those with Trichotillomania, a hair-pulling disorder. Othorexia is when eating decisions have excessively moral overtones.

Although no one can say for certain how Eating Disorders are caused, certain factors have been associated with them. For example, many anorexics tend to be perfectionists, whereas bulimics tend to be impulsive; in addition, many people who suffer from Eating Disorders experience feelings of helplessness, have low opinions of their worth, and are dissatisfied with the way they look. Though some research has suggested that society’s pressure to be thin has led to the development of many Eating Disorders, most researchers agree that Eating Disorders come about through the interplay of cultural, social, familial, genetic, biological and psychological factors.

Eating Disorders have been associated with osteoporosis, osteopinea, anemia, tooth decay, palpitations, irregular heartbeat, hair loss, diabetes, high blood pressure, and amenorrhea (the absence of menstruation). In addition to the physical problems associated with Eating Disorders, people with Eating Disorders tend to have higher rates of other psychological disorders; Anxiety Disorders, substance abuse, and depression are all common among those who suffer from Eating Disorders.

Over the years, there have been many Obsessive Compulsive symptoms noted among individuals with Eating Disorders.  These include ruminative thinking about body image, thinness, binge eating, food, and diet, as well as ritualistic eating and exercising behaviors, checking of weight, and binging and purging behavior.  Symmetry obsessions, ordering and arranging compulsions, and perfectionism were also frequently reported obsessive-compulsive symptoms among patients with Eating Disorders.  It is no surprise that a neurobiological overlap between eating disorders and OCD has been found in some research studies.

Psychological treatments for Eating Disorders include Cognitive Behavioral Therapy (CBT). CBT emphasizes challenging the thoughts and behaviors that serve to maintain unhealthy and self-defeating eating behaviors.  It is thought that individuals with Eating Disorders have core irrational beliefs that then influence their behavior and emotions regarding food. These beliefs in turn lead to maladaptive behaviors such as caloric restriction, caloric overconsumption, and purging by vomiting or over-exercising, as manifested on a case-by-case basis. This cycle results in negative emotions, which then lead to more eating problems in a vicious cycle.

From a psychological perspective, treatment for Eating Disorders emphasizes the development of more adaptive eating behaviors, exposure and response prevention (for example, exposure to the urge to purge food while preventing vomiting), skills training for coping with “triggers” in high risk situations, and cognitive therapy to modify irrational beliefs, and relapse prevention.  Individual with eating disorders often manifest issues with stress or relationships in how eat. Along with family therapy, interpersonal therapy, and support groups, CBT can be an effective treatment for many kinds of eating problems.  Depending on each individual’s profile, such as whether depression is or is not present, medications may be indicated. Certain Eating Disorders are so severe or life-threatening that there is no other option than residential or hospital-based treatment.

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