Eating Disorders and Addiction Explained
Of all addictions and related conditions, eating disorders are amongst the most widespread, most dangerous, most stigmatised, and yet least understood. Millions of people around the world are affected by these devastating disorders, and many thousands die each year as a result. Fortunately, there is now a good degree of expertise in treating eating disorders, and an array of facilities throughout the UK are now saving lives and helping sufferers return to normal, healthy and happy lives.
An eating disorder is a mental condition characterised by abnormal eating habits and conceptions of food and diet which have a negative impact upon the sufferer’s physical and/or mental health. A broad variety of eating disorders have been identified and although formal diagnoses have only emerged in the modern era, aspects of some eating disorders have been recognised since ancient times.
Although the psychological and neurochemical foundations of eating disorders are in many ways distinct from those of disorders more typically referred to as addictions, and while it might not be strictly medically correct to refer to an eating disorder as an addiction, there are also numerous similarities in terms of both causes and effects, and also in terms of some aspects of and approaches to treatment. As a result of these similarities, a number of organisations and facilities treating addiction also treat those suffering from eating disorders, with a good deal of emphasis placed upon changing negative patterns of behaviour and thought processes.
Types of Eating Disorders
The term “eating disorders” encompasses a variety of conditions whose symptoms and ramifications can differ very significantly from one another. While all have at their cores an imbalanced and unhealthy attitude towards, and relationship with, food and eating, one person’s experience of one particular eating disorder may vary hugely from someone else’s experience of another, as may the signs and behavioural patterns which might indicate the presence of a disorder.
Perhaps the best-known eating disorder – or at least the one which has gained the most mainstream attention and media coverage – is anorexia nervosa (from a Greek term meaning “nervous loss of appetite”), a dangerous condition characterised by a reluctance or refusal to eat, an overwhelming compulsion to lose weight, and/or a desire to remain thin – often extremely so – regardless of any negative consequences for the sufferer’s health.
Alongside any ramifications for an anorexic’s consumption of food – which is typically very restricted – they may also exercise to excess, purging (by vomiting and/or consuming laxatives), take appetite-suppressing drugs, drink excessive amounts of water to retain a feeling of being full, or take other steps all aimed at preventing any weight gain or encouraging its loss.
The implications for a sufferer’s health can be extremely serious, even fatal; anorexia nervosa has the highest mortality rate of any known psychological disorder. Likewise, their relationships with others and their life circumstances and prospects can be permanently damaged.
Almost as well-known as anorexia – and sometimes erroneously viewed as its “opposite” – bulimia nervosa (from a Greek phrase meaning “nervous ravenous hunger”) is characterised by compulsive binge eating followed by purging (typically by vomiting, but also through the use of laxatives). Although, unlike anorexia and some other binge-eating disorders, bulimia sufferers are normally at a relatively normal weight, the condition does have significant health (especially mental health) implications.
As with most other eating disorders, bulimia is significantly more likely to affect women than men, with up to 3% of women expected to experience the condition at some point in their lives; up to 4 million people globally are currently affected by bulimia.
Binge Eating Disorder
Binge eating disorder (BED) is a condition in which sufferers engage in bouts of compulsive eating – often featuring extremely large quantities of food – though without bingeing afterwards, as is the case with bulimia; many medical experts consider BED and bulimia to be very similar in terms of eating patterns, neurochemical and neurobiological drivers, and risk factors, and indeed BED has only relatively recently been described as a distinct condition. However, some of the long-term health impacts of BED – especially those related to obesity – differ from those typically seen in bulimia sufferers.
Though precise numbers are effectively impossible to establish, binge eating is believed to be one of the most prevalent eating disorders affecting adults worldwide and is seen as a major contributor to the ongoing obesity epidemic in the developed world in particular.
Pica (derived from the Latin for “magpie”, a bird thought in antiquity to be capable of eating anything) is a disorder characterised by the compulsive craving for, and consumption of, non-food items, typically including but not limited to hair, metal, paper, stones, soil and even faeces.
As well as being indicative of the possible presence of a range of other disorders, pica can have serious health implications due to the presence of non-nutritive – and potentially indigestible – objects in the stomach and intestines, and can lead to fatal complications.
Pica is recognised as a disorder only if it occurs consistently over a period of more than a month, at an age considered “developmentally inappropriate” (i.e., not in very young children). It is commonly seen to affect pregnant women and those with developmental disabilities but can afflict individuals outside those groups.
Rumination disorder – sometimes known as rumination syndrome or Merycism – is a comparatively little-understood condition which sees sufferers regurgitating most meals after consumption as a result of involuntary contraction of abdominal muscles. Though some of the symptoms and effects of rumination disorder resemble those of bulimia, the vomiting which takes place in cases of the former is unintentional, and as a result the condition is often confused with other disorders such as gastroparesis.
Although the causes of rumination disorder have so far not been identified, it does appear to be psychological in nature, and cases are typically described as being either habit-induced (resulting from prolonged habitual behaviour such as that resulting from bulimia) or trauma-induced (following either physical or emotional trauma, potentially quite some time previously). In either case, while there is no known cure, various therapeutic approaches including aversion therapy have been seen to have positive effects, and in some cases to reverse the condition altogether.
Avoidant or Restrictive Food Intake Disorder
Purging disorder is characterised by regular purging (by vomiting or through the consumption of laxatives) after eating; it is often confused with bulimia nervosa but differs from the latter in that sufferers do not binge-eat prior to purging. It is usually associated with the compulsion to maintain or attain a desired weight or body shape.
Purging disorder is far less well understood than bulimia (and indeed is often confused with and/or misdiagnosed for the latter), and many medical professionals do not consider it a distinct disorder with its own psychopathology. However, it is associated with a number of health risks and is known to be both symptomatic, and potentially causative, of a number of other disorders.
Night eating syndrome
Night eating syndrome (NES) is a disorder who sufferers experience an abnormal pattern of eating, featuring the desire to consume a significant proportion of their daily intake during nocturnal hours. It is differentiated from sleep-eating in that sufferers are awake and aware of their actions whilst eating. In order to constitute NES, three of five symptoms must manifest: urges to eat at night and/or after the supposedly final meal of the day; lack of appetite upon waking and/or during the morning; an inability to sleep until the cravings to eat are satisfied; a depressed mood; and a general difficulty sleeping.
Night eating syndrome is believed to affect between 1% and 2% of the population, and up to 10% of all obese people. It is being associated with obesity, depression, diabetes and anxiety disorders, and other complications relating to lack of sleep.
Eating disorder not otherwise specified (EDNOS)
Eating disorder not otherwise specified (EDNOS) is a classification of eating disorder formerly recognised in the authoritative Diagnostic and Statistical Manual of Mental Disorders (DSM) but which has now been replaced by the category “other specified feeding or eating disorder” (OSFED) in the fifth edition of the Manual (DSM-5).
The disorder refers to a condition that does not satisfy the criteria for either anorexia or bulimia; sufferers may exhibit features of both disorders, or very anomalous behaviour related to eating which does not fit into either of those two diagnoses. While many doctors, following the guidance laid out in DSM-5, no longer diagnose EDNOS, it was formerly diagnosed in up to 60% of eating disorder-related cases.
Stages of an Eating Disorder
Typically (though again not invariably) an eating disorder will begin with the development of an unhealthy preoccupation with food and/or bodyweight/shape – for example, in cases of anorexia or purging disorder, a growing reluctance to eat either specific or all foods, and the beginnings of habitual purging – or, at the other extreme, a growing obsession with eating increasingly large quantities of food, possibly at ever-shorter intervals.
Once the disorder has become chronic, the behaviour will have an ever-greater impact upon the sufferer’s life, with some disorders (including anorexia and BED) having increasingly visible deleterious health consequences (most obviously dangerous weight loss/gain). Serious mental health disorders including major depressive disorder may also result, whilst relationships and life prospects can suffer greatly if the sufferer is unable or unwilling to seek help. In the most serious cases permanent disability and death may result.
Causes of Eating Disorders
Some eating disorders are known to be caused by purely biological factors – which makes treatment via psychotherapy largely ineffective, and such cases often require pharmaceutical or even surgical intervention if they’re to be addressed. Research shows that up to 60% of eating disorders have biological and genetic components. Some prominent biological factors include:
- Irregular hormone functions: hormones play a major role in our experience of food and digestion, with, for example, some hormones found in the intestinal system triggering hunger and determining how much food we require to feel full. A hormonal imbalance can make a person constantly hungry regardless of the amount of food that they eat, or at the other extreme make them feel full after little or no food; such an imbalance can lead to extremely complicated attitudes towards food, contributing towards the development of eating disorders as well as other conditions.
- Genetics: several studies have shown that genetics can play a major role in predisposing someone towards developing an eating disorder. For instance, the parent, child or sibling of someone with an eating disorder is up to 12 times more likely than the average to have, or have had, an eating disorder themselves. Research is ongoing into the connection between specific genes and specific eating disorders, and future developments in gene therapy may lead to great advances in this field.
- Nutritional deficiencies: while it may be obvious that some eating disorders may lead to nutritional deficiencies, recent research suggests that it may also work the other way round – in other words, that pre-existing nutritional deficiencies may also cause some eating disorders. For example, undermethylation – an enzyme imbalance – is believed to contribute to up to 25% of cases of anorexia.
Though the popular belief that eating disorders are purely psychological is erroneous, it is true that psychology plays a major role in many cases. The complexity of the human psyche means that any number of factors could feasibly be in play; in practice, many cases of eating disorders involve an individual’s negative perception of their own appearance, and/or issues with self-esteem and self-worth.
- Negative body image: a huge number of cases of, especially, anorexia and BED are linked with negative body image. Sufferers strive to attain their idea of a desirable or “perfect” shape (which may in fact be much thinner than what is either healthy or socially acceptable) and often starve themselves – sometimes to the point of death – to do so. The modern world’s apparent obsession with female body image in particular, and the emergence of an “ideal” (in fashion especially) which is significantly thinner than the actual average body shape, is believed to be a major contributor to the proliferation of cases of anorexia and other eating disorders.
- Poor self-esteem: a belief in one’s essential worthlessness can contribute to many forms of eating disorder, especially those involving purging (as a form of self-punishment), and extreme over- or undereating. Sufferers with very low self-esteem can struggle to find reasons to continue to live well, and can find solace in eating (or in the self-harm which comes from depriving oneself of food). Moreover, low self-esteem can also equate to a belief in one’s unattractiveness, with the maintenance of an apparently “desirable” physique thus rendered irrelevant.
Environmental influences also play a major role in the emergence of many eating disorders. Some people’s childhood or adolescent experiences can lead to challenging relationships with food, though in other cases eating disorders may not manifest until much later in life.
- Dysfunctional family dynamic: an unhappy home life is a factor in many cases. Some people – especially young people – may seek escapism in food and eating, or may seek to find some degree of control which is denied them elsewhere at home. Dysfunctional families can often also struggle to maintain regular supplies of food or regular mealtimes, which can also contribute to the development of eating disorders in family members.
- Professions and careers that promote being thin and weight loss (ballet, modelling, rowing, diving, ballet, gymnastics, wrestling, long-distance running): some careers (especially in sport) place significant emphasis upon being as light as possible, or on staying below certain target weights, while others place great value on particular “look”, which may be significantly thinner than average. The pressure to attain and stay at such weights or looks can be overwhelming, and while some people manage to do so without developing actual eating disorders, in other cases the psychological pressure is too great, and the relationship with food becomes pathological.
Family and childhood traumas
Grief is known to drive people to compulsive overeating – as well as, at the other end of the spectrum, to a disregard for food – which can become habitual. Trauma can also contribute to other conditions which can be factors in the development of eating disorders, such as depression, anxiety disorders and others.
Cultural pressure and/or peer pressure among friends and co-workers
As noted above, the emphasis society places upon certain physical ideals can lead people into an obsessive quest to attain those ideals, often at great cost to their own health. The fashion industry, in particular, has been blamed for driving girls and women in particular – but also a growing number of boys and men – into anorexia.
However, such pressure can also be exerted by people much closer to the individual in question: for example, constant comments about a person’s weight or eating habits can drive a person into an obsessive preoccupation with their food consumption and appearance which can, in turn, lead to the manifestation of various eating disorders.
Stressful transitions or life changes
Major life events causing great stress can trigger a plethora of mental health issues, including eating disorders. Again, some people fixate upon their dietary patterns as a way of maintaining some semblance of control when they feel that other aspects of life are slipping out of kilter, while others may simply use eating – or not eating – as a means of escapism.
Signs & Symptoms of an Eating Disorder
Because of the sheer range of eating disorders and their different mechanisms and effects, a comprehensive list of the “symptoms of eating disorders” generally is effectively impossible to produce: the signs of binge eating disorder, for example, are very dissimilar to those of, say, anorexia.
The most visibly obvious signs of some disorders are of course, especially prominent weight gain or loss. Such changes in weight are not by themselves indicative solely of the presence of an eating disorder – there may be various other causes, such as chronic illness – coeliac disease, or other gastrointestinal diseases – or perhaps changing weight to fit a dramatic role or sporting criteria – but certainly, if there are no other identifiable causes, substantial weight gain or loss should at least prompt some degree of questioning.
Some disorders may be indicated by unusual eating behaviour such as – in the case of pica – the consumption of non-food items or – as with ruminative disorder – instances of sudden and uncontrolled regurgitation. However, as with many addictions, eating disorders typically are hidden as much as possible from external observers, so the signs may not be that obvious. Frequent brief disappearances from gatherings – especially during or shortly after eating – may indicate purging, as could be the presence of laxatives in medicine stores; again, however, there could be various other explanations for such factors.
Chronic disorders involving purging via vomiting are often evident via stained fingers (regularly used to induce vomiting) and dental problems (regularly corroded by digestive acids). Disorders involving the consumption of less than the healthy quantity of food can be betrayed by symptoms of malnutrition as well as by weight loss as mentioned above. Many disorders cause fatigue and irritability, and changes in mood and behaviour can sometimes be indicative of the presence of an eating disorder.
The long-term consequences of eating disorders can be catastrophic, including in the most serious cases the potential death of the sufferer from starvation, malnutrition and other conditions related to the consumption of insufficient quantities of food; or, at the other end of the spectrum, from obesity-related conditions including diabetes and heart failure. Chronic cases which do not result in death can nevertheless lead to permanent damage to the sufferer’s physical and mental health, leaving them severely debilitated and at risk of suffering from other conditions later in life.
Eating disorders can place huge stress on relationships, especially with loved ones, potentially leading to their destruction; alienation and isolation are serious risks associated with eating disorders, which can also lead to the development of other disorders such as depression (which may also result from other causes related to the eating disorder itself, such as a loss of self-worth and negative self-image).
If the disorder involves the excessive expenditure on food, and/or impacts negatively upon the sufferer’s work or academic prospects, financial consequences can be significant. This can be made worse if the eating disorder leads to substance abuse and subsequent addiction – for example, as a result of the regular consumption of appetite-suppressing drugs, including stimulants.
Eating disorders can also affect fertility, possibly permanently. The female menstrual cycle can be interrupted or suppressed – amenorrhoea – by an eating disorder, with cases of early onset menopause having been recorded; moreover, eating disorders can contribute to miscarriage and/or premature birth, and a host of developmental disorders in children born to mothers suffering from eating disorders. Male fertility can also be affected, with impotence and low sperm count potentially resulting from various eating disorders.
Treatment for Eating Disorders
The proliferation of eating disorders in the modern world has had a silver lining of sorts in the form of a significant rise in the number of facilities specifically treating sufferers, and in a great increase in the expertise of those providing the treatment.
There are now numerous options throughout the UK for sufferers of eating disorders seeking treatment, and many thousands of people each year are able to seek and receive professional – potentially life-saving – help.
Medical care and monitoring
Those with serious eating disorders are often in quite parlous physical condition upon being admitted for treatment,and round-the-clock care and monitoring may be required while the immediate pressures of either malnutrition or obesity (or other dangerous conditions) are addressed. Even after any immediate crises have passed, monitoring may be required to prevent self-harm or even suicide as a patient goes through any of various traumatic responses to their condition.
Although – especially in cases of anorexia or other disorders in which chronic weight loss and malnutrition have manifested – it is vital that the patient begins to eat normally, in some cases the immediate resumption of normal eating patterns and the consumption of typical foods could result in serious harm or even death: prolonged malnutrition can render the body temporarily unable to digest certain foodstuffs, especially fats. A careful programme of re-nutrition must be provided initially, which in the most serious cases – or if the patient is noncooperative – may involve nasogastric (via the nose) and/or intravenous administration. Normal levels and types of food need to be reintroduced slowly, with quantities wrapped up over time.
There are no medications which can currently produce a total and permanent “cure” for eating disorders; their primarily psychological foundation means that therapy remains the core element of treatment. However, some medication may be administered to address certain aspects of the condition – for example, appetite enhancers or suppressants to assist with the normalisation of eating patterns – while antidepressants often prescribed in an attempt to produce a general rebalancing of brain chemistry. Medicine may also be supplied to tackle any specific consequences of malnutrition, obesity, and other conditions derived from eating disorders.
Therapy forms the foundation of most effective treatment programs in cases of addiction and eating disorders. Various therapy models and approaches – including cognitive behavioural therapy (CBT), motivational therapy (MT) and others – may be applied, with the objective being to produce recognition of negative behaviour patterns and thought processes, and the development of suitable avoidance mechanisms on the part of the patient. In cases of eating disorders, long-term therapy may well be required, even after any intensive therapy applied as part of any residential treatment.
Prevention for Eating Disorders
In cases of addiction, though easier said than done, it’s a truism that the best way to prevent the development of any addiction is not to engage in a behaviour in the first place. In the case of eating, however, this is obviously impossible. Therefore the best route to prevention is to identify abnormal behaviour as early as possible, and if necessary to seek early treatment via a GP and/or therapist.
For example, if you notice that you are beginning to develop an unhealthy obsession with losing weight; if you start experiencing significant disruption to normal eating patterns, or start eating things or at times which you find strange; or if others begin to make comments expressing their concern about your appearance and health, consider seeking professional help immediately – even if you may not share that concern.
Eating Disorder Facts/Statistics
- Of all identified mental disorders, anorexia nervosa has the highest mortality rate.
- Approximately 70% of people with anorexia and 50% of people with bulimia recover within five years.
- People with anorexia are more than 50 times more likely to commit suicide than people without the condition.
- Over 1 ½ million people in the UK suffer from some type of eating disorder, of whom 10% are male.
- In the USA, one person every hour dies from an eating disorder.
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