Eating disorders are mental disorders in which people’s relationship with food, exercising, body image (the perception of personal appearance) or their general perception of themselves have a negative impact on their health. People with eating disorders may, for example, eat so little that they endanger their health, eat excessive amounts, vomit their food or exercise compulsively.
The most common eating disorders are anorexia nervosa (usually referred to simply as anorexia), bulimia and binge eating disorder. In addition, eating disorders can include symptoms from all of the above mentioned disorders. Indeed, eating disorders are often combinations of the classified disorders; for example, anorexia relatively rarely manifests exactly as described in the diagnostic criteria.
All eating disorders involve feelings of self-hatred, anxiety and depression, isolation and compulsive eating behaviour, such as avoiding or only eating certain foods. In addition, most eating disorders include some kind of self-punishment; for example, the person must take a longer run after meals than usual.
Pathological weight loss, excessive exercising and continuous self-induced vomiting can cause permanent damage to the body. Often people suffering from eating disorders also suffer from depression or have some other mental disorder at the same time.
Eating disorders are not age or gender-bound, although the majority of patients are young girls or women. Eating disorders are not a new phenomenon, but it is commonly believed that the number of people suffering from eating disorders increased in the 1960s when the fashion industry began to idolise thinness.
Patients suffering from eating disorders and their families often need the help of a doctor, psychiatrist or psychologist, and a nutritional therapist. With anorexia, the first priority is to return the patient’s body weight to a safe level and his/her diet back to normal. With binge eating disorder, the goal is to stop the vicious circle of losing weight and binge eating.
The different treatment methods include nutritional therapy and psychotherapy. Through psychotherapy, the patient begins to understand his/her life situation and determine the possible causes for the illness. Psychotherapy may be organised individually or in groups, and it may include hospitalisation, if necessary.
Individuals of normal weight with anorexia consider themselves fat and begin to lose weight. They cannot stop dieting, nor do they want to, causing their body weight to drop dangerously low in relation to their height. The low weight is maintained by continuously eating too little and exercising too much. The diagnostic criteria of anorexia include intense fear of gaining weight, weight loss to the extent that their weight becomes only 85% of normal body weight, refusal to admit they are seriously underweight and amenorrhoea in women.
Anorexic patients often react to food and exercise in a compulsive manner. They may, for instance, only eat certain foods, begin to avoid other people, and exercise too much. Anorexia is sometimes preceded by depression. Depression may also appear simultaneously with anorexia.
Thinness defines the self-esteem of an anorexic
It has been noted that hard-working, intelligent and ambitious girls are more likely to become anorexic than others. Anorexic individuals may also have trouble expressing negative feelings, such as disappointment and anger. They often set high goals in several areas of life, and demand a great deal of themselves.
However, one should keep in mind that not all people suffering from anorexia fit into the above mentioned description: children, adults, women and men, all alike, can become anorexic. For people with anorexia, thinness may become their main source of self-esteem and gaining weight can cause strong feelings of inferiority.
Attitudes in the media and in the surroundings may affect the onset of the illness
Our culture often links slenderness with success and happiness. The ideal is a woman below normal weight. Adolescents may begin to see dieting as a solution to their problems and, at first, it may bring them a sense of control.
However, pathological and compulsive dieting is very dangerous to both physical and mental health. Changes in life, such as divorce or change of schools, or a remark made by someone over the appearance of the individual, can also trigger the dieting process.
Anorexia is more likely to pass from one female to another in a family. The habits and attitudes passed in the family probably explain the higher predisposition to the illness to some extent. However, based on studies on twins, the predisposition to anorexia seems to be somewhat hereditary, although this cannot be yet properly explained.
Anorexia is a serious illness, but the majority of patients recover well
Anorexia is a very serious illness, which includes the risk of death as a result of excessive weight loss. Therefore it is important to seek treatment on time. Choosing the place for treatment is determined by the weight of the anorexic person, his/her overall physical condition and motivation for seeking treatment.
Patients are often treated as outpatients but, with the more severe cases, hospitalisation may be required. For example, when the weight loss has resulted in dangerously low pulse or blood pressure, in disturbances in the metabolic balance, changes in the EKG (electrocardiogram) or in serious mental problems, the patient will be hospitalised. The goal of the treatment is to correct malnutrition, restore normal eating behaviour and eliminate psychological symptoms. The goal is to influence both nutrition and state of mind.
The treatment is usually implemented in collaboration with the patients and their family, the doctor and other medical professionals, and possibly with the school. Patients must agree to certain terms regarding nutrition and exercise, and their weight is monitored. As the treatment progresses, the conversation will shift from weight control to the thoughts and feelings of the patient.
In addition to treatment, anorexic patients may need individual psychotherapy or family therapy. If the anorexia includes depression, medication may prove useful. In addition, different kinds of functional groups, such as art therapy, may promote recovery. Even though anorexia is a very serious illness, the majority of patients recover well.
Studies show that anorexia in Finnish women usually lasts about three years. During this period, the illness may restrict normal life to a significant amount; however, people who have recovered from anorexia participate in working life and studies, date and have children just like other people of the same age. Patients who have suffered from anorexia for years can also recover well; therefore patients should always seek treatment for anorexia. Read more about seeking help.
The symptoms of bulimia include repeated episodes of binge eating, followed by self-induced vomiting. Bulimia, as well, involves increased fear of gaining weight and focus on monitoring body weight. Binge eating is usually performed in secret and afterwards the person feels extremely ashamed.
During an episode of binge eating, bulimic patients feel they cannot stop eating or control the amount of food they eat. They may try to prevent weight gain by vomiting or by using diuretics or laxatives, or through fasting or excessive exercising. The vomiting in bulimia does not only occur after binge eating; some bulimics may vomit after eating normal or even small amounts of food.
Many bulimics have normal weight, and have no previous history of eating disorders. Sometimes people who have recovered from anorexia become bulimic. Bulimia often develops later than anorexia and it usually follows a fierce attempt at losing weight. People suffering from bulimia often feel that their weight defines their self-esteem: weight gain or the thought of weight gain brings on feelings of inferiority and anxiety. The self-esteem of bulimics is generally low.
The effects of bulimia on health
The effects of repeated vomiting include disturbances in the salt balance, disturbances in the menstrual cycle, cardiac arrhythmias and damages to the dental enamel. In addition, the salivary glands of bulimics are usually enlarged and their face may be swollen. Vomiting can also damage the oesophagus and cause abdominal pain and nausea.
People suffering from bulimia relatively often suffer from other mental disorders, as well. The most common disorders are anxiety disorders and depression. It has also been noted that bulimics often attempt to harm themselves in other ways, as well, such as by cutting themselves.
Predisposing factors of bulimia and treatment of the illness
It has been proven that the predisposing factors of bulimia are quite similar to those of anorexia. The attitudes of the surrounding culture and family often influence the onset of the illness, just as the events during individual development do, such as being bullied at school or being rejected in personal relationships.
There are various treatment methods developed for bulimia. In most cases, the treatment combines, for example, nutritional therapy, information on the illness, psychotherapy and treatment that aims at improving the physical condition of the patient. Sometimes antidepressants are used. Patients are taught how to monitor their health via food and symptom journals. Also, the patient can learn to overcome harmful patterns of thought and behaviour, such as basing self-esteem on thinness.
Bulimics often do not seek treatment until years after the first symptoms. This may be explained by the possible changes in the course of the illness: sometimes people suffering from bulimia do not feel the need for binge eating and vomiting or, even if they did feel it, they are able to resist the urge. However, sometimes patients cannot control the binge eating and vomiting, and the symptoms begin to interfere with their lives to a significant extent.
The treatment methods for bulimia help the patients prevent the illness from recurring and to control its symptoms. The treatments methods aim for permanent recovery: even people who have suffered from bulimia for years can permanently recover from the illness.
Atypical eating disorders
Despite the name, atypical eating disorder is the most common form of eating disorders. Atypical eating disorder resembles anorexia or bulimia, for example, but an essential symptom is missing. Someone suffering from an atypical eating disorder may, for example, suffer from binge eating but he/she does not vomit as a bulimic would. Similarly, if the diagnostic criteria of anorexia are strictly interpreted, a woman who still has her period cannot be diagnosed with anorexia. In cases like this, the disorder would be diagnosed as an atypical eating disorder instead of anorexia.
There is a thin line between eating disorders and so-called normal eating behaviour. For example, someone trying to lose weight with a tightly controlled and restricted diet may be hard to classify according to the diagnostic criteria. Therefore treatment can be determined on the basis of the type and severity of the symptoms alone without having to come up with a name for the eating disorder.
Binge Eating Disorder (BED) is the most common atypical eating disorder
Binge Eating Disorder or BED is a disorder that is likely to lead to obesity. The disorder is characterised by the consumption of large amounts of food without the so-called compensation behaviour, i.e. vomiting or using laxatives, for example. It has been estimated that 20 % of people seeking help for obesity suffer from the disorder. Patients with BED often suffer from considerable fluctuations in weight and the binge eating causes intense anxiety.
A person suffering from the binge eating disorder may try to control their eating by skipping meals; however, skipping breakfast or lunch, for example, may lead to binge eating in the evening. A regular and healthy diet is important to a person suffering from binge eating disorder. Patients suffering from binge eating disorder should avoid drastic weight loss programs, as they may make the binge eating episodes worse and more frequent.
Muscle dysmorphia is a condition in which a person experiences a compulsive need to develop their muscles and is ready to spend a considerable amount of time to achieve this purpose. Despite the fact that people suffering from muscle dysmorphia are usually very muscular, they see themselves as skinny and weak. Just like anorexic patients who see themselves as fat even though they are thin in reality, the body image of people suffering from muscle dysmorphia is distorted. People suffering from muscle dysmorphia often feel an intense anxiety, and a hard workout routine helps them tolerate the anxious feelings. They may also use substances that are dangerous to their health, such as hormones, to increase their muscle mass.
A person suffering from orthorexia presents a compulsive desire to eat healthy. They may spend several hours a day planning and preparing meals and absolutely refuse to eat certain foods. Orthorexia may begin, for example, when a person who is used to exercising a lot suffers a physical injury that prevents them from training. The fear of gaining weight may trigger the compulsive need to eat healthy; eventually, the eating pattern results in an eating disorder. Orthorexia may lead to anorexia or bulimia.
Men are not immune to anorexia or bulimia. However, men are more likely to suffer from the compulsive need to grow muscle mass, i.e. muscle dysmorphia, or the compulsive need to pursue a healthy diet, i.e. orthorexia.
If you live in Uusimaa area, you can seek support from for example Etelän-SYLI ry. They organize peer support evenings for English speakers and offer peer support by email.