All About Disordered Eating

Discussion in 'Diet, Nutrition and Supplements' started by Erik, Sep 18, 2009.

  1. Erik

    Erik Admin

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    Long, but good. Courtesy of Ryan Andrews:

    I remember the following statement from a lecture in 2006:

    “Use new information about eating disorders very carefully.”

    Becoming aware of new information isn’t always a good thing in the world of eating disorders.

    Some people learn new things about disordered eating and instead of using it to heal themselves, they add it to their destructive eating arsenal.

    If you struggle with disordered eating and you think reading this article offers more risk than benefit, and/or you think this article may trigger problematic behaviour, proceed with caution.

    What is disordered eating and when did it start?

    Anorexia

    “Anorexia” comes from the ancient Greek orexis, or appetite. The prefix “an” denotes “without”; thus “anorexia” is literally “without appetite”.

    Now we use the term to describe purposeful non-eating or avoidance of food.

    Historical examples

    We can track human anorexia back over 11,000 years.

    Nomadic foragers migrated from location to location and the biological capacity to suppress hunger may have offered an adaptive advantage.

    Modern yogic ascetic, demonstrating imperviousness to cold and hunger in the Himalayas

    Fasting days have often been part of religious rituals and processes across cultures. Many traditional indigenous societies include occasional prolonged fasts in order to strengthen their self-discipline and/or achieve spiritual insight.

    However, some groups and individuals tried to go without food longer and more frequently. For them, extreme food restriction was part of a daily routine that also included other forms of self-punishment.

    The premise was that the body’s needs were somehow immoral and sinful, and thus forcing the body to endure pain, extreme deprivation, and humiliation was a good thing.

    For instance, during the medieval period (approx. 5th century CE to late 1500s), early Christian saints often practiced extreme asceticism, refraining from as many fleshly indulgences as possible, and engaging in fasts lasting several days or more.

    This extreme food abstinence was linked to other forms of self-punishment in the name of religious devotion. As one source notes regarding medieval asceticism:

    Ascetics would deliberately inflict pain or damage (e.g. looking at the sun until they went blind); live in crude, unpleasant conditions (such as in caves); and generally endure extensive psychological and physical torment. This torment, notes the source:

    Binge eating & purging

    Binge eating has been known for thousands of years. Historically it was related to cycles of scarcity and abundance.

    Food insecurity can lead to overconsumption in times of plenty.

    Like fasting days, many world religions also had feasting days. Among populations accustomed to frequent famines or food shortages, feasting days or times of abundance were undoubtedly a license to over-eat.

    The modern-day equivalent, now that food is as close as the supermarket, is a cycle of extreme dieting followed by eating to excess. While not all eaters include the extreme dieting — some simply over-eat — a cycle of deprivation followed by over-eating is common.

    Humans have also known for millennia about forms of purging — methods of forcing the body to expel what it has consumed. This includes using emetics (substances or methods of inducing vomiting), diuretics (which flush out body water), laxatives, and/or enemas.

    Historically, some regarded purging as a “health promoting” practice.

    This was depicted in the novel and film The Road to Wellville, which satirized the 19th-century purging-oriented practices of Dr. John Harvey Kellogg (inventor of Kellogg’s Corn Flakes).

    Because of the reluctance to associate obesity with disordered eating, it wasn’t until the early 1990s that binge eating was understood to be separate from bulimia.

    Modern understandings and diagnoses

    The actual “diagnosing” of disordered eating began in the 1870s.

    There are two recognized eating disorder diagnoses: anorexia nervosa (AN), which is self starvation, and bulimia nervosa (BN), which is binging and purging.

    These diagnoses are incomplete. They reflect only two types of disordered eating, and focus mostly on extreme cases.

    They do not encompass the countless individuals who struggle with other disordered eating patterns.

    Health professionals can utilize a catchall diagnosis, “Eating Disorder Not Otherwise Specified (EDNOS).” Currently, binge eating disorder (BED) is simply a provisional diagnostic status under EDNOS. When the fifth revision of the Diagnostic and Statistic Manual of Mental Disorders (DSM) is released in 2011 (or 2012), BED will have its own separate category.

    The characteristics of disordered eating are listed below.
     
  2. Erik

    Erik Admin

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    Why is disordered eating important?

    Clinically defined “eating disorders” of any type are only a small proportion of the rate of disordered eating in the general population. Arguably, “disordered eating” of one kind or another defines the lives of many people in modern society.

    A poll of 10,000 readers in a popular teen magazine revealed that:

    Individuals who watch TV three or more nights per week are 50% more likely than non-watchers to feel “too big” or “too fat.”

    This negative self image and intense fear of gaining body fat can lead to dieting. Nearly 25% of those who diet will develop partial or full syndrome eating disorders.

    Yet the National Institute of Mental Health spends less money on eating disorder research than any other condition it handles.

    Research funding per case equates to:

    How common are eating disorders?

    In short, we don’t know. We can only guess.

    Since doctors have no requirement to report eating disorders to health agencies, and since most people who suffer disordered eating never seek treatment, it’s hard to get accurate statistics.

    Furthermore, extrapolating eating disorder statistics to the general population is tricky. Not all patients are captured in a clinical setting, and the ones that do seek help don’t always fall into a specific category.

    Indeed, a recent study suggests that mental health disorders — which can include disordered eating — may be more common than we realize.

    If we factor in the broad range of behaviours that make up disordered eating, the prevalence of disordered eating is thus probably quite high.

    One estimate (see graphic below) indicates that only 1 in 10 people with eating disorders seek treatment.

    The National Association of Anorexia Nervosa and Associated Disorders states that approximately 8 million people in the U.S. have AN, BN, and related eating disorders. This means 3 of every 100 people eat in a disordered way.

    Who is at risk?

    About 1% of female adolescents have AN. Nearly 4% of college-aged women have BN. Data has indicated that almost 1/3 of female athletes may struggle with disordered eating.

    For every 4 females with AN, there is one male. For every 8 to 11 females with BN, there is one male. Some studies indicate that up to 25% of adults with eating disorders are male.

    Eating disorders used to be considered a “female problem”; however, males are increasingly affected, particularly as cultural norms shift to feature more and more lean and muscular male bodies in mass media. Some researchers have suggested, for instance, that “bigorexia”, or the perception that one’s body is too scrawny, may underlie many male bodybuilders’ quest for muscularity.

    Nearly 90% of those with eating disorders report onset of illness by the age of 20 and the primary age groups affected are the teens and twenties. Yet increasingly, older people are reporting disordered eating.

    All segments of society are affected by disordered eating: men and women, young and old, rich and poor, all ethnicities, and all socio-economic levels.

    However, research suggests that worldwide, it’s the upper social classes of industrialized countries, particularly in Western countries but increasingly in Asian countries such as Japan who are most affected by disorders of food restriction and extreme dieting.

    Studies have also found that even in regions and among ethnic groups that value plumpness, disordered eating is emerging.

    One of the groups newly affected by disordered eating, for example, appears to be young women of Arab and South Asian origin now living in Western countries. One study remarks that this group is now vulnerable because these girls simultaneously experience the conflicting and multiple pressures of Western body-shape ideals, traditional family and cultural expectations, and the challenges of fitting in to a new society.
     
  3. Erik

    Erik Admin

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    What you should know about disordered eating

    Disordered eating is a complicated phenomenon. It should be viewed as a set of behaviours and experiences rather than a specific, narrowly defined medical condition.

    While there are some features that these behaviours and experiences may share, people’s individual situations can vary widely.

    Eating disorders can develop from various factors, including:

    * Family struggles
    * Genetics
    * Impaired body image
    * Ineffective coping strategies
    * Low self-esteem
    * No feeling of personal identify
    * Lack of perceived control

    Physiological & psychological explanations

    The exact origins of disordered eating are still unclear.

    Some experts claim that genetics play a significant role in eating disorders. Those with a mother or sister who had AN are 12 times more likely than others with no family history of that disorder to develop it themselves. However, it’s not clear whether genetics is responsible, or whether the disordered eater is simply mimicking the behaviour and attitudes of other family members (or both).

    Others argue that eating disorders might actually be due to underlying metabolic or digestive tract disorders.

    It’s been suggested that those with AN have serotonin overactivity, leading to exaggerated satiety. They might also have excess activity in the brain’s dopamine receptors, leading to a drive for weight loss, but no pleasure from shedding the weight. Over-eaters may also have some disruption of dopamine, which is known to stimulate the body’s “wanting” response, or under-active satiety mechanisms.

    Strict dieting and the inability to adjust to environmental stressors are two critical initiators for developing an eating disorder.

    Restriction of food can cause food preoccupation, as any strict dieter can attest.

    And food can become “drug-like” for those struggling to cope with stress. Some evidence links anxiety and depression with disordered eating.

    Some have even suggested that disordered eating is not a “disorder” at all but simply the body’s “normal” attempt to cope with “abnormal” situations of modern stresses, cultural ideals, and food availability. In this model, disordered eating is actually a “mismatch” between Paleolithic physiology/psychology and modern lifestyle demands.

    No single cause

    What seems clear is that disordered eating can have many, interlocking, causes and manifestations. It’s a set of complex behaviours and experiences that can not and should not be over-simplified.

    Cyclical nature

    Disordered eating can often be cyclical.

    Eaters may have disordered eating thoughts and behaviours daily, every few days, every few weeks, or even infrequently throughout their lives.

    Some disordered eating appears during periods of stress and/or life transitions, then disappears again for a while when things settle down. These periods can include things like:

    Other disordered eating may follow a daily or regular routine (e.g. fasting all day followed by an evening binge; extreme dieting during the week followed by a weekend binge then a Monday morning purge, etc.).
     
  4. Erik

    Erik Admin

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    Eating disorder types

    Again, bear in mind that these are collections of symptoms that have been given a clinical label. Not everyone with disordered eating will fall neatly into these categories.

    Many people will have a unique set of behaviours from all of these lists of symptoms, and the symptoms may change over time or with the situation.

    In all cases, however, there are physical, psychological, behavioural, and lifestyle causes and consequences.

    Anorexia nervosa

    Characteristics

    Causes

    AN can have causes rooting from biological, psychological and/or socio-cultural origin. There is a possible genetic link.

    Individuals who develop AN may have psychological and emotional characteristics that contribute to its development, including low self worth or obsessive compulsive personality traits.

    The Western culture cultivates the desire for thinness and muscularity.

    Peer pressure and sports may also promote the desire to alter one’s body.

    Anorexia athletica is the development of anorexia-like symptoms and behaviours in athletes. See below for more.

    Consequences

    AN has the highest death rate of any mental illness, with a mortality rate of between 6% and 20%. Other consequences include anemia, lung problems, dehydration, bone loss and fractures, abnormal heart rhythms, heart failure, amenorrhea, hypogonadism, constipation, nausea, electrolyte abnormalities and kidney problems.

    Bulimia

    Characteristics

    Causes

    Those with bulimia are usually of normal weight status and tend to be well-educated.

    Overweight parents (often mothers) sometimes teach their children to use food as a stress coping mechanism, or as a reward/punishment.

    Codependency can be present, which is a dysfunctional pattern of relating to one’s own feelings, focusing on others or on things outside of themselves. Admission and guilt tend to be more common among patients with bulimia.

    Biological causes have been suggested, e.g. disorders of neurotransmitters associated with reward, satiety and anxiety, such as dopamine and serotonin.

    Consequences

    Vomiting can lead to erosion of dental enamel, mucosal trauma from stomach acids, gingival recession, dental caries, dry mouth and salivary gland enlargement (a puffy face is common).

    Fluid and electrolyte disturbances can occur, notably low blood potassium (which causes heart arrhythmias).

    After a binge, the stomach can rupture or the esophagus can tear. This is often fatal. On a lesser scale, there may be damage to the esophageal sphincter that regulates food transport between esophagus and stomach, which can lead to gastro-esophageal reflux disease (GERD).

    Binge episodes increase gastric capacity, delay gastric emptying, blunt hormone release from the stomach and impair satiety response.

    Binge eating

    Characteristics

    Causes

    Binge eating contributes to excessive calorie intake and is most common in obese persons. The onset is usually beyond teen years.

    Individuals with this disorder tend to be distressed by it, with depression being a common symptom. Researchers have begun to classify BED as a “major public health burden.”

    Chronic dieting may predispose binge eating.

    Depression is not only a symptom but a common antecedent.

    More than 25% of patients in weight control programs binge at least twice per month. Many times, a history of parental or personal alcohol abuse is noticed. Other traumatic events, years of unusual stress, or mood disorders can also be involved.

    Consequences

    The physical outcomes of BED include diabetes, high blood pressure, obesity, cardiovascular disease, and other health ailments.

    After a binge, the stomach can rupture or the esophagus can tear. This is often fatal. Binge eaters are also more prone to gastro-esophageal reflux (GERD) and other GI disorders, due to the volume and speed of consumption.

    Psychologically, bingers often experience depression, since many people are always struggling to reduce body weight. They may become anxious in anticipation of upcoming

    Thus, lifelong weight cycling and psychological distress are typical when the disorder is uncontrolled.

    Anorexia athletica

    There are two related forms of anorexia athletica. One is defined by the use of excessive exercise to maintain body weight; the other is defined by disordered eating among recreational and competitive athletes.

    In both cases, exercise is usually part of a general attempt to control body size/weight, or a precipitating factor in disordered eating behaviours.

    Characteristics
    Causes

    Exercise anorexia is a compulsive behaviour and many individuals do it to gain more control over their lives. It can be provoked by dieting at an early age, comments about body shape by a professional/coach and sport specific training.

    Athletes engaging in team sports and sports/physical activities that emphasize either weight classes or body image (e.g. wrestling, swimming, dance) are most vulnerable, particularly if parents, coaches, or peers are focused on weight or body size.

    Consequences

    The health outcomes include dry hair, dry skin, hair loss, digestive difficulties, slowed heart rate, low blood pressure, dehydration, kidney problems, insomnia, joint weakness, suppressed immune function, and nutrient deficiencies.

    Athletic performance is eventually also affected, as athletes may suffer recurring injuries and illnesses, cognitive impairments, and poor recovery from training.
    Prevention and treatment of eating disorders

    Depending on the severity and duration of the eating disorder, treatment varies.

    Generally, however, treatment should be multi-factorial and address physical, psychological, and lifestyle factors.

    With advanced AN, treatment typically has two phases:

    Usually, a team approach is utilized with a physician, nurse, dietitian and psychiatrist.

    Two approaches for BN treatment are psychotherapy and antidepressant medications. Sessions can be done over a 6 month period and the antidepressants can be helpful for long-term results.

    No standard treatments are involved with BED and exercise anorexia. Conventional weight management programs or professional counseling may be involved. The treatment method is determined by the patient.
    Summary and recommendations

    “When the student is ready, the teacher will appear.”

    As with other types of addictions, there’s not much anybody can do until the person with the disordered eating wants to change.

    Confrontation and harassing generally don’t help. Nor does well-meaning advice such as “Get over it” or “You should love your body”.

    One of the best things to say to someone you suspect has disordered eating patterns is:

    “Let me know if there is anything I can do to help.”

    Direct statements or judgments about body size or eating habits will most likely elicit resistance.

    If you are concerned about your own eating patterns, and suspect they are disordered, we suggest seeking out resources to assist in recovery.

    Strict dieting will likely create further problems. Remember, the disorder probably extends beyond food.

    Find books, a counselor and/or a support group that can assist you in making a recovery. It’s tough, but it’s worth it.
     
  5. Erik

    Erik Admin

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    Further resources

    Intuitive Eating

    Books by Victoria Moran

    Eating Mindfully

    Breaking out of food jail

    Overeaters Anonymous

    NationalEatingDisorders.org

    Extra credit

    Inpatient treatment for disordered eating can reach $30,000 per month.

    Stress can trigger binge eating.

    No medications appear to be effective for treating AN. Medications may be useful for BN and BED. Behavioral therapy seems to be the most effective option.

    Some data has indicated that vegetarian adolescents may be more likely to display disordered eating attitudes and behaviors than non-vegetarians.

    Besides the obvious repercussions of disordered eating, other scary stuff can happen. Check out this case report from 2008:

     
  6. Blondell

    Blondell Former Postwhore

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    Good posts, Erik.
     
  7. Sandy

    Sandy Well-Known Member

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    Thanks for the post Erik.
     
  8. Patricia

    Patricia Well-Known Member

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    I can definitely relate here.
     
  9. Inatic

    Inatic Ya Gotta Wanna! Moderator

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    sticky worthy?

    Good info :)
     
  10. Erik

    Erik Admin

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    Good idea!
     
  11. BigDog

    BigDog Well-Known Member

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    I've had 3 out of 4.

    I wish they had gone more in depth about the "biological causes".

    Also, I find it discouraging that "seeking help" is not as easy as it sounds. I still have yet to find assistance that is affordable.
     
  12. magnolia

    magnolia Now a Mommy to 5!

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    I'm glad the author included strict dieting and preoccupation with food as part of disordered eating. I think a lot of people on strict diets, especially low calorie diets, believe that because they are eating something that they aren't anorexic. In high school and college I was a dancer and I would say the majority of dancers I danced with were like this, myself included.
     
  13. Redone

    Redone Member

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    Invaluable resources to add:

    Gurze.com also accessible as Bulimia.com

    Includes:
    -literature aimed at parents/friends, family, sufferers, clinicians, all EDs from a variety of perspectives, nutrition professionals
    -blogs by authors
    -links to therapists/medical resources
    -articles

    Something-fishy.org

    Includes
    -huge compilation of medical/health care resources
    -forum
    -medical information
    -etc etc etc
     
  14. Scarl3tbutt3rfly

    Scarl3tbutt3rfly Motivated and ready!!

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    Thanks for posting this. It was a good thing to read, even though I knew most of the information before.

    This is something that Ive been struggling with lately, or have come out of denial regarding anyway. It is the biggest reason, I at least on the outside have stopped dieting. It is still a struggle I deal with inside though (meaning, I still cannot stop trying to rigidly control my calories). It is also the reason I decided I couldnt compete for a while (if I can even compete again). My preoccupation with food, my cyclic eating, and punitive eating behaviors were to me unhealthy and something I was greatly not liking about myself.

    I am still, like I said struggling with it internally. But I am past the denial stage at least.
     
  15. laurawd

    laurawd Well-Known Member

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    I'd bet serious money that more than 1% of the female population has a disorder.
     
  16. chantilly

    chantilly Note to self: Just do it.

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    I totally agree! If I take my group of close female friends... I know that over the years almost all of them have struggled with some form of an ED and/or preoccupation with weight loss/calorie restriction - it was always directly linked to fitting into the "skinny ideal".

    So I can only imagine what the statistics would be if there was a way to capture data for the less severe cases of ED that go unreported.
     
    • Like Like x 1
  17. Scarl3tbutt3rfly

    Scarl3tbutt3rfly Motivated and ready!!

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    Alot of the problem is too. Alot of people wont even classify what they do as being a form of disordered eating. Even though what they are doing technically is. I see this all the time when reading all the figure/bodybuilding forums I read. Most people can pretty much be classified under that.

    I was talking to a trainer in my gym the other day about how I was feeling, whether I was going to compete again and whatnot. And she said, "well Ive never had an eating disorder, but when I was going to compete that last year, I ended up not, because that stuff starts to mess with my head and Im known to start overcontrolling my food intake. When things get chaotic around me, I know the only thing I can control is what I put into my mouth. I end up not eating." This is almost the very definition of anorexia. Hello. But yet she told me Ive never had an eating disorder...but...

    I think it is a huge problem in our society, and in reality is all of over the place. I dont know how many infomercials I see for losing weight. Commercials for diet products, etc, etc. This whole country has a problem with it. We have such a preoccupation, not only with food, but with physicality. We put so much status on being beautiful and perfect, and then on the reverse, we promote unhealthy behaviors.
     
    Last edited: Sep 20, 2009
  18. pavermama

    pavermama Rut Row!

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    I have a mixture of these ED's. I'm just now realizing it but learning about it and hearing peoples experiences with these issues are very helpful. I find it sad that they say depression is one of the causes of an ED, but yet they don't offer financial aid to those that need to seek professional help with the disorder. Now who wouldn't get MORE depressed because they can't AFFORD to get help?...especially when they REALIZE they need help, but CAN'T get it.
     
  19. Gnat

    Gnat Well-Known Member

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    :sad: Haven't been on here so long, I must have mussed up my last post. I'll try again.

    I have recently read The Other Side of the Mirror by Scott Abel. An incredible read for anyone, whether suffering from ED and/or body image disorders or not. Great insight. Gave me lots of lightbulb moments. It's an ebook available on his website.

    Hope everyone is well!
     
  20. kirstny

    kirstny Well-Known Member

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    Hi Gnat!!!

    Good to "see" you!
     

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