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What Are Eating Disorders?
Eating disorders are serious mental health conditions characterized by persistent disturbances in eating behaviors, body image, and weight regulation, leading to significant physical and psychological harm. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classifies major eating disorders as anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), and avoidant/restrictive food intake disorder (ARFID) (American Psychiatric Association, 2013). The ICD-11 similarly categorizes these under Feeding and Eating Disorders, emphasizing their impact on health and functioning (World Health Organization, 2022).
Symptoms of Eating Disorders
Symptoms vary by diagnosis but share core features of disordered eating and distress:
- Anorexia Nervosa (DSM-5):
- Restriction of energy intake leading to significantly low body weight.
- Intense fear of gaining weight or persistent behaviors preventing weight gain.
- Distorted body image or denial of seriousness of low weight.
- Subtypes: Restricting type or binge-eating/purging type.
- Bulimia Nervosa (DSM-5):
- Recurrent episodes of binge eating (consuming large amounts of food with loss of control).
- Compensatory behaviors to prevent weight gain (e.g., vomiting, laxatives, excessive exercise).
- Self-evaluation unduly influenced by body shape/weight.
- Symptoms occur ≥1x/week for 3 months.
- Binge-Eating Disorder (DSM-5):
- Recurrent binge-eating episodes without compensatory behaviors.
- Eating rapidly, until uncomfortably full, alone due to embarrassment, or with guilt/depression.
- Marked distress about binge eating, ≥1x/week for 3 months.
- ARFID (DSM-5):
- Avoidance or restriction of food intake unrelated to weight concerns.
- Driven by sensory sensitivities, fear of choking, or lack of interest in eating.
- Results in nutritional deficiencies, weight loss, or dependence on supplements.
Types of Eating Disorders
The DSM-5 and ICD-11 recognize:
- Anorexia Nervosa
- Bulimia Nervosa
- Binge-Eating Disorder
- Avoidant/Restrictive Food Intake Disorder (ARFID)
- Other Specified Feeding or Eating Disorder (OSFED): Includes atypical anorexia or subthreshold bulimia/BED.
- Pica: Persistent eating of non-nutritive substances (e.g., chalk, hair).
- Rumination Disorder: Repeated regurgitation of food (Oxford Textbook of Psychiatry).
Causes of Eating Disorders
Etiology involves a biopsychosocial model:
- Biological: Genetic predisposition (heritability 40–60% for AN/BN), dysregulation in serotonin/dopamine pathways, hypothalamic-pituitary-adrenal (HPA) axis abnormalities (Kaplan & Sadock’s Synopsis of Psychiatry).
- Psychological: Perfectionism, low self-esteem, body dysmorphia, or comorbid anxiety/depression (Maudsley Guidelines).
- Environmental: Sociocultural pressure for thinness, trauma, bullying, or family dynamics emphasizing dieting (ICD-11).
Diagnosing Eating Disorders
- Clinical Assessment:
- Detailed history of eating patterns, weight changes, and psychological symptoms (DSM-5/ICD-11).
- Physical exam to identify complications (e.g., electrolyte imbalances, dental erosion).
- Laboratory Tests: Rule out medical causes (e.g., hyperthyroidism, Crohn’s disease).
- Screening Tools:
- Eating Disorder Examination Questionnaire (EDE-Q).
- SCOFF Questionnaire (for rapid screening).
- Differential Diagnosis: Exclude mood disorders, OCD, or gastrointestinal conditions (NICE Guidelines).
Treatment for Eating Disorders
Evidence-based interventions vary by diagnosis:
- Psychotherapy:
- Cognitive Behavioral Therapy (CBT-E): Addresses distorted thoughts about food, weight, and body image.
- Family-Based Therapy (FBT): First-line for adolescents with AN/BN; parents oversee meal restoration.
- Dialectical Behavior Therapy (DBT): Targets emotional dysregulation in BED or BN.
- Pharmacotherapy:
- Anorexia Nervosa: No FDA-approved medications, but olanzapine (atypical antipsychotic) may reduce anxiety/obsessions.
- Bulimia/BED: SSRIs (fluoxetine, sertraline) reduce binge-purge cycles and impulsivity (Maudsley Prescribing Guidelines).
- Nutritional Rehabilitation:
- Structured meal plans to restore weight (AN) or normalize eating patterns (BED).
- Electrolyte monitoring for patients engaging in purging.
- Medical Hospitalization: Required for severe malnutrition, cardiac instability, or suicidal ideation (Oxford Textbook of Psychiatry).
- Adjunctive Therapies:
- Group therapy for peer support.
- Mindfulness-based interventions to reduce emotional eating.
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