What is Eating disorder?

Eating disorders consist of the disorders related to eating and dietary habits of an individual where one eats way more or way less than usual. There may be constant thoughts related to one’s diet or gaining weight.

Anorexia and Bulimia are the two most common type of eating disorders but there may be minor variations in the way they present.  Overall, around 8-10 % people have a diagnosis of eating disorder throughout their life. It is seen that girls are 10 times more prone to develop this disease than boys. It does not mean that it is uncommon in boys, manifestation of symptoms may be different e.g., boys tend to exercise more to reduce weight.

Anorexia Nervosa:  The patients with anorexia usually have an intense fear of getting fat which is beyond reasoning. As a result, they tend to avoid food items which they think will make them fat. They tend to monitor their weight quite frequently and have a constant worry that they are getting fat. Thus, without adequate calories they start to lose a lot of weight and typically their weight falls significantly below the population norms. This severe loss of weight causes hormonal imbalances in the body and the patient may suffer from problems like menstrual irregularities or sexual problems.

Bulimia Nervosa: Patients suffering from bulimia also have a similar kind of fear of getting “fat” which is beyond reasoning. But in addition, they also have craving to eat food. Thus, such patients usually have a phase where they binge eat certain food items and then they try to counteract the fattening effects of the food. The methods employed for such behaviour include taking purgative, inducing vomiting, taking medicine to decrease weight or supress appetite, or doing intensive exercise. These behaviours then result in various physical and psychological harm to the body e.g. harm to throat and mouth by repeated vomiting.

The ICD diagnostic criteria for both are given in the box below:

ICD-10 diagnostic guidelines:

For a definite diagnosis of Anorexia, all the following are required:

1. Body weight is maintained at least 15% below that expected (either lost or never achieved), or body-mass index is 17.5 or less. Prepubertal patients may show failure to make the expected weight gain during the period of growth.

2. The weight loss is self-induced by avoidance of “fattening foods”. One or more of the following may also be present: self-induced vomiting; self-induced purging; excessive exercise; use of appetite suppressants and/or diuretics.

3. There is body-image distortion in the form of a dread of fatness which persists as an intrusive, overvalued idea and the patient imposes a low weight threshold on himself or herself.

4. A widespread endocrine disorder involving the hypothalamic – pituitary – gonadal axis is manifest in women as amenorrhoea and in men as a loss of sexual interest and potency. (An apparent exception is the persistence of vaginal bleeds in anorexic women who are receiving replacement hormonal therapy, most commonly taken as a contraceptive pill.) There may also be elevated levels of growth hormone, raised levels of cortisol, changes in the peripheral metabolism of the thyroid hormone, and abnormalities of insulin secretion.

5. If the onset is prepubertal, the sequence of pubertal events is delayed or even arrested (growth ceases; in girls the breasts do not develop and there is a primary amenorrhoea; in boys the genitals remain juvenile). With recovery, puberty is often completed normally, but the menarche is late.

For a definite diagnosis of Bulimia, all the following are required:

1. There is a persistent preoccupation with eating, and an irresistible craving for food; the patient succumbs to episodes of overeating in which large amounts of food are consumed in short periods of time.

2. The patient attempts to counteract the “fattening” effects of food by one or more of the following: self-induced vomiting; purgative abuse, alternating periods of starvation; use of drugs such as appetite suppressants, thyroid preparations or diuretics. When bulimia occurs in diabetic patients they may choose to neglect their insulin treatment.

3. The psychopathology consists of a morbid dread of fatness and the patient sets herself or himself a sharply defined weight threshold, well below the premorbid weight that constitutes the optimum or healthy weight in the opinion of the physician. There is often, but not always, a history of an earlier episode of anorexia nervosa, the interval between the two disorders ranging from a few months to several years. This earlier episode may have been fully expressed, or may have assumed a minor cryptic form with a moderate loss of weight and/or a transient phase of amenorrhoea.

What is the cause of eating disorder?

It is not clear what is the exact cause of eating disorders, but many factors have been associated. Many cases have a strong family history of eating disorders and certain genes have been implicated. Some researchers have also found some association with hormonal change during puberty. One may also give in to the social pressure by peers or social trends or it may be a part of culture in some families. People suffering from psychiatric disorders like depression or anxiety may also have eating disorder. It is also common to find symptoms of eating disorders in physical illnesses as well. Some authors have commented on “control issues” as the clients are trying to gain control over their lives by way of controlling their diet.

How does it affect my body?

The depleted energy from the body may manifest as having weakness, feeling tired, unable to concentrate etc. Apart from this, one may also experience sadness, anxiety, constant thoughts of losing weight, difficulties in engaging with others, etc. There may also be multiple physical problems such as having difficulty in eating and swallowing food, constipation, hair fall, dry skin, stunted growth, brittle bones, sexual problem, menstrual irregularities, and in extreme cases even death.

Is eating disorder a part of depression?

The relationship between eating disorder and depression is complex. There are cases where some eating disorder symptoms may appear as aprt of the presentation of a depressive disorder while on the other hand many patients suffering from eating disorder may have clinical depression or depressive symptoms secondary to eating disorder. It can be ascertained mainly by the onset – which came first. The severity of symptoms would be another indicator as to which of the two disorders is primary.

Is there a treatment for eating disorder?

There are many treatment options for eating disorder. Usually a multimodal treatment is planned for the patients which includes psychological interventions, social interventions, and drug treatment. Usually first thing is to medically stabilise the patient by looking into the physical aspect of the illness through physical examination and blood tests.

CBT: Cognitive behavioural therapy (CBT) is mainly indicated in most patients as a part of psychological intervention. The therapist can help the client understand the irrational nature of their anorectic cognitions and therapy may also help in other aspects like problem solving or emotional regulation which reduces the chances of relapse.

Drug treatment: Antidepressants like fluoxetine, sertraline, and clomipramine are commonly used. It is seen that almost 50-70% patients respond well to treatment. Sometimes antipsychotics such as olanzapine may be prescribed to achieve response. It is also important to get treatment for any co-occurring psychiatric or medical illness. In very few resistant cases other modalities like transcranial magnetic stimulation.

Where should I seek help from?

If you or your dear ones are having symptoms mentioned above with significant distress or problems in carrying normal activities, you should consult your GP or psychiatrist immediately. They will evaluate thoroughly the symptoms of eating disorder, whether you require treatment or not and order any investigations if required.

After relevant examination the decision to treat on out-patient basis or in-patient basis will be taken. The situations where a psychiatric admission may be indicated are – if the patient has high suicidal risk, is unable to take adequate self-care, is danger to others, there is a need for intensive therapy, or if there are any medical/psychiatric complications.

Recommended reading:

• Anorexia and Bulimia. Royal college of Psychiatrist. Available from: https://www.rcpsych.ac.uk/mental-health/problems-disorders/anorexia-and-bulimia

You can use the following self-administered test to assess whether you suffer from an eating disorder.