I first learnt about the story of a teenage girl fighting Anorexia Nervosa from one of Chicken Soup for the Soul series of books, which I picked up from the school library when I was in class 9. That story stayed in my mind for a long time and later when I took up psychology I got to learn that the girl was a victim of something which fell in the category of Feeding and Eating Disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition or DSM-5. These disorders are characterized by a persistent change in eating or eating-related behavior that results in altered consumption or absorption of food and leads to significant impairment in physical health and psycho-social functioning. So, this article intends to give the readers a basic idea of several types of eating disorders starting with perhaps the one we most commonly hear of.
- Anorexia Nervosa, the most prevalent of the disorders of this group, is characterized by self-induced starvation leading to significant decrease in body weight than minimally expected, coupled with intense fear of fatness or gaining weight and disturbance in body weight or shape and self-evaluation. The individuals stubbornly work for further weight loss not recognizing the seriousness of the problem or the medical complications often refusing any help.It may include restrictive type behavior where the person restricts the amount of food consumed often to a dangerous extent or binge-eating/purging type behavior which encompasses binge eating which may be followed by self-induced vomiting or use of laxatives, diuretics or enemas in a bid to get the food out of the body overcome by guilt.
The self-esteem of the effected individuals is majorly dependent on their body shape and weight. While some continually seem to believe that they are fat even if they are grossly underweight, others may acknowledge that they are thin but place special emphasis on certain “fat areas” of their body like thighs, abdomen and buttocks. So, what follows is rigorous and stringent exercising, consistently checking their weight, measuring body parts or constantly checking their perceived fatness in the mirror to achieve a slimmer figure. This negative head space increases the risk of depression and suicide.
The disorder mostly occurs during adolescence or young adulthood and is more common in females than in males with a female-to-male ratio of 10:1.Sometimes symptoms of Anorexia may present themselves in an individual but without significant weight loss. Such a condition is called “Atypical Anorexia Nervosa“. Though in some severe cases death may occur, with proper treatment and follow up Anorexia can surely be treated.
2. In Bulimia Nervosa, a far larger than normal amount of food in consumed in a very short time period (2 hours) with little control over oneself. Individuals are typically ashamed of this behavior. Following the episodes, the person becomes guilt ridden and engages in recurrent, inappropriate, compensatory purging behaviors to avoid weight gain like self-induced vomiting or use of laxatives or other means to expel the food consumed.Like Anorexia, suicide risk is also elevated in Bulimia. It has the highest prevalence in young adults and it is far less common in males than in females (F:M=10:1). Prevalence increases with obesity.
3. Binge-Eating Disorder symptoms like Bulimia, comprise recurrent episodes of eating a more than normal amount of food in a discrete period of time (2 hours) where the effected individuals experience a sense of lack of control over their compulsive eating behavior, characterized by abnormally fast eating even when not hungry physically until uncomfortably full. However, unlike Bulimia, here the person does not engage in any compensatory behaviors but feels disgusted and embarrassed with themselves and typically eats alone or attempts to conceal their symptoms. Binge-Eating Disorder has a slightly higher prevalence in women than in men. It is also more common in people seeking weight-loss treatment.
4. Pica is commonly known by persistent eating of one or more than one type of non-nutritive or non-food substances over period of time that is not normal w.r.t to developmental level of an individual over 2 years of age, when it is not a part of their cultural or social traditions. The non-food items vary with age and availability and may commonly include paper, soap, chalk, cloth, hair, string, wool, soil, talcum powder, paint, gum metal, pebbles, coal, ash, starch or ice. People with intellectual disability have a higher prevalence of Pica with increasing severity.
5. Rumination Disorder includes repeated regurgitation, that is re-chewing followed by re-swallowing or ejecting after feeding (in case of a child) or eating (in case of adults) without any apparent nausea, retching or disgust and not caused by problems of another medical or psychiatric nature over a period of time, occurring typically daily. Prevalence of Rumination disorder is higher in individuals with intellectual disability.
6. In Avoidant/Restrictive Food Intake Disorder, the effected individuals exhibit apparent lack of interest in eating due to the sensory characteristics of the food itself or due to fear of aversive consequences of eating viz. choking or repeated vomiting, resulting in significant weight loss or inappropriate weight w.r.t. developmental stage (children and adolescents) and nutritional deficiency. The person may depend on oral nutritional supplements or enteral feeding instead and displays marked disturbances in psycho-social functioning.
7. Purging disorder is characterized by repeated purging i.e. vomiting or use of laxatives and other means to expel small amounts of ingested food due to a distorted view of weight or body image. But here neither an abnormally huge amount of food is ingested nor is the person underweight.
8. Night Eating Syndrome is a rather rare disorder occurring typically in insomniacs manifested by recurring episodes of night eating over a period of time. The person eats an excessive amount of food either after their evening meal or after waking up at night, followed by lack of desire of food in the morning.
For those suffering, proper professional help must be sought instead of self-medication. Treatment involves both psychiatric and psychological means. Serious medical complications, like in several cases of Anorexia, may require hospitalization and in-patient treatment. Pharmacotherapeutic measures include drugs which bring about changes in mood, anti-depressants and those helping in weight gain. Psychotherapeutic measures like Cognitive Behavior Therapy, Dynamic Psychotherapy and Family Therapy have proved to be helpful. In general family support and understanding helps a great deal in these cases.
To anyone fighting them-
- Gain more knowledge about the disorder through various sources. It is very important to consult a physician as in many cases such disorders may result in other serious health problems.
- Other than that, doctors will be able to give proper guidance regarding what to do and what not to do with regard to your physical health condition.
- Keep a strong support system of trusted family and/or friends whom you can confide in freely. It is not easy opening up but you must try to do so for your sake.
- Try not to constantly measure your body weight or keep checking yourself in the mirror. You can try avoiding full length mirrors if that helps. If checking your weight is absolutely necessary for medical reasons then get someone else or a professional to do it.
- Although normally exercising is considered a good thing and is beneficial, in cases like Anorexia it can actually be detrimental as your body is not strong enough to endure the exertion. Rather, get enough rest and sleep. Eat properly. Without feeling guilty about it or feeling ashamed. During the first phases of treatment where there is weight loss, you will gain weight and that is absolutely okay.
- If you have trouble eating alone at public places take a confidante or a trusted person to help with the anxiety. Stop computing your body weight with beauty. Believe the fact that you are beautiful and work towards a healthy body and mind.
- In this digital age of blogging and YouTube you will find that there are so many people who are or have been through what you are going through at the moment and have slowly come out triumphant. Follow their journeys to find inspiration. Finding such people who are fighting the same battle, and connecting and sharing with them, I am sure, would also help immensely.
About author– Bidisha Samanta is a Master of Science in Applied Psychology, with specialization in Clinical and Forensic Psychology from the University of Calcutta.