Many of us often feel concerned, and sometimes preoccupied, with our weight, eating, exercise patterns, and body image. We may go through phases when we feel discouraged, try different plans, feel successful, and repeat the cycle. We may then find what works, or does not work, and continue on with our daily lives. It is fairly common to experience cyclical phases regarding our diet and overall health behaviors. In recent years, our consumption of information related to body image, food, diet, and exercise has increased exponentially via social media and other outlets. From eating plans, to various exercise programs claiming to be the “right fit for you,” to fitness and nutrition experts providing varying and often confusing guidelines, we may feel overwhelmed by the overload of information. While these lifestyle choices are often healthy and manageable for many individuals, others may feel confused, stressed, and become overly concerned about their own choices. In some cases, a preoccupation with food, exercise, body image, and/or weight leads to unhealthy territory and disordered eating patterns. Furthermore, what begins for some as a general concern for overall wellbeing may eventually lead to the development of a clinical eating disorder. The goal of this article is to provide an overview of the common types of eating disorders, highlighting symptoms, early warning signs, and treatment options.
Eating disorders are a serious mental health issue that can cause significant impairment in an individual’s daily functioning. Eating disorders are not a lifestyle choice; they are associated with severe disturbances in eating and exercise behaviors and related thoughts and feelings. According to the National Institute of Mental Health (NIMH), eating disorders typically begin in teen years and progress into adulthood. However, early signs can occur even in childhood. Eating disorders affect individuals of all ages, races, ethnicities, and genders and are caused by a combination of genetic, biological, behavioral, social, and psychological factors. Symptoms significantly interfere with one’s daily psychological, physical, and social functioning. For example, an individual may be so preoccupied with when and what he or she will eat, work productivity decreases. Or, one may be distracted with thoughts of tonight’s workout and may lose track of time and miss the bus. Another might fear eating out, as it could create a perceived loss of control or possible weight gain. Some individuals even miss out on social events, gatherings, and work due to the stress related to disordered eating. In some cases, individuals may require intensive inpatient treatment to address symptoms. According to the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5), there are three main classifications of eating disorders: anorexia nervosa, bulimia nervosa, and binge-eating disorder. Below we examine these three disorders.
Anorexia nervosa, commonly called anorexia, is the most commonly known type of eating disorder. Individuals diagnosed with anorexia typically view themselves as overweight, although they are often significantly underweight. A core theme in anorexia is the restriction of food intake to a degree that is detrimental to one’s physical health. Other characteristics include an intense fear of gaining weight, consistent behavior that impedes weight gain such as excessive exercise or dieting, an unwillingness to maintain a normal weight, self-esteem directly dependent on weight, and a distorted view of how one sees and experiences his or her own body. Individuals diagnosed with anorexia typically have a low weight and body mass index (BMI).
Individuals diagnosed with bulimia nervosa, commonly known as bulimia, have frequent episodes of consuming unusually large amounts of food in a short amount of time and then engage in a behavior that compensates for the overeating. These periods of overeating are called binge-eating. Following a binge-eating episode, individuals with bulimia may force themselves to vomit, use laxatives, fast, or engage in excessive exercise with the hopes of reducing the impact of the binge. In many cases, individuals feel a lack of control at the onset and for duration of the overeating period. Following the binge, he or she may feel overwhelmed with a fear of gaining weight, feel shameful, and then engage in a behavior aimed to compensate for the binge. Individuals with bulimia may be slightly underweight, a normal weight, or overweight.
Individuals who struggle with binge-eating disorder often describe a lack of control, or an intense fear of losing control, over his or her eating patterns. Similar to bulimia, binge-eating disorder is characterized by recurrent episodes of binge-eating. Individuals typically consume large amounts of food in a very short period of time, usually within two hours. However, unlike individuals with bulimia, those with binge-eating disorder typically do not engage in compensatory behaviors (e.g., vomiting, excessive exercise) following a binge. Other characteristics of binge-eating disorder include eating when full, eating quickly, eating alone or in secret, sneaking food, and feeling distressed and ashamed following a binge. Binge-eating disorder typically occurs in normal weight, overweight, and obese individuals.
Although the above are the main classifications of eating disorders, individuals can present with a variety of symptoms from any or all three. Many times, individuals express a number of symptoms but do not meet full criteria for anorexia, bulimia, or binge-eating disorder; however, they still experience significant distress and impairment in daily functioning.
In addition to the problematic eating, symptoms of anxiety, depression, and other mood disorders are often present in individuals with eating disorders. According to reports from the NIMH, the majority of individuals who meet criteria for anorexia, bulimia, or binge-eating disorder also meet criteria for another mental health disorder such as anxiety or depression, with anxiety disorder having the highest co-morbidity rate. It is important to note that proper treatment for eating disorders is vital to the management of symptoms, and the earlier, the better. Treatment typically includes a combination of individual, group, and/or family therapy, medical care by a physician, nutritional counseling, and medication. See below for early warning signs that could be indicative of eating disorders.
Early warning signs
Note: This is not a complete list of symptoms. Also, please note that these symptoms could be due to other issues and not directly related to eating disorders.
- A preoccupation with weight, food, exercise, body image, etc.
- Increasing amount of comments/discussions about one’s weight, eating/exercise patterns, etc.
- Increase in online searches for articles, books, discussion groups on weight loss
- Rapid weight loss or gain
- Maintains a rigid schedule
- Has a strong need for control
- Increasing amounts of exercise
- Weighing daily or multiple times per day
- Initiates frequent discussions about food, exercise, weight, etc.
- Implementing strict boundaries related to food
- Decrease in attendance to social engagements involving food
- Makes excuses to avoid mealtimes
- Increase in depression or anxiety symptoms
- Complains of physical symptoms such as stomach aches or headaches
- Development of food rituals
If you or a loved one are concerned about a possible eating disorder, there is aid available to you. Online resources such as the National Institute of Mental Health (www.nimh.nih.com) and the National Eating Disorders Association (www.nationaleatingdisorders.com) provide articles, resources, and support. You or your loved one may also benefit from meeting with a therapist and a medical doctor to assess your symptoms and provide directions for treatment.
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