Although food is sustenance, it provides us comfort and alleviates stress. In some individuals, the intake of food, and how it relates to one’s body image, can be a source of stress and lead to a dysregulation in eating, or eating disorders.

Eating disorders are mental health conditions that affect about 9% of the population worldwide. In the United States, approximately 30 million Americans live with an eating disorder. With 10,200 yearly deaths, eating disorders are among the deadliest mental illnesses, second only to opioid overdose. To put it into perspective, that’s one death every 52 minutes.

Eating disorders can be found in all populations regardless of age, ethnicity, gender, sex, religion, socioeconomic status, etc. An overview of causes, risk factors, and treatment options assists individuals in identifying and addressing a potential eating disorder.

What are eating disorders?

Eating disorders (ED) stem from problems with the way the brain regulates eating behavior. Eating disorders are not a lifestyle choice. They are medical conditions that hinder the body from getting proper nutrition, leading to health issues such as heart, kidney problems, and worse.

These disorders may lead to eating less or more food than is needed. People with eating disorders often have a preoccupation with their body weight or shape and how to control their intake of food. These excessive thoughts on body image form an unhealthy relationship with food. For example, there is a significant overlap between anorexia nervosa and body dysmorphic disorder, a condition characterized by distress or an impaired “preoccupation with an imagined or slight defect in physical appearance.”

3 Common Types of Eating Disorders

There can be several types of eating disorders, and each has specific criteria that differentiate it from the others. Understanding the distinctions can help improve treatment and recovery outcomes. The three most common eating disorders in men and women include:

Bulimia Nervosa

Bulimia nervosa is an eating disorder characterized by episodes of binge eating followed by inappropriate compensatory behaviors that prevent weight gain. Such behaviors include:

• self-induced vomiting
• misuse of laxatives, diuretics, or other medications
• fasting, or 
• excessive exercise

According to the Diagnostic & Statistical Manual of Manual Health, Fifth Edition (DSM-5), you can be diagnosed with bulimia nervosa if you engage in these behaviors at least once a week for three months. 

Anorexia Nervosa

This eating disorder is characterized by a significant and persistent reduction in food intake, leading to extremely low body weight. The National Institue of Mental health describes an individual with anorexia as someone having: 

• A relentless pursuit of thinness;
• A distortion of body image;
• Intense fear of gaining weight;
• Extremely disturbed eating behavior.

Most anorexic individuals see themselves as overweight despite starving and being severely malnourished. Approximately 200,000 people in the United States struggle with this anorexia nervosa every year. It also has the highest mortality rate of any mental illness, killing 20% of individuals diagnosed with this disorder. 

Although anorexia nervosa is closely associated with diet, there are distinctive differences between the two. Anorexia nervosa strives to control one’s life and emotions rather than simply managing weight. Their attempt at dieting (perception of losing weight) is their way to achieve happiness and self-satisfaction. 

Binge Eating Disorder (BED)

BED is a type of eating disorder characterized by episodes of binge eating, but unlike bulimia, it doesn’t involve inappropriate compensatory behaviors. Although, individuals with this disorder feel immense shame and guilt afterward, leading to anxiety and depression. 

According to DSM-5, binge-eating episodes involve three (or more) of the following:

• Eating much more rapidly than usual;
• Eating until feeling uncomfortably full;
• Eating large amounts of food even when not physically hungry;
• Eating alone due to embarrassment by how much one is eating;
• Feeling depressed, disgusted with oneself, or very guilty afterward.

Causes and Risk Factors

Eating disorders are not exclusive. They can affect all people regardless of age, racial/ethnic background, body weight, and gender. While it appears more frequently during the teen years or young adulthood, it may also develop during childhood or later in life. Whichever the case, early detection plays a significant role in therapeutic outcomes. 

There is no single reason for why eating disorders begin. Researchers believe that a complex interaction of factors, including genetic, behavioral, biological, psychological, and social, contribute to their development.

The worldwide prevalence of eating disorders increased from 3.4% to 7.8% between 2000 and 2018. Research shows that in the United States, the prevalence rate of eating disorders is higher among young women (3.8%) than men (1.5%). Genetic hereditability increases your risk of developing eating disorders by 28-74%. 

Eating disorders can also result from past experiences and trauma, such as sexual abuse or bullying. A 2013 study published in the European Journal of Psychotraumatology found a correlation between traumatic events (TE) and eating disorders. Among the TEs, sexual trauma (6.3%) was the most common form of trauma experienced by individuals with EDs, followed by physical abuse at 4.0%. 

The Brain and Its Role in Eating Behaviors

Studies show that disordered eating behaviors, such as binge eating, alter the brain’s reward process, a condition known as Reward Deficiency Syndrome (RDS). Consequently, there is an impairment of the neurocircuitry that controls appetite and food intake. RDS disrupts the regular interactions of powerful neurotransmitters in the brain and results in abnormal craving behavior. 

For example, individuals with anorexia nervosa had a high prediction error response, which may strengthen their food intake control circuitry. This means that these individuals may be able to override hunger cues and continue to restrict food intake. The opposite seems to be the case with binge eating. Altering the food intake control circuitry makes it possible for an individual to eat large amounts of food within a short amount of time without feeling full. 

Another study (2011) identified the relationship between brain mechanisms and aberrant eating behaviors. The neurochemical evidence of reward-related brain dysfunctions obtained through animal models suggests the following:

• Bulimia Nervosa — Causes the release of dopamine (DA), but purging reduces the release of acetylcholine (ACh) that might otherwise signal satiety.
• Anorexia Nervosa — Restricted access to food enhances reinforcing effects of DA, and alterations in mesolimbic DA and serotonin occur due to starvation.
• BED — Causes alterations in DA, acetylcholine, and opioid systems in reward-related brain areas.

Options for Healing/Therapy

Treatment plans an individual requires may vary depending on the type and severity of the disorder. A collaborative effort among health care providers, including doctors, nurses, nutritionists, and therapists, is necessary to achieve better outcomes of the following treatments: 

Psychotherapy

Psychotherapy such as Cognitive Behavioral Therapy (CBT) helps you identify and learn to replace your harmful thoughts or habits with something healthy. CBT also helps develop your coping skills and change behavioral patterns.

Nutrition counseling 

Doctors, nurses, and nutritionists will help you develop a healthy eating plan to fit your individual needs. 

Medications

Medicines, such as antidepressants, antipsychotics, or mood stabilizers, may help control anxiety, urges, or unhealthy thoughts. These medicines help reduce depression and anxiety symptoms that often accompany eating disorders.

Alternative Therapies

Relaxation and stress reduction therapies may help people deal with their eating disorders. Some common alternative therapies include yoga, massage, meditation, and acupuncture.  

People who develop serious health problems due to eating disorders may need to be in a hospital or a residential treatment program. Some clinics offer housing and treatment services for a more intensive treatment program. 

Final Thoughts

A lot of people find comfort and sustenance in eating palatable foods. However, some individuals do not have a healthy relationship with food. Family history, traumatic events, and social pressure may relate to abnormal eating behaviors.

Since eating disorders do not receive much media attention, they are a silent epidemic.  These disorders have an insidious effect on all levels of health, including physical, psychological, and social factors. They are serious mental health problems that merit equal attention and resources. Due to the high mortality rate of eating disorders, they should not be ignored and treated as a minor health issue. 

Perhaps one of the most troubling statistics is the relationship of ED with suicide – about 26% of people with EDs have suicidal ideations. The cause of death in one in five individuals with anorexia nervosa was suicide. The prominence of social media in today’s day and age, where body-shaming is rampant, and cyberbullying is everywhere, makes matters worse. 

Many people confuse EDs with lifestyle choices — they are not! Spreading awareness is one of the many ways to reduce the stigma and open the channels of discussion for mental health issues such as EDs. Information and counseling can assist individuals struggling with them. Strong support from friends and family may encourage patients to get help for the unhealthy behavioral patterns and improve their coping skills.