Eating disorders are serious conditions often characterized by a chronic course and, if left untreated, can lead to severe physical and psychological consequences. However, not everyone who occasionally overeats is seriously ill, nor is everyone who loses weight on a diet anorexic. However, such behaviours, if combined with other factors, may signal the beginning of an eating disorder. The shift from noticeable to pathological eating behaviour is often gradual.
In industrialised countries, around 3.5% of the population will develop an eating disorder at some point in their lives. The prevalence of eating disorders is higher in women than in men.
Eating disorders can begin at various stages of life. Anorexia typically starts during adolescence, while bulimia and binge eating often begin later, even into a person’s thirties.
In the article, we provide a comprehensive description of eating disorders, their symptoms, causes, diagnostics, and treatment options. For more information about treatment for eating disorders, contact our specialists at CHMC.
The interested reader will find more information about treatment for the most common eating disorders in the articles listed below.
- Anorexia Nervosa. Diagnosis and Treatment
- Bulimia Nervosa. Diagnosis and Treatment
- Overweight and Obesity
Types of Eating Disorders
We can broadly categorise eating disorders into the following groups, including their ICD-10 coding:
• Anorexia
People with anorexia are often severely underweight. They may starve themselves, diet, vomit, use medications like appetite suppressants or laxatives, or exercise excessively to lose weight. Eating binges and vomiting can also be present in anorexia.
• Bulimia
Bulimia is characterised by recurrent episodes of binge eating. Afterward, individuals try to prevent weight gain by vomiting, using laxatives or diuretics, or exercising excessively. People with bulimia are usually of normal weight.
• Binge Eating Disorder
Similar to bulimia, people with binge eating disorder consume large amounts of food. However, unlike those with bulimia, they don’t take steps to prevent weight gain. As a result, they are often overweight.
• Atypical (unspecified) Eating Disorders
These don’t meet the exact criteria for any of the defined eating disorders. Some may show a combination of characteristics from various disorders or share features not yet recognised in classification systems.
Individuals with atypical anorexia nervosa or atypical bulimia nervosa exhibit key characteristics of these disorders but do not meet all criteria for the typical clinical picture. People with binge eating disorder often have significant obesity and a long history of unsuccessful dieting attempts.
Diagnosing Eating Disorders
A comprehensive and reliable diagnosis of symptoms is essential for initiating and planning eating disorder treatment. In all cases, the goal during the first contact with a patient suffering from an eating disorder is to create trust and initiate a thorough conversation with the patient.
Patients with eating disorders have the tendency to hide their problems. Doctors, being outside the patient’s immediate environment and bound by confidentiality, are neutral and well-suited to overcome the initial resistance.
The physician should take the time to understand the severity and nature of the disorder. Some patients, despite significant distress, are unaware of the severity of their condition. If the patient begins discussing his/her problem, the conversation can proceed as a structured clinical interview. If the patient downplays her symptoms, he/she should be informed about potential consequences calmly but clearly, without inducing fear.
Structured Clinical Interview
The diagnosis of eating disorders starts with a thorough clinical interview. The following questions help in the assessment and classification of such eating disorders as anorexia, bulimia, and bing-eating:
- When did the eating problems begin?
- What foods does the patient avoid? Does she skip meals? How many calories does she allow herself daily?
- Does the patient diet?
- Are there binge-eating episodes?
- If yes:
- How often in the past three months?
- Has the frequency changed over the course of the illness?
- How long do these episodes usually last?
- What does she eat and drink during them?
- How are they stopped (vomiting, sleeping)?
- If yes:
- Does the patient vomit or use laxatives, diuretics, or appetite suppressants?
- If yes, how many times per week?
- How many hours per week does the patient exercise?
- Does she self-harm (how, with what, when, how often)?
- Is the patient experiencing frequent weight fluctuations?
- Does he/she drink alcohol (how much and how often)?
- Has the symptomatology always been the same, or has it changed?
General Internal Medical Examination for Eating Disorders
- Oral cavity: check for injuries, rhagades, dental condition (erosions, caries, periodontitis), and sialadenosis.
- Body weight and height, BMI, and fat distribution types: android, gynoid, or Cushingoid.
- Waist-to-hip ratio.
- Skin and hair assessment: efflorescences, wounds, alopecia, puberty stages (Tanner stages).
- Blood pressure: measured lying and standing (cuff size: wide cuff for arm circumference >34 cm, pediatric cuff for <14 cm), along with lying and standing pulse.
- Circulation: assess for mottling, acrocyanosis, lanugo hair, petechiae, and Russell’s sign.
Body Mass Index (BMI) Guidelines:
- Severe underweight: BMI < 16
- Moderate underweight: BMI 16 to 16.99
- Mild underweight: BMI 17 to 18.49
- Normal range: BMI 18.50 to 24.99
- Overweight: BMI 25 to 29.99
- Obesity Grade I: BMI 30 to 34.99
- Obesity Grade II: BMI 35 to 39.99
- Obesity Grade III: BMI ≥ 40
Laboratory Diagnostics in Eating Disorders
- Electrolytes: sodium, potassium, calcium, magnesium, phosphate.
- Kidney function: creatinine.
- Liver function: ALT, AST, ALP, CK, GGT, total and direct bilirubin, PT, and PTT.
- Pancreatic enzymes: amylase and lipase.
- Urinalysis.
- Thyroid function: TSH.
- Additional tests for selected patients: Consider testing for iron, ferritin, vitamin A, vitamin E, vitamin B12, vitamin D, folic acid, β-carotene, zinc, copper, selenium, and an immunochemical or chromatographic drug screening.
Goals in Treatment for Eating Disorders
At the start of treatment, we establish with the patient individual goals, taking into account their personal context. Alongside these goals, treatment should aim to:
- Foster insight into the illness.
- Help patients understand and accept their symptoms as a necessary step toward change.
- Promote independence and self-responsibility as foundations for physical and mental health.
- Address psychological and social backgrounds, incorporating the patient’s life history to encourage understanding and acceptance.
- Develop a personal life plan integrating abilities, possibilities, interests, and goals.
- Improve relational skills with partners, friends, and colleagues.
- Change eating behaviours and eliminate harmful weight-control methods, such as vomiting or misuse of laxatives and appetite suppressants.
- Achieve weight stability and the return of menstruation.
- Reduce food-related rituals and enhance the ability to enjoy meals.
- Develop preventive strategies for crisis situations.
Multimodal Therapy for Eating Disorders
The nature of eating disorders with the psychogenic root cause, but at the same time with a severe physical impact on the patient’s body, requires a multimodal treatment plan consisting of medical and psychotherapeutic interventions. The psychotherapy and the medical treatment should not be conducted by the same person. The controlling role of the physician conflicts with the therapeutic needs of patients with eating disorders. If the patient is in psychotherapy, the medical treatment’s role is clear, which usually diffuses relational tensions. However, if the patient refuses psychotherapy, the physician should maintain contact to build trust and potentially motivate her toward treatment over time.
Doctors, regardless of their specialisation, are often the first point of contact for people with eating disorders. Alongside their medical responsibilities, they play a crucial role in shaping the treatment process and motivating patients.
Medical Monitoring in Patients with Eating Disorders
Patients with eating disorders often convey the dual message: “Help me, but let me do it myself.” Doctors can address this paradox by providing a clear offer of help, which includes:
- Monitoring bodily functions.
- Providing factual information about physical health and potential complications.
- Prescribing medication, if necessary.
It is challenging for physicians, especially those not trained in psychiatry, to avoid becoming entangled in the disorder’s dynamics. Clear signs of this entanglement include:
- Feeling anger toward the patient (e.g., due to perceived stubbornness or self-destructive behaviour).
- Experiencing guilt for being unable to elicit insight or behavioural change.
- Forming “alliances” with carers (e.g., parents, teachers, or partners) while bypassing the patient.
Doctors must recognise that medical treatment, with its focus on the body and control, can trigger anxiety in patients with eating disorders. Patients may respond with behaviours such as stubbornness, lying, denial, or trivialisation—not to provoke but because they lack healthier coping mechanisms.
Patients with eating disorders often appear superficially compliant. Emotional appeals may lead to short-term promises from the patient, offering temporary relief for both parties. However, this often results in disappointment and perpetuates the disorder’s dynamics over time.
Treatment for Eating Disorders with Medication
Psychiatric medication can be used if the eating disorder is combined with such psychiatric disorders as depression, anxiety, OCD, and others. Despite some promising studies, the effectiveness of psychiatric drugs in eating disorders is debated among experts.
Psychotropic drugs are not standard therapy for eating disorders without psychiatric comorbidities. However, in some cases their use can be considered.
Antidepressants:
Antidepressants are used for treatment of depression, anxiety, and OCD. In the treatment of eating disorders, only one drug, the SSRI fluoxetine, is officially approved for bulimia treatment. However, fluoxetine is prescribed exclusively alongside psychotherapy.
Neuroleptics:
This type of medication is typically used for the treatment of psychoses, such as schizophrenia.
In anorexia nervosa, they can help to reduce anxiety, obsessive thoughts about food, or uncontrollable hyperactivity.
Off-Label Use of Psychotropic Medication in Treatment for Eating Disorders:
Using drugs for non-approved conditions is considered “off-label” use. Psychotropic drugs should always be prescribed under specialist supervision. The key considerations for using off-label psychotropic medication in treatment for eating disorders are:
- Is there significant evidence supporting the drug’s use for this eating disorder?
- What specific benefits justify the prescription?
- What side effects might occur, and how burdensome could they be?
- Does the benefit outweigh short- and long-term risks?
- How long will the medication need to be taken?
Crisis Hospitalisation of Patients with Eating Disorder
Indications for inpatient treatment include significant weight loss, severe physical consequences (e.g., electrolyte imbalances), and suicide risk. Persistent family conflicts or social isolation may also warrant inpatient care. Treatment in a hospital should address both medical and psychological factors.
Psychotherapy in Treatment for Eating Disorders
Various psychotherapeutic approaches are used in the treatment of eating disorders. Due to a lack of broad comparative psychotherapy research, there is insufficient empirical evidence. Such proof for treatment efficacy does exist only for psychoanalysis, behavioural therapy, and humanistic psychotherapy schools. These include client-centered therapy, rational-emotive therapy, psychodrama, and gestalt therapy. Family therapy and body-oriented approaches have also contributed to the field.
The success of therapy depends on the patient’s willingness to engage and participate. Building a trusting therapeutic relationship to build motivation for change is crucial for effective treatment. Therapy should address specific eating disorder aspects: lack of meal structure, eating rituals, selective food choices, activity levels, and cognitive attitudes toward food, body image, and weight.
The psychotherapeutic approach depends not only on the type of the eating disorder but also on its stage. Psychotherapy can occur individually or in groups, enabling patients to share experiences. Involving family members or employers is also a vital part of therapy. They can support patients in applying new skills and preventing challenging situations.
The type of therapy that promises the most success largely depends on the patient’s preferences. Patient’s social and economic situation, prior therapeutic experiences, and the duration of the disorder matter.
A few key questions helping to guide the treatment:
- Wants the patient to participate in the therapy for the eating disorders?
- Does the patient have previous therapeutic experiences for treatment for the eating disorder?
- What is the patient’s own idea about her/his illness?
- Is the patient interested in understanding the roots of his/her problems?
Socioeconomic factors to consider in treatment of eating:
- How old is the patient?
- Who does she/he live with?
- Is the patient employed or financially dependent?
- Does she/he have a family to take care of and cook for?
Causes of Eating Disorders
Various factors contribute to the development of eating disorders, influencing each other. A distinction is made between causes and triggers, though the boundary between the two is sometimes fluid. Causes are influences that determine an individual’s vulnerability to the disorder. These include biological and genetic predispositions, as well as psychological and environmental factors. The pre-existing vulnerability increases the risk of developing an eating disorder while being exposed to a trigger.
Genetic and Biological Factors
In some families, eating disorders are more common, suggesting a genetic component. Relatives of individuals with eating disorders are more likely to develop one themselves. Experts have also noted a familial pattern of mental health issues, such as OCD or depression.
Psychological Factors
Perfectionism, anxiety, self-esteem issues, depressive moods, and emotional regulation difficulties seem to play a role in eating disorders. Performance orientation and concerns about appearance, body shape, and weight may also contribute to their development. A negative attitude toward one’s body and weight can lead to an eating disorder. Many people with anorexia or bulimia have distorted body perception, feeling overweight despite being objectively normal.
Sociocultural Influences
Eating disorders are much more common in Western countries than in other cultures. Particularly at risk are high-performance athletes and models. In some sports, like gymnastics or ballet, body weight plays a critical role. The societal beauty ideal favours “super-thin” individuals. The media and advertising often promote the ideal of being slim. This puts pressure on those who don’t meet society’s standards of beauty. Many young people struggle with what they believe are excess pounds. They often go through multiple diets before developing an eating disorder.
Family Factors
Negative experiences within the family can contribute to the development of bulimia. Those with eating disorders often have histories of physical or sexual abuse, neglect, parental addiction, or personality disorders. A family that highly values appearance and thinness may encourage an eating disorder. Overprotective parents who excessively shelter their children may also foster an eating disorder.
Triggering Factors for Eating Disorders
Triggers, on the other hand, are specific events and circumstances that can ultimately lead to an eating disorder. These include:
• Stressful experiences, such as loss, separation, relocation, or bullying.
• The onset of puberty with its physical changes and hormonal shifts.
Dieting in Eating Disorders
This phenomenon, termed “yo-yo dieting,” involves regaining or surpassing initial weight after dieting. The mechanism is as follows: during restricted intake, the body reduces basal metabolic rate to conserve energy. This adaptation helps the body survive during food shortages by maintaining essential functions on fewer calories. After restriction, the body does not immediately adjust to increased caloric intake, remaining in “low-energy mode.”
As a result, normal eating post-diet leads to weight gain due to the reduced basal metabolic rate. The first diet causes the greatest basal rate reduction, diminishing with each subsequent diet attempt. Efforts to maintain reduced weight through restricted eating may prevent metabolic rate normalisation, causing weight gain.
Not all obese individuals experience obesity as a coping mechanism for life challenges. Research highlights the significant role of genetic and somatic factors, discouraging psychological explanations for obesity. However, some psychosocial variables may still be relevant as characteristic factors in certain cases.
Atypical Eating Disorders and Their ICD-10 Coding
Diagnostic manuals such as ICD-10 try to categorise illnesses, which by definition creates sharp division lines between them. However, there is no sharp demarcation between distinct eating disorders; they rather flow indistinguishably into one another. Therefore, the term “atypical eating disorders” has been coined for such eating disorders that couldn’t be precisely coded by the manuals. Such disorders are less common but not necessarily “atypical.”
Examples of Atypical Eating Disorders
F50.1: Atypical anorexia nervosa
where one or more core symptoms, like amenorrhoea or weight loss, are absent. A woman meets all criteria for anorexia nervosa except that she has regular menstruation or, despite significant weight loss, the individual’s weight stays within the normal range, meeting all anorexia nervosa criteria
F50.3: Atypical bulimia nervosa
where one or more core symptoms of bulimia are absent. The individual meets all the criteria for bulimia nervosa, but the frequency of binge eating and compensatory behaviours is less than twice weekly or for less than three months or a normal-weight individual regularly engages in compensatory behaviours, like self-induced vomiting after consuming small amounts of food (e.g., after eating two cookies)
F50.4: Eating episodes in other psychological disorders
F50.5: Vomiting in other psychological disorders
F50.8: Other eating disorders
including psychogenic appetite loss or fasting in obesity, or the patient repeatedly chews and spits large quantities of food without swallowing.
F50.9: Unspecified eating disorders
For example, recurrent episodes of binge eating without the compensatory behaviours typical of bulimia nervosa.
Eating Disorders in Children and Adolescents
From birth, a child must sense hunger and satiety to regulate energy for growth and activity. Eating is a crucial developmental task requiring early behavioural regulation and interaction with a caregiver. Eating behaviour can be influenced by disruptive factors at any age, leading to age-specific pathological patterns. Patients follow strict diets, avoiding most foods consumed during binges. Adolescents with bullying often suffer from self-esteem issues.
Feeding Disorders in Infants
In these cases, interaction problems between carers and the child, often involving emotional neglect, play a major role. Paediatric or child psychiatric evaluations are recommended.
Dysfunctional oral-motor reflexes can also be a factor, potentially related to minor neurological developmental delays. Issues with sucking, chewing, swallowing, or tongue thrusting can lead to feeding difficulties, causing secondary problems for both mother and child.
Psychological disorders in the child, such as autism or hyperactivity, can also complicate feeding. Autistic children may resist dietary changes due to fear of change, while hyperactive children’s motor restlessness and excessive crying can disrupt mealtime routines.
Eating disorders in infants and young children are often not solely due to maternal misbehaviour, as previously believed, but rather a bidirectional issue involving both mother and child.
Eating Disorders in Infancy and Toddlerhood
Key symptoms of eating disorders in early childhood include food refusal, extremely selective eating, prolonged mealtimes, spitting out or vomiting food, and inadequate or excessive weight gain.
Estimates of eating disorders in infants and toddlers vary from a few percent to a quarter, depending on whether objective or subjective criteria are used. Higher prevalence rates often rely on mothers’ reports. Physicians must differentiate between severe eating disorders and temporary issues. The prevalence of eating disorders in preschool children ranges from 12% to 34%.
Eating Disorders in Preschool and Early School Age
The main cause of eating disorders in this age group is “neophobia,” where children reject unfamiliar foods. Most parents fail to recognise that this is often a temporary phase, which can be overcome by repeatedly offering the same food. The issue is often exacerbated when parents remove rejected foods from the child’s diet, further limiting their acceptable options.
Parental actions driven by fear that their child is not eating enough often backfire. For example, using force, such as holding the child’s nose to make them eat, can create a conditioned reflex where the child associates food preparation with a negative experience. As a result, when meals are served, parents may not understand why the child resists eating from the outset.
Some parents try to distract their child with games during meals. However, children who habitually refuse food may use play as an excuse to avoid eating altogether.
Meals for preschool and early school-age children should not exceed 20 minutes. Offering small portions of various foods sequentially, starting with familiar items, is recommended. Positive reinforcement for eating is effective. For children who are chronic poor eaters, eating in a social setting with peers, such as at kindergarten or in a playgroup, can be helpful.
Eating Disorders in Prepuberty and Puberty
The primary eating disorders during this stage are anorexia nervosa and bulimia nervosa. The diagnostic criteria according to ICD-10 and DSM-IV are the same as for adolescent or adult forms. Compared to other childhood eating disorders, excessive concern about body shape and weight is central. Amenorrhoea is not applicable in prepubertal anorexic patients due to their age, but delayed puberty and stunted growth are commonly observed. The earlier the disorder begins, the more severe these effects.
Children are increasingly influenced by societal pressure to conform to slim ideals. By the age of six or seven, many girls already wish to be thinner than they are. Growing preoccupation with weight, body image, and thinness is noticeable among children aged seven to nine. More than one-third of children aged seven to thirteen have attempted dieting at least once. Among all individuals with anorexia nervosa, children under 12 represent about 5% of cases. The earliest documented onset of anorexia nervosa is at seven years old.
With puberty, the incidence of anorexia nervosa rises sharply, affecting approximately 1% of 15- to 19-year-old girls, with the peak onset at age 14. There is no precise data on the prevalence of bulimia nervosa in childhood.
Symptoms of Anorexia Nervosa in Children
The symptoms of anorexia nervosa in children and adolescents largely resemble those of young adults. Unlike the variety of weight-loss methods used by older patients, children and younger adolescents primarily focus on severe food restriction (fasting) combined with excessive physical activity. Many young anorexic patients suffer from severe depressive moods, which can sometimes result in a misdiagnosis of depression. Pronounced compulsions and rituals, often centred around eating, are frequently observed in these cases.
Physical Complications in Children with Eating Disorders
Compared to adults and adolescents, children have significantly less fat mass, making the physical effects of starvation more severe. Some children and adolescents also restrict fluid intake, frequently leading to dehydration. Electrolyte imbalances are a concern in anorexic, bulimic, and bing-eating patients.
Long-term consequences of early eating disorders include osteoporosis, persistent menstrual irregularities, and growth delays or stunting. The risk of osteoporosis increases if amenorrhoea begins shortly after menarche and if the disorder persists for an extended period.
Girls with childhood anorexia nervosa are at high risk for insufficient bone mineralization. Between 30% and 50% of young patients experience prolonged cycle irregularities or amenorrhea. Prolonged illness can result in reduced adult height or even stunted growth.
Adolescents with obesity face increased risks of developing cardiovascular diseases, type II diabetes, and certain cancers in adulthood. Hypertension or diabetes occasionally manifests during adolescence. Severe obesity can lead to joint disorders in adolescence, further limiting physical activity.
The psychosocial effects of obesity on adolescents are significant. They often struggle more to form same- or opposite-sex friendships. Low self-esteem may lead to depressive disorders.
Eating Disorders in Postpartum Mothers and Their Impact on Children
Mothers with anorexia or bulimia nervosa often face challenges feeding their child. The aim of discussions with the mother or father is to determine whether parents have restrictive views about what a child should eat or if essential nutritional needs are genuinely unmet. Further medical intervention is necessary only in children with significant weight loss or insufficient weight gain due to food restrictions. If interaction problems are suspected as the cause of the eating disorder, a video recording of mealtime can be helpful. This recording, made by the parents at home or another suitable location, can be reviewed in detail with them later.
Eating Disorders in Men
Anorexia nervosa occurs in 5–10% of male cases, bulimia nervosa in 10–15%, and obesity in about 50%. Eating disorders in men are often diagnosed late, as they are considered a “female issue.” Men also face greater barriers to opening up about their struggles. The symptoms and progression of anorexia and bulimia in men largely mirror those in women. Diagnostic criteria are the same, except for amenorrhea. Medical complications are identical, though osteoporosis is more common in women. Key differences in men with eating disorders include the following:
Men with anorexia are more likely to exhibit the bulimic subtype, with self-induced vomiting. Behaviours like chewing and spitting out food, or “rumination” (regurgitating, rechewing, and reswallowing), are more frequently observed. Men with bulimia use laxatives, diuretics, and appetite suppressants less often, but hyperactivity is more common.
The internal pressure to eat minimally in public and display disciplined eating behaviour is less pronounced in men. Men report lower levels of weight phobia, fear of fatness, and body image disturbances compared to women. Men are more likely to report significant sexual inhibitions, reduced sexual interest, and occasionally impotence.
Obsessive-compulsive disorders appear to occur more frequently in men than in women. Childhood obesity is strongly linked to later eating disorders in men, occurring in 60% of male cases compared to 10–12% in females. Boys often begin dieting to build muscle and improve athletic performance, and sometimes to enhance sexual attractiveness. Some men aim to become the opposite of their fathers—slim, agile, and modern. A strong need for control and the desire to adopt an identity by committing to a specific diet (e.g., vegetarian or macrobiotic) can also motivate weight loss.
Eating Disorders and Addiction
Eating disorders and substance abuse converge into a singular mechanism to manage tension and conflict. Severe tension may also lead to self-harm, such as cutting, headbanging, or inflicting burns. Treatment for patients with both eating disorders and substance dependencies is especially challenging. Most healthcare systems separate facilities for eating disorders and substance-related disorders, complicating integrated care. Focusing on only one disorder often exacerbates the other. Integrated treatment addressing both conditions and underlying impulse regulation issues is essential. This approach helps manage stress, conflict, and crises without resorting to maladaptive coping mechanisms.
Reliable epidemiological data on the co-occurrence of eating disorders and substance dependence are unavailable. Among individuals initially diagnosed with eating disorders, 10–15% are reported to misuse or depend on substances. Comorbid alcohol dependence is particularly high among obese men.
For individuals initially diagnosed with alcohol or medication dependence, 20–30% are estimated to have a manifest eating disorder. The proportion of those where unresolved eating disorders play a key role in substance dependence development is likely much higher. In individual cases, eating disorders and substance abuse often develop in close interaction. In most cases, the eating disorder initially dominates, followed by the emergence of substance abuse. At times, both disorders may occur simultaneously.
Functional Characteristics of Substance Use in Eating Disorders:
- Hunger suppression, especially via alcohol, stimulants, heroin, or cocaine.
- Faster pursuit of slimness ideals using appetite suppressants, laxatives, diuretics, or cocaine.
- Addressing emptiness and hopelessness when eating behaviours no longer suffice to manage these feelings.
- Tension release and aggression regulation, often using alcohol or sedatives.
When eating disorders involve sexual themes, substances offer significant support, particularly in cases of abuse or exploitation. Substance use costs, combined with food expenses, can lead to theft for financial relief. For individuals with eating disorders, criminalisation represents a traumatic disruption to their already precarious self-control. Impulse regulation, often strained, may spiral completely out of control, leading to self-harm behaviours.
Treatment for Eating Disorders. Summary
The multifactorial origins of eating disorders require a multidimensional treatment approach focused on medical care and psychotherapy. Nutritional counselling alone, targeting weight gain or loss, is insufficient. Deciding between outpatient or inpatient treatment must consider physical, social, and psychological factors. Collaboration among all involved parties is essential throughout the treatment process.
Signs of Eating Disorders
Physicians should suspect an eating disorder if parents or patients report the following concerns:
- Increased interest in food composition and calorie content.
- Avoidance or refusal of main meals.
- Restriction to so-called “healthy” foods.
- Frequent weight checks.
- Dissatisfaction with appearance and body shape.
- Marked physical hyperactivity.
- Increased performance orientation and social isolation.
- Primary or secondary amenorrhoea.
If signs of an eating disorder are evident, physicians should openly discuss their concerns with the patient and, if appropriate, the parents. An informational conversation about potential consequences should follow. In suspected anorexia, the child or adolescent should have regular appointments for weight monitoring and brief discussions. Early interventions should be initiated if further weight loss occurs.
Atypical Eating Disorders
There are also non-categorizable atypical eating disorders. The transitions between different eating disorders can be fluid. Some people may even develop a mix of symptoms from different disorders, and one type can evolve into another. For example, bulimia can develop from anorexia.
FAQs about Eating Disorders
In the below FAQ section, we summarised answers to the common question asked by our patients about eating disorders.
What are eating disorders?
Eating disorders are serious mental health conditions with abnormal eating habits, characterized by a preoccupation with food, weight, and body image. The most frequent eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder.
What are the different types of eating disorders?
- Anorexia nervosa is characterized by severe food restriction and weight loss stemming from an intense fear of gaining weight.
- Bulimia nervosa is an eating disorder in which episodes of binge eating are followed by purging behaviors to prevent weight gain.
- Binge eating disorder is defined by episodes of consuming excessive amounts of food within a short time period, often accompanied by a feeling of loss of control.
- Avoidant/restrictive food intake disorder involves limited food intake due to sensory issues, lack of interest in eating, or fear of adverse consequences.
What causes eating disorders?
The exact causes of eating disorders are complex and multifaceted, involving a combination of biological, psychological, environmental, and sociocultural factors. These may include genetic predisposition, family history, personality traits, societal pressures, trauma, and low self-esteem.
What are the warning signs announcing an eating disorder?
Signs of eating disorders can vary depending on the specific type. Usually they are characterized by significant weight loss or weight fluctuations, obsession with body weight and shape, and distorted body image. Signs of eating disorders might be maticoulos counting of the calories, excessive exercising, and food rituals. Progressive eating disorders cause social withdrawal, mood swings, and physical symptoms like dizziness, fatigue, and gastrointestinal problems.
Can eating disorders be treated?
Yes, eating disorders can be treated. Treatment typically involves a multidisciplinary approach, including medical monitoring, nutritional counseling, psychotherapy (such as cognitive-behavioral therapy), and in some cases also treatment with medication. Support from family, friends, and support groups can significantly help in the recovery process.
How common are eating disorders?
Millions of people worldwide struggle with eating disorders. They affect individuals of all ages, genders, races, and socioeconomic backgrounds. Eating disorders often coexist with other mental health conditions, such as depression, anxiety, and substance abuse.
What are the long-term effects of untreated eating disorders?
Untreated eating disorders can have severe consequences. The physical damage caused by malnutrition leads to electrolyte imbalances, gastrointestinal complications, and bone loss. The psychological impact of eating disorders results in social isolation, depression, and anxiety. In extreme cases, eating disorders can cause death.
How do eating disorders affect the brain?
Such conditions can significantly affect the brain, causing other physiological changes such as hormonal imbalance and changes of the electrolytes. Malnutrition in anorexia nervosa can lead to malfunction in the brain, causing disruptions in cognitive function and emotional regulation. These brain changes can also lead to anxiety, depression, and other mental health problems. In bulimia, the electrolyte imbalances resulting from purging can affect not only the brain but also other organs, especially the kidneys.
When do eating disorders most commonly begin?
Eating disorders most commonly begin during adolescence or young adulthood, typically between the ages of 14 and 25. However, they can develop at any age, including childhood but also in mature age.
Which eating disorder involves out-of-control eating?
Binge eating disorder is characterized by out-of-control eating behavior. In binge eating disorder, people consume excessive amounts of food within a short time period, often accompanied by a feeling of loss of control.
How can I help someone with an eating disorder?
The most common misconception among laypeople is that they should compel the affected individuals to change their habits. If you suspect that your family member or friend is struggling with an eating disorder, it’s essential to express your concern in a supportive and nonjudgmental manner. Offer emotional support, listen actively, and educate yourself about eating disorders. Your primary responsibility would be to motivate your loved one to seek professional assistance from a psychologist or psychiatrist who specializes in treating eating disorders.