There is a commonly held view that eating disorders are a lifestyle choice. Eating disorders are a serious and often fatal illness that causes severe disturbances to a person’s eating behaviors. Obsessions with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.
Signs and Symptoms of Anorexia Nervosa
People with anorexia nervosa may see themselves as overweight, even when they are dangerously underweight. People with anorexia nervosa typically weigh themselves repeatedly, severely restrict the amount of food they eat, and eat very small quantities of food. While many young women and men with this disorder die from complications associated with starvation, others die of suicide. In women, suicide is much more common in those with anorexia than with most other mental disorders.
- Extremely restricted eating
- Extreme thinness (emaciation)
- A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
- Intense fear of gaining weight
- Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight
- Thinning of the bones (osteopenia or osteoporosis)
- Mild anemia and muscle wasting and weakness
- Brittle hair and nails
- Dry and yellowish skin
- Growth of fine hair all over the body (lanugo)
- Severe constipation
- Low blood pressure, slowed breathing and pulse
- Damage to the structure and function of the heart
- Brain damage
- Multiorgan failure
- Drop in internal body temperature, causing a person to feel cold all the time
- Lethargy, sluggishness, or feeling of always being tired
People with bulimia nervosa have recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. Unlike anorexia nervosa, people with bulimia nervosa usually maintain what is considered a healthy or relatively normal weight.
Symptoms of Bulimia Nervosa include:
- Chronically inflamed and sore throat
- Swollen salivary glands in the neck and jaw area
- Worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acid
- Acid reflux disorder and other gastrointestinal problems
- Intestinal distress and irritation from laxative abuse
- Severe dehydration from purging of fluids
- Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium and other minerals) which can lead to stroke or heart attack
Individuals with binge-eating disorder lose control over his or her eating. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. Individuals who suffer from binge-eating disorder often are overweight or obese.
Symptoms of Binge-Eating Disorder include:
- Eating unusually large amounts of food in a specific amount of time
- Eating even when you're full or not hungry
- Eating fast during binge episodes
- Eating until you're uncomfortably full
- Eating alone or in secret to avoid embarrassment
- Feeling distressed, ashamed, or guilty about your eating
- Frequently dieting, possibly without weight loss
Eating disorders frequently appear during adolescence or young adulthood but may also develop during childhood or later in life. These disorders affect both genders, although rates among women are higher than among men. Like women who have eating disorders, men also have a distorted sense of body image. For example, men may have muscle dysmorphia, a type of disorder marked by an extreme concern with becoming more muscular.
Treatments and Therapies
Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Family Based Therapy (FBT) have all been proven to help in the treatment of eating disorders. Adequate nutrition, reducing excessive exercise, and stopping purging behaviors are the foundations of treatment.
Treatment plans may include one or more of the following:
- Individual, group, and/or family psychotherapy
- Medical care and monitoring
- Nutritional counseling
Source: National Institute of Mental Health, https://www.nimh.nih.gov/index.shtml
Overview of Avoidant/Restrictive Food Intake Disorder (ARFID)
What is ARFID?
Avoidant/restrictive food intake disorder (ARFID) is an eating or feeding disturbance that is characterized by a persistent failure to meet appropriate nutritional and/or energy needs that leads to one or more of the following:
- Significant weight loss (or failure to achieve expected weight gain or faltering growth in a child)
- Significant nutritional deficiency
- Dependence on oral nutritional supplements or enteral feeding (the delivery of a nutritionally complete feed, containing protein, carbohydrate, fat, water, minerals and vitamins, directly into the stomach, duodenum or jejunum)
- Marked interference with psychosocial functioning
It’s also important to understand what ARFID is not. It is not:
- Associated with body image issues or any abnormalities related to how one perceives their body weight or shape
- The result of lack of available food
- A culturally sanctioned practice
- Explained by another medical or mental disorder (“If we treat that issue, the eating problem will go away”).
Causes of ARFID
Like other eating disturbances, there is no singular cause of avoidant/restrictive food intake disorder (ARFID). However, the evolving scientific literature suggests that this pattern of disordered eating develops from a complex interplay between genetic, psychological and sociocultural factors.
Eating disorders are familial illnesses, and temperamental traits predisposing individuals toward developing an illness are passed from generation to generation.
Obsessive compulsive features tend to accompany eating disturbances, as do co-occurring mood and anxiety disorders.
Cultural pressures to eat clean/pure/healthy as well as growing emphasis on food processing, sourcing, packing and environmental impact can influence food beliefs and intake.
Symptoms of Avoidant/Restrictive Food Intake Disorder (ARFID)
Symptoms of avoidant/restrictive food intake disorder (ARFID) vary widely, and may evolve with the developmental context of the individual (especially in children and adolescents).
Types and symptoms of ARFID include:
- Avoidant: Patients who only accept a limited diet in relation to sensory features (sensory sensitivity); sensory aversion; sensory over-stimulation
- Aversive: Individuals whose food refusal is related to aversive or fear-based experiences (phobic avoidance) including choking, nausea, vomiting, pain and/or swallowing
- Restrictive: Individuals who do not eat enough and show little interest in feeding or eating (low appetite); extreme pickiness; distractible and forgetful
- ARFID “Plus”: Individuals with avoidant, aversive, or restrictive types of ARFID presentations who begin to develop features of anorexia nervosa, including concerns about body weight and size, fear of weight gain, negativity about fatness, negative body image without body image distortion and preference for less calorically-dense foods
- Adult ARFID: Individuals with avoidant, aversive, or restrictive types of ARFID presentations beyond childhood; may have had similar symptoms since childhood including selective or extremely picky eating, food peculiarities, texture, color or taste aversions related to food.
Seek a diagnosis if you have ANY of these ARFID symptoms
If left untreated, ARFID symptoms can build in intensity and seriousness, which is especially concerning for children and adolescents going through the most developmentally important stages of their life.
Health Risks of (ARFID)
Health risks associated with (ARFID) include:
- Weight loss or being severely underweight.
- Nutritional deficiencies (e.g., anemia or iron deficiency) and malnutrition that can be characterized by fatigue, weakness, brittle nails, dry hair/hair loss, difficulty concentrating, and reduction in bone density.
- Growth failure in adolescents or an increased risk to not thrive. Many sufferers have stunted growth or have fallen off their growth curves for weight and height.
Effective Treatment for ARFID
Many behavioral and psychological interventions have demonstrated promising effects for those recovering from ARFID and may include forms of exposure therapy, cognitive behavioral therapy and more.
Because underlying biological factors may influence ARFID, seeking out specialized care by a treatment team should be sought for full assessment and diagnosis. This may involve collaboration with a speech language pathologist, occupational therapist, physical therapist, and registered dietitian.
If you suspect that someone you care for may be suffering with a form of ARFID, it is important to express these concerns to a treatment specialist. A disturbance in eating patterns is not something that should be ignored, and seeking out treatment early can assist with intervention and recovery.
Facts & Statistics of (ARFID)
In addition to understanding the symptoms, causes, health risks, and treatment options for avoidant/restrictive food intake disorder (ARFID), it’s also important to understand the facts and statistics:
- More common in children and young adolescents and less common in late adolescence and adulthood
- Often associated with psychiatric co-morbidity, especially with anxious and obsessive compulsive features.
- More than just “picky eating”; children do not grow out of it and often become malnourished because of the limited variety of foods they will eat.
- Boys may have a higher risk for ARFID than girls.
Sources: Eating Disorder Hope, http://www.eatingdisorderhope.com and Eating Recovery Center, http://www.eatingrecoverycenter.com
Body Dysmorphic Disorder
What is Body Dysmorphic Disorder?
It can be defined as a body-image disorder, where an individual has persistent and intrusive thoughts and/or preoccupations with an imagined or slight defect in their appearance. Typical areas of distress are hair, skin coloring, nose shape, chest, and stomach. Any area can be distorted with someone who has BDD. Typically, the area of focus is not distorted, it is a perceived defect, or there is a slight imperfection. The flaw, however, in the mind of someone with BDD, is grotesquely significant and noticeable to others. This can cause severe emotional distress, and often a person may spend several hours per day trying to cover up or conceal the defect before going out in public.
How Common is BDD?
BDD is typically seen first in teens and pre-teens, around the age of 12, and it affects both men and women equally. In the United States, body dysmorphic disorder occurs in approximately 2.5% men, and 2.2% women. Although more research is needed, BDD is thought to be both biological and environmentally developed. Some research has shown genetic predisposition, neurobiological factors, personality traits, and life experiences such as abuse and trauma can have an effect on the development of BDD. Even though BDD affects a rather small amount of the general population, it can be seen with eating disorders. Frequently many individuals who struggle with eating disorders have low self-esteem and poor body image. BDD can develop along with an eating disorder.
Connection Between Eating Disorders and BDD
Those with an eating disorder and BDD will spend many hours staring at their body and become fixated on a specific body part. Often methods to cover up that flaw or area is used, and the person will seek reassurance from others that they look okay. Frequently individuals with this dual diagnosis will begin to avoid social situations and leave their home less regularly for fear of others seeing and judging their flaw or body image. With most individuals, depression, anxiety, feelings of shame, and disgust accompany both disorders. With eating disorders, a person will have extreme worry and obsessive thoughts around body image, weight, and shape, where with BDD the person is concerned about a specific body part. Both, however, are long-term chronic disorders. In BDD, the focus typically tends to be around skin imperfections, such as acne, wrinkles, scars, and blemishes. It can also include skin tone. Hair type, body hair, or absence of hair is also an area of obsession. Facial features, most commonly the nose, can also include the shape and size of features on the face. Other common areas of perceived distortion are the genital area, muscle shape and size, breasts, thighs, buttocks, and body odor.
Some warning signs for those who may be concerned about a loved one or self are:
Spending an excessive amount of time in front of the mirror, and engaging in repetitive and time-consuming behaviors.
Reassurance seeking on perceived flaw or body shape and size
Having difficulties at work, home, or school as well as relationships due to an obsession with the perceived defect.
Decreased low self-esteem and self-confidence and avoiding public and social situations
Increased co-morbid issues such as anxiety and depression
Seeking numerous dermatologists or plastic surgeon consultations on appearance improvement
When the Mirror Lies
When the mirror lies, it can be difficult not to believe the negative thinking. Remember that BDD is manageable and treatable with psychoeducation, cognitive behavioral therapy, and dialectical behavioral therapy, to name a few. Learning how to manage distress, identify and process emotions is one way to help keep adverse behaviors at bay. Working with a treatment team is also crucial in the recovery process. Learning when the negative thinking is triggered, how to stop it, and finding your own empowerment through the process of healing can bring hope and success. Remember your self-care. Take care of yourself when you feel the negative and BDD thinking is taking over. Read a favorite book, listen to music, drink your favorite hot beverage, or cozy up on the couch for a favorite Netflix show. Being able to get out of your head and into something else can help with the healing process. It may be slow at times, but each step leads you closer to managing your disorder.