EATING DISORDERS

Eating disorders are considered serious and complex mental health issues, accompanied by unpredictable complications for both physical and mental well-being and can pose a threat to life.

What Are Eating Disorders?

Eating disorders (ED) are psychological disorders characterized by disturbances in behavior, thoughts, and feelings about weight, body shape, and/or food and eating. In general, people with eating disorders often have pathological fears about not being able to control their weight or have distorted thoughts about body shape and the value of appearance, which leads to behavioral patterns such as unhealthy eating habits or weight control.

Types Of Eating Disorders And Their Symptoms

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), eating disorders are classified based on their symptoms and frequency: Anorexia nervosa; Bulimia nervosa; Binge eating disorder (BED); Pica; Rumination disorder; Avoidant/restrictive food intake disorder (ARFID); Other specified feeding or eating disorder (OSFED); Unspecified feeding or eating disorder.

In this article, we will explore three common types of eating disorders: (1) Anorexia nervosa; (2) Bulimia nervosa; (3) Binge eating disorder (BED).

Anorexia nervosa

People with anorexia nervosa are characterized by a pathological fear of gaining weight and dissatisfaction with their appearance. They limit their energy intake by dieting or exercising harshly, leading to their body weight falling below alarming levels according to their body mass index (BMI) which can be harmful to their health and life. However, they did not find anything unusual about their weight loss. Most people with anorexia nervosa do not feel they need help.

DSM-5 divides anorexia nervosa into two subtypes:

  • Restrictive subtype: Limit the amount of calories absorbed into the body

  • Binge-purge subtype: Using elimination techniques to lose weight (such as taking drugs or making him/herself vomit)

Also, according to the DSM-5, people diagnosed with anorexia nervosa need to meet the following criteria:

  • Eating less than recommended (calorie intake is less than the minimum recommended by your doctor or nutritionist) leads to weight lower than the minimum normal level or lower than expected for age based on body mass index (BMI). For an accurate assessment, an individual needs an examination and diagnosis from a doctor;

  • Having an intense fear of gaining weight and persistent behaviors aimed at preventing weight gain (even though the person is already at a lower-than-normal weight);

  • Disturbance in the way in which their body weight or shape is experienced, not realizing the severity of being too low in weight.

Bulimia nervosa

Bulimia nervosa is manifested by repeated episodes of binge eating (usually unhealthy foods), and it is difficult for the sufferer to control this behavior. This is followed by compensatory behaviors for binge eating, such as vomiting, taking drugs, doing excessive exercise, etc. These are likely to become a recurring cycle, and over time, the above behaviors may become increasingly compulsive and uncontrollable, leading to obsessions with food, thoughts about eating or not eating, weight loss, dieting, and/or appearance.

DSM-5 has provided the following criteria for bulimia nervosa:

  • Recurrent episodes of binge eating: People with bulimia nervosa consume larger amounts of food than usual and cannot control their eating behavior during a discrete period of time;

  • Recurrent inappropriate compensatory behaviors in order to prevent weight gains, such as self-induced vomiting, fasting, excessive exercise or misuse of laxatives, diuretics or other medications, etc;

  • Over the course of three months, binge eating and inappropriate compensatory behaviors have averaged at least once per week;

  • Body shape and weight have an undue influence on one's self-evaluation;

  • The disruption does not always occur during episodes of anorexia.

Binge Eating Disorder (BED)

BED is characterized by eating large amounts of food in a short period of time and feeling unable to control this behavior. After ending binge eating episodes, people with this disorder often have feelings of guilt, disgust, or despair. This can lead to emotional and thought disorders and self-image problems, which require intensive treatment.

Individuals with BED do not engage in inappropriate compensatory behaviors such as drug abuse, excessive exercise, or self-induced vomiting, in contrast to those with bulimia nervosa.

According to DSM-5, the diagnostic criteria for BED include:

  • Recurrent episodes of binge eating: People with BED consume larger amounts of food than usual and cannot control their eating behavior during a discrete period of time;

  • The binge eating episodes are associated with at least 3 of the following 5 characteristics:

  1. Eating much more rapidly than normal

  2. Eating until feeling uncomfortably full

  3. Consuming a lot of food even when one is not physically hungry

  4. Eating by oneself when one feels ashamed of how much they are eating

  5. Feeling exceedingly guilty, dejected, or dissatisfied with oneself afterwards

  • There is noticeable distress about binge eating;

  • For three months, the binge eating has happened at least once a week on average;

  • Binge eating does not only happen when a person has anorexia nervosa or bulimia nervosa; it is not linked to the frequent use of incorrect compensatory behavior as in bulimia nervosa.

WARNING: The symptoms listed are for reference only. If you suspect you have depression, see a psychologist at a reputable psychological/psychiatric assessment and treatment facility for an accurate diagnosis.

Who Can Have An Eating Disorder?

Age

Although eating disorders can occur at any age, they are especially common in young people in general. The average onset of eating disorders is between 12 - 25 years old. Notably, adolescence is a high-risk period susceptible to eating disorders. 

Gender

Based on statistics on the incidence of eating disorders in the period 2000 - 2008, it can be seen that eating disorders are a common problem worldwide. Among them, the rate of women with this disorder is much higher than that of men. Women make up about 80% of people with anorexia nervosa and 70% of people with bulimia nervosa.

In addition, several recent studies have shown that non-binary and transgender people are two to four times more likely to have eating disorder symptoms or behaviors than others with their same-sex partners.

Reason

Eating disorders can stem from biological causes, psychological causes, or social causes. These factors interact with each other, leading to the formation and development of eating disorders in individuals, in which social factors play a key role.

  • Biological factors: Eating disorders are highly genetic. In addition, abnormalities in neurophysiological activity and the hormonal system can create biological vulnerability, easily activating risk genes and triggering symptoms of eating disorders. 

  • Psychological factors: Some psychological characteristics can put individuals at risk for eating disorders, including: Personality traits such as perfectionism, low self-esteem, self-criticism, distorted perception/body dissatisfaction, and poor acceptance of negative emotions.

  • Social factors: One of the important factors in the formation of eating disorders is appearance standards in the social group/culture where the individual lives and the accompanying process of social comparison. In addition, family interaction problems – members sharing risky personality traits and maladaptive thoughts – can lead to disordered eating behaviors.

Treatment

Eating disorders can lead to many serious physical and psychological consequences. Treatment must focus on improving the individual's health status after the consequences of unhealthy eating behaviors. Therefore, for treatment to be effective, a combination of different healthcare professionals, such as doctors, psychiatrists, and/or psychologists, is needed.

Psychotherapy is considered a solution that brings long-term and sustainable results to eating disorders. Some commonly used therapies are cognitive behavior therapy (CBT), enhanced cognitive behavior therapy (CBT-E), responsive feeding therapy (RFT), family-based treatment (FBT) and interpersonal psychotherapy (IPT). The above-mentioned therapies mainly focus on the main goals of (1) helping people with eating disorders understand and cooperate in the process of nutritional and physical recovery; (2) changing behavior and attitudes; (3) improving social and interpersonal functioning; (4) intervening with psychological conflicts and accompanying mental disorders.

Additionally, participating in non-professional support groups can help people who are being treated for eating disorders. Psychological support from family, friends, and people around them can help sufferers understand their own reactions, share hidden fears, and reduce anxiety. Behaviors or attitudes that resist the treatment process.

If you feel you are having symptoms of an eating disorder, go to a medical facility for timely examination and diagnosis, or contact the Vietnam - France Psychology Institute via Hotline: 0977.729.396 for specific advice. Early intervention is key to improving health and quality of life.

References:

[1] Tâm bệnh học. Đặng Hoàng Minh (chủ biên)

[2] Diagnostic and statistical manual of mental disorders _ DSM-5. https://repository.poltekkes-kaltim.ac.id/657/1/Diagnostic%20and%20statistical%20manual%20of%20mental%20disorders%20_%20DSM-5%20(%20PDFDrive.com%20).pdf

[3] Các chứng rối loạn ăn uống ở Úc. https://www.nedc.com.au/assets/Fact-Sheets/Translations/Eating-Disorders-in-Australia-Vietnamese.pdf

[4] Prevalence of eating disorders over the 2000-2018 period: a systematic literature review. https://pubmed.ncbi.nlm.nih.gov/31051507/

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