What are Eating Disorders?


‘Eating disorder’ is the umbrella term used to describe different patterns of eating that are disordered due to dysfunctional attitudes and emotions towards food and weight.

According to the Diagnostic Statistical Manual of Mental Disorders (DSM-IV), eating disorders are classified as Axis I disorders, which represent clinical syndromes (i.e. clinical symptomology that can cause significant impairment).

Anorexia nervosa and bulimia nervosa are the two most common types of eating disorder.

The criteria for a diagnosis of anorexia nervosa comprises:

  • an intense fear of weight gain

  • a refusal to maintain body weight above 85% of expected weight

  • three consecutive missed menses (periods)

  •  lack of recognition of the seriousness of the weight loss.

There are two subtypes of anorexia:

  • the restrictive type (i.e. food restriction)

  • the binge eating and purging type (i.e. some episodes of overeating or purging).

The criteria for a diagnosis of bulimia nervosa, which is only made when the behaviour is not part of anorexia, comprises:

  • the presence of episodes of binge eating (i.e. an episode of overeating that is perceived to be uncontrollable)

  • compensated for by excessive or inappropriate methods of avoiding weight gain, such as the misuse of laxatives, diuretics or slimming pills.

As with anorexia, there are two subtypes of bulimia nervosa:

  • the purging type (i.e. self-induced vomiting)

  • the non-purging type, where an individual may partake in excessive exercise or fasting (food abstinence) to counteract a binge.

There are other categories of eating disorder, such as:

  • Binge Eating (i.e. eating large amounts of food over a discreet time period, accompanied by perceived lack of control but no compensatory behaviour)

  • Eating Disorder Not Otherwise Specified (EDNOS) (i.e. disordered eating patterns that do not fit the criteria used to diagnose anorexia or bulimia).

Prognosis

Approximately one-third of people with eating disorders fully recover, whilst one-third continue to experience some symptoms and another one-third remain chronic (Devlin, Jahraus, & Dobrow, 2005).

Long-term follow-up studies on anorexia demonstrate recovery rates ranging from 44-76%, with mortality in approximately 20% of sufferers (mainly from cardiac arrest or suicide).

There is a less research on the long-term follow-up of people with bulimia, but short-term success rates of 50-70% have been reported, with 6-month relapse rates of between 30-50%.

People with bulimia generally have a better prognosis compared to anorexia, although the fact that bulimia often goes unrecognised can place women with this disorder at great risk.

Causes of Eating Disorders

There are a number of theories as to the cause and maintenance of eating disorders, including those that are biological, social, or psychological in nature.

Genetic factors have been found to have a significant influence on the development of anorexia:

  • It has been estimated that approximately 58% of people with anorexia have inherited the disorder (Wade, Bulik, Neale, & Kendler, 2000).

In terms of social explanations, there has been a large focus on media influence and the thin ideal.

Research on the psychological factors underlying eating disorders indicates that:

  • more than half of people with anorexia have experienced sexual abuse or some other major trauma.

There are also cognitive theories of eating disorders (Spranger, 2001), including that they are caused by:

  • Maladaptive beliefs

  • Information Processing Errors

  • Attentional problems

  • Cognitive Inflexibility

  • Control issues

If you have any experience of eating disorders, please feel free to share your own insight into the causes. It would also be good to hear what has helped you overcome an eating disorder.

 

References

Devlin, M., Jahraus, J., & Dobrow I. (2005). Eating disorders. Levenson. J. (ed). Textbook of Psychosomatic Medicine, (pp. 311-334). Washington, DC: American Psychiatric Association.

Spranger, S.C., Waller, G., & Bryant-Waugh, R. (2001).  Schema avoidance in bulimic and non-eating disordered women.  International Journal of Eating Disorders. 29, 302–306.

Wade, T.D., Bulik, CM., Neale, M. & Kendler, KS. (2000). Anorexia nervosa and major depression: shared genetic and environmental risk factors.  American Journal of Psychiatry, 157(3), 469-71.



Categories: Health

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4 replies

  1. Anorexia can be about a lack of control caused by (maybe) things like overbearing parents…never feeling good enough…having a (perceived) lack of control over your life… and anorexia gives you some of your power back… you feel good when you go X amount of time without eating because you feel like you’ve achieved something… As for recovering, realising that life is worth appreciating…

  2. For several months after going through a traumatic event three years ago, I really struggled to eat and I lost a lot of weight. It was more than just not having an appetite, I had a real emotional block about eating. I was seeing a counsellor at the time, and one day I told her about this and I said “It’s just a temporary thing, it’s not like I’m going down the road of an eating disorder or anything”, and she replied “Ok, so what would be different about your behaviour with food if you were going down the road of an eating disorder?”, and I didn’t have an answer. Just that simple question she asked had a huge impact on me, and I was then able to properly address the issue. For some reason I had thought that because I was aware of the problem, that meant I didn’t really have a problem at all – does that make sense? It sounds stupid now, but it was perfectly logical to me at the time!

  3. Thanks for your input, Alex. You raise a very good point regarding control, which is a huge issue in all types of eating disorders. I think, however, eating disorders such as anorexia tend to give a feeling of control that isn’t actually there (i.e. the anorexia has the control, not the person). Thanks again for sharing🙂

  4. Hi Vanessa – really interesting post – thanks so much for sharing. Yes, it makes perfect sense. In fact, I think what you describe about being aware of the problem meaning there wasn’t a problem is how many eating disorders creep in. Thankfully, you were in counselling at the time before it totally got you in its grips. Trauma is a key factor in the development of eating disorders, especially if your trauma is associated with a lack of control or a situation that made you low in self-esteem.

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