What is eating disorder?
Eating disorders are mental disorders defined by abnormal eating habits that negatively affect a person’s physical or mental health.

What are the various types of eating disorders?

  • Anorexia nervosa (AN), characterized by lack of maintenance of a healthy body weight.It is accompanied by an obsessive fear of gaining weight giving rise to an unrealistic perception towards one’s own body.Symptoms ofAnorexia are stopping of menstruation, bone loss, loss of skin integrity, etc. The main characteristic of anorexia is the immense fear of weight gain even if the person is drastically underweight, he/she would still be undertaking of all possible ways of losing weight. They would fail to perceive their actual shape and would continuously feel that they are “fat”. It greatly stresses the heart, increasing the risk of heart attacks and related heart problems. The risk of death is greatly increased in individuals with this diseasedue to dietary deficiencies.
  • Bulimia nervosa (BN), characterized by recurrent binge eating followed by compensatory behaviours such as purging (self-induced vomiting, excessive use of laxatives/diuretics, or excessive exercise). Fasting and over-exercising may also be used as a method of purging following a binge.
  • Binge Eating Disorder (BED), characterized by recurring binge eating at least once a week for over a period of 3 months while experiencing lack of control and guilt after overeating. The disorder can develop within individuals of a wide range of ages and socioeconomic classes
  • Pica, where people eat non-food items, it is an appetite for substances that are largely non-nutritive, such as paper, clay, metal, chalk, soil, glass, sand, etc.Iron deficiency is one of the causes.
  • Ruminationdisorder, where people regurgitate food. It is also known as Merycism. it is an under-diagnosed chronic motility disorder characterized by effortless regurgitation (the expulsion of material from the pharynx, or oesophagus, usually characterized by the presence of undigested food or blood, of most meals following consumption) due to the involuntary contraction of the muscles around the abdomen
  • Avoidant/restrictive food intake disorder, where people have a lack of interest in food,
  • Compulsive overeating, (COE), in which individuals habitually graze on large quantities of food rather than binging, as would be typical of binge eating disorder.
  • Diabulimia, characterized by the deliberate manipulation of insulin levels by diabetics in an effort to control their weight.
  • Food maintenance, characterized by a set of aberrant eating behaviors of children in foster care.
  • Orthorexia nervosa, characterized by an obsession with a “pure” diet, in which people develop an obsession with avoiding unhealthy foods to the point where it interferes with a person’s life
  • Selective eating disorder, is being picky in eating, it is also called as avoidant/restrictive food intake disorder. It is an extreme sensitivity to how something tastes. This sensitivity can lead to elimination of certain kinds of food with no logical basis to it or biological limitations like allergies to certain food types, for example: selection of food on the basis of colour, how soft it is or how hard it is, etc.This is very commonly seen in children with a notion that they will grow out of it, some children do grow out of it while the others may carry it throughout their adult lives. There are systematic desensitization processes that can be applied to children and their parents can be trained in that process to help the child at home while eating. With adults cognitive behavioural therapy and hypnotherapy can work best to change how they think about food and to reduce the anxiety over food.
  • Drunkorexia, commonly characterized by purposely restricting food intake in order to reserve food calories for alcoholic calories, exercising
  • excessively in order to burn calories consumed from drinking, and over-drinking alcohols in order to purge previously consumed food.
  • Pregorexia, characterized by extreme dieting and over-exercising in order to control pregnancy weight gain. Under-nutrition during pregnancy is associated with low birth weight, coronary heart disease, type 2 diabetes, stroke, hypertension, cardiovascular disease risk, and depression.
  • Gourmand syndrome, a rare condition occurring after damage to the frontal lobe, resulting in an obsessive focus on fine foods

What are the signs and symptoms of eating disorders?

  • Acne–acne vulgaris (or simply acne) is a long-term skin disease that occurs when hair follicles become clogged with dead skin cellsand oil from the skin.Acne is characterized by areas of blackheads, whiteheads, pimples, and greasy skin, and may result inscarring
  • Amenorrhoea – is the absence of a menstrual period in a woman of reproductive age.
  • Xerosis – also known as xerodermia, derived from the Greek words for “dry skin”.
  • Constipation – refers to bowel movements that are infrequent or hard to pass.
  • Telogen effluvium – is a scalp disorder characterized by the thinning or shedding of hair
  • Osteoporosis – is a disease where decreased bone strength increases the risk of a broken bone.
  • Pellagra – is a vitamin deficiency disease most frequently caused by a chronic lack of niacin (vitamin B3 or synonym: vitamin PP (from: Pellagra Preventing factor) in the diet.
  • Diarrhea – is the condition of having at least three loose or liquid bowel movements each day
  • Cardiac arrest – is a sudden stop in effective blood circulation due to the failure of the heart to contract effectively or at all.
  • Electrolyte imbalance – imbalance of the chemicals present in the blood stream.
  • Scurvy – is a disease resulting from a deficiency of vitamin C. Typical symptoms of scurvy are initially fatigue, followed by formation of spots on the skin, spongy gums, and bleeding from the mucous membranes. Spots are most abundant on the thighs and legs, and a person may look pale, feel depressed, and be partially immobilized. As scurvy advances, there can be open, suppurating wounds, loss of teeth, yellow skin, fever, neuropathy and finally death from bleeding
  • Water retention and/or edema–it is also known as fluid retention signifies an abnormal accumulation of fluid in the circulatory system or within the tissues or cavities of the body.
  • Hypokalemia – refers to the condition in which the concentration of potassium (K+) in the blood is low.
  • Hyponatremia – refers to low sodium concentration in blood
  • Kidney failure – the kidney would cease to function in certain ways or completely.
  • Tooth loss, cavities
  • Lanugo – is very fine, soft, and usually unpigmented, downy hair as can be found on the body of a fetus or newborn baby.
  • Brain atrophy – Atrophy of any tissue means a decrement in the size of the cell, in this case it would be decrease in the size of the brain.
  • Suicide – take away one’s own life willingly
  • Death

Who would get an eating disorder?

Binge eating disorder affects about 1.6% of women and 0.8% of men in a given year. Anorexia affects about 0.4% and bulimia affects about 1.3% of young women in a given year. During the entire life up to 4% of women have anorexia, 2% have bulimia, and 2% have binge eating disorder. Anorexia and bulimia occur nearly ten times more often in females than males. Typically they begin in late childhood or early adulthood. Rates of eating disorders appear to be lower in less developed countries.

Eating disorders are found to be comorbid with the following disorders

  1. Depression
  2. Substance abuse, alcoholism
  3. Anxiety disorders
  4. Obsessive compulsive disorder
  5. Attention-deficit hyperactivity disorder
  6. Obsessive compulsive personality disorder
  7. Borderline personality disorder
  8. Narcissistic personality disorder
  9. Histrionic personality disorder
  10. Avoidant personality disorder
  11. Body dysmorphic disorder

What are the causes of eating disorders?

  1. Genetics – research has shown that there can be a genetic predisposition towards eating disorders and it can also be inherited.
  2. Other psychological disorders – the disorders mentioned above as being comorbid with eating disorders can also be one of the causes of eating disorders.
  3. Eating disorder can start as a wrong coping strategy –For example: a girl who feels lack of control over her life can start controlling over the food she eats, a person who had been through a bad day might eat the food that he/she likes in large amounts to feel good.
  4. Media depictions of the body – media encourages the idea of a slim body as the beautiful body which can be misleading and can be taken to extremes by our present day teenagers to fit in the beautiful category.
  5. Cognitive attentional bias issues–it is form of selective attention that is given to only a few things those we like and those that do not match our thinking is not given any attention. For example, someone with anorexia may think that I do not want to become fat and hence may exercise vigorously and eat very less but fails to give attention to the fact that he/she is already under weight and the strategies that they are using would suite only an overweight person.

Prevention of eating disorder

The following can be done with children to prevent eating disorder –

    • Emotional Bites: a simple way to discuss emotional eating is to ask children about why they might eat besides being hungry. Talk about more effective ways to cope with emotions, emphasizing the value of sharing feelings with a trusted adult.
    • Say No to Teasing: another concept is to emphasize that it is wrong to say hurtful things about other people’s body sizes.
    • Body Talk: emphasize the importance of listening to one’s body. That is, eating when you are hungry (not starving) and stopping when you are satisfied (not stuffed). Children intuitively grasp these concepts.

Fitness Comes in All Sizes: educate children about the genetics of body size and the normal changes occurring in the body. Discuss their fears and hopes about growing bigger. Focus on fitness and a balanced diet

When these preventive techniques are done right from childhood, concerns in adulthood do not arise. It is important however to create a general awareness about eating disorders in schools, colleges, workplaces. This awareness can lead individuals already having the disorder or those on the verge of developing the disorder to take professionals help. It also encourages people to guide their loved ones suffering from the same to take help. For those suffering from this disorder medication and psychotherapy can help deal with the issues that have led to it along with other comorbid disorders.

We at Mumbai Psychiatry Clinics have a dedicated team of counsellors and clinical psychologists who will help you with your problems, cite interventions and assess the progress on regular intervals. There are experienced psychiatrists who will be guiding you throughout your journey and our Multidisciplinary team will try to assure you with the best help possible.