Introduction

Eating disorders are disorders generated by complex mental health conditions usually hidden from the suffering persons, and their manifestations require support from medical and psychological experts.

These disorders are described in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).

In the United States alone, an estimated 20 million women and 10 million men have or have had an eating disorder at some point in their lives.

Japan and other eastern countries are growing at the highest rate.

What are eating disorders?

Psychological conditions generate eating disorders, and they can start with mania in some aspect of the relationship with the food, body shape, or body weight.

The most severe untreated cases may result in death, and in any case, can seriously alter the healthy condition of a person.

People with an eating disorder can have different symptoms such as food restrictions, food binges, and purging behaviors like vomiting or over-exercising

Although the third world medical system could under-report eating disorders, it looks that modification of relation with food is intensively present in developed or growing economies.

Eating disorders can affect people of any life stage or gender but are more affecting young women less than 20 years of age.

What Causes Eating Disorders?

There are varieties of factors that can affect incorrect eating behaviors. These include genetics, brain biology, personality traits, and cultural ideals.

Genetics: Studies done on twins separated at birth and adopted by different families have shown that genes can impact the attitude with the food.

Indeed, these studies have shown that if one twin develops an eating disorder, the other has a 50% likelihood of developing one.

Personality traits: three personality traits often connected to potential developing eating disorders are neuroticism, perfectionism, and impulsivity.

Exposure to media: The exposure to media and the proposition of cultural models based on thinness can influence the population in a wrong interpretation of the canon of beauty messages.

Certain eating disorders appear to be mostly non-present in cultures that haven’t been exposed to Western ideals of thinness, indeed.

More recently, experts have proposed that differences in brain structure and biology may also play a role in developing eating disorders.

In particular, levels of the brain messengers serotonin and dopamine may be factors.

However, before conclusions, more studies are still needed.

1. Anorexia nervosa

A diagnosis of Anorexia nervosa is released when a patient weight is below the normal healthy weight of more than 15%

Usually, patients do not recognize to have problems with body image. They deny being underweight; however, they limit their food intake, refusing to eat enough; in addition, they usually over-exercise and sometimes purge themselves, vomiting or taking laxatives.

This causes people affected by Anorexia to lose weight.

After a time, the body reacts with survival mechanisms producing effects such as:

• • Fragile Hair/nails
• • Dry skin
• • Lost of calcium with consequences of Osteopenia or osteoporosis
• • Anaemia
• • Reduction of muscular fibers, including the heart muscle
• • Constipation
• • Blood pressure increase together with pulse rates
• • Thermal regulation system falls, causing a person to feel cold all the time
• • Depression and lethargy
• • Menstrual periods cease

Anorexia nervosa is the most known eating disorder, and it is often developed during adolescence and tends to affect more women than men (1).

Anorexia-affected people have a distorted perception of their condition. They see themselves overweight although they are seriously underweight; they restrict calories assumption, avoiding certain types of food, and constantly monitor the scale.

The most common symptoms of Anorexia Common include:

• • being underweight
• • very restricted eating patterns
• • despite being underweight, to be always on the avoidance to gain weight
• • a persistent chase of thinness
• • an influence of body weight on self-esteem
• • a distorted body image

Usually, an Anorexia-affected person presents obsessive-compulsive behavior, being constantly preoccupied with thoughts about food, collecting recipes, or cumulating food. In addition, they have difficulties eating in public, and their necessity to control the environment around them makes them difficult to be spontaneous.

There are two subtypes of Anorexia: the restricting type and the binge eating and purging type (2).

The restricting type affected people lose weight through dieting or excessive exercise.

The binge eating and purging type affected people may binge large quantities of food or eat very little. Still, in both cases, after they eat, they purge themselves vomiting, taking laxatives or diuretics, or over-exercising.

Anorexia can cause severe damage to the body with a possibility of developing, over time, infertility, thinning of their bones, brittle hair and nails, and the growth of a layer of fine hair all over their body (3).

In the worst scenarios, anorexia can result in heart, brain, or multi-organ failure and death.

2. Bulimia nervosa

Bulimia nervosa is the second most famous eating disorder.

Like anorexia, bulimia manifests itself more during adolescence and in the female gender (4).

People with bulimia often eat substantial amounts of food in a specific period of time.

During a binge, the person feels an uncontrollable or unstoppable sensation to continue eating. Each binge eating episode usually continues until the person becomes painfully stuffed.

The assimilation of food can involve any food but frequently happens with foods the individual normally avoids.

Afterward, individuals with bulimia attempt to purge themselves to relive the pain and compensate for the calories assumed.

The usual purges include forced vomiting, fasting, laxatives, diuretics, enemas, and excessive exercise.

Although symptoms of Bulimia are very similar to the Anorexia ones, individuals with bulimia usually maintain a relatively normal weight rather than becoming underweight.

Common symptoms of bulimia nervosa include (5):

• • frequents episodes of binge eating with a feeling of lack of control
• • subsequent episodes of purging behaviors to prevent weight gain
• • self-esteem overly influenced by body shape and weight
• • distress of gaining weight, despite having a normal weight

Because of the frequent vomiting, side effects of bulimia may include an inflamed throat, swollen salivary glands, worn tooth enamel, tooth decay, acid reflux, irritation of the gut, severe dehydration, and hormonal disturbances (6).

In the worst cases, bulimia can also create a decompensation in electrolyte levels such as sodium, potassium, and calcium. This can evolve into a stroke or heart attack.

3. Binge eating disorder

Binge eating disorder is currently the most diffuse disorder in the United States (7).

As Anorexia and Bulemia disorders, although they can develop later on, BED usually begins during adolescence and early adulthood.

The symptoms are similar to those of bulimia or the binge eating subtype of anorexia.

For instance, as for previous disorders, the lacking of control during a considerable amount of food ingurgitation in relatively short periods of time is a constant experience.

Unlike Bulimia and the second subtype of Anorexia, people with binge eating disorders do not feel the necessity to purge themselves with vomiting or excessive exercise to compensate for their binges.

Common symptoms of binge eating disorder include (8):

• • Despite not feeling hungry, eating large amounts of foods rapidly, in secret, and until uncomfortably full
• • Experiencing lack of control during BED
• • Feelings of guilt, thinking back to the binge
• • No purging methods such as diuretics, laxatives, vomiting, or over-exercise are used to compensate the binge

People with Binge Eating Disorder are often overweight or obese. The consequence is an increased risk of having heart disease, stroke, and type 2 diabetes (9).

4. Pica

Pica is another eating disorder that involves the ingestion of materials that are therefore not considered food.

Pica sufferers ingest non-food substances, such as ice, dirt, earth, chalk, soap, paper, hair, cloth, wool, pebbles, laundry detergent, or cornstarch (10).

Pica can occur at any age but is more common in children, pregnant women, and people with mental disabilities (11).

Those with Pica have an increased risk of poisoning, infections, intestinal injuries, and nutritional deficiencies. Depending on the substances ingested, pica can be fatal.

However, for an individual to be considered affected by Pica, the substances ingested must not be ingested for any reason that may be religious, cultural, or socially accepted.

5. Rumination disorder

Another eating disorder that has recently appeared on the panorama of eating disorders is the Rumination disorder.

It is thus defined because the action performed by those affected by it simulates the dietary style of ruminants. That is, once the food has been chewed and ingested, the food itself is regurgitated and chewed again and re-swallowed or spat out. (12).

This rumination is a voluntary gesture and is typically done within the first 30 minutes after a meal (13).

This disorder can also develop in childhood and at an older age, but it tends to disappear at an older age in newborns.

If it is not resolved at the neonatal level, rumination disorder can cause weight loss and severe malnutrition that can lead to death.

On the other hand, for children or adults, therapy is usually needed to resolve it.

Adults with this disorder can limit the amount of food they eat, especially in public. This can lead to weight loss and becoming underweight (14, 15).

6. Avoidant/restrictive food intake disorder

ARFID, or avoidant/restrictive food intake disorder, is a new name for a disorder formerly known as “childhood and early childhood eating disorder.”

In the past, the diagnosis was reserved for children under the age of 7, but it was discovered that it could persist even into adulthood and involve both men and women.

Individuals with this disorder have no interest in food due to a distaste for certain smells, tastes, colors, textures, or temperatures.

Common symptoms of ARFID include (16):

• • disinterest in food intake with consequently reduced caloric intake or reduced ingestion of sufficient nutrients
• • eating habits that interfere with normal social functions, such as eating with others
• • reduced weight or poor development with correlation to age and height
• • nutritional deficiencies or addiction to supplements or tube

It is important to note that people are affected by ARFID  when behaviors go beyond normal behaviors, such as picky eating in young children or reduced food intake by the elderly.

Furthermore, to be considered affected by ARFID, the substances avoided must not be avoided for religious, cultural, or socially not acceptable reasons.

Other eating disorders

Further to the six eating disorders mentioned above, there are also lesser-known eating disorders. These generally fall into one of the following categories (17):

• • Disorder of elimination: People with this disorder use elimination behaviors to control their weight or shape, such as vomiting, laxatives, diuretics, or excessive exercise. Either way, don’t binge.
• • Night feeding syndrome: People with this syndrome overeat, often after waking from sleep.
• • Other Specific Eating or Eating Disorders (OSFED): Although not found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), any conditions with symptoms similar to those of an eating disorder and not falling into any of the above categories can be considered as such.

One disorder that is currently categorized as OSFED is orthorexia. Indeed, this disorder is increasingly mentioned in the media and reported in scientific studies; orthorexia has not yet been recognized as an eating disorder and is still not included in the current DSM.

People with orthorexia tend to over-focus on a diet that they deem healthy to the extent that it disrupts daily life.

For example, those with orthorexia tend to eliminate entire food groups for fear that they are unhealthy, resulting in potential malnutrition, severe weight loss, difficulty eating out, and emotional distress.

People with orthorexia are not affected by weight loss. Instead, their self-esteem or satisfaction depends on how well they manage to adhere to their self-imposed dietary rules (17).

Conclusion

The overview we presented is intended to understand the most common eating disorders better and dispel the legends.

Eating disorders are mental health conditions that usually require treatment. However, they can also be dangerous to the body if left untreated.

If you have an eating disorder or know someone who may have one, don’t leave him alone but have him seek help from an eating disorder doctor.