Eating Disorders: Types, Symptoms, Diagnosis and When to Seek Help

Eating disorders are very serious mental-health conditions that affect how a person relates to food, eating, body-image, weight, and self-esteem. They are not a "lifestyle choice", a matter of "will power" or something only visible through physical manifestations.

The effects of eating disorders range from damage to the heart, bones, digestive system, hormone levels, moods, concentration levels, and relationships. Additionally many people with eating disorders have co-existing issues like anxiety, depression, trauma, obsessive compulsive thinking, substance abuse and/or suicide ideation. But there is good news. Recovery is possible. Early intervention can lower the risk of medical consequences and allow an individual to develop a healthier relationship with both food and their own body.

What Are Eating Disorders?

Eating disorders are characterized by abnormal eating behaviours or attitudes toward eating that result in altered consumption or absorption of nutrients and significantly impact an individual's physical health or ability to function normally in daily activities. These illnesses are multi-factorial and include a combination of biological, psychological, familial/social/cultural influences. Dieting or attempting to follow healthy eating practices do not automatically equate to having an eating disorder. Rather, it is when individuals' eating patterns begin to disrupt their normal lives due to distress related to food, weight, shape, eating rituals/compensatory behaviours that professionals should intervene.

Judging the severity of an eating disorder based solely upon a person's physical presentation is also misguided. For example, an individual who appears to be within a normal weight range could still be suffering from a serious eating disorder or be medically ill. Conversely, individuals engaging in binge-purge cycles, extreme amounts of exercise to compensate for calories consumed, severely restrictive diets and/or avoid certain foods due to fear of consuming them could benefit from seeking treatment.

Common Types of Eating Disorders

Anorexia Nervosa (AN)

Anorexia Nervosa is characterized by a persistent pattern of reduced food intake leading to significantly low body weight for the individual's height and developmentally appropriate weight status. In addition, this individual experiences an intense fear of gaining weight or becoming fat even though they may be below normal weight. Their self-esteem becomes overly linked with their body weight or shape and they tend to deny the severity of their low body weight or declining health.

Individuals with anorexia may primarily limit food intake or engage in other forms of maladaptive behaviour including binge/purging episodes. Anorexia can lead to muscle wasting/fatigue, fainting spells, decreased heart rate and blood pressure, bone thinning/hair loss/overtly low reproductive hormones, sterility/infertility and potentially life threatening medical complications.

Bulimia Nervosa (BN)

Bulimia Nervosa involves recurring episodes of binge eating followed by inappropriate compensatory behaviours. Binge eating episodes are defined as the ingestion of an objectively large amount of food during a short time frame accompanied by feelings of loss of control regarding eating. Compensatory behaviours may include forced vomiting, misuse of laxatives/diuretics, prolonged periods of fasting/excessive exercise.

Because bulimic individuals may appear to be at any weight level at any given time, it is common for these disorders to go undetected. Frequent purging can lead to dehydration/electrolyte imbalances/dental erosion/sore throats/gastrointestinal problems/rhythmic cardiac abnormalities.

Binge-Eating Disorder

Binge-Eating Disorder is characterized by recurring episodes of out-of-control eating that are not typically followed by regular compensatory behaviours. The most common characteristics of binge-eating episodes include rapid consumption of large amounts of food until uncomfortable/fullness develops while eating when not hungry, eating alone because embarrassed by one's hunger/appetite/quantity eaten after bingeing. While binge-eating disorder cannot be attributed to lack of will-power/discipline etc., it is considered a legitimate mental illness that may co-exist with depression/isolation/gastrointestinal problems/type II diabetes/cardiovascular disease and much emotional pain/distress.

Avoidant/Restrictive Food Intake Disorder (ARFID)

Avoidant/Restrictive Food Intake Disorder is an eating/feeding problem resulting in inadequate nutrition/energy intake but NOT motivated by concerns about body weight or shape. Individuals with ARFID may refuse food due to sensory characteristics (texture/smell/appearance), fear of choking/vomiting/lack of desire to eat/low interest in food.

ARFID can occur at any age and can lead to malnutrition/wasting/poor growth in children/nutritional deficiencies/dependence on dietary supplements/tube feedings or marked impairment in educational/work/travel/social functioning.

Other Specified Feeding or Eating Disorder (OSFED)

Other Specified Feeding or Eating Disorder (OSFED) refers to those individuals who display clinically significant symptoms consistent with an eating disorder but do not meet the criteria required for any one of the other three categories. This does NOT indicate that the disorder is any less valid/severe than another eating disorder. Examples of OSFED include atypical anorexia nervosa - where the primary psychopathological/behavioural aspects of AN are demonstrated but the individual is above the cut-off for "normal" body mass index; purging disorder - in which there are recurring episodes of purging without preceding binge-eating; and low frequency/brief duration bulimia/binge-eating disorder.

In addition to the four previously described disorders in the DSM Chapter on Feeding & Eating Disorders (pica - eating non-food items; rumination disorder - repetitive spitting up/regurgitating food; and unspecified feeding/eating disorder), "orthorexia" is frequently referred to as an unhealthy obsession with "healthy" eating; however orthorexia is presently not recognized as a distinct DSM-5-TR diagnosis

Symptoms and Warning Signs of Eating Disorders

Eating Disorders may develop over time and people with these disorders often go to great lengths to hide their symptoms behind appearances of healthy eating and exercise routines. There are many ways that you may notice symptoms of an eating disorder in yourself or in others.

Some of the most common signs of an eating disorder may be related to your feelings and behaviours. These can include:

1. constantly worrying about calorie count, weight, body shape, "good" vs. "bad" foods

2. skipping meals, eating very little, avoiding certain food types, having strict food habits

3. Binge eating, secretively eating, feeling unable to control food intake

4. frequent trips to the bathroom immediately following mealtime

5. vomiting, taking laxatives or diuretics, fasting, excessive exercise as compensation for food consumed

6. excessive exercise even while injured, tired, ill, or when social obligations come into play

7. feeling guilty or ashamed of food-related behaviour, experiencing anxiety, or being depressed about food

8. withdrawal from activities involving food such as dining out with friends and family or attending parties.

9. Withdrawal from social events due to concerns about food consumption;

10. Comparing oneself to others through body checking/weight comparisons/monitoring

11. Additionally you may notice a person appears to be: Irritated/depressed/preoccupied/seclusive/intrusive/concerned about food.

According to the national health service (NHS), these are all potential indicators of an eating disorder.

Physical Symptoms of Eating Disorders

Other than emotional & behavioural symptoms,individuals who suffer from Eating Disorders may also exhibit physical symptoms including:

1. Depression & Anxiety

2. Fatigue & lethargy

3. Feeling cold

4. Dizziness/fainting

5. Tachycardia/heart palpations

6. Dehydration

7. Diarrhoea

8. Bloating & Acid reflux

9. Oral/dental issues

10. Parotid gland swelling

11. Amenorrhea (absence of menstruation)

12. Delayed onset of puberty

You may see a person withdrawing from their normal routine, become isolated socially, withdraw from engaging in previous enjoyable social activities because of concerns surrounding food.

Complications of Eating Disorders

As a result a person may experience these complications of Eating disorder:

1. thin build

2. Hair Loss

3. Cold extremities

4. Dry & pale skin

5. Poor wound healing & muscle tone

6. Reduced ability to regulate body temperature

7. Poor overall health

8. Increased frequency of urination and/or bowel movements

9. Excessive thirst & Hunger

10. Dry mouth

DSM-V Diagnostic Classification of Eating Disorders

Anorexia Nervosa (AN)

For anorexia nervosa the main Diagnostic criteria involve significantly low body weight in the context of significant weight loss and a persistent fear of gaining weight or a lack of desire to regain lost weight. Individuals will also have distorted perceptions of their own body image.

Bulimia Nervosa (BN)

For bulimia nervosa the primary Diagnostic criteria involve recurring Binge eating and compensatory behaviours occurring on average at least once per week for 3 months. Additionally, an individual's self-esteem will frequently be based upon their body shape or weight.

Binge-Eating Disorder (BED)

Binge-eating disorder involves Binge-eating episodes occurring at least once weekly for three consecutive months that result in substantial distress and are not accompanied by regular compensatory behaviour.

Diagnosis and Management of Eating Disorders

All assessments need to evaluate each patient's physical well-being; nutritional status; mental health; Medication regimen; possible drug abuse; prior traumatic experiences; family dynamics; and any coexisting illnesses or disorders that could mimic an eating disorder or occur simultaneously with an eating disorder. An evaluation of the degree of disability caused by an eating disorder is not required to obtain professional assistance.

How quickly someone seeks help is directly correlated to success in obtaining proper treatment and achieving long-term Recovery.

Schedule an appointment with a healthcare provider (psychiatrist/psychologist/specialized eating disorder team); make contact with a medical professional if you observe restrictive food intake; bingeing; purging; compulsive exercise; sudden dramatic weight fluctuations; extreme fear of gaining weight; malnutrition; fainting spells; amenorrhea; or persistent guilt/anxiety related to food. Adayu, a Psychiatric hospital provides inpatient treatment and rehabilitation for all types of Eating disorder.

When to Seek Emergency Medical Help

Emergency medical evaluation is warranted if a person is fainting; experiencing chest pain; exhibits a rapid/lack of rhythm pulse; is severely weak/confused; dehydrated/vomited blood/unable to consume/retain fluids; or expresses suicidal ideation/thoughts.

To locate an emergency department in India please dial 112. Do not leave a potentially suicidal/hazardous person unattended.

How to Support Someone With an Eating Disorder

If you suspect another person may have an eating disorder select a time when you can speak privately. Only focus on what you've observed and avoid comments on their appearance. For example: “ since I have noticed mealtimes appear to be extremely stressful and you appear excessively fatigued I am concerned for your well-being and wish to assist you in accessing support.”

Do not attempt to provide them with ultimatums regarding dietary restrictions; offer constructive criticism for weight loss; argue with them regarding whether they “appear sick enough”. Eating disorder can be as dangerous as any medical conditions, keep a lookout if someone is experiencing these symptoms or with eating disorder, reach out for help.