I recently got an email from Emily Z, a 14-year old who is aspiring to be a mental health professional. She alerted me to an informative webpage on eating disorders.
Emily’s enthusiasm inspired me to look more into the topic, especially in how it relates to teenagers since they are more susceptible to develop them. I have however, also included some information about how eating disorders affect adults.
An eating disorder happens when a person develops an unhealthy relationship with food and can involve under eating and/or over eating. Often, eating disorders are associated with distorted body image (Maryville University, n.d.).
There is no identifiable cause for eating disorders, although there are factors that have been linked with eating disorders. I will explain these here, as well as possible treatment options. I will start by explaining the more common eating disorders.
Types of Eating Disorders
The most common types of eating disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder (BED).
In anorexia nervosa the person views themselves as overweight and is fearful of gaining weight. People with anorexia are often extremely underweight, but they don’t see this. As a result, they may eat very little, although this isn’t always the case. Sometimes anorexia involves cycles of binge eating followed by purging or compensatory behavior. Purging can consist of excessive exercising, vomiting, use of laxatives, or use of diuretics (Wu, Hartmann, Skunde, Herzog, & Friederich, 2013).
Bulimia nervosa also involves cycles of overeating and purging, but in bulimia, the person may have normal weight. They may also know that what they are doing is not right and feel guilty or shameful about it (Maryville University, n.d.).
BED involves binge eating or compulsive eating without some type of compensatory behavior (Wu et al., 2013). There are two types of BED: objective BED and subjective BED. Objective BED occurs when the person loses control over eating and consumes an objectively large amount of food, whereas subjective BED involves a loss of control over eating where the person perceives they are eating a large amount of food, but they are not (Fitzsimmons-Craft et al., 2014).
BED is apparently the most common type of eating disorder in the United States, and can result in obesity, although not always (Maryville University, n.d.).
Undernutrition & Overnutrition
Eating disorders can result in undernutrition or overnutrition. Undernutrition is often associated with anorexia and bulimia, and overnutrition is often associated with BED, although these are broad generalizations.
In undernutrition a person takes enough nutrients to stay alive, but not enough to sustain physiological or metabolic demands to heal from injury or illness, carry a healthy pregnancy, or create a growth spurt in a child. It can leave a person more susceptible to illness, disease, and malnutrition (Schlenker & Roth, 2011).
In overnutrition a person consumes too many nutrients and simultaneously does not engage in enough physical activity. Overnutrition can result in overweight conditions, obesity, type 2 diabetes, and cardiovascular disease. Overnutrition can also make a person more susceptible to diseases (Schlenker & Roth, 2011).
Why Teenagers are More Likely to Develop Eating Disorders
Adolescents are under a lot of pressure, and this has an impact on their food choices and eating behaviors. Part of the mental and emotional developmental process of teenagers involves preoccupation with their body image (Mahan, Escott-Stump, & Raymond, 2012). They are more likely to diet or restrict calories without relating to the future consequences of their present behavior. As their behaviors become more frequent and pervasive they are at a risk for developing eating disorders.
Eating disorders are often associated with a lack of support and lack of coherence or ability to make sense of the world. Adolescents have a harder time creating coherence and are also less likely to seek out social support. This makes it more likely for them to develop a disorder around food.
Emotional & Other Links to Eating Disorders
Studies have shown there are links to eating disorders. I have looked at a few here and included some that consider teenagers as well as adults.
Emotions such as depression, anxiety, and low self-esteem are often linked with eating disorders. One study on 80 adolescents looked at objective binge eating and subjective binge eating. Low self-esteem was associated with both, but depression was more strongly associated with subjective BED. Within the subjective BED group, the loss of control over eating was often related with hopelessness and sadness (Fitzsimmons-Craft et al., 2014).
Another study conducted a meta-analysis of 21 other studies that collectively included 582 patients with bulimic-type eating disorders. The patients ranged from 16 to 40 years. The studies linked brain dysfunction with the eating disorders, specifically a dysfunction in the “lateral prefrontal cortex activity” that they believed lowered inhibition and control in the patients (Wu et al., 2013).
History of trauma was also linked to eating disorders. Studies indicated that 37% to 100% of eating disorders in patients of all ages were related to some type of trauma. Trauma could include post-traumatic stress disorder (PTSD), childhood sexual abuse, sexual assault, life threatening illness, or death of a close person or family member (Tagay, Schlottbohm, Reyes-Rodriguez, Repic, & Senf, 2014). This seemed to be the case particularly in bulimia and BED. Out of a group of 51 patients with bulimia, 98% had suffered from a traumatic incident. Once the trauma occurred, the patient was affected by their sense of coherence and social support in dealing with the trauma, where the less coherence and support they received, the more likely they were to develop an eating disorder (Tagay et al., 2014).
Treating & Preventing Eating Disorders
Eating disorders are screened for in hospitals and other health care facilities. Health care providers look for indicators such as a BMI higher than 25 or lower than 18.5; unintentional weight loss; symptoms such as nausea, vomiting, and problems chewing or swallowing; or altered intake in diet, among others.
Eating disorders can be treated through the nutritional care process, which involves an assessment to look for signs and symptoms, diagnosis to identify the problem, intervention to create a plan, and monitoring and evaluation to examine the patient’s progress. However, this is rarely enough. Eating disorders also require treatment by a mental health practitioner, particularly for those suffering from depression, anxiety, self-esteem issues, or traumatic events.
Education and counseling from an early age is beneficial in preventing eating disorders, particularly involving topics such as body image and nutrition. Please see the resources below for more information.
Fitzsimmons-Craft, E. E., Ciao, A. C., Accurso, E. C., Pisetsky, E. M., Peterson, C. B., Byrne, C. E., & Le Grange, D. (2014). Subjective and objective binge eating in relation to eating disorder symptomatology, depressive symptoms, and self-esteem among treatment-seeking adolescents with bulimia nervosa. European Eating Disorders Review, 22(4), 230-236. doi:10.1002/erv.2297
Mahan, L. K., Escott-Stump, S., & Raymond, J. L. (2012). Krause’s Food and The Nutrition Care Process (13th ed.). St. Louis, MO: Elsevier Saunders.
Maryville University (n.d.). A nurse’s guide to eating disorders. Maryville University. Retrieved on July 29, 2018 from https://online.maryville.edu/online-masters-degrees/master-science-nursing/guide-eating-disorders/
Schlenker, E. D. & Roth, S. L. (2011). Williams’ Essentials of Nutrition and Diet Therapy- Revised Reprint (10th ed.). St. Louis, MO: Elsevier Mosby.
Tagay, S., Schlottbohm, E., Reyes-Rodriguez, M. L., Repic, N., & Senf, W. (2014). Eating disorders, trauma, PTSD and psychosocial resources. Eating Disorders, 22(1), 33-49. doi:10.1080/10640266.2014.857517
Wu, M., Hartmann, M., Skunde, M., Herzog, W., & Friederich, H. C. (2013). Inhibitory control in bulimic-type eating disorders: a systematic review and meta-analysis. PLoS One, 8(12), e83412. doi:10.1371/journal.pone.0083412