Eating Disorders in Women

Eating Disorders in Women

Eating disorders (ED) are defined as behavioral conditions characterized by persistent and severe disturbances in eating behavior. Eating disorders vary and are typically associated with distressing emotions and thoughts. 

Eating disorders are common and affect about 9% of the population worldwide. Approximately 9% (29 million) of Americans will suffer from an ED at some point in their lifetime. About 10,200 deaths occur each year as a result of eating disorders, making it one of the deadliest mental illnesses. Eating disorders also affect more women than men and have an economic impact of about $65 billion every year.

 What is an Eating Disorder?

An eating disorder is a serious, complex mental disorder characterized by severe disturbances in behaviors, thoughts, feelings, and attitudes toward eating, food, weight, and body image. ED is a serious mental and physical illness that requires professional intervention to prevent severe consequences, including death.

 What are the Different Kinds of Eating Disorders?

There are many types of eating disorders, including anorexia nervosabulimia nervosabinge-eating disorder, and avoidant restrictive food intake disorder (ARFID).

Anorexia nervosa

Anorexia is one of the most well-known eating disorders and generally affects women three times more than men. People with anorexia avoid food, severely restrict calorie intake, or eat very small quantities of specific foods. They often believe they are “fat” regardless of how much they weigh.

 There are two main subtypes of anorexia: restrictive and binge-purge. People who suffer from restrictive anorexia dangerously limit their food intake, while those who suffer from binge-purge anorexia limit their food intake as well as indulge in binge-eating and purging episodes. In binge-purge anorexia, consumption of a large quantity of food is immediately followed by vomiting or the use of laxatives and diuretics to pass the food quickly. 

Some symptoms of anorexia nervosa include extreme restricted eating, intense fear of weight gain, distorted body image, extreme thinness, and an unwillingness to maintain a healthy weight. Over time, other symptoms that can occur include anemia, cold hands, and feet, dental problems (from excessive vomiting), muscle loss, weakness, dry and yellowish skin, brittle nails, thinning of bones, infertility, heart issues, brain issues, changes in internal blood temperature, sluggishness, brain fog, and extreme fatigue. Anorexia Nervosa has the highest mortality rate of any psychiatric disorder.

 

woman stepping on a scale

Bulimia nervosa

Similar to anorexia nervosa, bulimia nervosa is also a very serious and potentially life-threatening eating disorder. People who suffer from bulimia have episodes of (secret) binge eating, where they eat a large amount of food with a loss of control over the eating, followed by purging to try to get rid of the extra calories in unhealthy and dangerous ways.

Most often, a bulimic patient will try to self-induce vomiting, misuse laxatives, use weight-loss supplements, and try using enemas after binging. They may also try to get rid of calories through fasting or excessive exercise. Unlike anorexics, bulimics do not typically restrict their food intake except when they are in the purge phase.

Some symptoms of bulimia include preoccupation with shape and weight, fasting, restricting calories, avoiding certain foods during the binge cycle, using supplements to induce weight loss, binge eating at one sitting, fear of gaining weight, forced vomiting, difficulty concentrating, loss of interest in friends and/or previously enjoyed activities, and lack of control during binging. Since bulimia is related to self-image and not just food, people who suffer from bulimia frequently judge themselves harshly for their self-perceived flaws.

Binge-eating disorder (BED)

Binge-eating disorder is a serious, life-threatening eating disorder characterized by periods of eating large amounts of food too quickly and to the point of discomfort. People who suffer from this eating disorder often consume an amount of food that is larger than most people would eat within a similar time span and circumstance.

Binge-eating disorder is also often associated with a sense of loss of control during the binge, a feeling that one cannot control what or how much they are eating, eating large amounts of food when not physically hungry, and embarrassment, shame, distress, and guilt afterward. Unlike bulimia nervosa, most binge eaters do not use inappropriate methods to counter the effects of excessive caloric intake.

Some symptoms of binge eating disorder include fear of eating in public or with others, extreme concern with body weight and shape, significant fluctuations in weight, stealing or hoarding food in unusual places, feelings of low self-esteem, frequent stomach cramps, and other gastrointestinal complaints, and difficulty with concentration.

Avoidant Restrictive Food Intake Disorder (ARFID)

ARFID is a new but dangerous eating disorder that affects mostly children; however, ARFID is becoming increasingly common among adults, especially with the popularity of trendy diets that eliminate food groups from the diet. With ARFID, people significantly limit the amount and kind of food they eat. Most people suffering from ARFID are selective eaters and have little or no interest in food. This often leads to malnourishment and poor growth, which can affect development and general health.

ARFID often starts in childhood, although it can affect adults. Picky eating due to dieting can lead to ARFID in adults. In childhood, ARFID is seen more in boys than girls. In adulthood, more women than men suffer from ARFID. Young people with ARFID are often selective eaters who have negative reactions to smells, tastes, texture, or colors of certain foods; afraid of trying new foods; have no interest in eating; have no appetite; deny feeling hunger; or are afraid that they might feel pain, choke, or vomit if they were to eat.

Some symptoms of ARFID include being underweight, skipping meals, limiting portions, missed periods, anxiety, poor growth, delayed puberty, dehydration, slow pulse, weak bones, hair loss, dizziness, and fainting. ARFID differs from other eating disorders in that body image and body weight concerns are usually not of importance to the individual. However, adults who suffer from ARFID generally have a lower quality of life, mood swings, and are more hypersensitive about their weight and body image.

Other Types of eating disorders include:

Diabulimia: Diabulimia, also known as Type 1 diabetes with disordered eating (T1DE), is a serious ED that can be developed by Type 1 diabetic patients. In diabulimia, the affected person reduces or stops taking their insulin with the goal of losing weight. They can also restrict the food they eat, over-exercise, or use laxatives to try to control weight. 

Although diabulimia is not an official medical diagnosis, it is estimated that up to 30% of people with Type 1 diabetes have an eating disorder. In fact, eating disorders are twice as likely to occur in people with Type 1 diabetes than people without. When your body does not get enough insulin, blood sugar levels remain elevated, and this can cause diabetic ketoacidosis, which can be dangerous and fatal. Insufficient insulin can also lead to kidney damage, loss of eyesight, and nerve issues, especially in your feet.

Some symptoms of diabulimia include unexplained weight loss, high blood sugar, extreme tiredness, frequent urination, excessive thirst, blurry vision, dry hair and skin, nausea/vomiting, discomfort testing blood sugar in front of others, discomfort administering insulin in the presence of others, secrecy about diabetes management, missed insulin prescription refills, neglect of diabetes management, anxiety about body image, depression, and mood swings.

Other Specific Feeding and Eating Disorders (OSFED): OSFED, which was previously known as Eating Disorders Not Otherwise Specified (EDNOS), is diagnosed when someone has an ED of clinical severity that doesn’t meet all of the diagnostic criteria to be diagnosed with specific eating disorders such as anorexia nervosa, bulimia nervosa, or binge eating. Most eating disorders are OSFED, as many eating disorders do not meet 100% of the criteria to be assigned a specific diagnosis. OSFED/EDNOS is equally as serious as other specific eating disorders, such as anorexia and bulimia.

Physical Consequences of Eating Disorders: Eating disorders threaten physical and mental health and have the highest mortality rate of any mental illness. Up to 10% of people with anorexia will die within ten years of contracting the disease. A whopping 20% will die after 20 years, and only about 30-40% of people ever recover.

Eating disorders also affect the body physically. For instance, eating disorders can lead to a variety of gastrointestinal problems. People who regularly purge by vomiting are at an increased risk of ruptures in the esophagus, a life-threatening situation. They are also prone to sore throats and a hoarse voice. Other gastrointestinal complications include inflammation in the pancreas (pancreatitis), constipation, intestinal obstructions, and intestinal infections. Binge eating can cause the stomach to rupture, and this can be fatal.

woman with a sore throat from an eating disorder

Eating disorders wreak havoc on the endocrine system and cause imbalances in essential hormones. Our body needs fats and cholesterol to make hormones. Without the necessary components, levels of sex hormones like estrogen and testosterone can drop, causing a low sex drive, irregular or stopped periods, and an increased risk of developing bone weakness. Lower sex hormones can also lead to bone loss. On the other hand, binge eating can lead to insulin resistance and, subsequently, Type 2 diabetes.

 Eating disorders can lead to insufficient nutrients for the brain, which, in turn, can lead to neurological disorders such as fainting, dizziness, concentration problems, and inability to think clearly. Low fat intake can affect neuron function and lead to numbness and tingling (pins and needles sensation) in the hands and feet. In some people, eating disorders can lead to seizures and sleep apnea.

 Other body systems can be affected by eating disorders. For instance, purging causes long-term starvation and electrolyte imbalances, which can affect the heart and lead to heart failure. The thyroid is also affected by these disorders, causing a decrease in thyroid production, low heart rate, cold intolerance, and dizziness. The production of our stress hormone (cortisol), essential for our well-being, is also negatively affected by eating disorders.

Treatment Options

Treating an ED will ideally be a multidisciplinary group effort that could involve a medical doctor or other healthcare provider who manages and treats physical symptoms. A dentist to care for damaged teeth, a nutritionist to help plan healthy and manageable meals, and a psychologist or psychiatrist to provide supportive therapy. Temporary admission into an inpatient facility or management by an outpatient facility may be necessary, depending on the severity of the illness.

Cognitive behavioral therapy, family therapy, and group therapy can all be beneficial. Holistic strategies have also shown some benefits. For example, yoga, meditation, and mindfulness practice have been shown to offer effective coping mechanisms that can lower stress and decrease unhealthy, eating-disordered thinking.

women doing yoga

Early recognition of eating-disordered behaviors is important. Early intervention increases the effectiveness of treatment options and offers the best chance at a full recovery.


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