Eating disorders

Eating disorders:

Eating disorders in the U.S. have dramatically increased as thinness has become a national obsession. “Approximately 24 million people in the United States suffer from an eating disorder, according to the National Association of Anorexia Nervosa and Associated Disorders.  Eating disorders are among the deadliest mental illnesses, second only to opioid addiction, resulting in approximately 10,200 deaths each year.” (Source)

 

Anorexia is restrictive eating that creates a very low body mass index. Anorexia means without appetite. Physical signs and symptoms of anorexia may include (Source):

·Extreme weight loss or not making expected developmental weight gains

·Thin appearance

·Abnormal blood counts

·Fatigue

·Insomnia

·Dizziness or fainting

 

The individual carrying distorted body perception tries to lose weight abnormally. The person wants to become thinner and thinner and carries the fear of becoming fat and attain out-of-proportion weight. The person engages in self-created negative behaviors (e.g., forced vomiting, laxatives) to prevent weight gain. Even though the person controls the diet, his mind gets preoccupied with food. The person loses control at times, eats just for satisfaction, and then moves into deep guilt. He could have distorted thinking and could tend to overestimate their actual proportions and could have over-inflated goals to be attained in undue timeline. The person measures self-esteem in relation to the shape and weight of the body. All these produce undue pressure and extreme stress in the person. If the extreme symptoms mentioned above occurs weekly for 3 months, it indicates a disorder. In addition to several medical issues such as lowered body temperature, low blood pressure, body swelling, reduced bone mineral density, slow heart rate, the person may face psychological symptoms such as

·Depression, anxiety, low self-esteem, sleep disturbances

·Substance abuse

·Obsessive-compulsive patterns

·Perfectionism

 

Even though a person can make diet restrictions to gain normal weight, escalation toward anorexia nervosa may follow a stressful event. There are two main subtypes of Anorexia. In the Restricting type, the person may lose weight by cutting out sweets and fattening snacks, eventually eliminating nearly all food. The person is adamant and shows almost no variability in the diet. In Binge-eating/purging type the person reduces weight by forcing themselves to vomit after meals or by abusing laxatives or diuretics. Even though the person has attained bodyweight much below average, the person is having extreme fear of eating again and gaining weight. Such a person is so overwhelmed with his body shape and its image that he even resists investigating the side effects of such harsh dietary restrictions. 

 

In Anorexia, the person is internally going through the strain of attaining self-constructed shape and weight of the body. There is a preoccupation with food and disturbed eating attitudes. The risk of suicide attempts is also high in Anorexia. However, Bulimia is more concerned about pleasing others. In Bulimia, a person’s relationship could grow from just enjoying taste pleasure to being lustful towards food. Intense mood swings, frustration and boredom, and impulsivity are more likely in Bulimia when compared to Anorexia. In Bulimia, cycles of binging and purging, a cycle of overeating followed by expulsion occurs. They can throw up at will soon after eating. The person keeps all these hidden, eats a lot of sweet high-calorie foods, and it might seem normal to that person. Around 75% percent of bulimia nervosa cases occur in females. It may involve 1 to 30 episodes per week and 2,000 to 6,000 calories per episode. Even though the episode is preceded by great tension, it is relieved through overeating. After eating, the person often repents for the action and move into weight gain fear, worthlessness, and depression.

 

Effective from Anorexia and Bulimia, one could face Amenorrhea, a disorder where the menstruation period is affected. She may not be aware that it happened due to a severe eating disorder. The weight may stay in the desired range, but severe symptoms of uneven menstrual cycles could surface for several years. The person may also have skin, nail, and hair problems. These are signs of body shutting down. It is an effect of problem-solving done in an unscientific way to attain the unattainable. 

 

Bulimarexia is a syndrome in which the symptoms of both Bulimia and Anorexia are present, characterized by distorted body image, excessive weight loss, and use of forced vomiting to compensate for periods of binge eating(Source). The effects are much more complicated than just the addition of the two. While in Anorexia Nervosa, a person can lose weight abnormally, in Bulimia Nervosa, the person may have normal weight, but the ill effects lie underneath. 

 

“Binge eating disorder (BED) is a severe, life-threatening, and treatable eating disorder characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress, or guilt afterwards; and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating (Source).” When in intense hunger, one can gulp a lot of food due to fast eating. If the person was not that hungry, he would not have eaten so much. He “binges” the food. 

The binge-eating episodes are associated with three (or more) of the following (Source): 

1.Eating much more rapidly than normal.

2.Eating until feeling uncomfortably full.

3.Eating large amounts of food when not feeling physically hungry.

4.Eating alone because of feeling embarrassed by how much one is eating.

5.Feeling disgusted with oneself, depressed, or very guilty afterward.

Binge-eating often results in obesity. 

 

Body dissatisfaction is the single most powerful contributor to dieting and to the development of eating disorders. Most women believe that they are overweight. Approximately 73 percent of all girls and women are dissatisfied with their bodies, compared with 56 percent of all boys and men in the U.S. These are human constructs – how our bodies need to be shaped. In different cultures, the standard weight varies. A person can travel from India to the U.S.A and suddenly become ‘fat’ within a day and be stressed due to bodyweight perception. 

 

Stress is a major reason for these disorders. Stress is caused mainly due to internalizing one’s emotions. It creates turbulences in ego. According to Psychodynamic theory, eating disorders are caused by inadequate Ego strength to mediate intrapsychic conflict. On one side, the Id seeks pleasure and forces to eat, on the other side superego resists. The Ego is supposed to mediate and come to a resolution, but as Ego is weak, one of the other conscious/unconscious aspects drives the person. If Superego drives the person, he enters Anorexia – ability to control. Super-ego prioritizes shame and guilt and while Id wants pleasure. If Id drives a person, he binges – shows the inability to control. According to a website, Psychodynamic therapy usually involves once-weekly 50-minute sessions, the length of treatment varying between 3 months and 2 years. Psychodynamic psychotherapy is classically indicated in the treatment of unresolved conflicts in early life. Adverse childhood experiences deposit painful emotions in the unconscious mind and if released, relieve the disorders. (Source)

 

In Cognitive-behavioral therapy, one is taken through a mental process of becoming aware of his limited perceptions. People inaccurately perceive internal cues and worry about how they are viewed by others. He labels himself as ‘fat,’ ‘ugly,’ ‘worthless,’ etc., and finds very little chance of recovery. One negatively self-judges for the shape and weight and connects it with his worthiness. In cognitive therapy, a person is given the chance to revisit the cognitions he carries about his body, ideal shape, and weight, culture, morality, etc. If cognitions are corrected, self-judgments reduce, and the person could be relieved. Behavioral therapy can correct dangerous eating patterns. One could monitor the link between feelings, hunger levels, and food intake and apply intelligence to unfollow the mental cues to overeat or undereat. 

 

In addition, people with depression are more likely to have eating disorders. If the person has a family history of depression and an effective eating disorder, family therapy or group therapy might be effective. Relatives of people with eating disorders are six times more likely to develop eating disorders themselves. Many times, it is a family problem rather than just individual. For e.g.: in my native place, it is customary to eat heavy gluten food and is part of the celebration. It is impossible to have a party without eating fattening foods and binge them. As the whole place is full of bingers, it seems quite normal. Group therapy lets individuals identify and challenge these group negative thoughts that precede the urge to binge. Mindfulness training combined with cognitive restructuring helps one recover. Any therapy is most successful when continued for at least a year beyond recovery and supplemented by mindfulness approaches. Relapses from recovery are often triggered by stress.