What are eating disorders?
Eating disorders are more and more common in Western civilizations and they have significantly increased in the last decade. If they are not treated in time with appropriate treatments they can become permanent conditions and can even lead to the patient’s death. These disorders are the result of an interaction between genetic, environmental, social, psychological and psychiatric factors and manifest themselves through a distorted relationship with food based on a common obsessive-compulsive disorder. The patient shows an obsessive attention towards his/her physical conditions and aspect, towards his/her body weight and the need to control the latter. There is also a hereditary component and in some cases these disturbs may occur as a consequence of traumas such as abuse and difficulty in being accepted by family and peers.
Anorexia is a symptomatic morbid state caused by a disease or by a psychic alteration (anorexia nervosa). The latter case is what we usually refer to when talking about anorexia. The term comes from the late Latin word “anorexia” which itself derives from the Greek word “anorexìa” which is composed of “an” (a negating particle) and “òrexis” (appetite). It initially manifests itself as an initial loss of appetite followed by the full on disease which is characterized by a total lack of appetite, a really fast weight loss, osteoporosis, a diminishment in all physical activities, an incorrect functioning of the immune system and, in female patients, the disappearing of the menstrual cycle. This disease presents both a nutritional and a behavioral component. The first is related to a nutritional deficiency which can have severe consequences on the physical integrity of the patient while the latter is related to psychological factors such as conflicts in the family, low self esteem and the desire to imitate extreme aesthetic role models.
Those who suffer from anorexia see themselves as fat and awkward and enact sophisticated strategies in order to fight their appetite (use of laxatives, induced vomiting and weight loss pills) and in order to hide their condition by lying with regards to how much they eat. Their mood is proportionate to their weight and to their control over it: weight loss makes them feel satisfied whereas putting on weight makes them feel sad and hypercritical. Self-esteem, successes in every field and the value as human beings for these patients seem to depend on their bodies and on the control they manage to impose on their appetite. This disease has several stages: initially, some of the dietary restrictions the patients impose on themselves are actually encouraged by their families or peers and they become a source for self gratification. In an intermediate stage, the patients no longer need to fight with their sense of appetite and actually feel empowered and full of energy thanks to the lack of food because of a mechanism which tends to preserves the species (it is not uncommon to see animals boost their energy to find food when there are famines). The mood of these patients becomes irritable because of their fear of losing control and of gaining back the weight they have lost. At this stage, obsessive thoughts about food start to appear and the patients enact all of the aforementioned strategies in order to continue with their self-mutilating actions.
In the last stage of the disease, the weight loss becomes significant (at least 15-20% of the optimal body weight has been lost), the mind starts to skip beats (lacks in concentration, memory loss, loss of critical judgment and sleep deprivation) and real manic behavior kicks in. Mortality in anorexic patients is now up to 1 in 5 patients.
Treating anorexia involves the family environment of the patients, especially if they are adolescents and it requires collaboration on behalf of the patients’ relatives. They need to be available to discuss their behavior and personal situations because these are possible causes of the disease. Nowadays, treatment facilities for anorexia exist, but the first step in therapy concerns an acknowledgement of the disease in the patient and of the patient’s family members. Although it is a complex disease, if it is treated by experts and if the patient cooperates, there may be a full recovery and the patient may go back to living a completely normal life. The sooner the disease is diagnosed, the more possibilities the patient has to make a full recovery. This is why attention on behalf of parents and family is extremely important.
Oral food supplements may play a key role in the therapeutic process of anorexia nervosa patients. This type of treatment must be considered an accessory to a more complex treatment of the pathology which must include a multidisciplinary approach both at home and in specific treatment facilities. The nutritional approach must always be accompanied by a psychiatric and medical treatment.
As opposed to what happens in anorexic patients, patients with bulimia nervosa may be characterized by normal body weight. They may even be underweight or overweight. Moreover, the weight of a bulimic patient may change significantly and this may be a symptom of a eating disorder. Bulimic patients show their discomfort through binges. They tend to eat enormous quantities of food which normally is equal to an incredible amount of calories in very short periods of time. Binges are characterized by the following aspects:
- eating enormous quantities of food in very short periods of time (much more than other people would be able to eat in the same period of time and in similar circumstances),
- feeling helpless during the binge episodes (the patient might feel as though he/she cannot stop eating and as though he/she cannot control what he/she is eating).
Bulimic patients also tend to adopt corrective measures in order to avoid gaining weight such as self-induced vomiting, diuretics, laxatives abuse, fasting, excessive practicing of sports and physical activities. These patients normally tend to hide this kind of behavior which is generally accompanied by a feeling of guilt and shame. Bulimic patients usually feel completely helpless about their actions. The patient will need to work with a team of specialists in order to regulate the food intake because the diminishment of binges brings on a renewed self esteem, more faith in one’s abilities and the feeling of being able to fight against this disorder actively.
Bulimia treatments are based on prescription drugs and cognitive and behavioral psychotherapies, in the more severe cases of malnutrition caused by anorexia, forced feeding and hospitalization may be necessary.
Prandial hyperphagia is a psychological and behavioral trait which is characterized by the assumption of enormous quantities of food mainly during meals. This kind of profile is associated with a love for food. The quantities of food are kept under control and are often connected with the convivial aspect of food. Individuals with hyperphagia do not feel guilt or shame after having eaten. Prandial hyperphagia is often the result of consolidated family habits and is often associated with cultural stereotypes. Excessive food intakes may cause obesity is this type of behavior occurs frequently, but the body weight may actually remain within the limits of excess weight (BMI>30) if these episodes occur sporadically.
There are two categories of prandial hyperphagia: some patients are gluttonous, while others are voracious. Gluttonous patients love food and all those circumstances which allow them to eat to their satisfaction starting from their commensals. Voracious patients prefer quantity over quality and rarely prepare dishes for company or guests. They eat faster than gluttonous individuals but they do not lose control over the quantity they ingest.
Grignottage is a term used to indicate nibbling on small quantities of food, mainly sweets and fats (foods with high levels of calories) throughout the day. Grignotteurs, just like individuals with prandial hyperphagia, eat slowly and enjoy their food. The difference is that grignotteurs tend to eat out of boredom or because of physical problems. They sometimes have low self esteem; they are anxious or may have mild anxiety-related or depressive syndromes.
Binge eating disorders
Binge eating disorders are a more severe and complex syndrome from a psychological point of view. Individuals who suffer from a binge eating disorder incur in sporadic bingeing episodes which are accompanied by a loss of control and by mood swings. These individuals eat significant quantities of food and are then overwhelmed by a sense of guilt. Aside form bingeing, these individuals are not capable of organizing their eating habits during the day and during the bingeing episodes. The treatment for this condition must be psychotherapeutic and must be integrated with medical and dietary assessments and interventions.