Understanding Eating Disorders - Explained by a Registered Dietitian


In the past few years, the prevalence of eating disorders in Canada has been increasing every year. And a global pandemic surely did not help! Since the start of the COVID-19, multiple studies have pointed out that eating disorders (ED) are on the rise. Increases in certain emotions like stress, anxiety, and depression are known to exacerbate people’s disordered eating behaviours. Hotline calls to the National Eating Disorders Association are up 70-80% in recent months, indicating that the loneliness and fear experienced during the current epidemic might be making people more vulnerable to troubled eating habits.


However, even with the increased prevalence of ED, there are still a lot of misconceptions about what EDs are and what they are not. In this article, let's dive deep and get a better understanding of the implications of different eating disorders.

*If you, or someone you know, is struggling with an ED please reach out for help. This article is meant to provide information and is not a substitute for any professional help.


What are EDs?

EDs are serious mental illnesses related to an individual’s abnormal pattern of eating or exercising which can greatly interfere with their physical, psychological and social functioning. They are characterized by extreme concerns regarding one’s weight, body shape, body size and/or eating habits, and can often last for several years if left untreated. They will affect many aspects of a person’s life by interfering with their thoughts, behaviours, beliefs, feelings, body and relationships. In Canada, ED are diagnosed by a physician or psychologist following guidelines from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).


EDs have the highest mortality rate of any psychiatric disorder, with 10-15% of sufferers passing away from related complications. They can lead to severe malnutrition, nutrient deficiencies, as well as critical complications from starvation. Suicide is also a leading cause of death among people struggling with EDs, with up to 20% of people with anorexia nervosa and 25-35% of people with binge eating disorder attempting suicide in their lifetime


EDs usually have multiple multifactorial and complex risk factors coming into play to determine who will have a higher chance of suffering from them.


Common risk factors for the development of an eating disorder



Who can be affected by ED?

It is estimated that one million Canadians are affected by an ED at any given time, including 1.5% of all women aged 15-24 years old. Even though these disorders are more common in women, the rates of men affected by ED’s have been growing increasingly. In 2007, the following rates were already reported:

  • The prevalence of anorexia nervosa is 0.9% in women and 0.3% in men

  • The prevalence of bulimia nervosa is 1.5% in women and 0.5% in men (with an average duration of 8.3 years)

  • The prevalence of binge eating disorder is 3.5% in women and 2.0% in men.


When people think of ED they think of a white underweight teenage girl...However, this is a misrepresentation. People of all ages, cultures, socioeconomic backgrounds, genders and sexual orientations are suffering from ED’s every day. It has also been reported that lesbian, gay, bisexual, and transgender individuals (LGBT) may actually experience an even greater incidence of such disorders.



Different types of ED

Anorexia Nervosa

When most people think of EDs, they think of anorexia. Anorexia nervosa is characterized by persistent behaviours that interfere with maintaining a healthy weight. These behaviours can vary from restricting food, compensating for food intake through intense exercise, and/or purging through self-induced vomiting or misuse of medications like laxatives, diuretics, enemas, or insulin. It is usually characterized by a very low weight (BMI<19). In adults suffering with anorexia, many will have a severe weight loss whereas in children, because they are still growing, some will not experience a weight loss however will not gain any weight despite growth and therefore become underweight.


Individuals who suffer from anorexia often have an irrational fear of gaining weight or being fat. The person also often has body dysmorphia, meaning they perceive themselves as being much bigger than they actually are.


Note: Atypical anorexia nervosa has the same characteristic as anorexia nervosa however the person is not necessarily underweight and can even be overweight. This can happen if the person was at a higher weight to start off and drops weight related to restrictive behaviour that can lead to cardiac instability.


Bulimia Nervosa

Bulimia nervosa is associated with periods of restrictions followed by binge episodes and compensatory behaviours such as self-induced vomiting, increased restrictions, intensive workouts, laxatives, diuretics, enemas, etc. The restriction-binge cycle needs to be on-going for at least 1 time per week for 3 months to be diagnosed. Bulimia nervosa can be characterized by weight loss or weight gain (often yo-yoing).


Individuals struggling with bulimia nervosa will typically have extreme concerns with their body (weight, shape and size) and their food intake (same as anorexia nervosa). Individuals often struggle with body dysmorphia as well.


A binge-eating episode is characterized by:

1) The consumption of an unusually large amount of food within a relatively short period of time. (More than you would usually eat in a sitting or in front of other people)

2) Feeling out of control over what and how much you ate (some people have described this as being in a trans/auto-pilot)


Note: Purging (vomiting) can cause severe dehydration, damage to the esophagus, mouth and teeth. Warning signs are tooth pain, discolouration, callus or cuts of hands/knuckles and frequent use of washrooms after meals.


Binge Eating Disorder

Binge Eating Disorder is characterized by frequent episodes of binge eating (read above for definition for a binge). Binge eating is very different from overeating. Overeating is eating more than the body needs without feeling distress and/or out of control. It is normal for most of us to overeat here and there, like taking an extra portion at meals (pass the point of satiety) or over-indulging during the holidays or celebrations. These occasional overeating periods do not lead to any long term consequences to our health and do not impact our everyday life. Some may experience regret or guilt following over-eating, however, it does not cause distress.


Binge eating, however, is characterized by eating an excessive amount of calories (pass the point of satiety) in a short period of time and is accompanied by feeling guilt, shame and distress. Binge eating disorder is diagnosed when an individual has these binge eating episodes 1x/week for at least 3 months. Many people will feel embarrassment, self-disgust, guilt, depression. Individuals with Binge Eating Disorder will often eat alone or in secret because of feelings of shame and guilt about their eating behaviours.


The binge-eating episodes are not followed by compensating behaviours (such as excessive exercise, self-induced vomiting, or the misuse of laxatives or diuretics) as in bulimia nervosa.


Note: Binge eating disorder usually leads to weight gain. However not all people who suffer from binge eating disorder live in larger bodies.


Avoidant and Restrictive Food Intake Disorder (ARFID)

This disorder usually happens during infancy and childhood. An infant/child suffering with ARFID develops feeding or eating disturbances such as lack of interest in food or lack of appetite, aversion to certain textures or colors, or feared consequences of eating from a traumatic experience involving food (i.e food poisoning or choking on food). Most times, this disorder has nothing to do with controlling body weight or shape. Some parents may describe this as an extreme picky eater, however, it goes beyond that. This ED can lead to malnutrition and failure to thrive.



Other Specified Feeding or Eating Disorder (OSFED)

A person with OSFED will present with some of the symptoms of other EDs (like anorexia, bulimia or binge-eating disorder), but does not quite meet criteria for official diagnosis. Here are some examples:


Atypical Anorexia Nervosa: same characteristic as anorexia nervosa however the person is not necessarily underweight and can even be overweight.


Bulimia nervosa type: same characteristics as bulimia nervosa, however the symptoms (binge/purge cycle) occurs less frequently.


Binge-eating disorder type: same characteristics as for binge-eating disorder however the binge-eating episodes occur less frequently.


Night eating syndrome: The excessive consumption of food (not necessarily a binge) usually in the middle of the night that creates distress and interferes with everyday life.


Purging disorder: Purging behaviours without the presence of binge-eating episodes.


Other Eating Disorders


PICA : Persistant consumption of non-food items for at least a month. (Example of non-food substances: paper, wood, pen, chalk, clay, soil, wool, soap, cloth, hair, ...)


Rumination disorder: Persistant regurgitation of chewed and/or partially digested food over a period of at least a month. This can also be a symptom of anorexia or bulimia.


Orthorexia: Obsessive behaviours around eating behaviours. The individual is fixated on 'healthy' eating and may not recognize their behaviour as being obsessive. This is not formally recognized as an ED therefore there are no diagnostic criteria.


Now that we know more about eating disorders, let’s debunk some common myths:

Conclusion:

There are many factors involved in the development of an ED. People of all genders, ages, sexual orientations, colours, sizes, cultures and socioeconomic backgrounds can be affected. There are different kinds of ED (anorexia nervosa, bulimia nervosa, binge eating disorder, OSFED, ARFID and others) with each their own sets of characteristics and symptoms. ED are not simple, and they are not a person’s choice. They are serious mental illnesses and individuals who are struggling require professional help.

I hope this article provided value for you and hopefully a better understanding of what ED’s are and what they are not!


If you are struggling with an ED or anybody you know- Please reach out.


The Balanced Practice is a team of professionals specialized in eating disorder outpatient treatment. We strive to provide evidence based nutrition counselling to support you, or your loved one, in achieving full recovery. Schedule a connection call now.

Marie-Pier Pitre-D'Iorio, RD, B.Sc.Psychology

Lead Registered Dietitian at The Balanced Practice



References:

Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies. Archives of General Psychiatry, 68, 724-731.


Government of Canada. (2006). The Human Face of Mental Health and Mental Illness in Canada 2006.


Hoek, H. W. (2007). Incidence, prevalence and mortality of anorexia and other eating disorders. Current Opinion in Psychiatry, 19(4), 389-394.


Hudson, J. I., Hiripi, E., Pope, H. G. & Kessler, R. C. (2007). The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3), 348-358.


Sullivan, P. (2002). Course and outcome of anorexia nervosa and bulimia nervosa. In Fairburn, C. G. & Brownell, K. D. (Eds.). Eating Disorders and Obesity (pp. 226-232). New York, New York: Guilford.





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