Understanding Eating Disorders Educational Series (Part 3)

Eating disorders can be fatal and are insidious.

Unfortunately, they are often underrecognized, and can even be dangerously reinforced.

Our current diet culture mindset preys upon our insecurities, worships thinness, portrays unattainable beauty standards, and views purification of the body as a sanctity.

Alarmingly, “health” marketers and influencers have used these memes manipulatively, or unintentionally, to reinforce their protocols and restrictive nutritional practices.

This means that, rather than people receiving intervention at the start of a disordered dietary pattern, the very experts that should be catching these patterns may, in fact, be applauding and promoting some of this damaging behavior.

My concern is that these current popularized approaches to nutrition, health, and fitness, if not carefully scrutinized, could be perpetuating and fueling health anxiety, false anxiety, and eating disorders.

I am on a mission to shed light on this so that people can find their way out of this dark cycle.

For the past few weeks, I’ve been discussing diet and wellness culture, food addiction, and eating disorders.

In my first post on eating disorders, I provided an overview and some statistics on them. Next, I reviewed specific risk factors and characteristics of eating disorders.

In this and upcoming articles, I will provide a summary of each type of eating disorder based on several references.

Perhaps, on review, you may find that you or someone you love has some of these characteristics and needs additional support.

Please don’t hesitate to get it, with the right expert. (See resources below.)

Now, I will first revisit the gravity of the situation and give a general overview of eating disorder symptoms.

The Rise in Eating Disorders

A recent article from John Hopkins University caught my attention on this topic (bold emphasis mine):

Since the beginning of the … pandemic, many members of the mental health community (including me) have become increasingly concerned about dramatic rises in eating disorder (ED) symptoms that have been reported both in the United States and globally. These include, and are not limited to:

• excessive and dangerous compensatory behaviors to prevent weight gain,
• disturbances in the way in which folks are experiencing their body weight and shape,
• intense fears of gaining weight, and
• restrictive eating.

The National Eating Disorder Association (NEDA) has reported increases as high as 107% in calls to its helpline at different points in the past two years. In July 2020, the International Journal of Eating Disorders published a survey of people in the United States who had already been diagnosed with anorexia nervosa and the responses showed that many were experiencing significantly worse symptoms. Similarly, nearly a third of those diagnosed with binge eating disorder reported an increase in episodes.

While experts have been working on teasing apart the various factors that underlie this trend, research provides clues as to what has been driving such significant increases in ED and ED-related symptoms.

Eating disorders are complex and have multiple biological, genetic, brain health, and psychosocial components that contribute to them. The authors point out several recent factors likely accounting for the steep rise in ED. These include social media messaging and the stress of the pandemic. As noted above, I also feel diet and wellness cultures have played a big role in their prevalence.

The General Symptoms of Eating Disorders: Do you recognize any?

According to John Hopkins University, the following are some characteristics of eating disorders.

Emotional symptoms may include:

• becoming preoccupied with weight, food, calories, carbohydrates, fat grams, and dieting;
• refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.);
• feeling uncomfortable eating around others;
• engaging in food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch);
• skipping meals or taking small portions of food at regular meals.

Physical symptoms may include:

• noticeable fluctuations in weight, both up and down;
• stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.);
• menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period);
• difficulties concentrating; and
• abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low white and red blood cell counts).

A more comprehensive list of emotional and physical signs and symptoms can be found on the NEDA website.

I am happy to see that attention is being given to the dangers of our messaging on social media and the impact of stress on ED, but we need to do much more to combat the powerful diet culture messages.

A first step is to provide more education on what the signs are for ED.

So, let’s look at specific characteristics of several common eating disorders.

Types of Eating Disorders

According to “Inside Out”, the Institute for Eating Disorders, which reports on the DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), the following categories exist for eating disorders:

• Anorexia Nervosa (AN)
• Bulimia Nervosa (BN)
• Binge Eating Disorder (BED)
• Other Specified Feeding and Eating Disorder (OSFED)
• Pica
• Rumination Disorder
• Avoidant/Restrictive Food Intake Disorder (ARFID)
• Unspecified Feeding or Eating Disorder (UFED)
• Other:
  • Muscle Dysmorphia
  • Orthorexia Nervosa (ON) proposed criteria

Now I will briefly go through each, starting in this post with the two most recognized, anorexia nervosa and bulimia nervosa.

My goal is to provide a summary of each type of eating disorder in this series. In the interest of space, I have compiled my summaries from several references, which are listed below. To review the full criteria, click on the links provided or go to these source documents:

• Inside Out
• DSM-5 and Eating Disorders (Reviews the changes from the previous DSM edition)
• Atypical Anorexia in Normal and Higher Weight Individuals
• Types of Eating Disorders
• DSM-5 Criteria for Eating Disorders
• NAED

Anorexia Nervosa

This is perhaps the most widely recognized, and the most fatal, eating and mental health disorder.

It is characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many individuals, distorted body image.

People with anorexia generally restrict the number of calories and the types of food they eat. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives, and/or binge eat. (source)

Diagnosis of Anorexia

According to NEDA:

To be diagnosed with anorexia nervosa according to the DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), the following criteria must be met:

1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
2. Intense fear of gaining weight or becoming fat, even though underweight.
3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

Even if all the DSM-5 criteria for anorexia are not met, a serious eating disorder can still be present.

Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss. Research studies have not found a difference in the medical and psychological impacts of anorexia and atypical anorexia.

Signs and Symptoms of Anorexia

Click here for a full list of symptoms and warning signs.

Atypical Anorexia

Regarding atypical anorexia, the following is important to acknowledge:

One can struggle with the same biological and psychological effects of anorexia and not be severely underweight. It can impact all body sizes and is just as dangerous.

According to Eating Disorder Hope:

Atypical Anorexia Nervosa is researched a great deal less than Anorexia Nervosa, however, as it becomes more prevalent, researchers are increasing their awareness of this disorder.

• Atypical Anorexia Nervosa hospitalizations comprise nearly one-third of hospital inpatient eating disorder treatment programs [2].
• 1 in 4 adolescents with atypical anorexia present with Bradycardia [2].
• 1 in 3 adolescents with atypical anorexia amenorrhea [2].
• At least 40% of those struggling with atypical anorexia nervosa require admission to a hospital [2].
• Research indicates that psychological distress related to eating and body image is worse in atypical anorexia than anorexia nervosa [2].

Bulimia Nervosa

NEDA states:

Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

Diagnosing Bulimia Nervosa

According to the DSM-5, the official diagnostic criteria for bulimia nervosa are:

• Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
  • Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
  • A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
• Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
• The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
• Self-evaluation is unduly influenced by body shape and weight.
• The disturbance does not occur exclusively during episodes of anorexia nervosa.

Signs and Symptoms of Bulimia Nervosa

Warning signs and symptoms can be found here.

Summary on Types of Eating Disorders… So Far

It’s so hard to get true clarity in anything related to food, much less what is truly nourishing, when our society and healthcare has “normalized” dieting, restriction, and rules around eating.

It is NOT healthy to worry about weight excessively and restrict yourself of vital nutrients.

By listing out the symptoms of disordered eating patterns and these mental health categories in black and white, I’m hoping to provide a wake-up call to many.

Besides offering more education, health professionals need to start widening their lens of what is truly healthy and embrace holistic wellness in all areas of life. We need to stop excessively focusing and preaching on dietary and fitness plans.

Integrative doctors can also provide additional support on the biological, physiological, neurological, and psychosocial levels as one seeks the psychological interventions necessary.

It’s a large order to combat ED, but it is necessary and doable.

Please comment below and look through the resources provided.

Eating Disorder Resources:

• National Association of Eating Disorders (NAED): Resources
• ANAD (National Association of Anorexia Nervosa and Associated Disorders)
• Eating Disorders Anonymous
• Resources on How to Be Healthy Without Obsessing About Weight

Click here to learn more about my approach to whole-person, mind-body care.

Free resources and more education are also available to you here.

Stay tuned for an upcoming opportunity that can support you in holistic mind-body-heart-soul healing. (Join my newsletter below to learn more.)

Many blessings.

*Important Note:

If you struggle with mental health or an eating disorder, please reach out for professional support.

You may also wish to consider implementing holistic resources and partnering with a naturopathic doctor.

For example, I offer mind-body support for general mood issues using a functional medicine and wellness-oriented approach. I also practice using a non-diet, HAES approach to nutrition.