Eating Disorders

Eating disorders are becoming increasingly prevalent throughout the world. They are responsible for more loss of life than any other mental health condition.

Sara Ariel Wong for NPR

For this reason it is crucial to increase the awareness of the Symptoms of Eating Disorders.

• Spending a lot of time worrying about your weight and body shape
• Having a distorted body image
• Avoiding socialising when you think food will be involved 
• Feeling anxious or irritable around meal times
• Feeling 'out of control' around food
• Eating very little food or sudden changes in food preferences
• Deliberately making yourself sick or taking laxatives after you eat 
• Exercising too much
• Having very strict habits or routines around food (e.g. frequent trips to the bathroom)
• Changes in your mood
• Changes in clothing (e.g. baggy clothes to hide weight loss/gain)

You may also notice physical signs, including:

• Feeling cold, tired or dizzy
• Problems with your digestion
• Your weight being very high or very low for someone of your age and height
• Not getting your period for women and girl
• Signs of damage due to vomiting including swelling around the cheeks or jaw, calluses on knuckles, damage to teeth and bad breath
• Lethargy and low energy

If you have recognised one or more of the above signs or symptoms in yourself or someone you care about, you should seek help immediately.You may wish to consult your local GP or you can also talk in confidence to an adviser from eating disorders charity Beat by calling their adult helpline on 0808 801 0677 or youth helpline on 0808 801 0711. 

If you are concerned about someone you care about, let them know that you are worried about them and encourage them to visit a GP (perhaps offer to attend with them for additional support). 

The NHS states that a GP will ask you questions about your eating habits and how you're feeling, and will check your overall health and weight. If they think you may have an eating disorder, they should refer you to an eating disorder specialist or team of specialists. It can be very hard to admit you have a problem and ask for help. It may make things easier if you bring a friend or loved one with you to your appointment.

The NHS information page on eating disorders also includes information about their treatment.

Epidemiology

Between 1.25 and 3.4 million people in the UK are affected by eating disorders and ~75% of them are female. Most eating disorders develop during adolescence and are most common between the ages of 16 and 40 years old. The exact cause is unknown. 

You may be more likely to develop an eating disorder if

• You or a member of your family has a history of eating disorders, depression, or alcohol or drug addiction
• You have been criticised for your eating habits, body shape or weight
• You're overly concerned with being slim, particularly if you also feel pressure from society or your job – for example, ballet dancers, jockeys, models or athletes
• You have anxiety, low self-esteem, an obsessive personality or are a perfectionist
• You have been sexually abused

Callum Heath

Types of Eating Disorders

There are four different types of eating disorders: anorexia nervosa, bulimia nervosa, binge-eating disorder (BED) and other specified feeding or eating disorder (OSFED).

Anorexia Nervosa

When an individual attempts to keep their weight as low as possible by either not eating enough food, exercising too much or both.

Bulimia Nervosa

An individual with bulimia sometimes loses control a lot of food in a very short period of time, known as binging. Following this they are deliberately sick, use laxatives, restrict what they eat or do too much exercise to try and stop themselves from gaining weight.

BED

When an individual regularly loses control of their eating, eating large proportions of food all at once until they feel uncomfortably full. This is often followed by feeling upset and/or guilty. 

OSFED

When an individual's symptoms do not quite match those of anorexia, bulimia or BED. This does not mean it is a less serious illness. Examples include:

• Individuals with all of the symptoms of anorexia, except that their weight remains within an 'normal' range.
• Individuals with all of the symptoms of bulimia, except that the binge/purge cycles do not occur as frequently or over as long a period of time as a doctor would expect.
• Individuals with all of the symptoms of BED, except that the binge periods do not occur as frequently or over as long a period of time as a doctor would expect.
• Purging disorder - when someone purges to alter their weight or shape but does not participate in binging periods.
• Night eating syndrome - when someone repeatedly eats at night, either after waking up from sleep or by eating a lot of food after their evening meal. 

The Science Behind Eating Disorders

Much remains unknown about the scientific facts behind eating disorders and their cause. However, there is some research providing theories to explain their occurrence.

Serotonin

Serotonin is a neurotransmitter (a chemical that activates many neurons in our nervous system, like a key in an ignition) that is associated with happiness and well-being; however, it also plays a role in cognition, reward, learning, memory and many physiological processes.

Many studies have found alterations in the serotonin levels of individuals with eating disorders, however this has be attributed to the lack of nutrients they are currently receiving and therefore an inability for their bodies to adequately synthesise the chemical. 

Nature Neuroscience published an article in 2009 discussing research that hypothesises that starvation may help people with anorexia to feel better by decreasing the serotonin in their brains (Kaye, Fudge, & Paulus, 2009). As anorexic individuals continue to starve themselves, however, the brain responds by increasing the number of serotonin receptors to more efficiently utilize the remaining serotonin (as illustrated in the diagram below). So in order to keep feeling better, the individual needs to starve themselves further, creating the illness’s vicious cycle. When someone with anorexia starts eating again, their serotonin levels spike. This may cause extreme anxiety and emotional chaos, which makes recovery difficult without adequate support.

Research shows that in bulimia a larger decrease in serotonin levels occurs in periods without food, such as during sleep, than in individuals without eating disorders. Hence, binge eating and increased irritability result. Serotonin levels in BED are thought to be similar to in bulimia, however research is more limited in this area.

Dopamine

Dopamine is a neurotransmitter that plays a significant role in pleasure, motivation and learning. For this reason, it is linked to many major diseases. 

Anorexia is thought to be associated with an overproduction of dopamine, resulting in anxiety, harm avoidance, hyperactivity and the ability to go without pleasure giving things such as food.

Research has shown that bulimia is associated with lower levels of both dopamine and certain of its receptors (Broft et al., 2012).

Binge eating disorder has been linked to a hyper-responsiveness to rewards such as food, which makes eating more rewarding and pleasurable than in people without this disorder (Davis et al., 2012) and leads to a continuation of compulsive overeating (Bello & Hajnal, 2010).