An eating disorder occurs when mental or cognitive impairments hinder an individual’s dietary behaviors. While the terminology is often used interchangeably with restrictive or bingeing and purging behaviors, eating disorders also include overeating behaviors and eating non-food substances.
Eating disorders aren’t a new concept. The first eating disorder – anorexia – dates back to at least the 12th century, per Psychology Today. In fact, the classification as a whole has expanded. There are now nine forms of eating disorders, including:
- Anorexia nervosa
- Bulimia nervosa
- Binge eating disorder
- Other specified feeding or eating disorder
- Muscle dysmorphia
- Body dysmorphic disorder
- Night eating disorder
While anyone can develop an eating disorder, certain people are more susceptible. Gender definitely plays a role. The American Psychological Association reports that 90 percent of people affected by these disorders are females. This may largely be due to the repeated emphasis that is placed on the appearance of women in today’s society.
Mental health issues also correlate. Anxiety and depression both impact individuals with eating disorders. The Anxiety and Depression Association of America states that around 42 percent of people with an eating disorder suffered from anxiety prior to the development of the eating disorder. In addition, two-thirds of people who suffer from an eating disorder also have an anxiety disorder, per a 2004 study.
Roughly 8 million people in America are living with an eating disorder that affects their everyday life, the South Carolina Department of Mental Health reports. Many of them are suffering with anorexia – a mental health disorder that causes people to obsess about weight loss or control to the point that they restrict food.
There is also a bingeing and purging form of anorexia, but these symptoms don’t generally appear at onset. Often, the disorder merges into a form of bulimia.
Warning signs of anorexia include extreme weight loss, excessive dieting, preoccupation with counting calories or eating low-calorie foods, starvation, incessant worry about gaining weight, and a loss of interest in spending time in public or with loved ones. Serious side effects can occur if anorexia isn’t treated. The most dangerous side effects include renal failure and cardiac arrest, both of which can be fatal. People who suffer from anorexia nervosa are more likely to break bones, because their bones become brittle and shrink due to lost calcium. They are often lethargic and weak, because their body starts to burn up their muscle mass as a form of energy when little to no fat is left to feed off and caloric intake is too low. Fainting spells, dry hair and skin, brittle nails, extreme dehydration, and abnormal hair growth all over the body are also common side effects.
Addiction alongside anorexia isn’t uncommon. Many who battle this co-occurring set of illnesses started with one disorder that led to another. For example, a lot of people who abuse certain drugs that cause them to gain weight, like marijuana, may not be willing to give up the drug to lose weight, so they give up food instead. The inverse can also be true.
Some people who suffer from anorexia use drugs as a way to suppress their appetites and lose more weight. Stimulants are the most common choice. Drugs like Concerta and Adderall – commonly prescribed for the treatment of attention deficit hyperactivity disorder and other neurological issues – are prescription stimulants that often carry the side effect of making the person using them feel like they have lost their appetite.
Roughly 36 percent of people surveyed who used Adderall reported having a reduced appetite and 11 percent lost weight while on the drug. These drugs also speed up the metabolism via increasing resting heart rate. Due to that, they can be even more dangerous for someone with anorexia whose heart is already at risk of damage. The National Eating Disorders Association notes as many as 20 percent of people living with anorexia nervosa will die as a result of it.
Bulimia nervosa is an eating disorder that includes restricting food intake to an extent, but the primary symptoms are bingeing and purging food. Loved ones who suffer from it may hide food under their beds or in their closets, sneak large amounts of food when others aren’t home or while family members are sleeping, and might even steal to get their food fix. Mirror-Mirror reports 4.7 million females and 1.5 million males suffer from bulimia in the United States.
If a loved one often leaves the dinner table for the bathroom after meals, it’s worth paying attention for possible purging behaviors. Sometimes, people may vomit into trash bags in their bedrooms to avoid detection. Then, they take the trash out later when no one is paying attention.
Long-term bingeing and purging will stain the teeth and wear away tooth enamel. Individuals who purge may have calluses on their knuckles and teeth marks too. The cheeks and jaw area often appear puffy.
Bulimia may involve incessant exercising, just as anorexia sometimes does. What often makes bulimia hard to pinpoint is that most people who suffer from it are of average weight. Left untreated, bulimia can cause depression, increase the risk of suicide, and even cause fertility problems.
Other Eating Disorders
There are other eating disorders that affect smaller numbers of people, such as:
- Other specified feeding or eating disorder
- Muscle dysmorphia
- Body dysmorphic disorder
- Night eating disorder
The other specified feeding or eating disorders diagnosis serves as a catchall for disorders that don’t qualify for diagnosis as anorexia, bulimia, or binge eating disorder. Orthorexia affects individuals who are obsessed with healthy lifestyle choices and foods. It commonly develops in people who once suffered from anorexia or bulimia. Mercury News reported that three-quarters of people with eating disorders have anxiety disorders and 75 percent of them exhibit symptoms of obsessive-compulsive disorder.
Muscle dysmorphia typically affects individuals who are obsessed with exercise. They often strive to maintain little body fat and a bulky or shapely muscular body. This disorder affects the mind and causes individuals suffering from it to view themselves in a negative light that is much different from reality, a lot like anorexia and bulimia do. Steroid abuse may be common among these individuals.
Body dysmorphic disorder also causes sufferers to see themselves differently than others see them. Within the limits of this disorder, it’s entirely possible for an incredibly thin person to look in the mirror and feel overweight. It goes as far as to affect other perceptions of appearance too, such as causing the individual to exaggerate the severity of their dry skin, blemishes, wrinkles, height, hair color, and so forth. The International OCD Foundation states around one in 50 Americans suffers from this disorder.
Night eating disorder is much like it sounds. Those who suffer from it often don’t have an appetite for breakfast; they’ll often delay their first meal of the day until well past lunchtime. Then, when they do eat, they tend to overeat or binge. After eating in the late afternoon or early evening, they may suffer from extreme guilt over eating too much. Around 1-2 percent of the population is affected by NED, per the Anorexia Nervosa and Related Eating Disorders website.
Pica drives individuals to crave non-food substances. They may have strong desires to consume things like laundry detergent, ice, baking soda, dirt, and even bleach. Given the nature of the substances some people with this disorder may be compelled to consume, it can be dangerous. The disorder is particularly common in children, more so than in adults. Everyday Health notes that 10-32 percent of children aged 1-6 are affected by it, and roughly 20 percent of kids treated at mental health facilities display symptoms of pica.
Substance use disorders affected 24.6 million people in 2013, per the National Survey on Drug Use and Health. Addiction often occurs alongside other mental health disorders. The National Alliance on Mental Illness states one-third of people affected by mental health disorders also struggle with drug and alcohol abuse. It is thought that individuals who suffer from mental illness may be predisposed to engaging in self-medicating behaviors.
The signs of addiction include:
- Using more of a drug than was previously needed to get high
- Veering away from friends and loved ones in favor of using instead
- Spending large amounts of time, energy, and money investing in the habit
- Trying to stop using or cut back and being unable to
- Using drugs to prevent withdrawal symptoms from coming on
- Facing financial, emotional, physical, and even legal repercussions and still continuing to use
Addiction may precede mental illness – in some instances causing it – or it may develop later. Often, people who suffer from eating disorders reach for drugs to help them restrict their appetite or burn calories. Dietary aids that contain substances like phentermine and ephedra are extremely dangerous and should only be used under a doctor’s supervision. When abused over time, tolerance toward these substances grows and addiction can take hold. To the contrary, individuals who already struggle with an addiction may grow to develop an eating disorder. Sometimes it comes out of a desire for control.
Illicit substances are also a preferable choice among people with eating disorders. Cocaine and methamphetamines are frequently abused for the added perk of reducing appetite. There is also a prescription drug, phentermine, which is an appetite suppressant and stimulant. It is meant to be used by patients who classify as obese and need to drop pounds quickly, but it is often abused by those who don’t need it. A journal of Pharmacotherapy study noted 2.43 million prescriptions were written for this drug in 2011; not all of them were medically necessary or appropriate. Nonetheless, many weight loss clinics around the nation prescribe this drug routinely to non-obese patients. The side effects of it also compound those of eating disorders. Headache, mood swings, and tremors are just some of the adverse effects that can occur when taking phentermine, even in an otherwise healthy patient.
Treating Co-occurring Illnesses
The journal of Psychosomatic Medicine noted that 22 percent of people being treated for eating disorders also qualified for a diagnosis of a substance use disorder. Managing an addiction that occurs alongside an eating disorder should not be attempted without professional help. Treating both mental illness and substance abuse at the same time presents a lot of challenges for treatment professionals. As such, the fate of a client’s wellbeing shouldn’t be left to just anyone; specialists are needed.
Both anxiety and depression are commonly seen in clients with eating disorders and addiction. ADAA reports addiction surfaces in roughly 20 percent of people who struggle with depression or anxiety.
Cognitive Behavioral Therapy (CBT) is the most widely prescribed and successful form of treatment for both addictions and eating disorders. The textbook Abnormal Psychology notes that CBT specifically reduces bingeing and purging in around 65 percent of clients treated with it. Verifying credentials and assuring that the chosen facility has the resources and experience required to treat eating disorders is crucial before beginning treatment.
What Treatment Entails
Part of the objective involved in treatment of someone with a co-occurring eating disorder and addiction is to teach them how to cope with both disorders after treatment. These clients have to know how to resist triggers to use drugs and alcohol, but they also need to learn how to carry on with a healthy lifestyle and avoid obsession with their weight and appearance. Continued therapy is strongly encouraged.
During treatment, dietary changes are a must. These changes can slowly be implemented during the withdrawal period. While someone is going through withdrawal, their body needs all the energy and support it can get from a healthy diet. Nausea, muscle weakness, and lethargy may cause many clients in this situation to resist food even more. Nutritionists on staff at a quality treatment center can develop meals that will help sufferers of eating disorders to get food in their bodies and keep it there. Medications can also be used to stimulate a client’s appetite if needed. In severe cases, hospitalization may be required to administer food through a feeding tube. The Substance Abuse and Mental Health Services Administration’s Treatment Facility Locator notes 587 facilities across the nation provide hospital-based care.
Due to the nature of eating disorders and the secrecy that is often a component of them, inpatient care is typically necessary for these clients. Routine weight assessments help to keep these individuals on track, and a doctor may not recommend release from rehab until a certain amount of weight has been gained.
The entire program isn’t about weight gain though. It’s about teaching healthy eating habits and adequate amounts of safe exercise too. In addition, clients will participate in group therapy and skills groups to bolster self-esteem and to acquire the skills they need to be a high-functioning and healthy person again.
Support group participation can help clients to connect with others who have faced struggles similar to their own. Individuals who have been abusing stimulants may find they have problems with depression in the wake of rehab. Antidepressants, like fluoxetine and bupropion, can often help them to mitigate the dysfunction that drugs like Adderall and cocaine have caused in their brains until it can heal itself.
Treatment isn’t complete when a client leaves rehab. It’s important for clients to remember that continual support is needed. Ongoing aftercare is crucial to sustained recovery.