When we hear the words eating disorder, the majority of us think of anorexia or bulimia, extreme dieting and those screaming headlines featuring pictures of underweight girls one can stumble upon at some point on social media. Meanwhile, a systematic review including 94 studies (time period 2000-2018) looking at the prevalence of eating disorders globally found the weighted mean of lifetime eating disorders to be 8.4% for women and 2.2% for men. Point prevalence of eating disorders is 4.6% in America, 2.2% in Europe, and 3.5% in Asia.
While many neuropsychological disorders are correctly associated with eating problems, others go beyond food intake and can be caused by a variety of factors. Let's take it one step at a time and familiarize ourselves with eating disorders (EDs as it is commonly referred to in the literature).
EDs are increasing in prevalence, making this a pressing topic in healthcare institutions worldwide. Distorted eating is suggested to affect around up to 8% of the population at least at some point in life, which means that if you have 300 friends on Facebook ,,roughly 24 of them would be affected". Some reports suggest a much lower rate, which would represent a cross-sectional prevalence, meaning at this particular time or prevalence of one particular ED.
Even though it is more common for women to be diagnosed with an ED, men are also affected. The gender stigma on EDs is particularly harmful as it creates a limiting environment for seeking out help.
The notion that EDs are “dieting” falls very short of reality, given that a restricted food intake manifests usually only in anorexia nervosa.
The variety of EDs are broadly categorized into:
- Anorexia Nervosa (AN)
- Bulimia Nervosa (BN)
- Binge Eating Disorder (BED)
- Rumination Disorder
- Avoidant/restrictive food intake disorder
- Night eating disorder (and more)
My advice would be to be critical of literature, consider the source and its references, but more importantly never ever try to diagnose yourself or your close one, even if you are concerned.
The staggering amount of questionnaire or checklist-like self-assessment tools on the internet is seriously concerning and instead of helping the situation, more often than not makes it worse - encourages stigma, unhealthy feeding behaviors, misdiagnoses, and alternatively scares the assessment takers.
If you are considering that your feeding behavior might be unhealthy, at all times, contact a physician. It can be extremely uncomfortable and scary to take that step, and if so, try talking to a close someone or reach out through a validated psychological health helpline first (those contacts can be usually found in government health websites).
Before getting into details of the different EDs, it is important to understand what EDs are not. They are not diets, “bad habits”, purely environmental or behavioral, nor are the skinny people, or people who eat little/a lot or even about food. EDs are serious mental health disorders that manifest through distorted feeding behaviors, which in some cases have very little or nothing to do with food altogether (E.g., PICA, an eating disorder that manifests through ingesting inedible substances or objects).
The contemporary literature lately yielded a strong body of evidence that EDs start “in the brain”. It has been shown that EDs are linked with altered neurobiology within the brain and exhibit a different pattern of functional connections between regions. Granted, the three most common EDs, namely AN, BN, and BED exhibit an unhealthy relation between an individual and food, however, the underlying cause of developing an ED is far more complex. To date, there is no single recognised basis for EDs, but it has been suggested that different EDs do share a number of traits and behaviors. This is referred to as the transdiagnostic view of eating disorders.
The transdiagnostic view recognises that the psychological mechanisms and processes that maintain the distorted feeding behaviors are largely similar in different EDs, therefore, it is proposed that if it is possible to change that behavior in one of the EDs, it should be similarly effective in other EDs, too. This view of EDs has been fruitful in terms of treatment options available. Enhanced Cognitive Behavioral Therapy (CBT) has been suggested to be one of the most effective treatment options.
This treatment approach has been developed during the 1970s and 1980s, with its original goal of treating BN, however, with adoption of the transdiagnostic view of EDs, it is currently widely applied to treat all EDs. CBT-E has been primarily developed for treating adult patients, yet currently, with some adjustments is being applied to adolescent patients. As it is the case with the majority of neuropsychological disorders, EDs are not an exception, where treatment is lengthy, involving both therapy and prescription medication. The efficacy of CBT-E has been reported to be as high as 60%, however, there are differences between studies and populations.
Additionally, the differences in diagnosis, prevalence, and treatment outcome is at least in part explained by the fact that EDs are commonly accompanied by other neuropsychological disorders, such as obsessive compulsive disorder, depression, substance use disorders, and anxiety. As with any neuropsychological disorder, support from clinician, family, or friends is essential. In people suffering from ED, it has been shown that family or friend support increases the success rate for long term remission, hence encouraging those suffering to open up to people around them.
Galmiche, Marie, Pierre Déchelotte, Grégory Lambert, and Marie Pierre Tavolacci. 2019. “Prevalence of Eating Disorders over the 2000–2018 Period: A Systematic Literature Review.” The American Journal of Clinical Nutrition. https://doi.org/10.1093/ajcn/nqy342.
Jong, Martie de, Maartje Schoorl, and Hans W. Hoek. 2018. “Enhanced Cognitive Behavioral Therapy for Patients with Eating Disorders: A Systematic Review.” Current Opinion in Psychiatry 31 (6): 436–44.
Qian, Jie, Ying Wu, Fanxiao Liu, Yikang Zhu, Hua Jin, Hongmei Zhang, Yumei Wan, Chunbo Li, and Dehua Yu. 2022. “An Update on the Prevalence of Eating Disorders in the General Population: A Systematic Review and Meta-Analysis.” Eating and Weight Disorders: EWD 27 (2): 415–28.