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What to Eat for Diverticulitis
Doctors sometimes recommend a diverticulitis diet as a temporary treatment for patients who have acute diverticulitis, according to the Mayo Clinic. The diet includes a variety of low-fiber foods and clear liquids. Antibiotics are often used in coordination with the diverticulitis diet to treat the inflammation in the intestines.
During an acute flare-up, your doctor may put you on clear liquids so your digestive system can rest until the bleeding and diarrhea stop, according to the Mayo Clinic. Recommended clear liquids include broth, pulp-free juice, pulp-free ice pops, gelatin and black coffee or tea. Ice chips and water may also be given during this phase before you are switched to low-fiber diverticulitis foods to eat.
The diet sheet for diverticulitis when you are first reintroducing solid foods includes low-fiber, easily digestible foods, according to the Mayo Clinic. Fruits and vegetables can be either canned or cooked with no skins or seeds. Protein sources should be light, such as eggs, poultry or fish. Juice should still be pulp-free. Milk, yogurt and soft cheeses are included in this phase of the diverticulitis diet. Carbohydrate selections during this time include white bread, low-fiber cereal, pasta and white rice.
Foods to Limit
While the diverticulitis diet doesn’t have patients omit any specific food type after the inflammation has passed, the correct diet for diverticulitis does limit the quantities of a few foods. These foods are called FODMAPS, which stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These foods should be limited because some researchers think they are linked to both irritable bowel syndrome and diverticulitis. The list of foods includes apples, pears and plums. Sauerkraut and kimchi are on this list of foods to limit. Dairy foods, beans, cabbage, onions, garlic and brussels sprouts are also on the list of foods to limit.
Transition to High-fiber Foods
The final phase of the diet for diverticulitis begins after the inflammation has passed when you transition to the best diet for diverticulitis on a long-term basis. This includes fiber-rich grains and fruits, vegetables that are high in fiber and legumes.
Changes in the Diverticulitis Diet
In the past, the diet for diverticulitis, after the inflammation passed, focused heavily on what to avoid rather than on what to eat for diverticulitis, but that has changed, according to the National Institute of Diabetes and Digestive and Kidney Diseases. While there are a few foods you may want to limit, the new guidelines suggest taking in at least 28 grams of fiber per day and that there is no reason to avoid nuts, seeds or popcorn.
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The explanation of eating disorders: a critical analysis.
Published online by Cambridge University Press: 29 April 2020
Eating disorders (EDs) are one of the most severe and complex mental health problems facing researchers and clinicians today. The effective prevention and treatment of these conditions is therefore of paramount importance. However, at present our treatments fall short: generally demonstrating only poor to moderate efficacy, and often completely ineffective for severe or chronic cases. A possible reason for this is that the current theories underlying these treatments are flawed. In this paper, we review and evaluate several prominent theoretical explanations associated with current frontline and promising treatments for ED. In doing so, we identify fundamental problems within the construction of current ED explanations and their implications for treatment. In response to these findings, we propose several strategies for the construction of future ED explanations which we believe have the power to ameliorate these problems and potentially help to develop more efficacious treatment downstream.
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- Volume 37, Issue 2
- Hannah Hawkins-Elder (a1) and Tony Ward (a1)
- DOI: https://doi.org/10.1017/bec.2020.6
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- Ann Neurosci
- v.20(4); 2013 Oct
A critique of the literature on etiology of eating disorders
Azadeh a rikani.
1 Douglas Hospital Research Centre, Montreal, Quebec, Canada, H4H 1R3;
3 Department of Psychiatry, McGill University, Montreal, Quebec, Canada, H3A 1A1;
2 Department of Human Genetics, McGill University, Montreal, Quebec, Canada, H3H 1B1;
4 Division of Research & Medical Education, International Maternal and Child Health Foundation, Montreal, QC, Canada, H7S 2N5;
Adnan M Choudhry
5 Neurochemistry Research Unit, University of Karachi, Karachi, Pakistan, 71000;
Muhammad W Asghar
6 Department of Pharmaceutical Sciences, University of Alberta, Edmonton, AB, T6G 2E1;
7 Department of Medical Imaging, University of Ottawa, Ottawa, ON, K1N 6N5;
8 Department of Family and Community Medicine, Pennsylvania State University, Hershey, PA, USA, 17033;
Nusrat J Mobassarah
9 Institute of Integrated Cell-Material Science, Kyoto University, Yoshida Ushinomiyacho, Sakyo – ku, JAPAN, 606-8501
The development of eating disorders including anorexia nervosa, bulimia nervosa, binge eating disorder, and atypical eating disorders that affect many young women and even men in the productive period of their lives is complex and varied. While numbers of presumed risk factors contributing to the development of eating disorders are increasing, previous evidence for biological, psychological, developmental, and sociocultural effects on the development of eating disorders have not been conclusive. Despite the fact that a huge body of research has carefully examined the possible risk factors associated with the eating disorders, they have failed not only to uncover the exact etiology of eating disorders, but also to understand the interaction between different causes of eating disorders. This failure may be due complexities of eating disorders, limitations of the studies or combination of two factors. In this review, some risk factors including biological, psychological, developmental, and sociocultural are discussed.
Eating disorders, particularly, anorexia nervosa and bulimia nervosa have been center of attention for clinicians and researchers. Eating disorders are one of the significant problems in the care of adolescents and even children. These complex disorders are believed to arise from interaction of multiple risk factors. Eating disorders are defined by disturbance in eating habits that may be either excessive or insufficient food intake. Bulimia nervosa, anorexia nervosa, and binge eating are the most common forms of eating disorder based on diagnostic and statistical manual of mental disorders (DSM-IV). As defined in DSM-IV, anorexia nervosa is a constant attempt to maintain body weight below minimally normal weight (85%) or body mass index <17.5 for age and height, with an intense fear of weight gain even though under weight, and inaccurate perception of own body size, shape, or weight. It may accompany with amenorrhea in girls and women after menarche. DSM-IV also defines bulimia nervosa as recurrent binge eating episodes followed by recurrent purging, excessive exercise, or prolonged fasting at least two times per week for three months. Excessive concern about weight or shape is also very common in bulimia nervosa. Another type of eating disorders is binge-eating disorder that is characterized with recurrent binge eating without purging, excessive exercise, or fasting. Atypical eating disorder is referred to clinically significant eating disorders associated with unexplained weight loss, rumination, unexplained food intolerances or an extremely picky eating habit that does not meet the criteria of anorexia nervosa, bulimia, or binge disorder. 1
Prevalence of Eating Disorders
The average prevalence rates for anorexia nervosa and bulimia nervosa are 0.3% and 1% among adolescence and young people in western countries respectively. Prevalence rates of anorexia nervosa and bulimia nervosa increase during transition period from adolescence to adulthood. 2 Lifetime prevalence rates for eating disorder are higher among women than men ( Table 1 ). 3 A Canadian study reported that 4% of Canadian boys in grade nine and ten used anabolic steroids. Use of anabolic steroid in males may be an indicator of body preoccupation. The estimated rate of anorexia nervosa and bulimia nervosa in males is between 5% and 15%. 4 Men’s reluctance to be diagnosed with eating disorders or to participate in the study of eating disorders have been a big challenge; consequently, rate of eating disorders in males may be higher than it is reported. According to a 2002 survey, prevalence of eating disorders is 1.5% among Canadian women aged 15–24 years. 5 Another Canadian survey in 2002 indicated that 28% of girls in grade nine and 29% of girls in grade ten showed weight loss behaviors. 4
Impact of Eating Disorders on the Canadian Economy
Although eating disorders mostly receive community treatment, hospitalization may be needed for severe cases. In-patient crude hospital separations for any diagnosed eating disorders have increased by 4.7% between 1994 and 1999 in Canada (Canadian Institute for Health Information, 1999). Despite decrease in hospitalization duration for eating disorders between 1987 and 1999 reported by the Center for Chronic Disease Prevention and Control, Public Health Agency for Canada reported increased rates of hospitalization for eating disorders among women in general hospitals. In 2005/2006, hospitalization rate for adolescence girl with eating disorders were 2.5 times the rate of young women and 6 times the rate of any other groups (Canadian Institute for Health Information, 2008). The increase in the rate of hospitalization could be due to either increased cases of inpatient treatment or higher rate of eating disorders, or combination of two factors. Further studies are required to clarify exact cause(s) of increased rate of hospitalization for eating disorders in Canada. In 1993 physician billing data, hospitalization data, and self-reported productivity losses were used to estimate mental illness cost to Canadian economy. It was estimated that the cost of mental illnesses was $7.331 billion in 1997. 6
Although eating disorders are among the mental illnesses that occasionally require hospitalization since hospitalization rate is increasing, even if costs of outpatient services are not taken into account, eating disorders can have a considerable impact on the Canadian economy. The exact estimation of economic burden of mental illness including eating disorders would be a big challenge, because of a lack of accurate data both on cost of services and productivity losses.
Mortality Rate in Eating Disorders
Anorexia nervosa has the highest mortality rate of any other mental illnesses. It is estimated that 10% of people with anorexia nervosa die within 10 years of the onset of disorder (Sullivan, 2002). One study showed the mean crude mortality rate of 5.0% for anorexia nervosa. In the surviving patients, on an average, only 46.9% of patients had full recovery, while 33.5% improved, and 20.8% had a chronic course of disease. 7 , 8 Based on total sample of 196 female with bulimia nervosa, the mean crude mortality rate was 2.0% for bulimia nervosa. 10 A lower standardized mortality rate (the ratio of the observed number of deaths to the expected number of deaths in a matched population) for anorexia nervosa compared to normal populations is reported by some studies. However, a recent Canadian study that assessed 326 patients diagnosed with anorexia nervosa for 20 years showed a higher mortality rate for anorexia nervosa patients than normal populations in Canada. 11 , 12 The challenges that this study faced over 20 years of follow up are: disconnection of cases with research group because of moving outside the British Columbia province; reassessment of previously diagnosed cases of eating disorders three times over 20 years based on three different revisions of DSM-IV that could have led to removal of few cases from study after a long term follow up.
Psychiatric Co-morbidity in Eating Disorders
Various psychiatric co-morbidities such as depression, anxiety disorder, obsessive-compulsive disorder, substance abuse, attention-deficit hyperactivity disorders, and personality disorders are prominent in patients with eating disorders. Suicide and suicide attempts are dangerous comorbidities in eating disorders. Although primary cause of pre-mature death in eating disorders are medical co-morbidities, a meta-analysis that combined the results of 42 published studies of mortality of eating disorders determined that the second most common cause of death in eating disorders is suicide. 7 About 10% to 20% of patients with anorexia nervosa and 25% to 35% of patients with bulimia nervosa have a history of at least one suicide attempt. Standardized mortality rate for suicide in anorexia nervosa is estimated to be up to 5 or even more. 11 According to the statistics from public health agency of Canada, suicide is the eleventh cause of death in Canada, and more than 3,500 suicides, at a rate of about 11 per 100,000 are recorded per year. Eating disorders clearly contribute to suicide rates in Canada. An accurate suicide rate of eating disorders is very difficult because of unreliability of suicide statistics in general, difficulties in uncovering the exact cause of death, and undiagnosed cases of eating disorders who commit suicide.
Medical Co-morbidity in Eating Disorders
Wide range of medical complications such as anemia, endocrine system dysfunction, electrolytes disturbances, and cardiovascular diseases accompany eating disorders. Severity of medical complications depend on speed of weight loss, severity of underweight, duration of eating disorders, age of patients, and the intensity of purging ( Table 2 ). 11
Etiology of Eating Disorders
Genetic effects: A growing body of twin studies confirmed that there is an undeniable link between genetic factors and eating disorders. One of the twin study, in which twenty- six twins with anorexia nervosa including 13 twins (7MZ, 6DZ) with threshold and 13 twins (7MZ, 6DZ) with sub-threshold anorexia nervosa were studied, 13 neither of DZ twins met the criteria for diagnosis of anorexia nervosa, while 29%–50% of MZ twins were concordant for anorexia nervosa. Although some of the twin studies believe that contributions of shared environmental effects (the same family environment in which twins grow up), and non-shared environmental effects (negative life events) are often small but these effects were also included in the reported twin studies.
One of the limitations of twin study could be due to the short follow up period. Some cases that are not concordant may turn to be concordant later, and unaccounted cases can affect heritability estimate for eating disorders. Small sample size is another limitation in twin studies that prohibits researchers to study wide range of non-shared and shared environmental effects, and probably overestimates rate of heritability. Study of larger sample size that preferentially includes different racial groups would be more useful.
Serotonin (5-hydroxytryptamin, 5HT) is believed to participate not only in appetite regulation but also in mood regulation. Altered tone or transmission of serotonin mediates anxiety reaction, problem with response inhibition, aggression, suicidality, heightened vigilance, and self-injury. 14 Although exact cause of 5-HT dysfunction in eating disorders is unknown, but several studies presumed that alteration of 5-HT1A and 5-HT2A receptor activities, the 5-HTT (5-HT transporter), and CSF 5-HIAA levels can be involved in patients with eating disorders. 15 Several studies confirmed persistence of alterations in serotonin activity, 16 , 17 and also persistence of anxiety, perfectionism, and obsessive behavior 18 after recovery from anorexia nervosa and bulimia nervosa.
Regarding these findings, serotonin may indirectly mediate its effects on development of eating disorders through some personality traits that are prominent in patients with eating disorders. Study of subtle differences in patterns of functional alteration of serotonin in subjects with pre-morbid personality traits without eating disorders, and in subjects with eating disorders without these personality traits may be helpful though sample size would be small in this group. Data collection related to pre-morbid personality traits would be highly desirable. Interestingly, one experimental study showed alteration of mesolimibic dopamine and serotonin as a result of restricted eating coupled with excessive exercise in activity-based anorexia model. 19 Based on this observation, it can be concluded that aberrant eating behaviors can potentially alter serotonin function and therefore result in persistence of functional alterations of serotonin after recovery of eating disorders. Neither of the studies interrogated persistence of functional alterations of serotonin as a “scar of prolonged aberrant eating behavior”. Although, study of possible functional alterations of serotonin due to aberrant eating behaviors is costly and invasive, but it would contribute to understanding complex relationship between functional alterations of serotonin and eating disorder.
Though one previous study suggested heritability of functional alterations of serotonin by showing anomalous peripheral uptake of serotonin in unaffected first-degree relatives of bulimia nervosa patients 20 but functional alterations of serotonin can be still considered as an outcome of aberrant eating behavior in patients. Further studies are required to confirm heritability of abnormalities of serotonin functions in eating disorders. To differentiate abnormalities of serotonin due to heritability from those due to aberrant eating behaviors, study of serotonin function in suspected subjects before the onset of eating disorders may be useful.
Body image disturbance.
Body cachexia, the degree of body satisfaction and dissatisfaction is believed to be an integral part of self-esteem. Individuals assess their bodies by measuring them against ideal body type of culture. The result of this self-assessment determines body satisfaction or dissatisfaction. 21 A prospective study on college freshman women showed that figure dissatisfaction, ineffectiveness and, public self-consciousness were associated with symptoms of eating disorders. 22 Since the body dissatisfaction data collection was done after development of eating disorders in this study, body dissatisfaction could be a predictor for worsening of eating symptoms rather than a predictor for development of eating disorders. Striegelmoore et al. also showed that severity of body dissatisfaction are correlated with worsening of disordered eating in sample of first year college women. 20 Another Study disproved body image disturbance as a predictive of later eating disorders after 2 years follow up of college students. 21 Considering to changes in patterns of thinking due to developmental process, studies that begin to collect data in very early adolescence, and follow up patients into adulthood may be more informative.
Another useful approach is the study of body dissatisfaction in subjects who already recovered from eating disorders (recovered study design). Regardless of the fact that eating disorders are known as psychiatric disturbances with persistent residual symptoms, this type of study could define the role of body dissatisfaction either as an etiology or as a clinical feature of eating disorders. Examination of other variables that decrease or increase the risk of eating disorders may overcome lack of unanimous agreement about role of body dissatisfaction in development of eating disorders. Stice et al. opposed the role of body image disturbances in development of eating disorder because they believe that body dissatisfaction is a risk factor for depression. 23 Regarding this notion, concurrent depression should be carefully assessed in patients with eating disorders when studying body dissatisfaction as a risk factor for eating disorders.
A Canadian survey showed that 34% of adolescent girls and 24% of adolescent boys in Grades 6 to 10 thought that they were too obese. This notion increased among adolescent girls from 25% in grade 6 to 40% in grade 10, while only 15% were actually obese (Public Health Agency of Canada, 2008). Regarding significant number of students with body dissatisfaction, prospective studies are required to find out what percentage of these Canadian adolescent girls and boys will develop full picture of eating disorders later. In addition to huge amount of budget required, this study may face another big challenge that is convincing adolescent girls and especially boys to participate in this study. This study helps health care system in Canada to plan prevention, early diagnosis, and treatment of potential future patients with eating disorders in advance.
Role of personality disorders in the development of eating disorders has been the center of attention for many researchers. Several studies have found that personality traits such as impulsivity, novelty seeking, stress reactivity, harm avoidance, perfectionism, and other personality traits are common in patients with eating disorders. Most of these studies assessed personality traits in their subjects during illness. Therefore, their personality traits could be a reflection of adverse effects of starvation. 24 A study shows the effect of starvation and recurrent binge and purging on development of anxiety, social withdrawal, and irritability in previously normal people only a few weeks after restricted food intake (Keys et al., 1950). Numerous studies used personality inventories such as Eating Disorder Inventory (EDI) to assess specific cognitive and behavioral dimensions of eating disorders such as drive for thinness, bulimia, body dissatisfaction ineffectiveness, perfectionism, interpersonal distrust, interceptive awareness, and maturity fear. Personality inventories are designed for the assessment of adult populations. Consequently use of these inventories for assessment of personality traits in majority of subjects with eating disorders who are typically in early adolescent may not be appropriate. 24 One important factor that could have possible effect on the accuracy of results in the study of personality traits in adolescences is the constantly changing patterns of perception about the environment and oneself due to ongoing developmental changes in personality. Medical and non-medical therapy in patients with chronic eating disorders could also affect post-morbid functions and personality traits of these patients. Interestingly some studies show the changes in behavior patterns such as harm avoidance, persistence, self-directedness, and self-transcendence after in-patient Cognitive Behavioral Therapy (CBT) for eating disorders. 11 Future researches should be aware of the effects of therapy on the result of study of personality traits in eating disorder cases.
Childhood sexual abuse.
Despite the fact that childhood sexual (CSA) abuse as a risk factor for eating disorders has been a source of debate among clinicians and researchers. While some studies showed strong relationship between CSA and eating disorders, some other studies strongly refuse to accept this relationship. Discrepancy between the results of various studies could be due to the non-uniformity in definition of CSA. Although association between different psychiatric disorders with severity of trauma due to CSA is not well understood yet, but different severity of CSA ranging from non-touching, single episode to long-term sexual abuse combined with physical abuse reported by victims may affect the result of studies. The entry time of sexually abused subjects with eating disorders into the study should also be considered. If the gap between the development of eating disorders and occurrence of sexual abuse is very short, subjects may not be recovered from memories of such a horrible experience. Severity of eating disorders might also affect their sexual abuse reports. In severe forms of eating disorders, CSA experience may be inaccessible to victims. 26 Increase in the rate of CSA reported between 1998 and 2003 in Quebec 27 ( Table 3 ) could be a warning sign for increased rate of psychiatric problems including eating disorder in Canada. A well-designed research project with consideration on the subject’s ethnic origins, age at the time of sexual abuse, socioeconomic class, and family dynamics could contribute to the understanding of possible relationship between CSA eating disorder with CSA. The challenges this research may face are accuracy of data, careful examination of other variables, lack of victims’ confidence to report the abuse to police or to child protection system, and clear definition of CSA. This study could also suffer from the problem of cost effectiveness.
Western cultural influence.
Exposure to western culture that values slim body for women is presumed to play an important role in the increased eating disorders worldwide. Rate of eating disorders in countries such as Japan, Iran, and Singapore continues to increase among women who have been exposed to western culture through temporary living in western countries for education, or even short-time vacation, or through mass media. 28 , 29 Increase in the rate of eating disorders in populations exposed to western culture in those countries could strongly support the role of western culture in the development of eating disorders. Study of effects of western culture in relation to incidence of eating disorders in non-western immigrant women and girls has been recently given special attention. Swanson et al. studied binge eating (BED) disorder in Mexican immigrants to U.S. 30 Although anxiety and depression may not be etiology of BED, they adjusted prior anxiety and depression that could act as non-specific markers of high risk for psychopathology. This study showed significantly increased rate of BED in U.S born Mexican with two U.S born parents. This study also concluded that cultural influence underlying in the increased rate of BED occurs slowly. Most of the studies failed to control at least one variable such as socioeconomic status especially family income, which may have a positive correlation with body dissatisfaction, age differences, despite strong link between age and eating disorders. 31 Usage of English language at home and religion could also be a potential cause of higher tendency for thinking about dieting and body shape, and as an indicator of acculturation. 32 , 33
Another study demonstrated that as generations further removed from immigration experiences, influence of western culture on body ideals and standards becomes prominent. In this study native Canadian born woman with one or no immigrant parent already completed acculturation had higher tendency to think about dieting than immigrant women or native-born women with two immigrant parents. Acculturation in this paper was defined as the adoption of Canadian values, lifestyle habits, particularly, eating habits, and dietary preferences. As far as development of eating disorders is concerned, the term “acculturation” is referred to adoption of negative aspects of Canadian eating and lifestyle habits similar to the symptoms of eating disorders, especially BED. 32 Although this research group carefully considered effects of family income, age differences, and English-speaking at home, but neither of the subjects in this study fulfilled diagnostic criteria for eating disorders based on DSM-IV criteria. This study also failed to control psychobiological factors that might possibly make the subjects vulnerable to sociocultural pressures.
A large population of immigrants in Canada coming from non-western countries provides an excellent opportunity to study influences of western culture on different ethnic origins with different religious affiliations, socioeconomic status, and eating habits.
This study could contribute to better understanding of connection between western culture and eating disorders. Careful examination of a broad range of non-specific factors that result in psychiatric disorders associated with immigration in immigrant patients with eating disorder and their family may be a challenge for this study. Study of gene influence, particularly, in generations of families of mixed heritage with eating disorders is highly recommended.
It has been hypothesized that eating disorders have multiple and often shared etiologies including biological, psychological, developmental, and sociocultural. A tightly woven network of causes, symptoms, and outcomes of eating disorders makes the study of etiology of these disorders very challenging. Some suggested risk factors for eating disorders require to be defined as either integral parts of eating disorders syndrome such as body dissatisfaction, and perfectionism or outcome of prolonged disordered eating such as functional alterations in serotonin, and some mood disturbances. Researchers should structure their thought processes around this concept that some of currently well-known risk factors for eating disorders are concurrent symptoms of eating disorders. Hence paying special attention to the new and evolved concepts is highly recommended while studying the etiology of eating disorders.
The article complies with International Committee of Medical Journal editor’s uniform requirements for manuscript.
Conflict of Interests: None; Source of funding: None.
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What are eating disorders?
Eating disorders are serious, biologically influenced medical illnesses marked by severe disturbances to one’s eating behaviors. Although many people may be concerned about their health, weight, or appearance from time to time, some people become fixated or obsessed with weight loss, body weight or shape, and controlling their food intake. These may be signs of an eating disorder.
Eating disorders are not a choice. These disorders can affect a person’s physical and mental health. In some cases, they can be life-threatening. With treatment, however, people can recover completely from eating disorders.
Who is at risk for eating disorders?
Eating disorders can affect people of all ages, racial/ethnic backgrounds, body weights, and genders. Although eating disorders often appear during the teen years or young adulthood, they may also develop during childhood or later in life (40 years and older).
Remember: People with eating disorders may appear healthy, yet be extremely ill.
The exact cause of eating disorders is not fully understood, but research suggests a combination of genetic, biological, behavioral, psychological, and social factors can raise a person’s risk.
What are the common types of eating disorders?
Common eating disorders include anorexia nervosa, bulimia nervosa, binge-eating disorder, and avoidant restrictive food intake disorder. Each of these disorders is associated with different but sometimes overlapping symptoms. People exhibiting any combination of these symptoms may have an eating disorder and should be evaluated by a health care provider.
What is anorexia nervosa?
Anorexia nervosa is a condition where people avoid food, severely restrict food, or eat very small quantities of only certain foods. They also may weigh themselves repeatedly. Even when dangerously underweight, they may see themselves as overweight.
There are two subtypes of anorexia nervosa: a restrictive subtype and a binge-purge subtype.
Restrictive : People with the restrictive subtype of anorexia nervosa severely limit the amount and type of food they consume.
Binge-Purge : People with the binge-purge subtype of anorexia nervosa also greatly restrict the amount and type of food they consume. In addition, they may have binge-eating and purging episodes—eating large amounts of food in a short time followed by vomiting or using laxatives or diuretics to get rid of what was consumed.
Symptoms of anorexia nervosa include:
- Extremely restricted eating and/or intensive and excessive exercise
- Extreme thinness (emaciation)
- A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
- Intense fear of gaining weight
- Distorted body or self-image that is heavily influenced by perceptions of body weight and shape
- Denial of the seriousness of low body weight
Over time, anorexia nervosa can lead to numerous serious health consequences, including:
- Thinning of the bones (osteopenia or osteoporosis)
- Mild anemia
- Muscle wasting and weakness
- Brittle hair and nails
- Dry and yellowish skin
- Growth of fine hair all over the body (lanugo)
- Severe constipation
- Low blood pressure
- Slowed breathing and pulse
- Damage to the structure and function of the heart
- Drop in internal body temperature, causing a person to feel cold all the time
- Lethargy, sluggishness, or feeling tired all the time
- Brain damage
- Multiple organ failure
Anorexia nervosa can be fatal. It has an extremely high death (mortality) rate compared with other mental disorders. People with anorexia are at risk of dying from medical complications associated with starvation. Suicide is the second leading cause of death for people diagnosed with anorexia nervosa.
If you or someone you know is in immediate distress or is thinking about hurting themselves, call the National Suicide Prevention Lifeline toll-free at 1-800-273-TALK (8255). You also can text the Crisis Text Line (HELLO to 741741) or use the Lifeline Chat on the National Suicide Prevention Lifeline website. If you suspect a medical emergency, seek medical attention or call 911 immediately.
What is bulimia nervosa?
Bulimia nervosa is a condition where people have recurrent episodes of eating unusually large amounts of food and feeling a lack of control over their eating. This binge eating is followed by behaviors that compensate for the overeating to prevent weight gain, such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. Unlike those with anorexia nervosa, people with bulimia nervosa may maintain a normal weight or be overweight.
Symptoms and health consequences of bulimia nervosa include:
- Chronically inflamed and sore throat
- Swollen salivary glands in the neck and jaw area
- Worn tooth enamel and increasingly sensitive and decaying teeth from exposure to stomach acid when vomiting
- Acid reflux disorder and other gastrointestinal problems
- Intestinal distress and irritation from laxative abuse
- Severe dehydration from purging
- Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and other minerals), which can lead to stroke or heart attack
What is binge-eating disorder?
Binge-eating disorder is a condition where people lose control of their eating and have reoccurring episodes of eating unusually large amounts of food. Unlike bulimia nervosa, periods of binge eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder are often overweight or obese.
Symptoms of binge-eating disorder include:
- Eating unusually large amounts of food in a short amount of time, for example, within two hours
- Eating rapidly during binge episodes
- Eating even when full or not hungry
- Eating until uncomfortably full
- Eating alone or in secret to avoid embarrassment
- Feeling distressed, ashamed, or guilty about eating
- Frequently dieting, possibly without weight loss
What is avoidant restrictive food intake disorder?
Avoidant restrictive food intake disorder (ARFID), previously known as selective eating disorder, is a condition where people limit the amount or type of food eaten. Unlike anorexia nervosa, people with ARFID do not have a distorted body image or extreme fear of gaining weight. ARFID is most common in middle childhood and usually has an earlier onset than other eating disorders. Many children go through phases of picky eating, but a child with ARFID does not eat enough calories to grow and develop properly, and an adult with ARFID does not eat enough calories to maintain basic body function.
Symptoms of ARFID include:
- Dramatic restriction of types or amount of food eaten
- Lack of appetite or interest in food
- Dramatic weight loss
- Upset stomach, abdominal pain, or other gastrointestinal issues with no other known cause
- Limited range of preferred foods that becomes even more limited (“picky eating” that gets progressively worse)
How are eating disorders treated?
Eating disorders can be treated successfully. Early detection and treatment are important for a full recovery. People with eating disorders are at higher risk for suicide and medical complications.
A person’s family can play a crucial role in treatment. Family members can encourage the person with eating or body image issues to seek help. They also can provide support during treatment and can be a great ally to both the individual and the health care provider. Research suggests that incorporating the family into treatment for eating disorders can improve treatment outcomes, particularly for adolescents.
Treatment plans for eating disorders include psychotherapy, medical care and monitoring, nutritional counseling, medications, or a combination of these approaches. Typical treatment goals include:
- Restoring adequate nutrition
- Bringing weight to a healthy level
- Reducing excessive exercise
- Stopping binge-purge and binge-eating behaviors
People with eating disorders also may have other mental disorders (such as depression or anxiety) or problems with substance use. It’s critical to treat any co-occurring conditions as part of the treatment plan.
Specific forms of psychotherapy (“talk therapy”) and cognitive-behavioral approaches can treat certain eating disorders effectively. For general information about psychotherapies, visit the National Institute of Mental Health (NIMH) psychotherapies webpage .
Research also suggests that medications may help treat some eating disorders and co-occurring anxiety or depression related to eating disorders. Information about medications changes frequently, so talk to your health care provider. Visit the U.S. Food and Drug Administration (FDA) website for the latest warnings, patient medication guides, and FDA-approved medications.
Where can I find help?
If you're unsure where to get help, your health care provider is a good place to start. Your health care provider can refer you to a qualified mental health professional, such as a psychiatrist or psychologist, who has experience treating eating disorders.
You can learn more about getting help and finding a health care provider on NIMH's Help for Mental Illnesses webpage . If you need help identifying a provider in your area, call the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Referral Helpline at 1-800-662-HELP (4357). You also can search SAMHSA’s online Behavioral Health Treatment Services Locator , which lists facilities and programs that provide mental health services.
For tips on talking with your health care provider about your mental health, read NIMH’s fact sheet, Taking Control of Your Mental Health: Tips for Talking With Your Health Care Provider .
For additional resources, visit the Agency for Healthcare Research and Quality website .
Are there clinical trials studying eating disorders?
NIMH supports a wide range of research, including clinical trials that look at new ways to prevent, detect, or treat diseases and conditions, including eating disorders. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.
Researchers at NIMH and around the country conduct clinical trials with patients and healthy volunteers. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you. For more information about clinical research and how to find clinical trials being conducted around the country, visit NIMH's clinical trials webpage .
This publication is in the public domain and may be reproduced or copied without permission from NIMH. Citation of NIMH as a source is appreciated. To learn more about using NIMH publications, please contact the NIMH Information Resource Center at 1-866 615 6464, email [email protected] , or refer to NIMH’s reprint guidelines .
For More Information
MedlinePlus (National Library of Medicine) ( en español ) ClinicalTrials.gov ( en español )
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health NIH Publication No. 21-MH-4901 Revised 2021
Eating Disorders: A Critical Issue
Male eating disorders essay.
- 10 Works Cited
The majority of the population suffering from eating disorders is female, so lets look at the general prototype of a patient. She is generally a teenager, from a middle to upper class background and white. She generally excels at schoolwork and extra-curricular activities, and is often times labeled a perfectionist. How does this differ from a male with eating disorders? Not all that much actually, he also does well in school although sports tend to be overemphasized.
The Influence of the Modeling Industry on Society
There are so many teens and women who risk their life just to be accepted. The way theses beautiful young teens and women risk their lives is by eating disorder. There is also a very high percentage of
Eating Disorders: Annotated Bibliography
The four sections that follow review the article “A qualitative study of transgender individuals experiences in residential addiction treatment settings: stigma and inclusivity” by Lyons, T. Shannon, K., Pierre, L., Small, W., Krüsi, A., Kerr, T. (2015).
Eating Disorders And The Media
Eating disorders have become a major problem throughout the world, specifically in the United States. The key factor that has an influence on eating disorders is the media. Including people of all ages and genders, up to twenty-four million people suffer from an eating disorder in the United States (ANAD np). This is a huge problem in the world today but what makes it so much worse is the fact that it can be prevented and it is in our control to change it. Young adults look to these celebrities, which are often their role models, and try to look just like them. What they fail to remember is the fact that celebrities have a lot of money, money that can afford nutritionists and personal trainers. They also fail to remember the extensive measures the celebrities may have to go through to look the way they do. An example of extensive measures can be considered plastic surgery. Ultimately, this creates a false goal that is almost unattainable for the “average” or “regular” person. Overall, the media has overtaken a huge impact on what the “ideal” body image has become today. Eating disorders are still on the rise and it is proven that an eating disorder such as anorexia affects up to 5 percent of women from ages 15-30 years old ("Media, Body Image, and Eating Disorders | National Eating Disorders Association np"). This may not seem that significant but it is also not considering other eating disorders such as bulimia. All in all, eating disorders
The Media and How it is Killing America’s Future Essay
- 2 Works Cited
Eating disorders are extremely serious and often even fatal. They are tremendously trying on both the person with the disorder, and those who are close to them. I remember the time that my roommate and I were watching TV with a group of girls when one of the girls started commenting on how fat a certain actress had become, and how gross she looked. I saw the look on my roommate’s face when she heard this girl criticize this actress who still looked practically perfect. More than anything, the weight this actress had put on made her look healthier than she had before. I became quite concerned though when I noticed that my roommate ate nothing for the next three days, and the one meal she did eat I am certain she threw up soon after. My roommate, like many other girls, was trying to achieve an unattainable goal. Some girls will just never be so thin, and struggling to be is very dangerous.
Eating Disorders Essay
- 3 Works Cited
An eating disorder is an illness that involves an unhealthy feeling about the food we eat. “Eating disorders affect 5-10 millions Americans and 70 million individuals worldwide” (www.eatingdisorderinfo.org 1). They also affect many people from women, men, children, from all ages and different races. People who have eating disorders usually see themselves as being fat when they really aren’t. This usually deals with women or teenage girls mostly. They watch television, movies, read articles in magazines, and see pictures of the celebrities whom they want to be like because they have the “ideal body” that everyone wants and craves for. The media makes us all think we need those types of bodies to be happy with ourselves, be more successful
There is a lot of misunderstood stigmas regarding eating disorders that can delay someone from getting the treatment that they need. Most people only notice a person has a problem if they have bulimia or anorexia that causes them to slowly take on a skeletal form from not getting enough nutrition. But there are many other eating disorders that cause the opposite to happen, such as Binge Eating Disorder. The age that a person can begin to have symptoms can also vary well past the teenage years. Many adults suffer needlessly because no one notices what is happening to them. It is the people who are the closest to the person with the eating disorder that can see that something is definitely wrong, though. And because of this, they can help fight the disease in several different ways.
Dyig to Be Thin
The reason that eating disorders are a growing problem is because people think they need to be stick thin to be accepted by the current society. When they get the results they want, they think, “If I keep doing this, it will get even better.” This isn’t true; their serious disease takes great physical and emotional tolls on themselves, and also to their family and friends.
Eating Disorders, The Silent Killer
- 11 Works Cited
Eating disorders are one of society’s most debilitating physical and psychological problems faced today. In the 1950s Marilyn Monroe was society’s role model, but would now be considered a plus-sized model and somewhat unattractive in society’s eyes (Steinem 5). Now in 2013, Demi Lovato, a pop singer, plays a huge role as a role model for young people, but has recently told the media that she suffers from anorexia nervosa and embraces it, ultimately showing adolescents that eating disorders are socially acceptable and even often encouraged (Cotliar 80). The psychological effects that eating disorders have on a patient can be very detrimental to themselves and often push the patient farther into the disorder than she could ever have
Eating Disorders In America
Ten to fifteen percent of people who have anorexia or bulimia are male. Teenage boys see themselves and think that they aren’t big enough. They turn to steroids or other methods to make them bigger and stronger. Teenage males are less likely to receive treatment because eating disorders are labeled as a “woman’s
Eating Disorders: The Influence Of Models
This can be catastrophic for some women. Eating disorders have the highest mortality rate of any mental illness (Mirasol, NP). A study by the National Association of Anorexia Nervosa and Associated Disorders (ANAD) reported the following eating disorder statistics: 5-10% of anorexics die within 10 years after contracting the disease and 18-20% of anorexics will be dead after 20 years. The mortality rate associated with anorexia nervosa is 12 times higher than the death rate of ALL causes of death for females 15-24 years old. Without treatment, up to 20% of people with serious eating disorders die. With treatment, the mortality rate falls to 2-3%. Because of these statistics, women need a better image of themselves. The unrealistic images of celebrities such as Kendall Jenner, or other models must be banned. The media should show the natural, pure body of cellulite, stretch marks, giggly stomaches and
Eating Disorders: The Gay Rights Movement
But right now eating disorders have an unholy stigma associated with them. It’s not going to change until society starts taking it seriously, realising that it can happen to anyone- not just Hollywood child actors. It’s scary to have a horrible relationship with food. It feels unnatural and it’s terrifying. But what’s most sad is that this topic doesn’t come up in serious
Eating Disorders Research Paper
As stated in the article “What are Eating Disorders?” by the NEDA (National Eating Disorders Association), “About 20 million women and 10 million men in America will experience some type of eating disorder at some point in their lives.” This means that eating disorders affect women more, but it affects men as well. Anorexia and Bulimia have been affecting women for generations, but recently it has blown up. The main reason for this is social media and magazines. Social media shows people models that are supposedly “perfect,” and then the women that see this then want to look just like them. This causes women to starve themselves, purge, etc. Women and teens still do this even though they know it hurts them. They may be addicted to doing it, and may not be able to stop themselves. People get seriously hurt and it’s not worth all the
Eating Disorder Research Paper
There are a number of warning signs that can be associated with any eating disorder such as: “body dissatisfaction, thin-ideal internalization, dieting, low self-esteem, maladaptive coping, reading teen fashion magazines, social pressure for thinness, social withdrawal, negative comments about eating, history of psychiatric disorders”(NEDA). With all these predetermined risk factors, it is easy to see why so many suffer from these disorders today. Anorexia can be described as the fixation of an individual's Body Mass Index (BMI); it is defined in the dictionary as “an emotional disorder characterized by an obsessive desire to lose weight by refusing to eat”(Johnson). The National Eating Disorder Association cites a list of possible risk factors that were identified in a number of studies; among the list is perfectionism. Bulimia Nervosa also defined as an “emotional disorder involving distortion of body image and an obsessive desire to lose weight” is differentiated by its “bouts of extreme overeating are followed by depression and self-induced vomiting, purging, or fasting.”(Johnson). These disorders are rooted in mental and emotional health and are not confined to females or teenagers. Modern media has done a very good job of perpetuating a desirable body type for people of all sexes and ages. People who suffer from a number of the aforementioned risk factors may be more heavily influenced to abuse or neglect their bodies in efforts to achieve this sought after
Eating Disorders : Eating Disorder
Other times, it’s the person choice on whether or not they’d like to open this hurtful portal to darkness. Scientists have done many studies on women involved in eating disorders and their brains function different than a healthy woman. Eating disorders aren 't just a mental illness, there are a physical illness as well that often destroy the body 's normal function. It may start as just starting to eat less or more, but it can have a dramatic effect to your body that it increases and gets worse. People who are going through puberty and changes on facial and body appearances often lean towards eating disorders because they want to be an ideal image that it advertised everywhere in media. Regardless of how you receive it, there is always help offered to anyone who is willing to accept that they need help. In many situations, a person has very low self-esteem and wishes they
- Anorexia nervosa
- Bulimia nervosa
- Mental illness
- Open Access
- Published: 03 November 2022
A critical analysis of eating disorders and the gut microbiome
- Sydney M. Terry 1 ,
- Jacqueline A. Barnett 2 &
- Deanna L. Gibson 1 , 2
Journal of Eating Disorders volume 10 , Article number: 154 ( 2022 ) Cite this article
The gut microbiota, also known as our “second brain” is an exciting frontier of research across a multitude of health domains. Gut microbes have been implicated in feeding behaviour and obesity, as well as mental health disorders including anxiety and depression, however their role in the development and maintenance of eating disorders (EDs) has only recently been considered. EDs are complex mental health conditions, shaped by a complicated interplay of factors. Perhaps due to an incomplete understanding of the etiology of EDs, treatment remains inadequate with affected individuals likely to face many relapses. The gut microbiota may be a missing piece in understanding the etiology of eating disorders, however more robust scientific inquiry is needed in the field before concrete conclusions can be made. In this spotlight paper, we critically evaluate what is known about the bi-directional relationship between gut microbes and biological processes that are implicated in the development and maintenance of EDs, including physiological functioning, hormones, neurotransmitters, the central nervous system, and the immune system. We outline limitations of current research, propose concrete steps to move the field forward and, hypothesize potential clinical implications of this research.
Plain English summary
Our gut is inhabited by millions of bacteria which have more recently been referred to as “our second brain”. In fact, these microbes are thought to play a role in ED behaviour, associated anxiety and depression, and even affect our weight. Recent research has dove into this field with promising findings that have the potential to be applied clinically to improve ED recovery. The present paper discusses what is known about the gut microbiome in relation to EDs and the promising implications that leveraging this knowledge, through fecal microbiome transplants, probiotics, and microbiome-directed supplemental foods, could have on ED treatment.
The gut microbiome has captured the attention of the medical field and has been implicated in a myriad of conditions including neuropsychiatric disorders, encompassing eating disorders (EDs) [ 1 ], metabolic disorders, and immune-mediated diseases. Research regarding EDs and the gut microbiome remains nascent and speculative, yet promising [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. Here we provide a critical analysis of the field, suggest practical steps that can be taken to move the field forward, and discuss the potential implications of this research.
EDs are mental health disorders comorbid with physical and psychosocial disease; only about 50% of affected individuals achieve lifelong remission [ 10 ]. The DSM-5 outlines eight ‘feeding and eating disorders’ [ 11 ], however ED research disproportionally investigates anorexia nervosa (AN) and to a lesser degree bulimia nervosa (BN) and binge eating disorder (BED). The present paper will focus on AN, which can be subdivided into restrictive type (ANR) and binge-eating/purging type (ANBP), as well as BN. BED will not be discussed, because, while not the same, BED is highly correlated with obesity and a large body of literature already exists that explores the relationship between the gut microbiome and obesity [ 12 ]. Additionally, avoidant/restrictive food intake disorder (ARFID), an ED not driven by a desire to be thin, but instead by food avoidance/restriction due to sensory sensitivity, lack of interest, and fear of adverse consequences, will not be discussed due to a lack of current research. However it is important to note that ARFID is a disorder of gut-brain interaction and is likely influenced by some of the same gut microbiota-ED behaviour correlations as AN [ 13 ]. Furthermore, there is currently no approved mediations for AN or AFRID [ 14 , 15 ], further supporting the need for research into the gut microbiome and AN and ARFID as this could lead to novel treatments.
The etiology of EDs is complex but includes genetic underpinnings, and indeed AN and BN display a genetic diathesis [ 16 ]. Recently, a genome wide association study identified eight significant loci for AN [ 17 ] and epigenetics has also been implicated in ED etiology [ 18 ]. Other biological, social, cultural, and psychological factors contribute to ED etiology [ 19 ], and gut microbes modulate a host of biological processes that affect the clinical manifestations of EDs—the details of which will be discussed in subsequent sections of this paper.
The gut microbiome refers to the 300–500 bacterial species inhabiting the human gastrointestinal system [ 20 ], and the dominate bacterial species are divided into three phyla: Bacteroidetes, Firmicutes, and Actinobacteria [ 21 ]. When studied in humans, obese individuals have more Firmicutes and almost 90% less Bacteroidetes than lean counterparts, and weight loss in the obese group is associated with a decrease in Firmicutes and increase in Bacteroidetes [ 22 ].
The gut microbiome changes over the course of the lifespan, as it is shaped by a multitude of factors including host genetics, age, and sex. Indeed, it is thought that development of the gut microbiome parallels that of brain development [ 23 ]. The gut microbiome is also influenced by diet, and in turn, the microbes regulate energy utilization, thus having implications on body composition. Obesity studies have revealed the gut microbiome is responsible for energy metabolism using twin fecal transplants in germ-free mice, revealing a causal role for microbes and energy harvest [ 24 ]. Indeed, macronutrient bioavailability is influenced by gut microbial metabolic processes [ 25 ]. Interestingly, short-chain fatty acids (SCFAs), produced from carbohydrate fermentation, may modulate glucose metabolism and fat deposition, and SCFAs are observed to be less abundant in AN populations compared to controls [ 9 ]. This may also reflect metabolic dysfunction observed in the microbiome of patients with AN, as perturbations in carbohydrate degradation and amino acid biosynthesis are observed [ 25 ].
The diversity of microbes in a single ecological community is known as α-diversity, and is commonly assessed in research, with increased α-diversity correlated with better health [ 26 ]. Perturbations within the microbiome, or ‘gut dysbiosis’, are associated with disease, often resulting from an overgrowth of potentially harmful organisms, loss of beneficial organisms, and reduction in species diversity resulting in the loss of the normally tolerogenic and symbiotic relationship [ 27 ]. In particular, a decrease in diversity of gut microbiota, especially in bacterial species producing butyrate, appear to correlate with increased anxiety, depression and ED psychopathology [ 9 ]. The gut microbiota may be a missing piece of the ED puzzle as two main pillars, eating behaviour and mental health, are influenced by gut dysbiosis (Fig. 1 ).
This figure summarizes the complex interplay between biological processes and gut microbes that are thought to be implicated in EDs, depicting the deeply interconnected nature of these relationships. Abbreviations: GI— gastrointestinal, HPA —hypothalamic–pituitary–adrenal
What does current research tell us?
Individuals with eds may have a distinct gut microbiome.
The ED field is turning its attention towards the gut microbiota. Commonly, reduced α-diversity is seen in ED rodent populations compared to controls [ 3 ], however this finding is not consistent across studies. Some clinical research postulates that α-diversity is negatively correlated with ED psychopathology, including depression and weight/shape concerns [ 5 ]. Interestingly, this study found that individuals with AN demonstrated reduced α-diversity before and after hospital-based weight restoration when compared to healthy controls, however as the AN group gained weight with treatment, the bacterial composition of their gut microbiome became more similar to that of the control group. Although conclusions cannot be made based on one study, this area warrants further research.
Microbial α-diversity in relation to BN has yet to be explored, but the gut microbiome and metabolomics profile in ANR and ANBP has been investigated. Although no significant differences in α-diversity between ANR and ANBP are observed, women with ANBP demonstrate a higher abundance of Bifidobacterium spp. and Odoribacter spp., and relative decreases of Haemophilus spp., compared to women with ANR [ 6 ]. ANR, ANBP, and control groups display differences in fecal metabolites, with similarities found between ED groups, perhaps suggesting distinct gut microbial functions are associated with EDs [ 6 ]. ED groups have altered metabolites reflective of reduced energy metabolism including deoxycytidine, isoleucine, malic acid, n-acetyl-glucosamine, palmitic acid, rhamnose, sorbose, tagatose, and xylose while some specific metabolites, including rhamnose, xylose, deoxyadenosine, thionic acid, arabinose, acetic acid, lactose, gamma-aminobutyric acid, pyroglutamic acid, succinic acid, and scyllo-inositol are altered between the ANBP And ANR groups [ 6 ]. These findings may be reflective of nutritional aberrations resulting from ED behaviours relating to ANBP and ANR, and suggest that ED behaviours including binging/purging and restricting are related to distinct gut microbiome compositions. Rigorous research regarding α-diversity, gut microbiome composition, and metabolomic variation in EDs may provide more insight into the validity of these preliminary findings and subsequently may have the potential to inform ED etiology and symptomology.
Gastrointestinal functioning affects the gut microbiome
Clinical manifestations of EDs are related to gastrointestinal (GI) functioning known to be influenced by gut microbe composition. Severe food restriction leads to delayed gastric emptying and a slower transit time, resulting in earlier satiety and bloating, reinforcing restrictive behaviour via physiological and psychological pathways [ 28 ]. These processes curate a specific GI environment, contributing to a distinct microbial profile. Additionally, slower transit time contributes to constipation, which in turn appears to be correlated with increased abundance of short-chain fatty acids in the gut microbiome [ 29 ]. Altered GI functioning affects gut microbial gene expression by disrupting circadian rhythms that govern their function [ 30 ]. Some gut microbes require the by-products of others to flourish, for example, butyrate producers need lactate produced by B. adolescentis [ 31 ], thus the effects of GI function on one gut microbe may have a cascading effect, on the entire community. Escherichia coli produces lipopolysaccharide that delays gastric emptying [ 32 ]. Research demonstrates that the intestinal microbiota of individuals with AN are enriched with Enterobacteriaceae, of which Escherichia coli is a member [ 7 ], and while this does not confirm or deny a relationship between altered GI function, AN and gut microbes, this observation is a springboard into further research. Additionally, the selection of gut microbes in individuals with AN and low adiposity may be an adaption that perpetuates AN pathology by providing the host with energy in a caloric-deprived environment, perhaps contributing to the high relapse rates observed in AN [ 33 ]. Furthermore, the nutrient-poor state associated with AN may lead to physiological changes including decreased small intestine surface area, and alterations to villus architecture, which reduce the gut’s absorptive capacity. This may pose difficulties with weight restoration and threaten recovery [ 34 ].
Purging behaviours also affect GI physiology and functioning, potentially resulting in damage to the mucosal lining, motility disturbances, and changes to gastric capacity and gastric emptying [ 35 ]. Many individuals with ANBP and BN purge through laxative misuse, which, depending on the frequency and quantity, may result in chronic diarrhea, electrolyte imbalances, and colonic motility impairment. Mice given laxative treatment show a 75% difference in gut bacterial taxa composition two weeks after cessation of treatment, a change mediated by host-dependent factors (colonic mucus loss and immune function) and host-independent factors (growth inhibition due to altered gastrointestinal osmolality) [ 36 ]. Over-exercise and self-induced vomiting are other purging behaviours not yet explored in relation to the gut microbiome. However, preliminary research into the relationship between exercise and the gut microbiota in the general population suggests that regular exercise is related to greater α-diversity, the gut microbiome composition changes in response to exercise regime,—but these changes are not sustained after 6 weeks of stopping the exercise regime, and the microbiota of lean individuals appears to be more influenced by an exercise intervention compared to the gut microbiota of overweight individuals [ 37 ].
The hypothalamic–pituitary–adrenal axis and gut microbiome may be intimately intertwined
The hypothalamic–pituitary–adrenal (HPA) axis regulates metabolism, emotion, and stress and is implicated in EDs. In early life, gut microbes help shape the HPA axis, a process mediated by stress. Exposure to trauma and adverse events during critical periods of prenatal and early postnatal life interferes with colonization of the gut, increasing propensity towards mental health disorders, and dysregulated GI, metabolic, and immune processes [ 38 ]. In rodents, early life stress induced by maternal separation results in dysbiosis with specific reductions in Lactobacillus spp. [ 39 ]. Chronic stress later in life affects the gut microbiome forming an axis with the HPA system leading to anxiety-like behaviours [ 40 ]. HPA axis dysregulation is implicated in both AN and BN [ 41 ]. In fact, AN is considered a state of functional hypercortisolism, resulting from hypersecretion of corticotrophin-releasing hormone (CRH), the primary regulatory hormone of the HPA axis. CRH is a powerful anorexic agent that likely mediates starvation behaviour in AN. Conversely, BN is associated with reduced plasma cortisol, and consequently reduced satiety, likely exacerbating bingeing behaviour [ 41 ]. Thus, early life stress may be a predisposing factor for ED, through its role in shaping the HPA-axis and subsequent consequences on hunger and satiety cues.
The gut microbiome interacts with neurotransmitter activity
The melanocortin system (MC) system is composed of MC peptides, MC receptors, endogenous antagonists, and ancillary proteins which together play a role in energy homeostasis, inflammation, pigmentation, and sexual function [ 42 ]. In the case of EDs, increased MC system activity causes dysregulated neurotransmitter signalling, notably of serotonin and dopamine. Serotonin is synthesized from tryptophan, an essential amino acid obtained from food, in both the brain and the gut. Under physiological conditions, serotonin has many roles as its receptors are found throughout the body. Notably, serotonin regulates smooth muscle in the gastrointestinal systems and aids in digestion, as well it has been implicated in mood regulation and has been colloquially termed the “feel good” chemical [ 43 ]. Altered neurotransmitter activity affects feeding and behavioural aspects of EDs. Increased binding of the serotonin receptor 1A (5-HT 1A ) occurs in individuals with EDs affecting satiety, impulse control, and moods [ 44 ]. Serotonin promotes food restriction, a behaviour which reduces anxiety in individuals with AN, and thus increased binding of the 5-HT 1A receptor promotes negative post-prandial affect in individuals with AN [ 45 ]. Additionally, decreased serotonin signaling contributes to bingeing observed in BN [ 8 ]. A blunted dopamine response is associated with reduced food intake in AN [ 46 ], but with bingeing in BN [ 47 ].
Gut microbes modulate the host’s neurotransmitter activity and produce neurotransmitters autonomously [ 48 ], yet this has not been explored in relation to EDs. Several neurotransmitters like serotonin, indoles, and kynurenines are regulated by tryptophan metabolism which is influenced by the gut microbiome. Indeed, inadequate nutrition has been correlated with a decreased concentration of kynurenic acid in the cerebral spinal fluid of individuals with AN, however the clinical consequence of this remain unclear [ 49 ]. Additionally, Bifidobacterium spp . are instrumental in maintaining homeostasis between kynurenine and tryptophan production [ 50 ] and individuals with AN have reduced Bifidobacterium spp. [ 51 ]. While no conclusions can be made yet, the relationship between gut microbes and neurotransmitters in EDs warrants future investigation.
The gut microbiome interacts with hunger hormones
Hunger and satiety hormones including, leptin, ghrelin, peptide YY (PYY) and neuropeptide Y (NPY) are implicated in ED behaviours may be affected by gut microbes. Under normal physiological conditions, leptin inhibits hunger via a negative feedback mechanism, and ghrelin works in opposition to stimulate hunger [ 52 ]. Like leptin, PYY has anorexigenic, proprieties and it is secreted in proportion to caloric intake, and like ghrelin, NPY stimulates food intake [ 52 ]. When studied in rodents, leptin is positively correlated with the quantity of Bifidobacterium spp. and Lactobacillus spp., and negatively correlated with the quantity of Clostridium spp., Bacteroides spp., and Prevotella spp. Conversely, ghrelin levels are negatively correlated with abundances of Lactobacillus spp., and positively correlated with abundances of Bacteroides spp. [ 53 ]. Significant weight loss, characteristic of AN, leads to lower leptin levels and higher ghrelin levels. These observations could provide clues into the potential role gut microbes may hold in ED behaviours. Further adding to this, the immune system is likely implicated in the relationship between gut microbes and hormones. Human serum contains IgG and IgA autoantibodies against appetite-regulating peptides, including leptin, ghrelin, PYY, and NPY [ 54 ]. These autoantibodies cross the blood–brain barrier and interact with hunger centres, including the arcuate nucleus. Sequence homology is observed between peptide hormones and gut microbes including Lactobacillus spp, Bacteriodes spp, Helicobacter pylori , E. coli , and Candida spp., suggesting the gut microbes, through molecular mimicry, may impact feeding behaviour.
The gut microbiome may affect hunger and satiety through interactions with the immune system
Connections between the immune system, central nervous system (CNS), and gut microbes may explain satiety differences observed in AN and BN. The CNS contributes to abnormal feeding behaviour, in part, through the MC system. The MC type 4 receptor (MC4R) is implicated in feeding, mood, and emotional regulation, and the MC system shows increased activity in individuals with EDs [ 2 ]. Stimulation of the MC4R induces anorexia while blocking it leads to hyperphagia. Additionally, stimulation of the MC4R is correlated with higher levels of anxiety, a trait commonly comorbid with EDs [ 2 ].
Gut microbes influence MC activity via an immune-mediated pathway. E. coli produces caseinolytic protease B (ClpB), a heat-shock disaggregation chaperone protein which is a molecular mimic of α-MSH, the primary MC4R activating ligand. ClpB forms immune complexes (IC) with α-MSH-reactive IgG (α-MSH/IgG IC), which bind the MC4R and activate the MC system [ 55 ]. Indeed, plasma concentrations ClpB are significantly increased across ED groups compared to controls, and these increased levels are correlated with increased EDI-2 scores [ 56 ]. A lower BMI is correlated with a higher prevalence of E. coli in the gut [ 57 ] and AN and BN populations display increased plasma α-MSH-reactive IgG levels compared to controls [ 58 ]. IgG generally binds the central portion of α-MSH, however variation in binding location is seen between AN and BN populations, and is implicated in MC4R signaling variation [ 2 ]. The C-terminal of α-MSH is essential for α-MSH to bind to MC4R, thus if IgG binds the C-terminal in the α-MSH/IgG IC, MC4R cannot be activated, and satiety would not be induced. This pattern of binding is seen in BN, but never in AN, and could explain a reduced satiety response in BN, but enhanced response in AN. An epitope shift of the α-MSH/IgG IC may contribute to an individual switching from AN to BN behaviours over the course of their ED [ 9 ]. Moreover, α-MSH/IgG IC binds and activates the MC4R at a lower threshold than α-MSH alone, further impacting the starvation behaviour [ 58 ]. When studied in rodents, stress is associated with an increase in ClpB production, thus physiological stress resulting from starvation may amplify this process [ 59 ].
Experimental treatments leveraging the gut microbiome
While no approved treatments that leverage the gut microbiome exist for EDs yet, experimental treatments involving fecal microbiota transplantations (FMT), tailored probiotic supplements, and microbiome-directed supplemental foods are being investigated. Two case studies explore FMT for ED treatment. In one case, a 26-year-old female, who after clinical recovery from AN failed to maintain a healthy bodyweight (her BMI settled at 15 despite a 2500 kcal diet), received a FMT which resulted in weight gain of 13.6% over 36 weeks, with no negative side effects reported [ 60 ]. Additionally, 37-year-old female with a 25-year history of severe and enduring AN and more recent co-occurring small-intestinal bacterial overgrowth (SIBO) received a FMT from a healthy 67-year-old, female, first degree relative. The patient maintained a BMI of 17.4–18.4 over the 12-months following the FMT, and 1-year post-FMT she reports digestion complaints and restricts to almost no intake [ 61 ]. While these cases illustrate the potential therapeutic role of leveraging the gut microbiome, they also illustrate the complexity of ED treatment, and the importance for individualized considerations in treatment.
The role of probiotics for ED treatment is also a novel frontier in ED research. In rat models of binge eating and anxiety behaviour, the selective administration of Bacteroides uniformis CECT 7771 results in cessation of binge eating and a reduction in anxiety-behaviour [ 62 ]. Additionally, randomized control trial comparing the effects of probiotics vs. placebo on 60 adolescent inpatients (ages 13–19) with AN has been planned and the results will glean insight on how probiotics may influence weight gain, ED pathology, and neuropsychological symptoms in adolescents [ 63 ]. Like the potential role of FMT to leverage the gut microbiome in ED treatment, probiotic supplementation is an exciting and promising avenue of research.
Additionally, tailoring re-feeding in a manner that leverages the gut microbiome to promote weight gain and decrease ED behaviours may be an effective treatment tool. Specifically, increasing the diversity of microbes may alter dietary preferences and patterns, resulting in weight gain, and repopulating the gut microbiome with organisms that decrease ED-related symptoms—such as Lactobacilli, Bifidobacterium spp. and Enterococcus spp.,—may result in improved ED recovery rates [ 64 ]. As well, restoring the gut microbiota, may correct the dysfunctional physical changes that hinder recovery (e.g. decreased nutrient absorptive capacity), and result in sustained weight gain and improved outcomes [ 34 ].
Limitations and future directions
Emerging evidence demonstrates widespread, yet interconnected, relationships between the gut microbiome and various body systems central to EDs. However, current conclusions are speculative and more robust research is needed to prove causation in the relationship between the gut microbiome, the gut-brain axis and EDs. We propose future research focuses on establishing or refuting causality and the subsequent ability to apply the research to clinical practice. We suggest practical steps, outlined in Fig. 2 , to work towards this while also addressing the following limitations in the field:
Current studies rely on small, and relatively homogenous samples, hindering our ability to draw any significant conclusions that can be applied widely.
Current studies in the field, when done on humans, primarily use ED populations from Western ED treatment centers, resulting in an almost exclusively white, female ED sample.
Proxy measures used to characterize the gut microbiome differ between studies, limiting our ability to compare outcomes between studies
The majority of research has been conducted on AN populations, potentially restricting our understanding of the role of the gut microbiome in EDs as other, often co-occurring EDs are not considered. In particular, future research should continue to explore the various subtypes of AN, and should include BN, BED, and ARFID populations.
Current studies are inconsistent in their designs and the outcome variables cannot suggest causality.
This figure outlines practical steps to move the field of EDs and the gut microbiome forward through: (1) increasing validity of research, (2) developing a more comprehensive understanding of the field, and (3) working towards demonstrating causality
Validity: Larger sample sizes are needed to increase the statistical power of the research, and more diversity among the samples would increase the external validity of the research. More diversity is needed within the sample groups as demographic factors are formative in shaping the gut microbiome [ 65 ] and without considering these factors the results may be inadvertently confounded. Furthermore, EDs affect individuals of all genders and ethnicities across the globe and a lack of representation in research limits the external validity of the findings. We propose consistent methods are used to characterize the gut microbiome as current studies use different proxy measures to characterize the gut microbiome (e.g. some use α-diversity, others use fecal metabolites), limiting our ability compare findings across studies.
Comprehensive understanding: Most research in the ED field has been conducted on AN populations and the research on the gut microbiome in EDs is no exception. To most comprehensively understand the intricacies of the gut microbiome in ED it is important that a spectrum of EDs are considered especially when considering EDs from a transdiagnostic perspective.
Causality: Studies have used fecal transplants from humans to germ-free mice demonstrate causality between gut microbes and anthropometric states (e.g. lean vs. obese) [ 24 ]. As previous studies have modeled AN in mice, and we propose that the same type of study is first carried out in control mice and AN-mice, and subsequently in human ED groups and germ-free mice, to provide more insight into the relationship between the gut microbiome and EDs, potentially demonstrating causality.
We propose enhanced methodology and more robust studies will propel this field forward. The future of ED treatment could consider FMT to improve recovery rates, continue investigating the role of prebiotics in ED care, and even re-consider refeeding protocols.
Availability of data and materials
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The corresponding author receives funding from the Natural Sciences and Engineering Research Council of Canada.
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Sydney M. Terry & Deanna L. Gibson
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ST wrote the majority of the main manuscript text and prepared Fig. 2 . JB wrote the section regarding neurotransmitters and prepared Fig. 1 . DLG supervised the students and critically analyzed all aspects of the work. All authors reviewed and edited the manuscript.
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Terry, S.M., Barnett, J.A. & Gibson, D.L. A critical analysis of eating disorders and the gut microbiome. J Eat Disord 10 , 154 (2022). https://doi.org/10.1186/s40337-022-00681-z
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DOI : https://doi.org/10.1186/s40337-022-00681-z
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The addiction model of eating disorders: a critical analysis.
Addiction is a poorly understood and widely misused concept. Far from providing an explanation of eating disorders, the concept is itself in need of explanation. Addiction is most commonly viewed as a disease, and it is this notion that has been applied uncritically to eating disorders in general and binge-eating in particular. The associations between eating disorders and psychoactive substance abuse are reviewed. The evidence indicates a greater than expected rate of psychoactive substance abuse in patients with eating disorders, and vice versa. Interpretation of these findings is obscured by a number of methodological problems, including inconsistent diagnostic criteria and assessment methods of questionable validity. Family studies show a similar co-occurrence, but suffer from comparable shortcomings. Moreover, comorbidity rates between eating disorders and other psychiatric disorders are higher. Studies of clinical samples might simply reflect the well-known tendency for patients with multiple problems to seek treatment. Consistent with this view, the results of two community studies of eating disorder patients show no significant co-occurrence with substance abuse. Theoretical and therapeutic implications of the addiction model are measured against available evidence on the nature and treatment of eating disorders.
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Critical Analysis of Eating Disorders in Women
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- Eating Disorders
The researcher had the opportunity on collecting and gathering critical information on eating disorders. What is an eating disorder you my ask? As defined in the oxford school dictionary it is defined as “any range of psychological disorders characterized by abnormal or disturbed eating habits (such as anorexia nervosa). This article summary is going to be a detailed outline of the information of eating disorders in women. There are a large number of persons who suffer from eating disorders, 90% of which are females. Older women who suffer with this disorder, tend to keep it a secret and don’t feel the need to speak up about it. Which leads to them not seeking any assistance. This usually happens because woman fear gaining weight and being branded, as having a “Teenage Disorder”.
Older woman have suffered with eating disorders for many years, while for others the problem is new. In recent years clinicians and treatment centers reported that they had seen a uprise of older woman, requesting help for these diseases. This article summary will be going into details about eating disorders. The types of eating disorders, what can cause these disorders to emerge or reappear and lastly how can these disorders be treated. Surveys that were conducted throughout the years indicated that, although these disorders in young women were reported more often, it dramatically increased in older woman of ages 45-65 in Australia. This survey was also conducted in Canada as well, but it is said that woman from these age groups, were most likely to feel guilty about eating and were more likely to rampage on food, compared to the younger ones.
There are many types of eating disorders. This article explains each one and gives detailed information about them. The types of eating disorders are as followed: Anorexia Nervosa, Bulimia Nervosa, and Binge-eating Disorder. The word anorexia comes from a two-part Greek word, which means “without appetite”. These types of individuals are scared of gaining weight and they eventually convinced themselves that they are too fat, when in fact they are malnourished. In the result they starve themselves to where they endanger their lives. in server cases of anorexia nervosa patients grow life threatening difficulties, such of which include, kidney failure, liver failure and cardiac arrhythmias. This disorder is known to be one of the deadliest psychiatric disorders.
Bulimia nervosa is another type of eating disorder which consist of binge-eating. This then forces some kind compensatory action to dodge the gaining of weight. “Researchers estimate that one to three women out of 100 will develop bulimia nervosa at some point in their lives. In men, the rate of diagnosis is only about one-tenth the rate in women”. (Harvard Health Publications, Mar 2012). Binge eating involves eating a large amount of food, within a time frame which usually consist of two hours.
All the disorders previously stated are said to have a subtype as stated from the DMS-IV these goas as followed: Anorexia Nervosa subtypes are the restricting subtype and the binge-eating subtype. Bulimia Nervosa subtype would include the purging and nonpurging subtype. Binge-eating disorder, people who have these types of disorders usually hide due to the sense of feeling guilty or ashamed. This disorder can cause an individual to be overweight or obese. This disorder may never be recognized. Many older women don’t usually fit the strict descriptions for having an eating disorder, yet the deserve treatment.
In most cases, Eating Disorders may appear and reappear later in a woman’s life, for numerous reasons. Our first being Grief, this is inevitable in someone’s life, we are likely to lose someone we once loved. Usually adult woman uses Mourning to cope with grief; this could take away their ability to eat or have an appetite for food. Purging food can be a stress reliver in this situation. Secondly, is Divorce this may consist of loss and grief, this may make the women feel insecure about their bodies comparing themselves to other singles and younger woman, this can result in excessive eating or malnourishment. Another factor could include the Heightened awareness of aging, this factor consists of females coming back to work or school past the retirement age with a different appearance. Lastly, Medical Illnesses. Woman tend to lose weight due to short term illnesses. Sometimes they receive compliments, and this may cause them to decrease their food intake so that they could keep their slender figure.
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Eating Disorders may cause many illnesses such include: Dental Problems, Heartbeats that are Irregular (arrhythmias), or osteoporosis, which is a common difficulty of eating disorders. In females that are older it may case vomiting, which is forced, and this may result in a medical emergency. If this is severe it could cause the stomach to rapture or tear in the esophagus, which at this time will need professional attention. However, woman’s priorities may shift due to time and energy. A reality of life might hit them as a unrelated health scare, death of a loved one, or other event. this may cost a woman may finally decide that enough is enough and seek treatment.
The purpose of treating these types of eating disorders are so that we could aid these women in achieving healthy weight, exercise level, and eating patterns; by doing so we could eradicate binge eating and purging as well. A Nutritionist, Mental Health Professional or Clinicians are responsible in aiding these women who are going through this. Upon my research I stumbled upon ways to help prevent or treat these types of disorders. These are Psychotherapy, Nutrition Rehabilitation, Medication and Hospitalization. Psychotherapy is the way to help an individual to talk about their problems and help them come up with a solution. Nutritional Rehabilitation can be a dietitian or a Nutritional Counselor who can help woman recover and learn about their eating disorders, they also motivate you to start eating healthier and advises you on the changes need to make that step. Medications such as Fluoxetine (Prozac) is the only prove medication to work for treating eating disorders. Lastly, they can be treated on an outpatient basis in the hospital. This is usually recommended if a woman is seriously underweight.
The author of this article is clearly speaking about what is an Eating Disorder, What causes this disorder to happen, the different types of disorders and their subtypes, and lastly how can these disorders be treated and prevented.
In my text eating disorder is said to be caused by excessive dieting, restricting certain foods and a disorder body dissatisfaction. It goes to state how the disorder is caused because people fear gaining weight. The age for females getting this disorder is usually 15-19. My notes state anorexia to be a eating disorder characterized by the maintenance of the body weight well below average though starvation and or excessive exercise. For example, my notes talk about Dysmorphia this is a distorted body image. This is when a person looks in the mirror, they believe themself to be overweight. My text also talks about Bulimia, which is another eating disorder, where a person engages in binge eating behavior that is followed by an attempt to compensate for the large amount of food consumed in two hours’ time. Bing is another eating disorder which consist of a person eating foods that are unhealthy for a specific period of time and then use some kind of compulsory behavior to rid the body of all the calories it might of consumed. Finally, is the Binge eating disorder with is where he/she does not use compensatory behavior to rid the body of extra calories. they are guilty and embarrassed.
The magazine article relates to the course in many ways talking about eating disorders. The article explains more on older women but also states types of eating disorders giving definitions and examples. these eating disorders consist of Anorexia nervosa, Bulimia nervosa, and binge eating disorder. The magazine article goes and talks about ways in which can trigger such disorder to occur. Finally, the article explains ways in which you can get help for eating disorder. All of this information was related to the course and helped me to understand the topic better. this magazine article relates to the course with the detailed information and explanation of this topic teaches us a little more than we already knew. It also expands my knowledge on the topic with other interesting facts and formation on eating disorder, the information in this article was helpful in my understanding on eating disorder and did not conflict with the information i already knew.
the magazine article made me understand how important and serious eating disorders can be. i never use to take the disorders seriously because I just thought it was an easy fix by just eating more food. However, I know that this is something that has a mental, physical and emotion effect on the individual. This magazine article expands my knowledge by stating the ways in which you can try to treat eating disorders. in addition to this the article talks about how eating disorders may reappear in someone’s life. this made me understand how the study of psychology is important by teaching me how important the mind can be and what effects it can carry once damage. this article shows me how psychology should be taken seriously and if it wasn’t for certain psychologist certain disorders would never exist meaning that the cure would never be found as well. the study of psychology goes deeper than just the mind, but it explores one true nature and how to see the world for what it really is.
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There are a lot of illnesses, diseases, and addictions in America today. The one we hear the most about is cancer. Cancer has so many variations and forms. Some are curable and some are fatal. The one disease and addiction we don’t hear and know about is eating disorders. “Eating disorders are a very serious problem”, according to Kathleen Merikangas, Ph.D., senior investigator at the National Institute of Mental Health (Doheny, 2011). An eating disorder is a condition that causes...
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Essay Examples on Eating Disorders
Eating disorders and methods of its treatment, the correlation between social media and the development of eating disorders, the damages of eating disorders, stereotypes around eating disorders, anorexia – a growing issue in teenage girls, examining eating disorders and social learning theory to draw useful conclusions, photoshopping images and how it impacts eating disorders, nutrition intervention for eating disorders, how beauty pageants can cause health difficulties, a look into the life of people with anorexia nervosa, bulimia nervosa: causes, symptoms and treatment, the prevention and treatment of anorexia nervosa, food addiction: does it really exist, depiction of anorexia nervosa in the movie to the bone, a study of eating disorders in judaism and the impact of patriarchal values and pressures, the differences between anorexia and bulimia, social media as the reason of body dissatisfaction and eating disorders, feeling stressed about your essay.
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An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's physical or mental health.
Types of eating disorders include binge eating disorder, anorexia nervosa, bulimia nervosa, pica, rumination syndrome, avoidant/restrictive food intake disorder (ARFID), and a group of other specified feeding or eating disorders.
Genetics, psychological issues, personality traits, celiac disease, environmental influences, food insecurity, trauma, heterosexism.
Serious health problems, depression and anxiety, suicidal thoughts or behavior, problems with growth and development, social and relationship problems, substance use disorders, work/education issues, death.
30 million people in the U.S. have an eating disorder. 95 percent of people with eating disorders are between the ages 12 and 25. Eating disorders have the HIGHEST risk of death of any mental illness. Eating disorders affect all genders, all races and every ethnic group.
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Home » Eating Disorder Awareness & Education » What is an Eating Disorder: Types, Symptoms, Risks, and Causes
What is an Eating Disorder: Types, Symptoms, Risks, and Causes
Eating disorders are serious mental and physical illnesses that involve complex and damaging relationships with food, eating, exercise, and body image. These disorders impact approximately 20 million women and 10 million men in the United States and are found in all populations regardless of age, ethnicity, socioeconomic status, religion, sex, gender, etc.
Eating Disorder Definition from the DSM-5
Eating disorder facts, what are the different types of eating disorders, eating disorder symptoms, risk factors for eating disorders, what causes eating disorders, how to treat eating disorders, ed articles.
The DSM-5 (Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition) lists eating disorders under the category of “Feeding & Eating Disorders” and describes that they are “characterized by a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food that significantly impairs physical health or psychosocial functioning .”
This category specifies diagnostic criteria for the disorders of “pica, rumination disorder, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nervosa, and binge-eating disorder .”
Eating disorders are complicated and nuanced disorders and vary from person to person. However, there are some overall eating disorder facts that research has been able to clearly delineate regardless of the individual.
- Eating disorders do not discriminate and are observed in “people of all ages, racial/ethnic backgrounds, body weights, and genders [2 – NIMH].”
- Eating disorder onset typically occurs in adolescence or young adulthood but is not limited to these life stages.
- There is no one distinct cause of eating disorders. Research has found a number of “genetic, biological, behavioral, psychological, and social factors” that can increase the risk of eating disorder development .
- Eating disorders can be life-threatening and have the highest mortality rate of any mental illness.
- While eating disorders do not have a “miracle cure,” there are numerous evidence-based practices proven to support eating disorder recovery.
As mentioned above, there are many more eating disorder diagnoses than the three most commonly heard about (Anorexia Nervosa, Bulimia Nervosa, & Binge Eating Disorder). Each diagnosis has specific criteria differentiating it from other mental illnesses and eating disorders. Recognizing the distinct difference in disorders can help to improve treatment and recovery outcomes.
For Anorexia Nervosa to be diagnosed, the DSM-5 specifies that the individual must engage in persistent energy intake restriction, have an intense fear of gaining weight or becoming fat, or be engaging in a persistent behavior that interferes with weight gain, and the individual has a disturbance in their own perception of their body weight or shape .
These individuals often present with a bodyweight that is “below a minimally normal level for age, sex, developmental trajectory, and physical health,” but this is not always the case. You cannot determine if someone struggles with anorexia based on their body appearance alone.
Learn About Anorexia Nervosa
Bulimia Nervosa is characterized by three essential features: “recurrent episodes of binge eating, recurrent inappropriate compensatory behaviors to prevent weight gain, and self-evaluation that is unduly influenced by body shape and weight .”
An individual must engage in these behaviors at least once per week for three months to meet the criteria for diagnosis .
Referring to the first feature, a binge is characterized by an individual “eating, in a discrete period of time, an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances” and that the individuals feel “a sense of lack of control over eating during the episode .”
Learn About Bulimia Nervosa
Binge Eating Disorder (BED)
Binge Eating Disorder, commonly referred to as BED is the most common eating disorder diagnosis among all others. The DSM-5 specifies that BED involves binge eating episodes defined as mentioned above in the Bulimia Nervosa diagnosis.
BED differs from Bulimia Nervosa in that BED involves no recurrent use of inappropriate behaviors to compensate for binge episodes and does not occur exclusively during anorexia or bulimia episodes
BED also does not include an individual’s perception of body shape and weight in diagnostic criteria.
Learn About Binge Eating Disorder
Pica involves an individual eating one (or more) non-nutritive, nonfood substance on a persistent basis for at least one month . Pica is diagnosed when this behavior occurs, often enough to warrant clinical attention .
The DSM-5 specifies that the eating of non-nutritive, non-food substances must be inappropriate to the developmental level of the individual and “not part of a culturally supported or socially normative practice .”
Rumination Disorder is characterized by “repeated regurgitation of food occurring after feeding or eating over a period of at least one month .” Those with Rumination Disorder regurgitate previously swallowed food with no apparent symptoms of nausea, involuntary retching, or disgust .
Diagnostic criteria of Rumination Disorder specifies that it should not be diagnosed if behaviors can be better explained by a gastrointestinal or medical condition or if they occur exclusively during an anorexia, bulimia, BED, or ARFID episode .
Avoidant/Restrictive Food Intake Disorder (ARFID)
Avoidant Restrictive Food Intake Disorder, often shortened to ARFID, replaced the previous DSM-5 diagnosis of “feeding disorder of infancy or early childhood.” One reason for this is that ARFID occurs predominantly, but not exclusively, in infants or children.
An essential diagnostic feature of ARFID is “avoidance or restriction of food intake manifested by clinically significant failure to meet requirements for nutrition or insufficient energy intake through oral intake of food .” This restriction does not occur as a result of another eating disorder diagnosis, and there should be no evidence of disturbance in body weight or shape perception.
Individuals that struggle with ARFID often experience food-related distress based on sensory characteristics of qualities of food. ARFID behaviors may also be based on a conditioned negative response associated with certain foods, such as a trauma.
Learn More: Avoidant Restrictive Food Intake Disorder
Other Specified Feeding or Eating Disorder (OSFED)
This category is intended for cases wherein symptoms of a feeding or eating disorder are present and cause clinically significant distress or impairment but do not meet the full criteria for the above-specified disorders.
OSFED Disorders include:
- Atypical Anorexia Nervosa: An individual meeting all criteria for anorexia are met except the individual’s weight is within or above the normal range.
- Bulimia Nervosa (of low frequency and/or limited duration: As the individual meets, all criteria for bulimia except binge eating and compensatory behaviors occur less than once a week and/or for less than three months.
- Binge-Eating Disorder (of low frequency and/or limited duration): An individual meets all criteria for BED except binge eating episodes occur less than once/week and/or for less than three months.
- Purging Disorder: An individual engages in regular purging behavior to influence body weight or shape but does not engage in binge eating behaviors.
Learn About Other Specified Feeding or Eating Disorder (OSFED)
Unspecified Feeding or Eating Disorder
This category, as with OSFED, includes disorders that are symptomatic of an eating disorder diagnosis but do not meet the full criteria.
UFED differs from OSFED in that it is used “in situations in which the clinician chooses not to specify the reason that the criteria are not met” for a specific disorder or “there is insufficient information to make a more specific diagnosis” such as emergency room settings .
What about the term ‘food addiction’? Is it an addiction, an eating disorder, or, neither? It’s currently not listed in the DSM-5 and with the limited research, It is too early to determine if there is a clinical importance to the idea of food addiction .
Learn About Unspecified Feeding or Eating Disorder (UFED)
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Eating disorders manifest in varying ways as they are complicated disorders that impact psychological, physical, and sociological health. Determining whether someone is struggling with an eating disorder is not an exact science due to the many manifestations of these disorders, but, there are some symptoms that can present as warning signs.
Emotional & Behavioral ED Symptoms
Our physical bodies, psychological, functioning, cognitive wellness, and choices and behaviors are all deeply intertwined and impactful of one another. Below are a few emotional and behavioral symptoms that may indicate an individual is struggling with eating disorder beliefs or behaviors.
- Beliefs/patterns/choices that indicate a focus on weight loss, dieting , food rules, or eating patterns.
- Extreme mood swings.
- Checking in the mirror often.
- Withdrawing from others, decreased socializing, especially when food is involved.
- Presenting as hyper-focused on weight, food, calories, nutritional content of food.
- Eating alone or hiding food.
- Skipping meals.
- Intense fear of gaining weight.
- Distorted body image.
- Tangential thought process and difficulty concentrating.
Physical Warning Signs of an Eating Disorder
A starved brain and body cannot function optimally. Therefore, an individual struggling with an eating disorder will present with at least some, if not all, of the physical signs of an eating disorder below:
- Weight fluctuations (both up and down) that occur rapidly.
- Severe constipation.
- Low blood pressure
- Slowed breathing and pulse.
- Lethargy, sluggishness, or consistent reports of feeling tired.
- Brittle hair and nails.
- Dry, yellowish skin.
- Loss of menstrual cycle (amenorrhea).
- Growth of soft hair all over body (lanugo).
- Stomach/gastrointestinal issues.
- Muscle weakness.
- Impaired immune system functioning.
It is unsurprising with all of the physical, emotional, and behavioral symptoms of eating disorders above that the long-term consequences can be severe. The malnourishment that results from disordered eating impacts all organ systems in the body including the brain as well as the cardiovascular, endocrine, and gastrointestinal systems.
Due to malnourishment, the body breaks down its own tissues, including the heart, which leads to a lack of energy to pump blood through the body, lowering pulse and blood pressure and increasing the risk of heart failure. The electrolyte imbalance caused by vomiting or laxative use or excessive water intake can also increase the risk of heart failure.
Lack of fat and cholesterol through disordered eating impacts functions of the endocrine system, such as the production of sex and thyroid hormones. For this reason, individuals may experience loss of or irregularities in the menstrual cycle. This also impacts bone density, metabolic rate, and issues regulating core body temperature (which can result in hypothermia).
It is difficult for the brain to function when it is not receiving proper and consistent nourishment. This leads to difficulty concentrating, sleeping, or staying asleep, sleep apnea, and dizziness or fainting. The electrolytes mentioned above are also used to create signals in the brain, meaning malnourishment disrupts the ability of the brain to communicate effectively to the body.
Finally, gastrointestinally, eating disorders impact stomach emptying and absorption of nutrients which can lead to severe stomach issues. Consistent vomiting can wear down the esophagus causing it to rupture, which is life-threatening. Binge eating can also cause a life-threatening emergency in that it can lead to a stomach rupture. Essentially, all of the organs and gastrointestinal functions are severely disturbed in eating disorder behaviors and can result in many life-threatening illnesses and issues.
There are many genetic, environmental, and sociological factors that contribute to eating disorder development.
Biological risk factors for eating disorders include many genetic factors such as predispositions to medical and mental illness.
Individuals that have a family history of mental illness diagnoses are more likely to experience mental illness themselves. Even if the predisposed mental illness is not an eating disorder, eating disorders commonly co-occur with diagnoses such as depression, anxiety, or substance use issues, to name a few.
An individual’s medical history can also increase eating disorder risk, as research indicates that certain illnesses, such as Type 1 Diabetes, are associated with increased risk for eating disorder development.
Psychological factors for eating disorders include a co-occurring diagnosis of another disorder, as mentioned above.
Additionally, there are specific personality traits that research indicates can increase the likelihood of developing an eating disorder, such as perfectionism, low self-worth, distorted body image, or impulsivity.
Experiencing a past or present trauma also increases one’s likelihood of developing a disordered eating belief or pattern.
Environmental factors include the dynamics that surround an individual.
This can include family dynamics, as family-related beliefs and discussions around weight, food, and self-view are shown to be associated with eating disorder diagnoses.
The social views one absorbs via peers, social media, television/movies, and consumer culture are also related to the increased development of eating disorders.
Due to the insidious ways in which eating disorders pervade all aspects of one’s body, mind, and life, receiving the appropriate treatment is important. There are various levels of care designed to treat specific stages of eating disorder severity—these range from inpatient at a medical facility down to outpatient. Any eating disorder treatment center can assess a struggling individual to determine the appropriate level of care.
Outside of receiving treatment in general, it is also important to ensure the facility uses evidence-based practices, as these can lead to better long-term outcomes.
There are many evidence-based treatments that can support eating disorder recovery; the most well-known and most commonly used is Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Family-Based Treatment (also known as “The Maudsley Method”).
Do not be afraid to ask any questions that arise if you or a loved one are searching for the treatment that will best support recovery.
Author: Margot Rittenhouse, MS, LPC, NCC Page Last Reviewed and Updated By: Jacquelyn Ekern, MS, LPC on June 14, 2021
1. Anorexia kills people. In fact, this disease enjoys the highest fatality rate of any psychiatric disorder. In the case of a celebrity death, the media provides coverage. Perhaps the first recognized case was that of Karen Carpenter in the early 8Os. An anorexic who relied on ipecac for vomiting, she died of heart failure. Years later, she was followed by Christina Renee Henrich, a world-class gymnast who died in 1994.
2. Female Athlete Triad Syndrome is a dangerous illness that can cause women who are extreme in their sports to have lifelong health concerns. Their coaches, friends, and family need to pay attention and help prevent the athlete from developing Female Athlete Triad Syndrome .
3. Major life changes can be a trigger to those fighting an eating disorder. Beginning college is no exception. The young man or woman is leaving home, friends and family to venture off into the unknown. College can be challenging and difficult for all students, but more so for others. This progression into adulthood is often a significant life altering event, and college can sadly trigger or lead to an eating disorder.
4. Eating disorders are more commonly associated with Caucasian females who are well-educated and from the upper socio-economic class. Eating disorders are also viewed as a western world affliction and not commonly related to other ethnic groups. This is not an accurate assumption. Eating disorders are prevalent in many different cultures and have been for a long time. This just continues to prove there are no barriers when it comes to disordered eating. Males, females, Caucasians, African Americans, Asian Americans, Mexican Americans and other ethnic minorities all can struggle with eating disorders.
5. According to the National Eating Disorders Association, people who are lesbian, gay, bisexual and transgender (LGBT) are at a higher risk of developing eating disorders including anorexia and bulimia. Gay and bisexual men who are single tend to feel more pressure to be thin and resort to restrictive EDs while those in a relationship turn to bulimia. Women in the lesbian and bisexual community still struggle with eating disorders similar to most heterosexual women with eating disorders, but lesbian and bisexual women are more likely to have mood disorders .
6. There is no such thing as the perfect dancer. Female ballet dancers work very hard at their craft but often find themselves in the throes of an eating disorder. Ballet dancers have long been known to develop eating disorders, and this can, to a degree, be understood because the dancer stands in front of a large mirror during practice and compares herself to all of her peers. In addition, it does not help that the industry of ballet dancing is extremely obsessed with weight .
7. Is vegetarianism contributing to disordered eating? Currently, just about five percent of Americans define themselves as a vegetarian (a person who removes meat and animal products from their diet). This percentage does not include those who consider themselves to be “quasi-vegetarians” (people who eat some animal-based products but primarily rely on a plant-based diet). Vegetarianism is much more prevalent for those who struggle with eating disorders. About half of the patients fighting an eating disorder practice some form of vegetarian diet.
8. In addressing the many medical complications of an eating disorder, the more urgent concerns typically take priority, such as undernourishment or an unstable heartbeat. However, some of the health consequences related to disordered eating affect the individual in the long term, even if they aren’t more apparent or obvious. Bone loss, or osteoporosis, is a silent but debilitating condition that commonly impacts women with EDs, such as Anorexia Nervosa. If you or a loved one is struggling with an eating disorder, read this article to learn more about ways you can prevent and treat bone density loss and eating disorders
9. With the mass amount of misguided information about eating disorders, it is common for these serious illnesses to be misunderstood, oversimplified, or greatly generalized. The truth of the matter is that Eating Disorders are complex diseases caused by a multitude of factors. Men or women who struggle with disordered eating have a serious mental illness with potentially life-threatening consequences. Understanding the implications of disordered eating can help increase awareness about ways to get help. Read this article to learn the myths vs. facts about eating disorders, which are serious mental conditions.
10. In the rapid evolution of our society today, advances in technology have dictated the course of human interactions. The way we interface with one another is largely hinged on the capacities that have developed throughout the years. Face-to-face connections are often pushed aside for text messaging, emails, and the like. What has been lost and sacrificed in the name of convenience and expediency? Read more here .
11. The media can be a culprit for generating images that falsify the reality of human bodies, but what drives an individual to idealize the representation of body perfection? As scientists unfold the blueprint of our genetic make-up, it is evident that both environment and genetics play an integral role in the formation of body image. Read more here .
12. While the transition to college is an exciting time for young adults, full of opportunities for independence and self-discovery, it also comes with an array of stressors. It’s often the first time a young adult lives apart from their primary support system. Learn about how college life (and especially as an athlete) can put people at risk for eating disorders.
13. Anyone who has any experience with doing battle with an eating disorder knows the challenge of wrestling with their “demons” and regaining control of their lives. I can’t think of any time more difficult than the free time from work or college, aka summer vacation . This is when most of us can find ourselves even more focused on body image and hear our ED talking loudest to us.
14. For individuals struggling with an eating disorder spurred from pressures or dysfunctions in their family, this summer break readjustment is exacerbated. For most, home is a loving and safe environment. However, for some, home may have been different .
15. In the treatment of eating disorders, mirror neurons play an interesting role . Often those with a disorder such as anorexia tend to experience rigidity and inflexibility in their thoughts and actions. The way they conduct their lives is often through a very black and white perspective. This is particularly evident in their perceptions of food and food consumption.
16. Most college students have been primed on how not to gain the “freshman 15.” But they likely haven’t been primed on just how dangerous it can be to try and avoid gaining those 15 pounds as a freshman or primed on the red flag warning signs of an eating disorder.
17. There is a close relationship between anxiety and all types of disordered eating. One study found that 64% of the 674 anorexic and bulimic participants had a diagnosable anxiety disorder at some point in their lives.
18. Eating disorders have the highest mortality rate of any mental illness, which is why treatment is often so critical. In ED treatment, those with anorexia, bulimia or binge eating disorder are given the tools and skills to get well. These strategies are designed to help them cope with uncomfortable feelings or distress; they are intended to replace the need for disordered eating and prevent a relapse . Because the truth is, an eating disorder is an unhealthy, maladaptive coping technique.
19. Anyone, from a princess to a pauper, can fall victim to these life-altering—and life-threatening—mental illnesses. Friends, relatives, lovers, acquaintances—even celebrities, the people we admire as stars, the most powerful, or the most beautiful among us, are or have been afflicted.
20. Interview with Dr. Thomas Britton, DrPH, LPC, LCAS, CCS, ACS: “I was very fortunate that my own journey to recovery didn’t include the pain and isolation of disordered eating, but the patterns and pain experienced in my early years shared many parallels and gave me great empathy for those with eating disorders. Back then, there was only one treatment center in my area that provided hospital-based care and no outpatient therapists existed that were trained in ED. ”
21. Many individuals work diligently and tirelessly to make college a reality, and can abruptly interfere with these goals and dreams. Is it possible to both attend college while receiving treatment for disordered eating?
22. If you’ve also had a pre-existing fear about food and a pre-occupation (or full-blown obsession) with your weight, shape, and size then college can be an extremely difficult time. In addition, there can be whole new levels of social pressure around being thin that you’re just not used to dealing with.
23. Your loved one cannot be in a position to communicate effectively with you until that stabilization and maintenance have occurred. After that stabilization of eating patterns occurs, the real family work can develop. It is important to recognize that your loved one still needs patience from you as they continue to learn how to communicate their emotions in a healthy way .
24. As a marriage and family therapist, I have treated numerous families where a son or daughter is recovering from these debilitating disorders. Moms and Dads and brothers and sisters are on the front lines with the one struggling to recover from anorexia or bulimia. They are also vital members of the treatment team whose support is crucial in helping someone fully recover from their eating disorder. And one thing I reiterate to all of the families I work with during counseling is that no one is to blame for the disorder but everyone can assist in the recovery.
25. Most eating disorders are anathema to those who do not have one, but certain food-related illnesses are particularly alarming and baffling to the public at large. PICA is certainly one of them .
26. This led me to wonder- how hard must mindfulness be for those that look toward these holidays with dread rather than joyous anticipation? While there are many reasons that the holiday season is challenging for people, for the purposes of this article, I will focus on those individuals whose difficulty around the holidays is related to their eating disorders.
27. We all have well learned that while there is excitement about being with family and friends during the Holiday season, there is also a certain amount of stress. For those who are feeling “pretty good” emotionally, the holidays can enhance those positive emotional and relationship experiences .
28. The holidays can be a stressful time for anyone, regardless of whether an eating disorder is involved in your life. Commonly, there are plans to be made, family members and loved ones to visit with, parties and social gatherings to attend, gifts to buy, meals to make, and often inundation with food .
29. Thyroid problems are extremely common population-wide and are an issue for some in recovery from eating disorders as well. However, the type of dysfunction that occurs in the general population and those with a history of an eating disorder are not usually the same.
30. Today, we are bombarded with photos of today’s “beautiful women” in magazines, commercials, TV shows, movies and online photos. These women that represent today’s standard of beauty look very different from women of the past. The women displayed on the nationally broadcasted Victoria’s Secret runway shows each year epitomize the extreme standards the media portrays as “sexy” and “beautiful.”
Study: the role of cannabidiol (cbd) in regulating meal time anorexia nervosa: safety, tolerability and pharmacokinetics, the renfrew center foundation’s 2023 professional webinar series, rock recovery’s building bridges breaking bread 2023, fbt with a twist: creative and practical strategies for adapting family based treatment webinar, targeting shame and self-criticism: missing interventions in eating disorder treatment webinar by alsana, do you have a loved one battling an eating disorder and would like a better understanding of this disease, our newsletter offers current eating disorder recovery resources and information. join today.
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What is anorexia nervosa?
Anorexia, formally known as anorexia nervosa, is an eating disorder . People with anorexia limit the number of calories and the types of food they eat. Eventually, they lose weight or cannot maintain an appropriate body weight based on their height, age, stature and physical health. They may exercise compulsively and/or purge the food they eat through intentional vomiting and/or misuse of laxatives.
Individuals with anorexia also have a distorted self-image of their body and have an intense fear of gaining weight.
Anorexia is a serious condition that requires treatment. Extreme weight loss in people with anorexia can lead to malnutrition , dangerous health problems and even death.
Who does anorexia affect?
Anorexia can occur in people of any age, sex, gender, race, gender, ethnicity, sexual orientation and economic status and individuals of all body weights, shapes and sizes. Anorexia most commonly affects adolescents and young adult women, although it also occurs in men and is increasing in numbers in children and older adults.
How common is anorexia?
Eating disorders affect at least 9% of the worldwide population, and anorexia affects approximately 1% to 2% of the population. It affects 0.3% of adolescents.
What is the difference between anorexia and bulimia?
Anorexia nervosa and bulimia nervosa are both eating disorders. They can have similar symptoms, such as distorted body image and an intense fear of gaining weight. The difference is that they have different food-related behaviors.
People who have anorexia severely reduce their calorie intake and/or purge to lose weight. People who have bulimia eat an excessive amount of food in a short period of time ( binge eating ) followed by certain behaviors to prevent weight gain. Such behaviors include:
- Intentional (self-induced) vomiting.
- Misuse of medications such as laxatives or thyroid hormones.
- Fasting or exercising excessively.
People with bulimia usually maintain their weight at optimal or slightly above optimal levels whereas people with anorexia typically have a body mass index (BMI) that is below 18.45 kg/m2 (kilogram per square meter).
Symptoms and Causes
What are the signs and symptoms of anorexia.
You cannot tell if a person has anorexia just by their appearance because anorexia also involves mental and behavioral components — not just physical. A person does not need to be underweight to have anorexia. Larger-bodied individuals can also have anorexia. However, they may be less likely to be diagnosed due to cultural stigma against fat and obesity. In addition, someone can be underweight without having anorexia. Remember, anorexia also includes psychological and behavioral components as well as physical.
There are several emotional, behavioral and physical signs and symptoms of anorexia. If you or someone you know experiences the signs and symptoms of anorexia below, it’s important to seek help.
Emotional and mental signs of anorexia
Emotional and mental signs of anorexia include:
- Having an intense fear of gaining weight.
- Being unable to realistically assess your body weight and shape (having a distorted self-image).
- Having an obsessive interest in food, calories and dieting.
- Feeling overweight or “fat,” even if you’re underweight.
- Fear of certain foods or food groups.
- Being very self-critical.
- Denying the seriousness of your low body weight and/or food restriction.
- Feeling a strong desire to be in control.
- Feeling irritable and/or depressed.
- Experiencing thoughts of self-harm or suicide.
Behavioral signs of anorexia
Behavioral signs of anorexia include:
- Changes in eating habits or routines, such as eating foods in a certain order or rearranging foods on a plate.
- A sudden change in dietary preferences, such as eliminating certain food types or food groups.
- Making frequent comments about feeling “fat” or overweight despite weight loss.
- Purging through intentional vomiting and/or misusing laxatives or diuretics
- Going to the bathroom right after eating.
- Using diet pills or appetite suppressants .
- Compulsive and excessive exercising or extreme physical training.
- Continuing to diet even when your weight is low for your sex, height and stature.
- Making meals for others but not yourself.
- Wearing loose clothing and/or wearing layers to hide weight loss and stay warm.
- Withdrawing from friends and social events.
Physical signs and symptoms of anorexia
The most well-known physical sign of anorexia is low body weight for a person’s height, sex and stature. However, it’s important to remember that someone can have anorexia without being underweight. In addition to weight-related signs of anorexia, there are also physical symptoms that are actually side effects of starvation and malnutrition.
Physical signs of anorexia include:
- Significant weight loss over several weeks or months.
- Not maintaining an appropriate body weight based on your height, age, sex, stature and physical health.
- Unexplained change in growth curve or body mass index (BMI) in children and still growing adolescents.
Physical symptoms of anorexia that are side effects of starvation and malnutrition include:
- Dizziness and/or fainting .
- Feeling tired.
- Slow heartbeat (bradycardia) or irregular heartbeat (arrhythmia).
- Low blood pressure (hypotension).
- Poor concentration and focus.
- Feeling cold all the time.
- Absent periods ( amenorrhea ) or irregular menstrual periods .
- Shortness of breath.
- Bloating and/or abdominal pain .
- Muscle weakness and loss of muscle mass.
- Dry skin , brittle nails and/or thinning hair.
- Poor wound healing and frequent illness.
- Bluish or purple coloring of the hands and feet.
What causes anorexia?
Anorexia and all eating disorders are complex conditions. For this reason, the exact cause of anorexia is unknown, but research suggests that a combination of certain genetic factors, psychological traits and environmental factors, especially sociocultural factors, might be responsible.
Factors that may be involved in developing anorexia include:
- Genetics : Research suggests that approximately 50% to 80% of the risk of developing an eating disorder is genetic. People with first-degree relatives (siblings or parents) with an eating disorder are 10 times more likely to develop an eating disorder, which suggests a genetic link. Changes in brain chemistry may also play a role, particularly changes to the brain reward system and neurotransmitters, such as serotonin and dopamine, which can affect appetite, mood and impulse regulation.
- Trauma : Many experts believe that eating disorders, including anorexia, are caused by people attempting to cope with overwhelming feelings and painful emotions by limiting food. Physical abuse or sexual assault, for example, can contribute to some people developing an eating disorder.
- Environment and culture : Cultures that idealize a particular body type — usually “thin” bodies — can place unnecessary pressure on people to achieve unrealistic body standards. Popular culture and images in media and advertising often link thinness to popularity, success, beauty and happiness. This may contribute to someone developing anorexia.
- Peer pressure : Particularly for children and adolescents, peer pressure can be a very powerful force. Experiencing teasing, bullying or ridiculing because of appearance or weight can contribute to the development of anorexia.
- Emotional health : Perfectionism, impulsive behavior and difficult relationships can all play a role in lowering a person’s self-esteem and perceived self-worth. This can make them vulnerable to developing anorexia.
It’s important to note that there’s no single path to an eating disorder or anorexia. For many people, irregular eating behaviors (also called “disordered eating”) represent an inappropriate coping strategy that becomes permanent over time. This pathway to disordered eating is true for some, but not all, who develop anorexia.
Diagnosis and Tests
How is anorexia diagnosed.
A healthcare provider can diagnose a person with anorexia based on the criteria for anorexia nervosa listed in the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5 ) published by the American Psychiatric Association. The three criteria for anorexia nervosa under the DSM-5 include:
- Restriction of calorie consumption leading to weight loss or a failure to gain weight resulting in a significantly low body weight based on that person’s age, sex, height and stage of growth.
- Intense fear of gaining weight or becoming “fat.”
- Having a distorted view of themselves and their condition. In other words, the individual is unable to realistically assess their body weight and shape believes their appearance has a strong influence on their self-worth and denies the medical seriousness of their current low body weight and/or food restriction.
Even if all of the DSM-5 criteria for anorexia aren’t met, a person can still have a serious eating disorder. DSM-5 criteria classifies the severity of anorexia according to body mass index (BMI). Individuals who meet the criteria for anorexia but who aren’t underweight despite significant weight loss have what’s known as atypical anorexia.
Diagnostic guidelines in the DSM-5 also allow healthcare providers to determine if a person is in partial remission (recovery) or full remission as well as to specify the current severity of the condition based on body mass index (BMI).
If signs and symptoms of anorexia are present, a healthcare provider will begin an evaluation by performing a complete medical history and physical examination. The provider or a mental health professional will likely ask questions about the following topics:
- Dietary history (attitudes about food, dietary restriction).
- Exercise history.
- Psychological history.
- Body image (this includes behaviors such as how often you weigh yourself).
- Bingeing and purging frequency and elimination habits (use of diet pills, laxatives and supplements).
- Family history of eating disorders.
- Menstrual status (if your periods are regular or irregular).
- Medication history.
- Prior treatment.
It’s important to remember that a person with anorexia or any eating disorder will have the best recovery outcome if they receive an early diagnosis. If you or someone you know is experiencing signs and symptoms of anorexia, be sure to talk to a healthcare provider as soon as possible.
What tests are used to diagnose or assess anorexia?
Although there are no laboratory tests to specifically diagnose anorexia, a healthcare provider may use various diagnostic tests, such as blood tests, to rule out any medical conditions that could cause weight loss and to evaluate the physical damage weight loss and starvation may have caused.
Tests to rule out weight-loss causing illness or to assess anorexia side effects may include:
- Complete blood count to assess overall health.
- An electrolyte blood panel to check for dehydration and your blood’s acid-base balance.
- Albumin blood test to check for liver health and nutrient deficiency.
- Electrocardiogram (EKG) to check heart health.
- Urinalysis to check for a wide range of conditions.
- Bone density test to check for weak bones (osteoporosis).
- Kidney function tests .
- Liver function tests .
- Thyroid function tests.
- Vitamin D levels.
- A pregnancy test in people assigned female at birth who are of childbearing age.
- Hormone tests if evidence of menstrual problems in people assigned female at birth (to rule out other causes) and measuring testosterone in people assigned male at birth.
Management and Treatment
How is anorexia treated.
The biggest challenge in treating anorexia is helping the person recognize and accept that they have an illness. Many people with anorexia deny that they have an eating disorder. They often seek medical treatment only when their condition is serious or life-threatening. This is why it’s important to diagnose and treat anorexia in its beginning stages.
The goals of treatment for anorexia include:
- Stabilizing weight loss.
- Beginning nutrition rehabilitation to restore weight.
- Eliminating binge eating and/or purging behaviors and other problematic eating patterns.
- Treating psychological issues such as low self-esteem and distorted thinking patterns.
- Developing long-term behavioral changes.
People with eating disorders, including anorexia, often have additional mental health conditions, including:
- Depression .
- Anxiety disorders .
- Borderline personality disorder .
- Obsessive-compulsive disorder .
- Substance use disorders.
These conditions can further complicate anorexia, so if an individual has one or more of these conditions, their healthcare team will likely recommend treatment for the condition(s) as well.
Treatment options will vary depending on the individual’s needs. A person may receive treatment through residential care (outpatient care) or hospitalization depending on their current medical and mental health state. Treatment for anorexia most often involves a combination of the following strategies:
- Nutrition counseling.
- Group and/or family therapy.
Psychotherapy is a type of individual counseling that focuses on changing the thinking (cognitive therapy) and behavior (behavioral therapy) of a person with an eating disorder. Treatment includes practical techniques for developing healthy attitudes toward food and weight, as well as approaches for changing the way the person responds to difficult situations. There are several types of psychotherapy, including:
- Acceptance and commitment therapy : This therapy’s goal is to develop motivation to change actions rather than your thoughts and feelings.
- Cognitive behavioral therapy (CBT) : This therapy’s goal is to address distorted views and attitudes about weight, shape and appearance and to practice behavioral modification (if “X” happens, I can do “Y” instead of “Z”).
- Cognitive remediation therapy : This therapy uses reflection and guided supervision to develop the capability of focusing on more than one thing at a time.
- Dialectical behavior therapy (DBT) : This therapy helps you not just develop new skills to handle negative triggers but also helps you develop insight to recognize triggers or situations where a non-useful behavior might occur. Specific skills include building mindfulness, improving relationships through interpersonal effectiveness, managing emotions and tolerating stress.
- Family-based therapy (also called the Maudsley Method) : This therapy involves family-based refeeding, which means putting the parents and family in charge of getting the appropriate nutritional intake consumed by the person with anorexia. It’s the most evidence-based method to physiologically restore health to an individual with anorexia who is under 18 years of age.
- Interpersonal psychotherapy : This therapy is aimed at resolving an interpersonal problem area. Improving relationships and communications and resolving identified problems may reduce eating disorder symptoms.
- Psychodynamic psychotherapy : This therapy involves looking at the root causes of anorexia as the key to recovery.
Some healthcare providers may prescribe medication to help manage anxiety and depression that are often associated with anorexia. The antipsychotic medication olanzapine (Zyprexa®) may be helpful for weight gain. Sometimes, providers prescribe medications to help with period regulation.
Nutrition counseling is a strategy to help treat anorexia that involves the following:
- Teaching a healthy approach to food and weight.
- Helping restore normal eating patterns.
- Teaching the importance of nutrition and a balanced diet.
- Restoring a healthy relationship with food and eating.
Group and/or family therapy
Family support is very important to anorexia treatment success. Family members must understand the eating disorder and recognize its signs and symptoms.
People with eating disorders might also benefit from group therapy, where they can find support and openly discuss their feelings and concerns with others who share common experiences.
Hospitalization might be needed to treat severe weight loss that has resulted in malnutrition and other serious mental or physical health complications, such as heart disorders, serious depression and suicidal thoughts or behaviors.
Are there complications related to treating anorexia?
The most serious complication of treating anorexia is a condition called refeeding syndrome . This life-threatening condition can occur when a seriously malnourished person begins to receive nutrition again. Basically, their body cannot properly restart the metabolism process.
People experiencing refeeding syndrome can develop the following conditions:
- Whole-body swelling ( edema ).
- Heart failure and/or lung failure.
- Gastrointestinal problems.
- Extensive muscle weakness.
Since refeeding syndrome can have serious and life-threatening side effects, it’s essential for people with anorexia to receive medical treatment and/or guidance.
People who have one or more of the following risk factors for developing refeeding syndrome may need to be treated in a hospital:
- Are severely malnourished (less than 70% median BMI in adolescents; a BMI of less than 15 in adults).
- Have had little or no calorie intake for more than 10 days.
- Have a history of refeeding syndrome.
- Have lost a lot of weight in a very short period of time (10% to 15% of total body mass within three to six months).
- Drink significant amounts of alcohol.
- Have a history of misusing laxatives, diet pills, diuretics, or insulin (if they have diabetes ).
- Have abnormal electrolyte levels before starting refeeding.
How long does it take to recover from anorexia?
Every person’s anorexia recovery journey is different. The important thing to remember is that it is possible to recover from anorexia. Treatment for anorexia often involves many components, such as psychological therapy, nutritional counseling and addressing the cause of the person’s anorexia, if possible, and each of these components can take different amounts of time.
No matter where you or a loved one are in their journey of recovery, it’s essential to continue working toward recovery.
What are the risk factors for developing anorexia?
Anorexia can affect anyone, no matter their gender, age or race. However, certain factors put some people at greater risk for developing anorexia, including:
- Age : Eating disorders, including anorexia, are more common in adolescents and young adults, but young children and older adults can still develop anorexia.
- Gender : Women and girls are more likely to be diagnosed with anorexia. However, it’s important to know that men and boys can have anorexia and may be under-diagnosed due to differences in seeking treatment.
- Family history : Having a parent or sibling (first-degree relative) with an eating disorder increases your risk of developing an eating disorder, such as anorexia.
- Dieting : Dieting taken too far can develop into anorexia.
- Changes and trauma : Big changes in your life, such as going to college, starting a new job or going through a divorce, and/or trauma, such as sexual assault or physical abuse, may trigger the development of anorexia.
- Certain careers and sports : Eating disorders are especially common amongst models, gymnasts, runners, wrestlers and dancers.
Can anorexia be prevented?
Although it might not be possible to prevent all cases of anorexia, it’s helpful to start treatment as soon as someone begins to have symptoms.
In addition, teaching and encouraging healthy eating habits and realistic attitudes about food and body image also might help prevent the development or worsening of eating disorders. If your child or family member decides to become vegetarian or vegan, for instance, it’s worth seeing a dietitian versed in eating disorders and touching base with your pediatrician or healthcare provider to make sure that this change occurs without a loss in nutrients.
Outlook / Prognosis
What is the outlook (prognosis) for people with anorexia.
The prognosis for anorexia varies depending on certain factors, including:
- How long the person has had anorexia.
- The severity of the condition.
- The type of treatment and adherence to treatment.
Anorexia, like other eating disorders, gets worse the longer it’s left untreated. The sooner the disorder is diagnosed and treated, the better the outcome. However, people with anorexia often will not admit they have a problem and might resist treatment or refuse to follow the treatment plan.
Anorexia is a serious and potentially life-threatening eating disorder if it’s left untreated. Eating disorders, including anorexia, are among the deadliest mental health conditions, second only to opioid addiction. Individuals with anorexia are 5 times more likely to die prematurely and 18 times more likely to die by suicide.
The good news is that anorexia can be treated, and someone with anorexia can return to a healthy weight and healthy eating patterns. Unfortunately, the risk of relapse is high, so recovery from anorexia usually requires long-term treatment as well as a strong commitment by the individual. Support of family members and friends can help ensure that the person receives and adheres to their needed treatment.
What are the complications of anorexia?
The medical complications and health risks of malnutrition and starvation, which are common in people who have anorexia, can affect nearly every organ in your body. In severe cases, vital organs such as your brain, heart and kidneys can sustain damage. This damage may be irreversible even after a person has recovered from anorexia.
Severe medical complications that can happen from untreated anorexia include:
- Irregular heartbeats ( arrhythmia ).
- Loss of bone mass ( osteoporosis ) and tooth enamel erosion.
- Kidney and liver damage.
- Fatty liver disease (steatosis).
- Seizures caused by extremely low blood sugar (hypoglycemia).
- Rhabdomyolysis (rapid breakdown of skeletal muscle) due to loss of water and electrolyte/acid-base imbalances.
- Delayed puberty and physical growth.
- Infertility and menstrual problems.
- Ventricular arrhythmia , a heart rhythm disorder.
- Mitral valve prolapse (caused by loss of heart muscle mass).
- Cardiac arrest .
In addition to physical complications, people with anorexia also commonly have other mental health conditions, including:
- Depression, anxiety and other mood disorders.
- Personality disorders.
- Obsessive-compulsive disorders.
- Alcohol use disorder and substance misuse.
If these mental health conditions are left untreated, they could lead to self-injury, suicidal thoughts or suicide attempts.
If you’re having suicidal thoughts, call the Suicide and Crisis Lifeline at 988. Someone will be available to talk with you 24/7.
How do i take care of myself if i have anorexia.
It can be uncomfortable and scary, but it’s important to tell a loved one and/or your healthcare provider if you have anorexia.
If you have already been diagnosed with anorexia, there are some things you can do to manage your condition and stay committed to recovery, including:
- Get enough sleep.
- Don’t abuse alcohol or drugs.
- If you take prescribed medication, be sure to take it regularly and do not miss doses.
- If you are participating in talk therapy to treat your anorexia, be sure to see your therapist regularly.
- Reach out to family and friends for support.
- Consider joining a support group for people who have anorexia.
- See your healthcare provider regularly.
How can I care for a loved one who has anorexia?
There are multiple things you can do to help and support someone with anorexia, including:
- Learn about anorexia : Educate yourself about anorexia to better understand what they are going through. Don’t assume you know what they are experiencing.
- Be empathetic : Don’t downplay or dismiss their feelings and experiences. Let them know that you are there to listen and support them. Try to put yourself in their shoes.
- Encourage them to seek help and/or treatment : While having an understanding and supportive friend or family member is helpful to a person with anorexia, anorexia is a medical condition. Because of this, people with anorexia need treatment such as therapy and nutritional counseling to manage their condition. Encourage them to talk to their healthcare provider if they are experiencing the signs and symptoms of anorexia.
- Be patient : It can take a while for someone with anorexia to get better once they’ve started treatment. Know that it is a long and complex process and that their symptoms and behaviors will eventually improve.
When should I see my healthcare provider?
If you or someone you know is experiencing signs and symptoms of anorexia, be sure to talk to a healthcare provider as soon as possible.
When should a person with anorexia go to the emergency room?
Someone with anorexia should go to the emergency room (ER) if they’re experiencing any of the following physical symptoms:
- Unusually low blood pressure.
- Decreased heart rate or irregular heartbeat.
- Chest pain.
- Seizures (due to extremely low blood sugar levels).
If you’re having thoughts of harming yourself, get to the nearest hospital as soon as possible or call the Suicide and Crisis Lifeline at 988. Someone will be available to talk with you 24/7.
If you recognize suicidal behaviors in someone with anorexia, get them care as soon as possible.
A note from Cleveland Clinic
Anorexia is a serious and potentially life-threatening condition. The good news is that recovery is definitely possible. If you or someone you know is experiencing signs and symptoms of anorexia, it’s essential to seek help and care as soon as possible. It’s never too late to seek treatment, but getting help early improves the chance of a lasting recovery.
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