Eating Disorders: an Overview

Eating disorders stem from an unhealthy relationship with food, leading to severe disturbances in eating behaviour.

connection between eating disorders and depression anxietyThis may include extreme reduction of food intake or extreme overeating, or feelings of extreme distress or concern about body weight or shape, and may result in anorexia nervosa, bulimia, or binge eating.

Of these disorders, the most common is binge eating which afflicts 3% of adults in the US.

A person with an eating disorder may diet, exercise, or eat excessively, which can have life-threatening or even fatal consequences. Usually appearing during adolescence or young adulthood, eating disorders can also develop during childhood or later in adulthood. Approximately 90 percent of individuals who suffer from an eating disorder are between the ages of twelve and twenty-five.

The characteristics of each disorder differ, however, individuals who suffer from eating disorders have a greater likelihood of suffering from anxiety and depression than those who do not suffer from eating disorders.

In fact, up to 80 percent of those with anorexia have suffered major depression and as many as 80 percent of bulimics have suffered from an anxiety disorder.

Anorexia Nervosa

An individual with anorexia has the view that they are overweight, even though they may be dangerously thin.

The process of eating becomes an obsession and can interrupt the normal functioning of the individual. Unusual eating habits develop, including avoiding food and meals, eating certain food in very small quantities, or carefully weighing and portioning food based on calories.

The individual may repeatedly check their weight and engage in intense and compulsive exercise, purging by vomiting, abusing laxatives, enemas and diuretics.

As a result of the eating disorder, the individual may develop problems such as:

  • thinning of the bones;
  • brittle hair and nails;
  • dry and yellowish skin;
  • growth of fine hair over body;
  • mild anemia and muscle weakness and loss;
  • severe constipation;
  • low blood pressure, slowed breathing and pulse;
  • drop in internal body temperature;
  • fatigue;
  • infrequent or absent menstrual periods.

Bulimia Nervosa

Individuals with bulimia usually weigh within a normal range, but they fear gaining weight, wish to lose weight, and feel intensely dissatisfied with their bodies.

Bulimia is characterised by eating unusually large amounts of food and feeling a lack of control over the eating. This binge-eating is followed by purging, fasting or excessive exercise. Many physical conditions often result from their behaviour including:

  • electrolyte imbalances;
  • gastrointestinal problems;
  • oral and tooth-related problems due to frequent exposure to stomach acids;
  • chronically inflamed sore throat, with possible rupture of the larynx;
  • swollen glands in the neck and below the jaw;
  • gastroesophageal reflux disorder (GERD);
  • intestinal distress and irritation from laxative abuse;
  • kidney problems from diuretic abuse;
  • severe dehydration from purging of fluids.

Binge Eating Disorder and Eating Disorder Not Otherwise Specified (EDNOS)

Individuals with binge eating disorder experience frequent episodes of out-of-control eating. However, they do not purge, fast or exercise excessively, generating overweight or obese individuals.  They experience feelings of guilt, shame or distress, often leading to another cycle of binge eating.

Obese individuals with binge eating disorder often have psychological illnesses, including anxiety, depression and personality disorders.

In addition, obesity is associated with cardiovascular disease, hypertension, diabetes, high blood pressure, sleep apnea, and psychological issues.

The Chicken or the Egg – Eating Disorder or Depression/Anxiety?

Which one comes first – an eating disorder or depression and anxiety?

which comes first - eating disorder, depression and/or anxiety?

Does having an eating disorder create depression or anxiety symptoms? Or does anxiety and depression create an eating disorder?

While this is not always easy to define, what is clear is that low self-esteem and a lack of feeling control are common traits of individuals with eating disorders.

Feelings of inadequacy, anger, loneliness, troubled personal relationships, physical or sexual abuse, or body image issues are also common in individuals with eating disorders.

A study in 2004 found that two-thirds of individuals with eating disorders suffer from an anxiety disorder at some point in their lives, and that 42% had developed an anxiety disorder during childhood, well before the onset of their eating disorder.

Other studies also confirm that an anxiety disorder usually  is the onset of an eating disorder, but a panic disorder often follows.

Obsessive compulsive disorder (OCD) is the most common anxiety disorder to co-occur with an eating disorder.

Individuals with both disorders often develop compulsive rituals connected to food, such as weighing food or cutting it into tiny pieces, or binge eating. Individuals with post-traumatic stress disorder (PTSD) and social anxiety disorder have a greater risk of also having an eating disorder.

High levels of cortisol and vasopressin have been found in individuals who have depression. These hormones are released when individuals are stressed. Studies show that high levels of stress hormones can be harmful to the immune system and various organs, including the brain.

Likewise, serotonin and norepinephrine regulate functions in the mind and body including appetite, emotions, and sleep.

When these regulatory systems are not working properly, the brain cannot communicate messages to the body effectively.  This can result in mood disorders and abnormal appetite regulation.

Treatment for Eating and Mood Disorders

To be effective, eating and mood disorders are required to be treated together.

Bulimia and binge eating disorder usually include anti-depressant medication and cognitive therapy, which teaches the individual to recognise what triggers their binges.

Advanced stages of anorexia require hospitalisation to restore nourishment to the body; since anorexics have extreme body image issues, they also benefit from cognitive behavioural therapy to work on healthy methods of coping with stress.

Younger anorexic patients can benefit from family therapy, so the entire family can work together to recognise symptoms of relapse and encourage healthy eating habits.  Anti-depressants are not recommended for anorexics, as generally the medication supresses appetite.

A psychologist experienced in the treatment of eating disorders can monitor individuals for symptoms of anxiety and depression, as mood disorders left untreated can cause disordered eating to recur.

Ultimately, treatment involving a number of health professionals, including a psychologist, can help guide individuals to a more positive lifestyle.

Cassandra Gist treatment for eating disordersAuthor: Cassandra Gist, BPsych (Hons), MPsych, MAPS.

Brisbane Psychologist Cassandra Gist has a Masters in Health Psychology, and is able to treat clients aged from two years old right through to adulthood. She is experienced in working with Aboriginal and Torres Strait Islander communities, as well as children and families affected by Autism Spectrum Disorder.

To make an appointment with Brisbane Psychologist Cassandra Gist, try Online Booking – Loganholme or Online Booking – Mt Gravatt. Alternatively, you can call M1 Psychology (Loganholme) on (07) 3067 9129, or Vision Psychology (Mt Gravatt) on (07) 3088 5422.