1. How common are eating disorders?
In a literature review conducted by Galmiche et al. (2019), where they studied the prevalence of eating disorders between 2000 and 2018, the review of 94 studies with accurate eating disorders diagnosis suggested a prevalence in a lifetime of 8.4% women and 2.2% men.
2. When do you need treatment for eating disorders?
As with any other mental health issue, an eating disorder becomes a problem and requires treatment when the symptoms start to impact your physical, mental, emotional and/or social life.
3. Can someone overcome an eating disorder without treatment?
They can, but it is not common. Eating disorders can be life-threatening, and getting the right treatment is very important to recover and prevent the disorder to become more severe. It is shown that the sooner an eating disorder is treated, the higher likelihood of recovery.
4. Can you tell if someone has an eating disorder by just looking at them?
No, not everybody with an eating disorder is skinny or underweight. Many people with a disorder of this kind have a normal weight and it is hard to tell by just looking at them.
The best way to detect possible problems with food is by looking at certain behaviours and attitudes. Some of these behaviours include:
- Losing or gaining weight quickly
- Worries about food, calories, and diet
- Avoiding eating in front of others
- Having rules about food, such as forbidden foods (e.g., sweets or carbs)
- Having constipation or stomach pain
- Exercising excessively
- Wearing loose clothes to hide the body
- Dieting constantly
- Sounds or smells of vomiting
5. Why it is so difficult for someone with certain eating disorders to eat?
Several factors can make eating a difficult task for someone with an eating disorder:
Firstly, they may have intense and diverse fears. These fears can include:
- Fear of getting fat or gaining weight with just one meal or food
- Fear of losing control of food
- Fear of being judged by others
- Fear of the food itself (eating can soothe some individuals)
Some people use food as a way to gain a sense of control they lack in other areas of their life. They may feel their lives are out of control for other life events like their parent’s divorce, loss of a loved one, changing schools, bullying, etc. They may think that restricting food is the only thing they can have a say on, they can influence, and nobody can take that away from them.
People with eating disorders may restrict food as a way to reduce unpleasant feelings, such as fear, depression, anxiety, helplessness, or hopelessness. Hence, for them restricting food help to regulate emotions. Re-initiating eating is hard at first because it can increase the intensity of these emotions, which can be very overwhelming.
Disrupted hunger signals
Several studies have shown that after periods of sustained food restriction, the brains of people with eating disorders are neurobiologically changed (Frank et al., 2018; DeGuzman et al., 2017; Frank et al., 2016). More specifically, the brain circuits in charge of regulating the hunger or fullness signals are disrupted and don’t allow one to experience normal hunger and satiety cues. As such, it becomes really difficult to eat when you don’t feel hungry and are terrified of food.
6. Can’t someone with anorexia nervosa see they are too skinny?
Disturbance in the way in which one’s body weight or shape is experienced, and denial of the seriousness of the current low body weight are key symptoms of anorexia nervosa included in the DMS-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). This body image disturbance comprises a cognitive-affective component (negative feelings and attitudes toward one’s body), and a perceptual component (body size overestimation).
The disturbance in perception in anorexia nervosa has been documented in previous studies (Gardner & Brown, 2014; Cash & Deagle, 1997; Smeets et al., 1997; Smeets et al., 2009) and could explain why anorexic people can’t see that they are too skinny. Their visual perception, the way they see, is altered and they overestimate the size of body parts such as the head, the abdomen, or the thighs (Smeets et al., 1997). Moreover, Madsen et al. (2013) also indicated that visuospatial abnormalities were present when observing images of others and for non-appearance-related stimuli.
7. Can people have more than one eating disorder at the same time?
Eating disorders symptoms don’t always fit clearly into one classification. Some people with anorexia also purge, and others can have symptoms of both anorexia and bulimia. Many people start with anorexia, and over time the disorder evolves into more bulimic symptomatology.
In fact, the most frequent type of eating disorder encountered in clinical practice is what is called EDNOS (Eating Disorder Not Otherwise Specified; Fairburn & Bohn, 2005). EDNOS is the category of eating disorder where they gather all disorders that don’t exactly meet the criteria for anorexia nervosa, bulimia nervosa, or binge eating disorder. It is the most frequent because most eating disorders present with a mix of symptoms of anorexia, bulimia, or other eating disorders, or symptoms completely different.
As such, it is not so important to have an exact diagnosis but to understand the overall behaviours, feelings and thoughts of the person.
8. Will someone with an eating disorder have to go to the hospital?
Most people with an eating disorder won’t need to stay in the hospital. Most of them will need some type of therapy that can be delivered in the hospital, or privately in a counselling clinic.
Some people with a more severe eating disorder may require attending the hospital more often or staying on as an inpatient during a period for more intensive help and treatment.
9. Is it all the same with males with an eating disorder?
The main symptoms of an eating disorder are similar in males and females. Both genders can experience the same emotional and health outcomes.
However, males with eating disorders may differ in certain aspects from females. One significant difference is that men often have been mild to moderately obese sometime in their lives before having an eating disorder, while most women typically had a normal weight across their lifespan (Strother et al., 2012).
Since there is a stigma around men with these disorders, they can have a higher sense of shame and embarrassment than females. Also, eating disorders are sometimes mistakenly considered a women’s problem, hence men are more likely to be ignored in diagnosis and treatment (Strother et al., 2012).
Compensatory behaviours, like exercising, are used more frequently by men and they may focus not only on losing weight but also on gaining muscle.
10. What if I say something wrong and make it worse?
The factors that keep an eating disorder going are complex. It is unlikely that you can say something that makes the problem worse than it is. In the same way that is difficult to say something that makes the situation improve.
Cash, T. F., & Deagle, E. A., 3rd (1997). The nature and extent of body-image disturbances in anorexia nervosa and bulimia nervosa: a meta-analysis. The International journal of eating disorders, 22(2), 107–125.
DeGuzman, M., Shott, M. E., Yang, T. T., Riederer, J., & Frank, G. (2017). Association of Elevated Reward Prediction Error Response With Weight Gain in Adolescent Anorexia Nervosa. The American journal of psychiatry, 174(6), 557–565. https://doi.org/10.1176/appi.ajp.2016.16060671
Fairburn, C. G., & Bohn, K. (2005). Eating disorder NOS (EDNOS): an example of the troublesome “not otherwise specified” (NOS) category in DSM-IV. Behaviour research and therapy, 43(6), 691–701. https://doi.org/10.1016/j.brat.2004.06.011
Frank, G., DeGuzman, M. C., Shott, M. E., Laudenslager, M. L., Rossi, B., & Pryor, T. (2018). Association of Brain Reward Learning Response With Harm Avoidance, Weight Gain, and Hypothalamic Effective Connectivity in Adolescent Anorexia Nervosa. JAMA psychiatry, 75(10), 1071–1080. https://doi.org/10.1001/jamapsychiatry.2018.2151
Frank, G. K., Shott, M. E., Riederer, J., & Pryor, T. L. (2016). Altered structural and effective connectivity in anorexia and bulimia nervosa in circuits that regulate energy and reward homeostasis. Translational psychiatry, 6(11), e932. https://doi.org/10.1038/tp.2016.199
Galmiche, M., Déchelotte, P., Lambert, G., & Tavolacci, M. P. (2019). Prevalence of eating disorders over the 2000-2018 period: a systematic literature review. The American journal of clinical nutrition, 109(5), 1402–1413. https://doi.org/10.1093/ajcn/nqy342
Gardner, R. M., & Brown, D. L. (2014). Body size estimation in anorexia nervosa: a brief review of findings from 2003 through 2013. Psychiatry research, 219(3), 407–410. https://doi.org/10.1016/j.psychres.2014.06.029
Madsen, S. K., Bohon, C., & Feusner, J. D. (2013). Visual processing in anorexia nervosa and body dysmorphic disorder: similarities, differences, and future research directions. Journal of psychiatric research, 47(10), 1483–1491. https://doi.org/10.1016/j.jpsychires.2013.06.003
Smeets, M.A., Klugkist, I.G., Rooden, S.V., Anema, H.A., & Postma, A. (2009). Mental body distance comparison: a tool for assessing clinical disturbances in visual body image. Acta psychologica, 132 2, 157-65 .
Smeets, M. A. M., Smit, F., Panhuysen, G. E. M., & Ingleby, J. D. (1997). The influence of methodological differences on the outcome of body size estimation studies in anorexia nervosa. British Journal of Clinical Psychology, 36(2), 263–277. https://doi.org/10.1111/j.2044-8260.1997.tb01412.x
Strother, E., Lemberg, R., Stanford, S. C., & Turberville, D. (2012). Eating disorders in men: underdiagnosed, undertreated, and misunderstood. Eating disorders, 20(5), 346–355. https://doi.org/10.1080/10640266.2012.715512
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