• Edin Sehovic

What are Eating Disorders and Disordered Eating? How Can I Fix It?



First and foremost, I would like to recognize that I have been lucky enough to receive formal education in Nutrition, Food, and Dietetics and have thus spent a great deal of time learning about eating disorders and disordered eating compared to the average individual. As such, I have approached others who have NOT received similar education to hear what they think when asked about eating disorders or disordered eating. I have to say, I was not baffled by their responses. Some of the responses were:

"People with Anorexia," "People that vomit after they eat (bulimic)," "Starving yourself." With those three responses, I gathered that there might be a discrepancy between how much information people truly have about eating disorders and disordered eating. You might even be wondering as you are reading this now, "Why does Edin keep saying eating disorders and disordered eating when it's the same?!" Actually, they are not but sometimes in the media, they get used interchangeably. The difference is:


Eating Disorder (ED): any of a range of psychological disorders characterized by abnormal or disturbed eating habits (such as anorexia nervosa). They are illnesses in which the people experience severe disturbances in their eating behaviors and related thoughts and emotions. People with eating disorders typically become pre-occupied with food and their body weight in an obsessive fashion. This is done from a self-critical lens. Aberrant eating behaviors that result in an imbalance between energy intake and energy expenditure –eating disorders where the individual is eating in a surplus– not only contribute to excess weight gain but may also be associated with psychological distress. Hence, eating disorders are actually considered mental health disorders and should be treated patiently and seriously.


Signs and symptoms of an eating disorder may include, but are not limited to:


Emotional and behavioral

  • General behaviors and attitudes which indicate that weight loss, dieting, and control of food are becoming primary concerns

  • Preoccupation with weight, food, calories, carbohydrates, fat grams, and dieting

  • Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)

  • Appears uncomfortable eating around others

  • Food rituals (e.g. eats only a particular food or food group [i.e. condiments], excessive chewing, doesn’t allow foods to touch)

  • Skipping meals or taking small portions of food at regular meals

  • Any new practices with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)

  • Withdrawal from usual friends and activities

  • Frequent dieting

  • Extreme concern with body size and shape

  • Frequent checking in the mirror for perceived flaws in appearance

  • Extreme mood swings

Physical

  • Noticeable fluctuations in weight, both up and down

  • Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

  • Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)

  • Difficulties concentrating/focusing

  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low white and red blood cell counts)

  • Dizziness, especially upon standing

  • Fainting/syncope

  • Feeling cold all the time

  • Sleep problems

  • Cuts and calluses across the top of finger joints (a result of inducing vomiting)

  • Dental problems, such as enamel erosion, cavities, and tooth sensitivity

  • Dry skin and hair, and brittle nails

  • Swelling around the area of the salivary glands

  • Fine hair growth on the body (lanugo)

  • Muscle weakness

  • Yellow skin (in the context of eating large amounts of carrots)

  • Cold, mottled hands and feet or swelling of feet

  • Poor wound healing

  • Impaired immune functioning



Disordered Eating (DE): While disordered eating can also be a risk factor for obesity, believe it or not, disordered eating differs from an eating disorder. Disordered eating is used to describe a range of irregular eating behaviors that may or may not warrant a diagnosis of a specific eating disorder. The most significant difference between an eating disorder and disordered eating is whether or not a person's symptoms and experiences align with the criteria defined by the American Psychiatric Association. The term "disordered eating" is a descriptive phrase, not a diagnosis. Thus, while many people who have disordered eating patterns may fit the criteria for an Eating Disorder Not Otherwise Specified (EDNOS), it also is possible to have disordered eating patterns that do not fit within the current confines of an eating disorder diagnosis. Many people who suffer from disordered eating patterns either minimize or do not fully realize the impact it has on their mental and physical health. This lack of understanding may unnecessarily exacerbate the harm of disordered eating. Detrimental consequences can include a greater risk of obesity and eating disorders, bone loss, gastrointestinal disturbances, electrolyte and fluid imbalances, low heart rate, and blood pressure, increased anxiety, depression, and social isolation.

Signs and symptoms of disordered eating may include, but are not limited to:

  • Frequent dieting, anxiety associated with specific foods, or meal skipping

  • Chronic weight fluctuations

  • Rigid rituals and routines surrounding food and exercise

  • Feelings of guilt and shame associated with eating

  • Preoccupation with food, weight, and body image that negatively impacts the quality of life

  • A feeling of loss of control around food, including compulsive eating habits

  • Using exercise, food restriction, fasting, or purging to "make up for bad foods" consumed


ED/DE and the Microbiome


Patients with anorexia nervosa (AN) and bulimia nervosa (BN), two classical forms of eating disorders (ED), suffer from a lack of physiological control of their appetite leading to aberrant/abnormal feeding behavior expressed as chronic restriction and/or periodic compulsory eating (binging and purging), respectively. Due to their altered behavior, ED are classified as psychiatric diseases implying an impaired brain function. What shocks me, is that eating disorders have the highest mortality rate of any other psychiatric disorder and is the 12th leading cause of mental health-related hospitalizations GLOBALLY. Nevertheless, their origin may reside outside the brain involving interactions with the endocrine and immune systems as well as with gut microbiota. More research in the field of gut microbiota – brain axis may contribute to potentially clarifying the origin of anorexia nervosa and bulimia, which are the two principal forms of eating disorders. We already know that in healthy individuals with an active gut microbiome, there is a hugely diverse range of microbes that help promote a healthy environment and can be associated with emotional/behavioral changes (as illustrated by the Gut-Brain Axis). Interestingly, someone with an Eating Disorder could have a significantly lower/ very different level of diversity of microbes in the gut further exacerbating DE behaviors. Not only can an "unhealthy" gut make for worse treatment of eating disorders, but it can lead to manifestations of other physiological conditions along the digestive tract, and can be associated with the presence of mental health conditions like depression, anxiety, etc.


Binge Eating Disorder (BED)

Considered a "non-normative" eating pattern instead of an eating disorder, BED affects both Men and Women similarly. Although non-normative eating patterns may not always be considered mental disorders (like eating disorders are), they should receive equal mention due to their impact on body weight and overall health. BED can be defined as a severe, life-threatening, and treatable non-normative eating pattern characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterward; and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating.


Signs and symptoms of disordered eating may include, but are not limited to:


Emotional and behavioral

  • Evidence of binge eating, including the disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food.

  • Appears uncomfortable eating around others

  • Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)

  • Fear of eating in public or with others

  • Steals or hoards food in strange places

  • Creates lifestyle schedules or rituals to make time for binge sessions

  • Withdraws from usual friends and activities

  • Frequently diets

  • Shows extreme concern with body weight and shape

  • Frequent checking in the mirror for perceived flaws in appearance

  • Has secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over the ability to stop eating

  • Disruption in normal eating behaviors, including eating throughout the day with no planned mealtimes; skipping meals or taking small portions of food at regular meals; engaging in sporadic fasting or repetitive dieting

  • Developing food rituals (e.g., eating only a particular food or food group [i.e. condiments], excessive chewing, and not allowing foods to touch).

  • Eating alone out of embarrassment at the quantity of food being eaten

  • Feelings of disgust, depression, or guilt after overeating

  • Fluctuations in weight

  • Feelings of low self-esteem

Physical

  • Noticeable fluctuations in weight, both up and down

  • Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

  • Difficulties concentrating

The health risks of BED are most commonly associated with clinical obesity, weight stigma, and weight cycling (aka, yo-yo dieting). Most populations that are clinically diagnosed as obese do not have binge eating disorder. However, among individuals with BED, up to two-thirds are labeled clinically obese; people who struggle with binge eating disorder tend to be of normal or higher-than-average weight, though a BED diagnosis is not dependent upon weight.


Evidence-Based Treatment of ED/DE/BED


We see from the research that a holistic approach to dealing with eating disorders, disordered eating, and binge eating disorders must be taken. This approach means more than just looking at the type of food we eat, but instead, understanding the behaviors associated with these disorders and trying to reframe our habits to improve these behaviors. Below are a few of the best evidence-based therapies one can take to help deal with ED/DE/BED. These may not be for everyone, like with everything, it might not help everyone but a large majority of the population with eating disorders might find these improve symptoms.


For ED/DE: Cognitive behavioral therapy (CBT) is currently the treatment of choice for bulimia nervosa and binge-eating disorder, and existing evidence supports the use of a specific form of family therapy for adolescents with anorexia nervosa. Even the most effective interventions for eating disorders fail to help a substantial number of patients. A priority must be the extension and adaptation of these treatments to a broader range of eating disorders to adolescents, who have been largely overlooked in clinical research, and to chronic, treatment-resistant cases of anorexia nervosa/bulimia nervosa.

For BED: Leading research showed that women treated with Dialectical Behaviour Therapy (DBT) provided significant improvement in measures of binge eating and eating pathology compared with controls, and 89% of the women receiving DBT had stopped binge eating by the end of treatment. DBT treatment is a type of psychotherapy — or talk therapy — that utilizes a cognitive-behavioral approach. DBT emphasizes the psychosocial aspects of treatment and should be considered by patients suffering from BED.


You skimming for the conclusion/ TLDR section

TLDR;/ Conclusion:


While popular culture uses them interchangeably, and they share various similarities, eating disorders and disordered eating are not the same. While they affect the uptake of nutrients in different ways, eating disorders are considered mental health disorders and should be treated as such. Disordered eating, on the other hand, is used to describe a range of irregular eating behaviors that may or may not warrant a diagnosis of a specific eating disorder. The most significant difference between an eating disorder and disordered eating is whether or not a person's symptoms and experiences align with the criteria defined by the American Psychiatric Association. Different forms of treatment exist, but evidence suggests that the most effective forms of treatment for ED/DE are therapies that address behavioral and mental interactions with or without food.

Extra Tools for Parents/Coaches/Friends Since I am a Sports Nutritionist, I have shared a great tool to help Parents/Coaches/Friends support their (young) athletes should symptoms of ED/DE arise :


Shout Out Craig!


Resources:


Bubnov, R., & Golubnitschaja, O. (2019). Flammer Syndrome, Disordered Eating and Microbiome: Interrelations, Complexity of Risks and Individual Outcomes BT  - Flammer Syndrome: From Phenotype to Associated Pathologies, Prediction, Prevention and Personalisation. In O. Golubnitschaja (Ed.) (pp. 317–330). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-030-13550-8_18


Fetissov, S. O., & Hökfelt, T. (2019). On the origin of eating disorders: altered signaling between gut microbiota, adaptive immunity and the brain melanocortin system regulating feeding behavior. Current Opinion in Pharmacology, 48, 82–91. https://doi.org/https://doi.org/10.1016/j.coph.2019.07.004


Gupta, A., Osadchiy, V., & Mayer, E. A. (2020). Brain–gut–microbiome interactions in obesity and food addiction. Nature Reviews Gastroenterology & Hepatology. https://doi.org/10.1038/s41575-020-0341-5


Holland, G., & Tiggemann, M. (2017). “Strong beats skinny every time”: Disordered eating and compulsive exercise in women who post fitspiration on Instagram. International Journal of Eating Disorders, 50(1), 76–79. https://doi.org/10.1002/eat.22559


O’Dea, J. A., & Abraham, S. (2002). Eating and Exercise Disorders in Young College Men. Journal of American College Health, 50(6), 273–278. https://doi.org/10.1080/07448480209603445


Seitz, J., Trinh, S., & Herpertz-Dahlmann, B. (2019). The Microbiome and Eating Disorders. Psychiatric Clinics, 42(1), 93–103. https://doi.org/10.1016/j.psc.2018.10.004


Smith, A. R., Fink, E. L., Anestis, M. D., Ribeiro, J. D., Gordon, K. H., Davis, H., … Joiner, T. E. (2013). Exercise caution: Over-exercise is associated with suicidality among individuals with disordered eating. Psychiatry Research, 206(2), 246–255. https://doi.org/https://doi.org/10.1016/j.psychres.2012.11.004


Tanofsky-Kraff, M., & Yanovski, S. Z. (2004). Eating disorder or disordered eating? Non-normative eating patterns in obese individuals. Obesity Research. https://doi.org/10.1038/oby.2004.171


https://www.eatright.org/health/diseases-and-conditions/eating-disorders/what-is-disordered-eating

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© 2018 by Edin Sehovic