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Anorexia Nervosa

Anorexia Nervosa is a condition where a person keeps their body weight as low as possible either by restricting the amount of food he/she eats, or making himself/herself vomit, and exercising excessively. Contradictory to Bulimia Nervosa, Anorexia nervosa is a syndrome of self-starvation involving significant weight loss of 15 percent or more of ideal body weight.

Usually, this condition develops due to anxiousness about body shape and weight.

People suffering from this condition, fear being fat or aspire to be thinner than everyone around. They tend to have a distorted image of themselves, by actually believing that they’re fat when they’re overly skinny. Anorexia most commonly affects girls and women.

There are two common types of anorexia, which are as follows:

  • Binge/Purge Type – In this type of anorexia, a person purges when he or she eats because of the overpowering feelings of guilt that he/she experiences in relation to eating. In order to compensate they choose either vomiting, abusing laxatives, or excessive exercising.
  • Restrictive – In this type of anorexia, a person severely limits the quantity of food consumed, typically eating a minimal amount that is well below their body’s caloric requirement. Basically he/she starves himself/herself.

Though two classifications of anorexia nervosa exist, both types display similar symptoms, such as irrational fear of weight gain and abnormal eating patterns.

Signs and symptoms

  • Prolonged dieting despite being disturbingly underweight
  • Obsession with calories and fat contents of food
  • Engaging in ritualistic eating patterns. for e.g. eating alone, and/or hiding food
  • Continuous obsession with food, recipes, or cooking
  • Irregularity in menstruation cycle
  • Depression or lethargic stage
  • Development of soft, fine hair on the face and body
  • Reported sensation of feeling cold, particularly in extremities
  • Hair loss
  • Social isolation

According to the DSM-5 criteria, to be diagnosed as having Anorexia Nervosa a person must display:

  • Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health).
  • Either an intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain (even though significantly low weight).
  • Disturbance in the way one's body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Bulimia Nervosa

People suffering from bulimia may secretly over-eat and then purge, with a view to get rid of the extra calories by adopting unhealthy behaviours such as forcefully vomiting or excessive exercise. Contradictory to anorexia patients, patients with bulimia nervosa are, by definition, at normal weight or above.

Bulimia nervosa, commonly called bulimia, is a dangerous and to an extent - life-threatening eating disorder.

Bulimia can be categorized in two ways:

  • Purging bulimia : In this case, a person habitually self-induces vomiting or misuses laxatives / diuretics after bingeing.
  • Nonpurging bulimia : In this case, a person makes use of unhealthy methods to get rid of calories and prevent weight gain, such as fasting, strict dieting or excessive exercise

However, it’s important to note that these behaviors are often connected to each other.

Signs and Symptoms:

  • Perpetual weight fluctuations
  • Electrolyte imbalances, which can result in cardiac arrhythmia, cardiac arrest, or ultimately death
  • Broken blood vessels within the eyes
  • Enlarged glands in the neck and under the jaw line
  • Oral trauma, such as lacerations in the lining of the mouth or throat from repetitive vomiting
  • Severe dehydration
  • Chronic gastric reflux after eating or peptic ulcers
  • Infertility
  • Disappearance of large amounts of food
  • Eating in secrecy
  • Lack of control when eating
  • Switching between periods of overeating and fasting
  • Frequent use of the bathroom after meals
  • Having the smell of vomit

According to the DSM-5 criteria, to be diagnosed as having Bulimia Nervosa a person must exhibit:

  • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
    • A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
  • Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
  • The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for three months.
  • Self-evaluation is excessively influenced by body shape and weight.

Binge Eating Disorder (BED)

Binge eating disorder (BED) is a severe, life-threatening condition in which a person consumes abnormal amounts of food, while experiencing a loss of control over one’s own behaviour. During an episode of this disorder, a person may eat despite no hunger at all. For example, he may continue eating long after being full as well.

He may also binge so fast that he may barely register what he’s eating or tasting. Contradictory to bulimia, there are no regular attempts to compensate for the binges through vomiting, fasting, or over-exercising.

One may initially start binging as a comforting, coping mechanism to deal with life. However, the eventual consequence of binge eating is mostly obesity. The negative feelings that usually accompany binge eating often lead him or her to continue to use food to cope; thus creating a vicious cycle.

Signs and symptoms:

  • Inability to stop eating or control what you’re eating
  • Rapidly eating large amounts of food
  • Eating even when you're full
  • Hiding or hoarding food to eat later in secret
  • Eating normally around others, but gobbling when you’re alone
  • Eating continuously throughout the day, with no planned mealtimes
  • Feeling stress or tension that is only relieved by eating
  • Embarrassment over how much you’re eating
  • Feeling numb while bingeing—like you’re a robotic machine who has no control over the ‘stop’ button.
  • Never feeling satisfied, no matter how much you eat
  • Feeling guilty, disgusted, or depressed after overeating
  • Desperation to control weight and eating habits

According to the DSM-5 criteria, to be diagnosed as having Binge Eating Disorder a person must display:

  • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
  • Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
  • The binge eating episodes are associated with three or more of the following:
    • Eating much more rapidly than normal
    • Eating until feeling uncomfortably full
    • Eating large amounts of food when not feeling physically hungry
    • Eating alone because of feeling embarrassed by how much one is eating
    • Feeling disgusted with oneself, depressed or very guilty afterward
  • Marked distress regarding binge eating is present
  • Binge eating occurs, on average, at least once a week for three months

Night Eating Syndrome (NES) And Sleep-Related Eating Disorder (SRED)

Also known as nocturnal eating syndrome (NES), this is a rare but debilitating eating disorder in which a person eats vast majority of calories in the late evening or throughout the night. NES is a serious eating disorder that has been linked with depression, stress, hormonal imbalances and abnormal sleep patterns. SRED is a condition in which a person eats while sleepwalking and is not aware of what he/she is doing.

Individuals with night eating syndrome (NES) often describe feelings such as lack of control over their eating behaviors, resulting in feelings of guilt and shame related to their condition.

Difference between NES and SRED (Sleep Related Eating Disorder)

SRED is a condition in which a person eats while sleepwalking, or while in a twilight state between sleep and being awake and is not aware of what he/she is doing. Whereas those with night eating syndrome are fully awake and aware of what they are consuming-with no memory deficits or lack of recall for their nightly eating rituals.

Signs and symptoms

  • The person has little or no appetite for breakfast. Delays first meal for several hours after waking up. Is not hungry or is upset about how much was eaten the night before.
  • Eats more food after dinner than during that meal.
  • Eats more than half of daily food intake during and after dinner. May leave the bed to snack at night.
  • This pattern has persisted for at least two months.
  • Person feels tense, anxious, upset, or guilty while eating.
  • NES is thought to be stress related and is often accompanied by depression. Especially at night the person may be moody, tense, anxious, nervous, agitated, etc.
  • Has trouble falling asleep or staying asleep. Wakes up frequently and then eats.
  • Foods ingested are often carbohydrates: sugary and starch.
  • Behavior is not like binge eating which is done in relatively short episodes. Night-eating syndrome involves continual eating throughout evening hours.

NES is included in the “Other Specified Feeding or Eating Disorder” category of the DSM-5.

According to the DSM-5 criteria, to be diagnosed as having OSFED a person must present with feeding or eating behaviours that cause clinically significant distress and impairment in areas of functioning, but do not meet the full criteria for any of the other feeding and eating disorders.

Orthorexia Nervosa

Orthorexia Nervosa is an eating disorder in which a person engages in obsessive behavior with a view to maintaining a healthy diet. They will fixate on eating foods that give them a feeling of being pure and healthy.

An orthorexic may avoid numerous foods, including those made with artificial colors, flavors or preservatives, pesticides or genetic modification, fat, sugar or salt, animal or dairy products and so on.

A person with orthorexia will be obsessed with defining and maintaining the perfect diet, rather than an ideal weight.

Orthorexia sufferers often display signs and symptoms of anxiety disorders that frequently co-occur with anorexia nervosa or other eating disorders.

Signs and Symptoms:

  • Emotional eating
  • Associating self-esteem to healthy food habits
  • Isolation from all the food groups with a view to maintain a clean or perfect diet
  • Severe anxiety regarding the preparation of food
  • Avoidance of social events involving food, immense fear of not being able to comply with diet
  • Thinking critically of others who do not follow strict diets
  • Spending undue amount of time and money in meal planning and food choices
  • Feelings of guilt or shame when unable to adhere to diet standards
  • Noticeable increase in consumption of supplements, herbal remedies or probiotics
  • Drastic reduction in opinions of acceptable food choices, such that the sufferer may eventually consume fewer than 10 foods
  • Feeling fulfilled or virtuous from eating “healthy” while losing interest in other activities once enjoyed
  • Avoiding meals cooked by others

Some other mental health conditions that can develop in an individual who is battling with orthorexia can include: Depression, Anxiety, Obsessive compulsive disorder.

Pica

Pica is an eating disorder in which, a person eats food items that are not typically thought of as food and are completely non-nutritive such as dirt or paper. These substances may contain poisons, toxic chemicals, or bacteria that can severely damage the gastrointestinal tract and many other medical problems.​

Pica got its name from the Latin word for magpie, a bird that eats just about anything.

People with pica may eat:

  • Paper
  • Soap
  • Cloth
  • Hair
  • String
  • Wool
  • Soil
  • Chalk
  • Talcum powder
  • Paint
  • Gum
  • Metal
  • Pebbles
  • Charcoal
  • Ash
  • Clay
  • Starch
  • Ice

Stating the obvious – Pica is an extremely dangerous and life-threatening disorder.

According to the DSM-5 criteria, to be diagnosed with Pica a person must display:

  • Persistent eating of non-nutritive substances for a period of at least one month.
  • The eating of non-nutritive substances is inapt to the developmental level of the individual.
  • The eating behaviour is not part of a culturally supported or socially normative practice.
  • If occurring in the presence of another mental disorder (e.g. autistic spectrum disorder), or during a medical condition (e.g. pregnancy), it is severe enough to warrant independent clinical attention.

Pica often co-occurs with other mental health disorders involving impaired functioning.

Physical findings of Pica may include the following:

  • Manifestations of toxic ingestion (eg, lead poisoning)
  • Manifestations of infection or parasitic infestation (eg, toxocariasis and ascariasis)
  • Gastrointestinal manifestations (eg, mechanical bowel problems, constipation, ulcerations, perforations, and intestinal obstructions)
  • Dental manifestations (eg, severe tooth abrasion, abfraction, and surface tooth loss)

Rumination

​A person suffering from rumination disorder repeatedly and unintentionally re-chews, re-swallows or spits out food. He/ she may not appear to make a deliberate effort for the same with no apparent signs of being stressed, upset or disgusted. The food is only partially digested, so he/she may find no difference in the taste of the food.

This food is brought up into the mouth without apparent nausea, retching, disgust, or associated gastrointestinal disorder. The food is then either evicted from the mouth or, more frequently, chewed and re-swallowed.

Rumination typically occurs every day, and at every meal, usually within 30 minutes of eating.

Symptoms of rumination disorder include:

  • Re-chewing, re-swallowing, spitting out
  • Weight loss
  • Bad breath
  • Tooth decay
  • Repeated stomachaches
  • Indigestion
  • Raw and chapped lips
  • Electrolyte imbalance
  • Dehydration

According to the DSM-5 criteria, to be diagnosed as having Rumination Disorder a person must display:

  • Repeated regurgitation of food for a period of at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out.
  • The repeated regurgitation is not due to a medication condition
  • The behaviour does not occur exclusively in the course of other eating disorders
  • If occurring in the presence of another mental disorder (e.g. intellectual developmental disorder), it is severe enough to warrant independent clinical attention.