“Eating disorder” is a rather confusing phrase in that it is a blanket term for a complicated and wide range of illnesses. All eating disorders are different in etiology, physiology and behavioral aspects although on a surface level they can look similar and be easily misinterpreted.
Eating disorder can refer to : Anorexia, Bulimia, ARFID, EDNOS, binge eating and emotional eating, plus all the subsets and places in-between. They are all serious, and they can all be treated.
All eating disorders are very different, as people are different and therefore should be treated as individual cases
Eating disorders are not chosen, they are serious medical conditions and should be treated as such.
In the United States, 20 million women and 10 million men suffer from a clinically significant eating disorder at some time in their life (Wade, Keski-Rahkonen, & Hudson, 2011). Many cases are likely not to be reported. The prevalence rate therefore is suspiciously much lower than what the actual affect is on the general population. Eating disorders cross cultural boarders and effect all ages, although are predominantly identified in teens and young adults. However due to the long term psychological and behavioral effects, many sufferers continue to suffer well into later life and old age. There is also a growing rate of young children getting diagnosed.
Anorexia Nervosa has many health risks if it remains untreated, it can result in death. A review of nearly fifty years of research confirms that anorexia nervosa has the highest mortality rate of any psychiatric disorder (Arcelus, Mitchell, Wales, & Nielsen, 2011).
For females between fifteen to twenty-four years old who suffer from anorexia nervosa, the mortality rate associated with the illness is twelve times higher than the death rate of all other causes of death (Sullivan, 1995).
In Medieval Europe, girls who fasted or refused to eat were labeled with the term “anorexia mirabilis”; these girls were seen as miracles, able to survive on spiritual devotion alone. (Later, some would suggest that these women were possessed by demons.) During the Victorian Era, people would pilgrimage to these fasting girls and leave offerings. A famous fasting girl could be a financial boon to a struggling family.
Anorexia is not a ‘new’ disease. The first medical description of anorexia nervosa was written up by Richard Morton in 1689 in a paper where he referred to it as a ‘wasting condition’ . Sir WIlliam Gull coined the term Anorexia Nervosa much later in 1868. There have been reports of Anorexia in the Hellenistic period, that is the period of ancient Greek and mediterranean history between the death of Alexander the Great in 323 BC and the emergence of the Roman Empire in 31 BC. Holy anorexics abused their bodies, rejected marriage and sought religious asylum where many perished and apparently became saints.
Anorexia is not caused by parents, external influences alone or a “will to be thin”
Clinical Classifications
The DSM-V (Diagnostic and Statistical Manual, volume 5) provides guidelines and criteria for mental disorders. In terms of eating disorders the DSM V provides diagnostic criteria for anorexia, bulimia and various disordered eating behaviors. It is important to remember that someone can still have an eating disorder or body image issues and not meet the diagnostic criteria. See here for an additional note on the difference between anorexia and bulimia.
Anorexia Nervosa (DSM)
- A refusal to maintain body weight at or above a minimally normal weight for age and height (e.g. weight loss leading to a maintenance of body weight less than 85% of that expected, or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
B. Intense fear of gaining weight or becoming fat, even though underweight.
C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
D. In postmenarcheal females, amenorrhea, i.e. the absence of at least three or more consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g. estrogen, administration).
Specify type:
Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e. self-induced vomiting or the misuse of laxatives, diuretics or enemas)
Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior (i.e. self induced vomiting or the misuse of laxatives, diuretics or enemas). This was my subtype – it looked like 6 hours of exercise per day and an inability to be still.
Bulimia Nervosa (DSM)
A. 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), and 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)
B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas or other medications; fasting; or excessive exercise.
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.
- Self-evaluation is unduly influenced by body shape and weight.
D. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
Specify type:
Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics or enemas.
Non-purging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics or enemas.
Eating Disorder Not Otherwise Specified (EDNOS)
The Eating Disorder Not Otherwise Specified category is for disorders of eating that do not meet the criteria for any specific Eating Disorder. It has more recently been removed from the DSM 5 and replaced by more specific outlines but is still often referred to .
Examples include:
1 For females, all the criteria for Anorexia Nervosa are met except that the individual has regular menses.
2 All the criteria for Anorexia Nervosa are met except that, despite significant weight loss, the individual’s current weight is in the normal range.
3 All the criteria for Bulimia Nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for a duration of less than 3 months.
4 The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (e.g. self-induced vomiting after the consumption of two biscuits.
5 Repeatedly chewing and spitting out, but not swallowing, large amounts of food.
6 Binge-eating disorder: recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of Bulimia Nervosa.