Eating disorders are psychiatric illnesses characterised by severe and persistent disturbances in eating behaviour and disturbing thoughts and feelings related to this behaviour. Eating disorders can be so severe that they affect physical, psychological and social functioning. These disorders are divided into several types, including anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive feeding disorder (ARFID), other specific feeding and eating disorders (OSFED), pica and purging disorder.

Eating disorders can affect around 5% of the world's population and usually develop during adolescence and young adulthood. These disorders can occur in any age group and gender, although disorders such as anorexia nervosa and bulimia nervosa are more common in women. Eating disorders are often associated with obsessive thoughts about food, weight, body shape and anxiety about the consequences of consuming certain foods. These conditions can manifest themselves in behaviors such as overeating, avoiding certain foods, vomiting or purging with the use of laxatives. Over time, such behaviors can reach an addictive level.

Eating disorders are often associated with mental health problems. The most common comorbid psychiatric disorders include mood disorders, anxiety disorders, obsessive-compulsive disorder and alcohol and substance use disorders. There is evidence that these disorders are genetically and heritably linked to a higher risk of occurrence in individuals. However, eating disorders can also occur in people without a family history of such disorders. Treatment of eating disorders involves managing psychological, behavioral, nutritional and medical complications. Treatment can also cover long-term health problems, such as heart and digestive problems. Although there can be challenges such as ambivalence towards the treatment process, refusal of treatment or anxiety about changing eating habits, with the right medical intervention, individuals can regain healthy eating habits and improve their psychological health.

Types of Eating Disorders

Anorexia Nervosa

Anorexia nervosa is a psychiatric disorder characterized by a perception of one's own body as excessively thin and a fear of gaining weight based on this perception. The disorder often leads to health-threatening weight loss and has the highest patient mortality rate compared to any other psychiatric illness except opioid addiction. In anorexia nervosa, the body mass index (BMI) is usually below 18.5. Symptoms of this disorder include intense dieting, excessive exercise, and behaviors such as vomiting or using laxatives after eating.

Anorexia nervosa can be divided into two main subtypes:

• Restriction type: Individuals with this type lose weight through dieting, fasting or excessive exercise.
• Binge eating/purging type: These people occasionally binge eat and then resort to purging behaviors such as vomiting or using laxatives.

The physical and psychological effects of anorexia nervosa are far-reaching. The menstrual cycle can be interrupted by starvation, excessive exercise and malnutrition can lead to muscle loss, osteoporosis and heart rhythm disturbances. Depression, anxiety, irritability and concentration difficulties are also common psychological symptoms. If left untreated, this disorder can result in serious medical complications that can lead to heart problems, kidney problems or seizures.

Treatment of anorexia nervosa aims to help individuals regain healthy eating habits and normalize weight control behaviors. Treatment plans should include psychological and medical assessments and aim to overcome eating anxieties through nutrition education. Family supportive treatment can be particularly effective in adolescents and young adults. In severe cases of anorexia nervosa, patients may need to be referred to inpatient treatment programs if there is no response to treatment.

Eating disorders are serious psychiatric illnesses that affect a person's eating habits and body image. While these disorders carry great risks to physical health, their psychological aspects are also very complex. Eating disorders include anorexia nervosa, bulimia nervosa and binge eating disorder.

Bulimia Nervosa

Bulimia nervosa is an eating disorder characterized by episodes of binge eating followed by purging (vomiting). In bulimia nervosa, individuals often try to control the amount of calories they eat, just like in anorexia nervosa, with the desire to have a thin body. However, unlike anorexia nervosa, people with bulimia nervosa usually have a normal or slightly overweight body. After eating, they resort to behaviors such as vomiting, using laxatives or diuretics to counteract the caloric effects.

People with bulimia nervosa often secretly consume large amounts of food and these binge eating episodes are associated with a sense of loss of control. Food is eaten quickly, often beyond saturation, and the person overeats in a way that makes the stomach uncomfortable. These eating behaviors are often hidden and the person may feel ashamed. After overeating, various “compensatory behaviors” occur. These may include vomiting, fasting, excessive exercise or the use of laxatives to prevent weight gain.

The physical effects of bulimia nervosa can include:

• Persistent sore throat
• Erosion of oral tissues, erosion of tooth enamel
• Swelling of the salivary glands
• Heartburn and gastroesophageal reflux
• Health problems related to the use of laxatives or diuretics
• dehydration and fainting due to over-purification
• Life-threatening complications such as potentially dangerous heart rhythm disturbances, esophageal ruptures or stomach ruptures.

Cognitive behavioral therapy (CBT) is considered the most effective treatment for bulimia nervosa. This therapy helps patients normalize their eating habits and manage the thoughts and feelings that help perpetuate the disorder. Antidepressants (e.g. fluoxetine) can also be helpful in reducing urges to binge and purging. In addition, family-centered treatment can be especially helpful for younger patients. Treatment involves families receiving guidance to help patients normalize their eating patterns.

Binge Eating Disorder

Similar to bulimia nervosa, binge eating disorder is characterized by eating episodes in which individuals consume large amounts of food and lose control over what they eat. However, unlike bulimia nervosa, individuals with binge eating disorder do not engage in “compensatory behaviors” such as vomiting, fasting, exercising or using laxatives to compensate for the food they eat. As a result of binge eating episodes, this disorder can lead to serious health problems such as obesity, diabetes, hypertension and cardiovascular disease.

In order to be diagnosed with binge eating disorder, an individual must have at least one of the following three or more characteristics in which the individual is unable to control eating behaviors at least once a week for three months:

• Eating faster than usual
• Eating until full in a disturbing way
• Consuming large amounts of food without being hungry
• Eating alone with a sense of shame about what they eat
• Feeling disgusted, depressed or guilty after an eating episode

Cognitive behavioral therapy, either individual or group therapy, is the most effective treatment for binge eating disorder. In addition, interpersonal therapy and some antidepressant medications and lysodexamphetamine are among the methods that can help treatment.

Causes of Eating Disorders

No single specific cause of eating disorders has been identified. However, several biological, psychological, and social factors are thought to play a role in the development of these disorders.

Adolescence and psychological factors: The age of onset of anorexia nervosa usually coincides with adolescence. This is a time when physiological changes, body perception, and the search for identity are important. Therefore, difficulty in adjusting to the changes of adolescence may play an important role in the development of the disorder. Adolescents may have difficulty understanding their bodies and identities and may focus excessively on their appearance, which can lead to eating disorders.

Psychology of femininity: The fact that eating disorders are more common in women suggests that the psychology of femininity is effective in the development of these disorders. Societal notions of beauty, pressure on body image, and the importance placed on thinness are thought to increase the psychological stress that can lead to eating disorders in women.

Social changes: Social factors may be particularly influential in the development of disorders such as bulimia nervosa. Media and societal standards of beauty can cause individuals to develop negative thoughts about their bodies. Social environment, peer relationships, family dynamics, and social pressures also play an important role in the development of these disorders.