What happens when you eat too much or too little?

Ala Mokhtabad
Sep 6, 2021
6 min read

Eating disorders; types, symptoms, causes, complications, treatment

Theme: Health Issues and Diseases

Author: Sushmit Roddur

Editor: Anooshka Chiddarwar

Introduction

How does one know if they fulfill the demands of an ‘ideal’ body image laid by our society? Or which direction are they going, or has it already reached a stage of being an- eating disorder? A mirror is not enough to tell them. Our primary biological system requires an appropriate intake of nutrients for proper metabolism of various bodily functions carried out by our body. An imbalance of these nutrients, irrespective of it being excess or lack, causes eating disorders. These disorders give rise to many other psychological and physiological complications resulting in organ failure, and in worst cases even death!

What is an Eating disorder?

Eating disorders are severe psychological disorders marked by significant changes in eating habits and disturbing thoughts, feelings and emotions. They impact our body's ability to obtain adequate nutrition, thus resulting in health complications such as heart & renal difficulties and unfortunately even mortality!

According to American Psychiatric Association, the most common eating disorders that affect both genders include;

Anorexia Nervosa (AN): An eating disorder associated with severe weight loss, marked by extreme control over calorie intake.
Bulimia Nervosa (BN): Frequent over-eating in successful intervals with a sense of loss of control over eating.
Binge Eating Disorder (BED): Frequent phases of excessive overeating mostly because of psychological and social pressure.
Other Specified Feeding and Eating disorder(OSFED): Eating disorders or eating behavioral problems that cause distress and impede family, social, or occupational function but do not fall into any of the other categories listed below

Anorexia Nervosa

Anorexia nervosa (anorexia for short) is a severe eating disorder characterized by excessive food restriction and calorie intake, resulting in unhealthy low body weight. Stemming from fear of intense weight gain, according to “Anorexia & Bulimia Care,” the average age of onset of anorexia is around 16 - 17 years. Yet, the number of children affected progressed and has the highest mortality rate than any other psychiatric diagnosis other than opioid use disorder as per the “American Psychiatric Association.” Several complications may arise, such as mild anemia, muscle wasting, and weakness, thinning of the bones (osteoporosis), thin, brittle hair and nails, organ damage, heart problems, and in severe cases, death.

Symptoms of anorexia are usually:

Extreme weight loss,
Fatigue, insomnia,
Menstrual periods cease,
Dizziness or fainting from dehydration,
Stomach pain,
Poor memory and many more undetected symptoms.

Many speculations are going around in response to finding the etiology of the disease; however, multiple studies have shown that biological and psychological factors may have contributed to this disastrous disorder. Other evidence suggests that early childhood societal pressure and insistence on having the “perfect” body image and thinness is another important factor that may cause anorexia.

Treatment strategies are adapted to the needs of the person. It mainly involves helping the affected ones normalize their eating habits through newly found nutrition counseling, psychotherapy, support groups, and hospitalization in severe cases. For adolescents, support from parents and loved ones would be crucial to monitor their dietary needs. For any support or to report cases of anorexia or to seek professional help, check the website Anorexia & Bulimia care (Helpline in the website).

Bulimia Nervosa

Bulimia nervosa, or bulimia for short, is another potentially life-threatening eating disorder characterized by episodes of uncontrolled eating known as bingeing. It is then accompanied by compensatory behaviors such as purging - an unhealthy method of getting rid of extra calories, vomiting, a rigorous diet, excess laxatives (medicinal drugs that stimulate bowel movements), pills, or enemas. Patients with bulimia nervosa, like those with anorexia nervosa, are excessively preoccupied with perceptions of food, weight, or shape, which have a negative and disproportionate impact on their self-worth, and that seems to be its etiology.

According to "American Psychiatry Association," the symptoms include:

eating uncontrollably followed by purging,
chronic sore throat,
successive visits to the bathroom right after meals,
successive weight changes,
recurrent unexplained diarrhea,
suffering from fainting or dizziness spells,
engaging in repetitive, secretive, or antisocial behaviors related to food and many more.

Bulimia often results in lethal complications such as esophageal tears, gastric rupture, dangerous cardiac arrhythmias, or even PTSD due to trauma.

The treatment for bulimia nervosa is somewhat similar to those of anorexia, including nutritional groups, psychotherapy, support groups, and appropriate medications. "Cognitive Behavioral Therapy" is another very successful method of treating bulimia. Other than these, it is a must that the patient continues to follow a healthy lifestyle, avoiding excessive junk food, and consult a physician if required.

Binge Eating Disorder (BED)

Binge eating disorder is characterized by frequent out-of-control eating in a short period, often until the person feels uncomfortably full and is agitated by the binge behavior. Unlike anorexia or bulimia, it is often impossible to predict BED just by the appearance of the person, which is why it wasn't officially classified as an eating disorder until 2013, with the release of the fifth version of the American Psychiatric Association Diagnostic and Statistical Manual (DSM-5). The basic difference between bulimia and binge eating is that people with bulimia tend to compensate themselves by vomiting or other methods, but those with binge eating do not.

According to Mayo Clinic, though the etiology for BED could be genetics, biological factors, long-term dieting, and psychological issues, a reasonable cause is still to be found. However, some risk factors that include family history, strict dieting, and psychological problems may have contributed to BED.

The various symptoms include

evidence of binge eating,
chaotic, unpredictable eating patterns,
fear of eating in public,
a feeling of disgust, depression, or guilt after binging, eating when not physically hungry, and lots more.

BED treatment is similar to those for anorexia and bulimia, which includes cognitive behavioral therapy, interpersonal psychotherapy, dialectical behavior therapy, and antidepressant medications are some known treatments. In addition, constant love and care from close ones and consultation from the general practitioner is also very effective for curing BED.

Other Specified Feeding and Eating disorder(OSFED)

According to the DSM-5, to be diagnosed with OSFED, a person must exhibit symptoms comparable to other eating disorders but not satisfy the complete criteria of other conditions such as anorexia or bulimia. This does not indicate that it is not a severe illness but a serious one. There are several examples of OSFED, which includes

Atypical anorexia: It satisfies all the criteria for anorexia except the significant weight loss.
Binge Eating Disorder (of low frequency and/or limited duration): It meets all the criteria for BED except at a lower frequency.
Bulimia Nervosa (of low frequency and/or limited period): It satisfies all the criteria for bulimia except that binge eating and inappropriate compensatory behavior occurs at a lower frequency.
Purging Disorder: Repetitive purging behavior influencing weight or shape in the absence of binge eating.
Night Eating Syndrome: Frequent episodes of eating at night. Eating immediately after waking up or consuming an excessive a

mount of food after the evening meal.

Complications do arise with OSFED and must not be neglected and treatment should be sought immediately until it reaches the stage of a diagnosed eating disorder.

Other types of eating disorders, not listed:

Pica

Pica is an eating disorder where the person consumes items that contain no nutritional value for over a month. Such as paper, paint chips, soap, cloth, hair, string, chalk, metal, pebbles, charcoal, or coal. Pica may first occur in childhood, adolescence, or adulthood; however, early onset is the most prevalent.

The diagnosed patient may be at risk of potential intestinal blockages or toxic effects of substances consumed. Behavior interventions and nutritional testing deficiencies and addressing them is the best treatment in recent times.

Avoidant/restrictive food intake disorder (ARFID)

ARFID is a recently introduced eating disorder that entails a disruption in eating that results in the continuous failure to achieve nutritional needs and severe picky eating. ARFIC is similar to anorexia, but unlike anorexia, ARFID does not involve any torment on body shape or size, or level of fatness.

ARFID does cause significant weight loss and nutritional deficiencies in children due to a lack of interest in intake of food. Treatment for AFRID involves proper nutritious dieting and also may include several mental health professionals.

Rumination disorder

Rumination disorder is characterized by frequent regurgitation and re-chewing of food after eating, in which ingested food is voluntarily taken back up into the mouth and re-chewed, re-swallowed, or spit out. To clear the confusion between rumination and bulimia, rumination-based regurgitation happens within 10 minutes of eating a normal-sized meal and is involuntary, whereas bulimia is characterized by a cycle of binging and purging and is often purposeful.

Complications such as unhealthy weight loss, bad breath, malnutrition, and social isolation may arise due to this. Treatment may include behavioral therapy or medications and diaphragmatic breathing techniques to use after eating in order to avoid regurgitating their food.