What are these disorders?
Eating disorders are characterized by persistent and pervasive disruptions in attitudes and behaviours related to body image, weight and food. Individuals living with these disorders feel their effects in every area of their lives, sometimes with irreversible health consequences.
Eating disorders are often associated with industrialized societies that encourage an obsession with thinness. But these disorders are caused by a combination of biological, psychological, social and environmental factors. They are therefore present in different cultures—including ones with diverse standards of beauty—especially when it comes to anorexia nervosa. Eating disorders usually manifest in adolescence or early adulthood. Although difficult to understand, these eating behaviours are a sign of significant distress and discomfort that must be addressed.
Currently, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes three commonly diagnosed eating disorders in adolescents and adults: anorexia nervosa, bulimia nervosa and hyperphagia. Each of these disorders may have different clinical presentations and symptoms. Other eating disorders are still being studied and are not yet included in the DSM-5.
Anorexia nervosa is characterized by severe dietary restriction that, over time, leads to significant and potentially life-threatening weight loss. People with anorexia nervosa engage in two types of dietary strategies: restrictive and/or purgative.
- Restrictive strategies are the most common. A person may restrict their food intake or refuse to eat, eliminating several foods from their diet and limiting the number of calories they ingest.
- Purgative strategies include the taking of laxatives, engaging in excessive amounts of exercise and forcing oneself to vomit.
These behaviours lead to a state of extreme thinness that cannot be perceived by those living with the disorder. Because of their distorted body image and impaired cognition, individuals with anorexia nervosa do not recognize their thinness and continue to obsess over their body. This obsession with weight and body image contributes to the persistence of anorexia nervosa and is the source of great distress.
Hyperphagia (binge eating) is characterized by repeated episodes of excessive food consumption beyond what the body requires. It differs from bulimia in that people with hyperphagia do not engage in compensatory behaviours to eliminate ingested calories. Binge eating episodes generate feelings of shame, guilt, loss of control and disgust. Individuals living with hyperphagia are usually overweight or obese. In addition, between 40% and 50% of people living with hyperphagia are men.
Bulimia nervosais characterized by episodes of abusive, excessive and rapid food consumption followed by episodes of restrictive and purgative compensatory behaviours. Compensatory behaviours seek to eliminate ingested calories (i.e., restricted eating, forced vomiting, exercise, laxatives, etc.). The activities that characterize bulimia are often conducted in secret, generating shame and guilt that lead to compensatory behaviours later on. Individuals living with bulimia nervosa are usually of normal weight or overweight.
Another eating disorder that is currently being studied is orthorexia. This disorder is characterized by an obsession with healthy eating and the complete avoidance of unhealthy foods (i.e., foods containing chemicals, sugar or fat). A person with orthorexia will spend a significant amount of time thinking about food, reading labels or planning meals. Unlike other eating disorders, this one has more to do with the quality of food than the quantity.
How do these disorders impact loved ones?
It’s not always clear whether a loved one is developing an eating disorder. Because these disorders most often appear during adolescence, at this transitional age it is often very difficult for family members to distinguish normal shifts in eating habits from abnormal changes. Mealtime can often become a source of tension and conflict when a loved one is living with an eating disorder. In the early stages of the disease, a person will often remain in denial and will refuse to acknowledge that they have a food or body image problem. Their relatives, friends or spouses will frequently experience anxiety and feel powerless to help.
Although we now know that eating disorders are caused by a multitude of physiological, biological, psychological and family-related factors, it was long believed that overly strict parents were the cause of this disease. Family members and family dynamics are often wrongly blamed, even today.
It’s important to understand that family issues are only one of many contributing factors. Family members often suffer from deep yet unjustified guilt.
What about seniors?
Eating disorders are often perceived as affecting only young white people in industrialized countries. Symptoms of an eating disorder in seniors often go unnoticed by family members or doctors. However, these disorders have an enormous impact on almost every system in the body, and in older people, these systems are naturally less resilient. Eating disorders can therefore affect the health of seniors more quickly, more seriously and irreversibly.
Here are some signs of eating disorders in older adults:
- Changes to behaviour around mealtimes, such as using the bathroom right after eating
- Increased sensitivity to cold
- Loss of hair, the onset of gastrointestinal problems or dental problems
- The desire to eat alone rather than with friends or family members
Everyone living with an eating disorder deserves access to proper treatment, no matter how old they are. Remission is possible at any age!