What is an Eating Disorder?
Deterioration in eating behavior, persistent weight control behaviors, impairment of physical and psychosocial functioning due to these reasons are defined as clinical manifestations with these symptoms and dysfunctions not secondary to a medical condition or psychiatric disorder.
General Features of Eating Disorders
It is not possible to explain the occurrence of diseases in this group with a single factor. It is mostly a disease of women. It is the psychiatric disease group in which medical complications are most common and severe. It is the psychological disorder with the highest mortality rates. In the personality traits of those with eating disorders; low self-esteem, feeling of powerlessness on the environment, being assertive and not expressing feelings and desires, and inability to express emotion (alexithymia). In the characteristics of the families of those with eating disorders; emotions and contradictions are not expressed and accepted openly, sexual matters are not discussed, individuality is not accepted, perfectionism is the only accepted behavior, and the family has strict rules. Eating disorders consume the person with obsessive and negative thoughts and behaviors, and the person’s relationships with family members, loved ones and life deteriorate. They avoid relationships because they think others will pressure them to feed. Symptoms related to an eating disorder are one way a person refuses to face problems.
What are the Subtypes of Eating Disorders?
Obesity; It is expressed as excessive body fat. Body weight is often used to determine obesity, since it takes a long time to determine the exact body fat ratio and is very costly.
Obesity is one of the biggest health problems. 54.9% of adults in the USA are overweight and 22.3% are obese. Studies have shown that obesity increases the risk of developing hypertension, type 2 diabetes mellitus, dyslipidemia, cardiovascular system diseases and certain types of cancer (colon, breast, gall bladder, endometrial cancers). The main psychological factors that cause obesity are;
- Close family relationships
- Social environment factor
- Eating in response to emotions such as stress, loneliness, helplessness, unhappiness, anger (emotional eating), depression, anxiety, night eating syndrome, binge eating disorder
- Besides the biological development of obesity, the major factor is childhood trauma. Conflicts in family dynamics or divorce stages reveal the binge eating behavior as a mechanism to counter sadness in pre-adolescence.
Among the many factors involved in the etiology of obesity, there are excessive energy intake, insufficient energy consumption, genetic predisposition, low fat oxidation, decreased sympathetic activity, stress, and low socioeconomic level. Approximately 25-30% of obese patients have depression or other psychological problems. Emotional tension is often associated with overeating. These people eat a lot in short periods of time and lose control while doing so.
In the treatment of obesity;
- Dietary regulation,
- Increasing physical activities,
- Surgical treatment (bariatric surgery)
- And their combined application is one of the most effective methods.
2. Anorexia Nervosa
In AN, the patient refuses to eat. There is extreme weight loss and weakness. Due to the deterioration in the body image, the person still perceives himself as fat.
AN contains 2 types:
1-Restricting type: Patients refuse to eat or eat too little to control their weight.
2-Eating – taking out type (Bulimic type): Beyond the restriction on eating, there is an effort to control calories through self-vomiting, using laxatives and diuretics.
Weight loss is slow at first slow, then it becomes rapid. Vomiting, laxative, diuretic, exercise are observed. Self-confidence due to weight, intensity of weight loss discipline, inability to lose weight due to self-control disorder, obsessional struggles with food (such as feeding others), avoiding eating with everyone and hyperactivity are observed. It is the disorder least associated with bariatric surgery, but there are rumors of being anorexic due to the inability to stop losing weight after bariatric surgery. It has not been conclusively proven by research.
Biological causes include family genetics, hormonal influences, and the neurotransmitter cycle in the brain. Among the psychological reasons, there are denial of sexuality, the search for autonomy in mother-child relationship, dysfunctional family relationships (dependency requirements of the family). Among the social reasons, social acceptances and cultural pressures (20th-21st century) cause the body obsession of the person.
Treatment of this disease is usually done by specialist doctors in the hospital and outpatient. The purpose of the treatment is to return the eating habits of the person to their old and healthy order and thus to eliminate the physical problems caused by the bad eating style in the body. In the psychological phase of this treatment, the main goals are to make the person love his / her own body and correct the wrong judgments related to his / her body and weight or eating habits. Cognitive behavioral therapy (CBT) methods have a great effect in the psychological phase of the treatment. Due to the various diseases caused by anorexia nervosa in the body, the person should use certain medications recommended by his doctor during the treatment. In some cases, the use of antidepressants is also recommended.
BN is manifested by binge eating behavior in the form of seizures. The patient is constantly in a mental struggle with the body image, and develops behaviors to compensate for excessive eating. For example, voluntary / involuntary vomiting, diuretic and laxative abuse, excessive bodily movements. Bulimia: Means Bous (Ox) + Limos (Hunger). Binge (binge eating) attacks can be seen twice a week for 3 months.
Bulimia Nervosa DSM-IV Diagnostic Criteria
The main symptoms are binge eating attacks, inappropriate balancing behavior (vomiting, laxative, diuretic, etc.), excessive weight and body work. Other symptoms include having recurrent episodes of binge eating, eating much more food than most people can eat in the same period of time.
Bulimia Nervosa Types
Taking out type: During a BN seizure, the person regularly displays self-induced vomiting or laxative, diuretic, or enema abuse.
Non-taking out type: During a BN seizure, the person demonstrates other inappropriate compensatory behaviors, such as strenuous exercises, but does not have regular self-induced vomiting or laxative, diuretic, or enema abuse.
The exact cause of bulimia nervosa is currently unknown; however, many factors are thought to contribute to the development of this eating disorder, including genetic, environmental, psychological, and cultural influences. These two different eating disorders, which are called obesity and bulimia nervosa, are actually two different aspects of the same mental problematic. Bulimia nervosa pattern can be seen in some patients who have undergone bariatric surgery. If this disorder is not treated, the person may experience weight gain again.
The treatment of bulimia nervosa is said to be long and difficult. Patients often refuse treatment because they feel that the specialists who treat him are trying to make him gain weight. However, the main purpose of the treatment is not to bring the patient to the ideal weight, but to return the person’s body to a healthy enough health and to give the person a new and appropriate eating habit. In the last 20 years, an effective treatment with Cognitive Behavioral Therapy has been applied in addition to drug therapy. Professional intervention alone is not sufficient in recovery, family and friends also play an important role in the recovery process. For this reason, family therapies are also effective. In addition to SSRI (selective serotonin reuptake inhibitor) type drug therapy, individual and group therapy, body therapy, social worker support, etc. interventions can be applied.
In the nutritional counseling phase, a dietician who is expert in eating disorders should be worked with. The patient’s cycle of binge eating and then removing it can be broken in this way. The patient should be tried to gain daily calorie intake and other healthy eating habits.
Orthorexia is the name given to the obsession with eating healthy food. “Ortho” means “correct” and “normal” in Greek. In other words, eating right can turn into an obsession and this situation can cause psychological problems for individuals. In the latest publications of the American Dietetic Association, it is said that this problem will become widespread within 10 years.
Are You Orthorexic?
Are you planning tomorrow’s meal today?
Is a healthy meal more important to you than delicious food?
Have you ever noticed that your health deteriorates as you eat sterile food?
Does the diet you made yesterday seem insufficient for you today?
Do you ever underestimate those who do not eat healthy?
Those who answer “Yes” to these questions may be in the orthorexic risk group. Orthorexia may occur in people who are obsessed with dietary culture after bariatric surgery. For this reason, internalizing the diet as a “healthy eating” scheme and adapting it to life in this way, making reward days in dietician follow-up after reaching the ideal weight will keep you away from being orthorexic.
5.Not Otherwise Specified Eating Disorders
Binge Eating Disorder
People with binge eating disorder lose control while eating. Unlike Bulimia Nervosa, it does not compensate for eating behavior (such as vomiting, exercising, fasting). At the same time, the embarrassment, guilt, and boredom caused by overeating cause them to go through the same eating cycle again. As a result, these patients usually weigh slightly above normal or much higher than normal. Obese people with binge eating disorder are particularly at risk of cardiovascular disease and high blood pressure. Most binge attacks are carried out in secret. Therefore, binge eating may be associated with feelings of guilt and shame. Binge eaters; It was determined that their parents had depression more often, they had a higher tendency towards obesity, they were more exposed to negative comments about their bodies, and they had a negative perfectionist nature.
- Having binge eating attacks and repeating the following together during this time:
- Eating much more food than any individual can eat under similar conditions and time periods, in a short period of time (for example, every 2 hours),
- Feeling of loss of control during an attack (for example, inability to stop eating or how much),
- Binge eating episodes should include at least 3 of the following:
- Eating much faster than usual
- Eating until you feel uncomfortably full,
- Eating excessively despite not feeling physically hungry,
- Feeling ashamed of seeing the amount of food you eat and therefore not be able to eat alone.
- Feeling depressed or guilty after eating
- Binge eating attacks at least once a week for 3 months,
- Having compensatory behaviors (such as vomiting, using laxatives, enema) after a binge eating attack
Binge eating disorder is the most common eating disorder in obese individuals. Depression, alcohol dependence and impulse control disorder are also more likely to occur in these patients. Psychotherapy plays a major role in the treatment of this disorder. The most effective therapy method is Cognitive Behavioral Therapy. If drug therapy is administered, accompanying psychological disorders (such as depression, anxiety, impulse control disorder) should also be treated. This disorder, which is quite common in bariatric surgery patients, should be treated by a psychologist in order not to recur during the postoperative diet process.
b) Emotional Eating
Emotional eating can be defined as trying to cope with many negative emotions such as anger, sadness, and shame by eating. Due to the sense of relief it temporarily gives, the individual may feel that they are moving away from the emotions they are trying to escape. However, eating when the hunger is not felt causes the stomach to expand and the calories consumed in daily meals to increase. This leads to a serious weight problem and the risk of losing the individual’s self-esteem.
In emotional eating behavior, individuals’ interpretation of daily events and their basic needs such as being loved and feeling valued in the past have a great role. According to Erickson, as a result of meeting the needs such as being loved, valued and approved in childhood, the human mind stores these experiences as resources that can be used later and chooses functional solutions against negative life events. People deprived of such emotional food sources may choose to eat to cope with adverse events. This can also be interpreted as an effort to fill the emotional void one feels. Other studies on this subject show that emotional eating can become a habit as a result of learning. Repeating the eating habits of the family environment where learning occurs most is an example.
In psychotherapy studies that directly target emotional eating, therapy currents are used to increase our awareness of our body and emotions. For example, in a therapy study based on Gestalt principles, there are many exercises to distinguish the taste and smell of what we eat, how hungry our stomach feels, and the feelings that accompany the moment. Apart from this, Mindfullness Based therapy techniques also play a big role in eating awareness. Cognitive Behavioral Therapies also help us understand the relationship between our thoughts, emotions and behaviors. After bariatric surgery, a therapist working with the CBT method can provide a healthy diet process and permanent weight loss by counseling the patient on the issues of recognizing the emotions of the patient, expressing them as required, finding constructive solutions to their problems.
c) Night Eating Syndrome
People with night eating syndrome experience sleep interruptions accompanied by waking up full in the morning, delaying the first meal for a few hours after waking up, overeating in the evening, and night food intake. Night eating syndrome is seen when at least 50 percent of the daily calories are taken with snacks after dinner, waking up at least once a week for three nights, and then having high-calorie snacks for at least three months. Emotional states such as guilt, distress, tension, pessimism and irritability can be seen in people with this condition after eating.
- Sleep disorders
- Psychological problems (depression or high anxiety)
- Hormonal reasons (Person is hungry due to imbalances in blood sugar.)
- In addition to night eating syndrome, there is also a “binge eating disorder”, which is very common in recent years.
In this syndrome, which is quite common in bariatric surgery patients, although hormonal problems are treated with endocrinologists, compliance with sleep hygiene rules or sleep disorders are solved with sleep medications, psychologist and dietitian support should be absolutely necessary.
- During night eating syndrome, the goal should be to balance the diet plan during the day.
- Try to stay away from stress factors that cause nighttime eating. Afterwards, foods that cause excessive eating should be removed from the table and, if possible, should not be kept at home.
- High sugar and fatty foods are generally preferred during night eating syndrome. These foods are low in volume and high in calories. For this reason, dietician counseling control is very important in the treatment phase.
- Exercising regulates the whole biorhythm of man. By balancing the appetite metabolism, problems such as anorexia or increased appetite more than once are prevented, and emotional eating attacks are reduced. Since exercise also releases the hormone of happiness (serotonin), it makes the person more positive and can protect against such syndromes.
- If there is a psychological (depression, anxiety) eating syndrome at night, psychological counseling should definitely be obtained.