Eating disorders

Eating disorders

Anorexia, Bulimia, Binge Eating

Eating disorders, also known as eating behavior disorders, refer to serious disturbances in eating behavior. The behavior is considered "abnormal" because it is different from usual eating practices but mainly because it has negative repercussions on the physical and mental health of the individual. ED affects many more women than men, and often starts in adolescence or early adulthood.

The most well-known eating disorders are anorexia and bulimia, but there are others. Like any mental health disorder, eating disorders are difficult to identify and categorize. The most recent version of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-V, released in 2014, proposes a revised definition and diagnostic criteria for eating disorders.

For example, binge eating, which is characterized by compulsively eating a disproportionate amount of food, is now recognized as a separate entity.
We currently distinguish, according to the DSM-V:

Symptoms of eating disorders

Eating disorders are very diverse and their manifestations are extremely varied. What they have in common: they are characterized by disturbed eating behavior and relationship to food, and have a potentially serious negative impact on human health.

1/ Anorexia Nervosa (restrictive type or associated with overeating)

Anorexia is the first Eating disorder to be described and recognized. We talk about anorexia nervosa, or nervous. It is characterized by an intense fear of being or of becoming fat, and therefore a strong desire to lose weight, excessive dietary restriction (going as far as a refusal to eat), and a deformity of the body. body image. It is a psychiatric disorder that mainly affects women (90%) and usually appears during adolescence. Anorexia is thought to affect 0.3% to 1% of young women.

It is characterized by:

Voluntary restriction of food and energy intake (or even refusal to eat) leading to excessive weight loss and resulting in a body mass index that is too low for age and gender.

Intense fear of gaining weight or becoming obese, even when thin.Distortion of body image (seeing yourself fat or fat when you are not), denial of the real weight and gravity of the situation.

In some cases, anorexia is associated with episodes of binge-eating, that is, disproportionate ingestion of food. The person then "purges" themselves to eliminate excess calories, such as throwing up or using laxatives or diuretics.

Malnutrition caused by anorexia can be responsible for many symptoms. In young women, periods usually go away below a certain weight (amenorrhea). Digestive disturbances (constipation), lethargy, fatigue or chilliness, cardiac arrhythmias, cognitive deficits and kidney dysfunction may occur. If left untreated, anorexia can lead to death.

2/ Bulimia Nervosa

Bulimia is an eating disorder characterized by excessive or compulsive consumption of food (binge eating) associated with purging behaviors (attempt to eliminate ingested food, most often by induced vomiting).

Bulimia mainly affects women (around 90% of cases). It is estimated that 1% to 3% of women suffer from bulimia in their lifetime (it can be isolated episodes).

It is characterized by:

recurring episodes of binge eating (swallowing large amounts of food in less than 2 hours, with the feeling of losing control) recurring "compensatory" episodes, intended to prevent weight gain (purging) these episodes occur at least once a week for 3 months.

Most of the time, people with bulimia are at normal weight and hide their "fits", which makes diagnosis difficult.

3/ Binge Eating Disorder

Binge eating or "compulsive" binge eating is similar to bulimia (a disproportionate absorption of food and a feeling of loss of control), but it is not accompanied by compensatory behaviors, such as vomiting or taking laxatives.

It is characterized by:
  • Eating too fast
  • Eating until you feel "too full"
  • Eating large amounts of food even when you are not hungry
  • Feeling of disgust, depression or guilt after the episode of binge eating

Overeating is associated with obesity in the vast majority of cases. The feeling of satiety is impaired or even nonexistent. Binge-eating disorders are believed to be the most common. During their lifetime, 3.5% of women and 2% of men would be affected.

4/ Selective Feeding

This new category of DSM-5, quite broad, includes selective eating disorders and / or avoidance (ARFID, for Avoidant / Restrictive Food Intake Disorder), which mainly affect children and adolescents. These disorders are characterized in particular by a very strong selectivity towards food: the child eats only certain foods, refuses them a lot (because of their texture, their color or their smell, for example). This selectivity has negative repercussions: weight loss, malnutrition, deficiencies. In childhood or adolescence, these eating disorders can interfere with development and growth.

These disorders are different from anorexia in that they are not associated with a desire to lose weight or a distorted body image.

Few data have been published on the subject and therefore little is known about the prevalence of these disorders. although they start in childhood, they can sometimes persist into adulthood.

In addition, pathological disgust or aversion to food, after a choking episode for example, can occur at any age, and would be classified in this category.

5/ Pica (ingestion of inedible substances)

Pica is a disorder characterized by the compulsive (or recurrent) ingestion of substances that are not food, such as soil (geophagy), stones, soap, chalk, paper, etc.

While all babies go through a normal phase in which they carry whatever they find in their mouths, this habit becomes pathological when it persists or recurs in older children (after 2 years).

While all babies go through a normal phase in which they carry whatever they find in their mouths, this habit becomes pathological when it persists or recurs in older children (after 2 years).

The prevalence is not known because the phenomenon is not systematically reported.

In some cases, pica would be associated with iron deficiency: the person would unconsciously seek to ingest non-food substances rich in iron, but this explanation remains controversial. Cases of pica during pregnancy (ingestion of earth or chalk) have also been reported, and the practice is even part of the traditions of some countries in Africa and South America (belief in the “nutritious” virtues of the earth.

6/ Merycism (phenomenon of "rumination", that is to say regurgitation and remastication)

Merycism is a rare eating disorder that results in the regurgitation and "rumination" (chewing) of previously ingested food.

This is not vomiting or gastroesophageal reflux, but voluntary regurgitation of partially digested food. Regurgitation is done effortlessly, without gastric cramps, unlike vomiting.

This syndrome occurs mostly in infants and young children, and sometimes in people with intellectual disabilities.

Some cases of rumination in adults without intellectual disability have been described, but the overall prevalence of this disorder is unknown.