Eating disorders

Eating disorders fall under the category of mental health. These disorders are related to problems with eating. The patients might be eating too much or too little, depending on the type of disorder. There are a few eating disorders, each with different diagnostic criteria and signs and symptoms. These disorders might be co-existing with other mental disorders like anxiety, depression, substance abuse, etc. These patients have distorted ideas of body imaging and uncontrolled eating habits that are harmful to the extent of endangering life. These are more commonly found in young individuals.

A combination of genetic and environmental factors is thought to be responsible for the disease, although the exact cause is still unclear. A person is more likely to have a condition if they have some other mental illness or a family member with the disease. The environmental factors can trigger changes in chemical composition in the brain. They may include childhood abuse, strictness from parents regarding weight control, inability to cope with harsh behaviors, perfectionism in the personality, inability to continue relationships, etc.

There are 5 common types; the first two being the most common:

• Anorexia nervosa
• Bulimia nervosa 
• Binge-eating disorder
• Rumination disorder 
• Avoidant/restrictive food intake disorder

Anorexia nervosa: The patients with this condition have a very strict principle of ideal weight in their mind and avoid eating due to an intense fear of gaining weight. They might be involved in excessive exercise, use of laxatives, or purging habits by putting their fingers to irritate the back of the throat to throw out whatever they have eaten. Eating fewer calories results in deficiencies of vital nutrients that are needed for the body to perform important functions resulting in life-threatening consequences. Patients have a very low weight. 

Bulimia nervosa: In this disease, patients have an uncontrolled urge to eat more than the average person would eat, which is followed by feelings of guilt and then adopting habits that can help in losing weight like purging, excessive exercise, using laxatives. These episodes are recurrent, and the patient may be of normal weight or overweight. 

Binge-eating disorder: in this disorder, patients have episodes of binge eating, they eat more than they need, even when they are full, which is followed by a feeling of embarrassment, but they don’t try the methods to revert it used by the above two categories. Instead, they hide when they eat so that people won't know about their bingeing. Patients may be of normal weight or obese. 

Rumination disorder: in this disorder, there is unintentional regurgitation of food that is not associated with gagging or nausea, and the regurgitated food can be chewed and swallowed back again or spit out. It usually occurs in infancy or mentally disabled people. 

Avoidant/restrictive food intake disorder: In this disorder, the patients avoid food, not because of the fear of gaining weight but due to strange aversions to the texture, smell, or consistency of food or unexplained fears of choking resulting in serious nutrient deficiencies and undesired weight loss. 

You are at an increased risk of getting eating disorders if you have one or more of the following risk factors;

• Suffering from any other mental condition like anxiety, depression, substance abuse
• Being abused in the childhood
• Having a family member with the same illness
• Living in an environment with strict dieting and weight loss habits 
• Stress
• Female gender and low self-esteem
• Having a perfectionist Personality disorder 
• Being in unsupportive surroundings where you are unable to share negative emotions or solve conflicts

Eating disorders are found all over the world. These disorders are prevalent more in developed countries, White Americans, young age groups, and women. They are found more in the particular groups of people interested in weight gain or loss like models, actors, skaters, bodybuilders, athletes, flight attendants, etc. In the USA, 0.3- 1 % of women and 0.1-0.3% of men are affected with anorexia nervosa. Bulimia nervosa affects 1% of the people of the USA. The prevalence of binge eating is 2.3%-3.1% in females and 0.3%-1% in males aged 16 and 24.

A combination of genetic and environmental factors is thought to be responsible for the disease, although the exact cause is still unclear. A person is more likely to have a condition if they have some other mental illness or a family member with the disease. The environmental factors can trigger changes in chemical composition in the brain. They may include childhood abuse, strictness from parents regarding weight control, inability to cope with harsh behaviors, perfectionism in the personality, inability to continue relationships, etc.

Eating disorders result in the deficiency of essential food nutrients, so most symptoms result from those deficiencies. For example;

• Drying of skin
• Thinning of body hair
• Shrinking of the breasts
• Swelling of the parotid and submandibular gland
• Peripheral edema
• Purging induces callouses on the dorsum of the hands
• Dental problems like enamel erosion
• Muscle mass loss
• Low blood pressure
• Decreased or increased heart rate
• Decreased body temperature
• Menstrual irregularities
• Abdominal bloating, pain, blood in vomitus
• Edema

Eating disorder is a clinical diagnosis. A detailed history and physical examination along with mental health evaluation are crucial. There are no specific tests related to the condition; however, the following investigations should be performed to manage the disease efficiently due to its effects on all organ systems. 

• Blood tests: Complete blood count (CBC), electrolyte, renal profile, lipid profile, calcium, magnesium, liver function tests, pregnancy test in females.
• Urinalysis, urine toxicology screening
• ECG to exclude the complications on the heart.
• DEXA scan to find out the bone condition and osteomalacia 

Due to its multi-organ presentation, many diseases can mimic the symptoms of eating disorders that must be ruled out, for example;

• Celiac Disease 
• Achalasia
• Hypothyroidism
• Irritable Bowel Syndrome (IBS)
• Malabsorption
• Protein-Losing Enteropathy
• Obesity
• Obsessive-Compulsive Disorder
• Gastric Outlet Obstruction

The treatment of this disorder is multidisciplinary. It is based on the following principles;

• Treating the emergency symptoms 
• Replacement of deficient nutritions
• Psychological treatment, especially cognitive behavioral therapy, changes the perception of body weight and feeding habits. Interpersonal psychotherapy and Family therapy are also effective.
• Medicines include antidepressants like SSRI’s (fluoxetine, Sertraline), SNRI’s, TCAs, etc

The treatment of the eating disorder is difficult. Difficulties are faced with keeping patients adherent to the treatment. Only 50% of the patients are cured completely. 20% of the patients remain emaciated and thin. Many die of suicide, the remaining die of the complications of the disease.