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Anorexia, ARFID, Binge Eating & Other Eating Disorders Types







Quick Summary


  • Eating disorders or eating behavior disorders (EDs) are behavioral conditions characterized by severe and persistent disturbances in eating behaviors, associated with distressing thoughts and emotions. They include anorexia nervosa, bulimia nervosa, BED, ARFID, pica, rumination disorder, and OSFED.


  • Eating disorders have serious implications for the physical and mental health of those affected, with most consequences falling on the cardiovascular, gastrointestinal, nervous, and endocrine systems.


  • Statistics on EDs are alarming as, in Italy, they represent the leading cause of death among teenagers after road accidents and are continuously increasing worldwide.




A boy suffering from anorexia, an eating disorder, is struggling eating food.

What is Eating Disorders Awareness Week?


EDAW stands for "Eating Disorders Awareness Week", a globally recognized acronym. It is an entire week promoted internationally and occurs every year starting from the last Monday of February: for 2024, EDAW will run from February 26 to March 3, 2024 (NEDA).


The goal of this event is to raise awareness about eating disorders, or eating behavior disorders (EDs), promote understanding, disseminate information, and support those affected by these conditions. The occasion emphasizes the importance of early intervention, access to treatment, and the attempt to reduce the percentages of individuals associated with eating disorders.



Behind the Appearances: An In-Depth Analysis of What Eating Disorders Are


Eating disorders are behavioral conditions characterized by severe and persistent disturbances in eating behaviors, associated with distressing thoughts and emotions (American Psychiatric Association, 2023).


But what are the main EDs? There are several types, including:


  • Anorexia nervosa: an eating disorder defined by the restriction of energy intake relative to requirements; this leads to significant weight loss and is due to patients having an obsessive fear of gaining weight and a self-image so distorted they are unable to recognize the severity of their excessive thinning (Moore et al., 2023). Anorexia nervosa is more common in women than in men and primarily affects very young girls, in late adolescence and early adulthood. To understand the frequency of a disease as a "state," in medicine, the concept of "prevalence" is used, i.e., "the proportion of a population affected by the disease at a given moment" (University of Verona). Regarding anorexia, regardless of cultural and ethnic factors, the prevalence of people who have experienced this disorder at least once in their lives reaches up to 3.6% in women and 0.3% in men. These figures tend to increase in Western countries simply because more studies are conducted there (Van Eeden et al., 2021). Anorexia has one of the highest mortality rates among all EDs due to medical complications, substance abuse, and suicide. Among patients with anorexia nervosa, there is an increased rate of suicide, which accounts for 25% of associated deaths (Moore et al., 2023).


  • Bulimia nervosa: is an eating disorder characterized by binge eating, during which people consume larger portions of food than most individuals. This is followed by inappropriate compensatory behaviors to prevent weight gain (self-induced vomiting, laxative abuse, use of diuretics, extreme physical activity, fasting) (Jain et al., 2023).. Bulimia nervosa can affect both sexes but is disproportionately prevalent among women. Between 2000 and 2018, the one-time prevalence rates of bulimia nervosa reached 4.6% in women and 1.3% in men (Galmiche et al., 2019).



A sad woman is struggling receiving support for bulimia, an eating disorder.


  • Binge-Eating Disorder (BED): is an eating disorder characterized by episodes of consuming larger amounts of food than normal in a short period. General medical disorders, such as obesity, diabetes, hypertension, and chronic pain, are some of its comorbid conditions. BED is most commonly manifested in obese individuals but not exclusively. The most evident symptom of people with binge-eating disorder is weight gain (Iqbal et al., 2022). Binge-eating disorder is more common in women than in men and usually manifests around the age of 23. The prevalence of people who have experienced this eating disorder at least once in their lifetime in the United States is 2.6%. About 79% of people with binge-eating disorder suffer from a psychiatric disorder; 49% of people have a history of two or more comorbid disorders (Kessler et al., 2013). In 2016, in the United States, there were 2.8 million people affected by BED, of which 3.5% were women, 2% men, and 1.6% adolescents (Healthline, 2016).


NOTE: BED and obesity should not be used synonymously because they are not the same thing! BED falls under psychiatric illnesses; obesity, on the other hand, is a physical condition defined by a high body mass index. Obesity and BED have high rates of comorbidity, with over half of the individuals affected by BED also meeting the criteria for overweight and obesity. Obesity can be a direct consequence of BED, but not necessarily every obese person has BED (Boswell et al., 2020).


  • Avoidant / Restrictive Food Intake Disorder (ARFID): The Avoidant / Restrictive Food Intake Disorder was only introduced among Eating Disorders in 2013 (Seetharaman et al., 2021). ARFID is a selective eating disorder, characterized by limitations in the quantity and type of food: patients believe that only certain foods are okay to eat, avoid foods with certain colors, flavors, textures, or smells, refuse to eat because they are convinced something bad might happen, like choking or vomiting (WebMD, 2023). Eating disorders of ARFID can lead to a decrease in the variety/volume of food intake, causing a persistent failure to meet adequate energy/nutritional needs and/or psychosocial deterioration. ARFID can be diagnosed at any age. Although it seems to manifest more often in childhood, adults can also suffer from ARFID, and this is more likely among those who have had ARFID or other EDs since childhood. The prevalence of ARFID in the general population is still partly uncertain but is probably between 1% and 5%. Moreover, the comorbidity with anxiety disorders in people with ARFID is very high: about 35-72% have a diagnosis of anxiety disorders (Gillberg Neuropsychiatry Centre, 2023). 


NOTE: ARFID and anorexia nervosa should not be confused! Both are indeed EDs related to the limitation of the food we ingest, but the reasons are different. People with anorexia are concerned about their image, shape, or size of their body, as they have such a distorted image of themselves that it triggers in them the desire to change their appearance. On the contrary, although ARFID can lead to weight loss, people with this disorder are not trying to lose weight: this happens because they are convinced that by avoiding specific foods (especially new ones), they do not run the risk of choking, being poisoned, or dying (WebMD, 2023).


  • Pica: is an eating disorder characterized by the consumption of non-nutritive and non-food substances. The nature of the ingested objects varies and includes soil (geophagia), raw starches (amylophagia), ice (pagophagia), coal, ash, paper, chalk, fabric, talcum powder, coffee grounds, and eggshells. Although pica is found in children, it is also common in patients with intellectual deficits. In some parts of the world, the consumption of non-nutritive substances is culturally accepted. Pica usually presents as an isolated disorder, but there are cases where it can coexist with schizophrenia, obsessive-compulsive disorder, and trichotillomania (Al Nasser et al., 2023). A range of reasons makes it difficult to estimate the exact prevalence of pica (first and foremost, the cultural factor). The prevalence is between 4% and 26% (WebMD, 2023) and, in the United States alone, this ED seems to mostly affect:

    • pregnant women: between 27.8% and 68%;

    • young children: 18.5% is present in children, of which 50% are aged between 18 and 36 months and 10% are older than 12 years;

    • people with mental health issues: about 10% (The Recovery Village, 2023).


  • Rumination disorder: is an eating disorder characterized by the regurgitation, usually voluntary, of food after eating (MSD, 2020). A percentage between 6% and 10% of people institutionalized with severe or profound mental retardation presents this type of ED. This syndrome represents the main cause of death for a percentage between 5% and 10% of ruminating patients (Fredericks et al., 2000).


  • Other Specified Feeding and Eating Disorders (OSFED): are a clinical category used to describe a variety of disordered eating behaviors that do not meet all the diagnostic criteria for a specific ED. OSFED affects up to 6% of the population, and has a mortality rate of 5.2%. Nearly half of OSFED patients have a mood disorder in comorbidity; as well as one in ten OSFED patients has a comorbidity with substance abuse disorder, mainly alcohol (Eating Recovery Center).




A teenager is crying against a wall, suffering from bulimia, an eating disorder.


Beneath the Surface: What Are the Consequences of EDs on Body and Mind?


First and foremost, it's crucial to emphasize that eating disorders cannot and must not be underestimated: they are serious and dangerous disorders that can become life-threatening for individuals. They are neither a temporary "crisis" nor a whim. They are something much more insidious, lurking in the depths of the subconscious, typically affecting people experiencing particular psychological conditions. Eating disorders can have potentially fatal repercussions on the body, in terms of weight and energy needs. Therefore, this issue cannot be trivialized with a simple "They don't know how to eat properly"!


What exactly are the consequences of EDs, and how dangerous can they be for those suffering from them? The consequences of eating disorders are numerous and can affect (NEDA):


  • The cardiovascular system: Insufficient calorie intake damages muscles, the most important of which is the heart. Pulse and blood pressure decrease, increasing the risk of heart failure. Elimination through vomiting or the use of laxatives can deplete the body of crucial nutrients, such as potassium, essential for heart rhythm.


  • The gastrointestinal system: Dietary restriction and/or elimination through vomiting interfere with the natural "emptying" of the stomach and the digestion of nutrients, causing gastroparesis, a slowed digestion. This can lead to various symptoms and complications, including stomach pain, bloating, nausea, vomiting, blood sugar fluctuations, intestines blocked by undigested food, bacterial infections, and feeling full after eating only small amounts of food. Constipation can also result from insufficient nutritional intake, weakening of intestinal muscles, or improper use of laxatives. Binge eating can cause dangerous emergencies like stomach rupture, while frequent vomiting can damage the esophagus and cause problems like sore throat, hoarse voice, and ulcers. More severe issues can include intestinal obstructions, perforations, infections, and heavy metal poisoning, as well as pancreatitis and liver inflammation.


  • The nervous system: Although the brain only accounts for a small percentage of total body mass, it consumes up to a fifth of the body's calories. Dieting, fasting, or starvation can deprive the brain of the necessary energy, leading to an obsession with food and difficulty concentrating. Extreme hunger or feeling full before sleeping can cause sleep problems. Neurons require fats, and insufficient intake can cause numbness and tingling in the extremities of our body (e.g., hands and feet), as well as seizures and muscle cramps. If blood flow to the brain is insufficient, fainting or dizziness can occur, especially when standing up.


  • The endocrine system: A lack of fats and calories in the diet can harm the production of essential hormones, including sex hormones, thyroid hormones, and insulin. A decrease in sex hormones can cause menstrual irregularities, bone loss, and reduced sexual desire. Binge eating episodes over time can increase the risk of insulin resistance and type 2 diabetes. A lack of energy can lower the internal body temperature, leading to hypothermia. Hunger can also be responsible for high cholesterol levels: in this case, limiting fats in the diet is not the solution and could even worsen the situation.


Additionally, there are consequences such as dry skin, hair fragility and loss, kidney failure, a reduction in the number of certain types of blood cells, anemia, fatigue, weakness, and shortness of breath.


A Look at the Numbers: The Global Alarm of EDs


The prevalence of eating disorders was estimated at 1.66% in the United States in 2018-19 (5.48 million cases), believed to be higher in females (2.62%, i.e., 4.39 million cases) compared to males (0.67%, i.e., 1.09 million cases). The most common ED was OSFED, with a percentage of 1.18% in females and 0.27% in males. The statistics are higher in the age group of 20-29 years for both males and females.



A teenager is in therapy session to deal wither eating disorder (ED), a psychologist is listening.


In the United States, it is estimated that about 21.0 million people suffered from EDs at some point in their lives in 2018-19, with 14.4 million cases occurring in women and 6.6 million in men.


Evidence suggests that eating disorders are associated with a high rate of premature mortality, with one person dying every 52 minutes as a direct consequence of EDs. Mortality rates are 5.86 times higher than the general population in people with anorexia nervosa, 1.93 for bulimia nervosa, and 1.92 for unspecified eating disorders. About 10,200 deaths (ranging between 5,500 and 22,000 deaths) were caused by eating disorders in 2018-19. More deaths were associated with OSFED (about 3,400 deaths or 33% of total deaths due to EDs) than any other eating disorder (Deloitte, 2020). The weighted averages of point prevalence of EDs increased from 3.5% for the period 2000-2006 to 7.8% for the period 2013-2018 (Marie et al., 2019).


It has been shown that 20 million people suffer from EDs in Europe, of which three million are in Italy alone (European Parliament, 2021). Even before Covid-19, the statistics were increasing year by year. With the outbreak of the pandemic, things have worsened: in Italy, eating disorders affect about 3 million people and represent the leading cause of death among teenagers, after road accidents. In the last 3 years, there has been a 40% increase in new cases and a 50% increase in first-visit requests for Eating Behavior Disorders. Furthermore, there is a constant lowering of the age of onset: 30% of those who suffer from these disorders are under 14 years old, and there is a greater spread in the male population (the 12-17 age group includes 10%) (RaiNews, 2022).



Lilac Ribbon: The Battle for Eating Disorders in a Disappointing Italy towards its Citizens


Given the high number of cases, Italy is not lacking in initiatives to raise awareness, sensitize, and share everything about EDs, from the most technical and scientific aspects to life experiences. Foremost among these is the “Settimana Lilla”, literally the “Lilac Week”, from March 9 to 16, 2024, with March 15 recognized as the National Lilac Ribbon Day against eating behavior disorders (Settimana Lilla).



A liliac ribbon, for the "Settimana Lilla", a week of raise awareness about eating disorders, or eating behavior disorders (EDs).

This year more than ever, the issue of "eating disorders" is delicate and on the agenda. In the Beautiful Country, in 2022, a fund of 25 million euros was established, evenly distributed among the regions, to combat eating and nutrition disorders. However, in January 2024, the new government had the idea to close the said fund. This meant that the activity of healthcare workers hired on a fixed-term basis to support care in the territory, especially in the most deficient areas of the country, had to be interrupted. That money would not have been enough, but it was starting to make a difference, to trace a path to follow to help as many people as possible to come out of this dark tunnel. Instead, because of the cut, today there is a risk of dramatically going backward, leaving uncovered, above all, patients and families (IlSole24Ore, 2024). Only after a series of demonstrations and protests in Italian squares did the Italian government "take pity" and granted a "Special Fund" of 10 million euros.


A gesture of support and care from the State? From my point of view, and I believe I am not the only one to think so, this intervention should not be interpreted as an act of generosity, but rather as an institutional duty. Such commitment represents, in fact, only a partial adherence to the obligations provided, as the funds allocated are not sufficient to guarantee the protection of health, which is a fundamental right of every individual.


FAQs

What does EDAW stand for?


EDAW stands for "Eating Disorders Awareness Week," a globally recognized event aimed at raising awareness about eating disorders. It occurs annually, starting from the last Monday of February.



What is an eating disorder best described as?


An eating disorder is best described as a behavioral condition characterized by severe and persistent disturbances in eating behaviors, accompanied by distressing thoughts and emotions.



What are the types of EDs?


The types of eating disorders (EDs) include anorexia nervosa, bulimia nervosa, binge-eating disorder (BED), avoidant/restrictive food intake disorder (ARFID), pica, rumination disorder, and other specified feeding and eating disorders (OSFED).



What is anorexia nervosa?


Anorexia nervosa is an eating disorder defined by a restriction of energy intake relative to requirements, leading to significant weight loss. It is driven by an obsessive fear of gaining weight and a distorted self-image.



What is the meaning of binge eating?


Binge eating refers to episodes of consuming larger amounts of food than normal in a short period, often leading to feelings of distress or loss of control during these episodes.



What is the difference between ARFID and picky eating?


ARFID, or Avoidant/Restrictive Food Intake Disorder, is characterized by a significant limitation in the quantity and type of food consumed, leading to nutritional deficiencies or psychosocial impairment. It goes beyond picky eating by involving intense aversion to certain foods' colors, textures, or smells, and can lead to serious health consequences.



What is pica?


Pica is an eating disorder involving the consumption of non-nutritive and non-food substances, such as soil, paper, chalk, or other inedible items. It can occur in children and adults, particularly those with intellectual disabilities.



What are the consequences of EDs on our body and mind?


The consequences of eating disorders on the body and mind include damage to the cardiovascular, gastrointestinal, nervous, and endocrine systems, leading to potentially life-threatening conditions. Psychologically, EDs can cause severe distress, anxiety, and depression.



What percent of the population has an eating disorder?


The prevalence of eating disorders varies by type and region, but it was estimated that 1.66% of the U.S. population had an eating disorder in 2018-19, with higher rates in females compared to males.



Have eating disorder statistics increased?


Yes, eating disorder statistics have increased over time. The prevalence and awareness of EDs have risen globally, with significant increases noted during and after the Covid-19 pandemic, highlighting the growing concern and need for awareness and treatment options.

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