All About Eating Disorders
There is no one weight or shape associated with an eating disorder - eating disorders are mental illnesses not weight disorders
Fast Facts (from the Academy of Eating Disorders)
Eating disorders are serious mental illnesses. They are treatable, and the sooner someone gets the help they need, the better the chance of recovery.
Eating disorders are NOT choices, passing fads or phases. Eating disorders are severe and can be fatal.
Eating disorders occur all over the world, especially in industrialized regions or countries. They affect people of all gender, ethnic background, socioeconomic status, age, sexual orientation, etc.
Eating disorders have the highest mortality rate of any psychiatric illness (Eating Disorder Hope).
Although there are formal guidelines that health care professionals use to diagnose eating disorders, unhealthy eating behaviors exist on a continuum. Even if a person does not meet the formal criteria for an eating disorder, they may be experiencing unhealthy eating behaviors that cause substantial distress and may be damaging to both physical and psychological health.
Types of Eating Disorders (Eating Disorder Hope)
The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA), offers a common language and standard criteria for the classification of mental disorders. It is used, or relied upon, by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies, the legal system, and policy makers together with alternatives (such as the ICD-10 Classification of Mental and Behavioural Disorders, produced by the WHO.) The DSM is in its fifth edition, the DSM-5, published on May 18, 2013. In this most recent edition, several distinct categories of eating disorders are recognized:
Binge Eating Disorder - is defined as recurring episodes of eating significantly more food in a short period of time than most people would eat under similar circumstances, with episodes marked by feelings of lack of control. Someone with binge eating disorder may eat too quickly, even when he or she is not hungry. The person may have feelings of guilt, embarrassment, or disgust and may binge eat alone to hide the behavior. This disorder is associated with marked distress and occurs, on average, at least once a week over three months.
Pica - describes a disorder in which a person consumes non-nutritive items over a period of at least one month. This consumption of non-nutritive items is inappropriate to the person’s developmental level, culture, and may occur in the presence of another mental disorder associated with impaired functioning.
Rumination Disorder - involves repeated regurgitation of food for a period of at least one month Regurgitated food may be re-chewed, re-swallowed, or spit out. The repeated regurgitation is not due to a medication condition (e.g. gastrointestinal condition). The behaviour does not occur exclusively in the course of Anorexia Nervosa, Bulimia Nervosa, BED, or Avoidant/Restrictive Food Intake disorder. If occurring in the presence of another mental disorder (e.g. intellectual developmental disorder), it is severe enough to warrant independent clinical attention.
Avoidant-Restrictive Food Intake Disorder - is manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following: significant loss of weight (or failure to achieve expected weight gain or faltering growth in children), significant nutritional deficiency, dependence on enteral feeding or oral nutritional supplements, marked interference with psychosocial functioning. The behavior is not better explained by lack of available food or by an associated culturally sanctioned practice. It is important to note that the behavior does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way one’s body weight or shape is experienced. The eating disturbance is not attributed to a medical condition, or better explained by another mental health disorder. When is does occur in the presence of another condition/disorder, the behavior exceeds what is usually associated, and warrants additional clinical attention.
Otherwise Specified Feeding and Eating Disorders (OSFED) - is a catch all diagnostic category that includes atypical anorexia, purging disorder, binge eating disorder (where not all the criteria for a stand-alone diagnosis are met), bulimia nervosa (where not all the criteria for a stand-alone diagnosis are met), and night eating syndrome.
Unspecified Feeding and Eating Disorder - this category applies to where behaviours cause clinically significant distress/impairment of functioning, but do not meet the full criteria of any of the Feeding or Eating Disorder criteria. This category may be used by clinicians where a clinician chooses not to specify why criteria are not met, including presentations where there may be insufficient information to make a more specific diagnosis
Bulimia Nervosa - is characterized by frequent episodes of binge eating followed by compensatory behaviors such as self-induced vomiting to avoid weight gain.
Anorexia Nervosa - is characterized by distorted body image and excessive dieting that leads to severe weight loss with a pathological fear of becoming fat. There are two sub-types: A) restrictive type (AN-R), and B) binge-purge type (AN-BP).
Canadian Statistics (National Eating Disorder Initiative, 2017)
Research indicates that the prevalence rate of eating disorders is between 2% and 3%. Based on Statistics Canada population data (Statistics Canada 2016), an estimated 725,800 - 1,088,700 Canadians will meet the diagnostic criteria for an eating disorder. Many more may be on a spectrum of disordered eating.
As described by Pinhaset al., (2011), very little quantitative information exists on the outcomes or co-morbid diagnoses of Canadian ED patients. The large Ontario Mental Health Survey (Garfinkelet al., 1995; Woodside et al., 1996) provided information on co-morbidity in eating disorders where 34% of women and 15% of men with an eating disorder had a lifetime diagnosis of major depression; 37% of men and 51% of women had a lifetime diagnosis of anxiety disorders and 45% of men and 21% of women had a lifetime diagnosis of alcohol dependence. In a cohort study of cases from the only adult tertiary care ED program in British Columbia (954 consecutive patients referred to the only adult tertiary care eating disorders program), the standardized mortality ratio for AN was 10.5 (Birmingham et al., 2005) with a life expectancy reduction of 20-25 yrs (Harbottleet al., 2008).
70% of doctors receive 5 hours or less of eating disorder-specific training while in medical school (Girz, LafranceRobsinson, & Tessier, 2014). In 2004, only 6.3% of psychiatry residents felt they had spent enough time with ED patients to work effectively with them in clinical practice (Williams & Leichner, 2006)
While financial data is not available in Canada on a national scale, a study conducted in British Columbia in 2003 reported the provincial costs of those with anorexia nervosa on long-term disability may be as high at $101.7 million/year, up to 30 times the cost of all tertiary care services for eating disorder treatment in the province (Su & Birmingham, 2003). It is important to consider that there are hidden costs associated with eating disorders, including lost earnings of sufferers and carers (PricewaterhouseCoopers, 2015)