Eating Disturbances

An eating disturbance shares many similar characteristics with eating disorders, but is less severe in scope. As a result, many abnormal dietary patterns and behaviors, such as binge eating, excessive exercising, weight cycling, and chronic dieting may involve many of the same attitudes and impulses as eating disorders, though they do not meet the clinical criteria for diagnosis.

Eating disturbances usually develop during adolescence and early adulthood. While they occur in both males and females, they are far more prevalent among females. They are characterized by distorted eating patterns and usually occur in individuals of normal weight who have a history of dieting and a strong desire to become thin. As with eating disorders, body perception and self-esteem are closely intertwined. Many cases may start out innocently, with only small dietary changes such as eating smaller or larger portions of food, and eventually progress beyond the individual's control. For some, eating may become highly restrictive, accompanied by stringent elimination of certain high-calorie, high-fat foods. Others may consume these foods in excess, but only during episodes of gorging. Symptoms include obsession with food and calories, fear of specific nutrients (such as fat), rigid categorization of foods as "good" or "bad," irrational fear of weight gain, excessive weighing, avoidance of social situations where food is served, and denial of eating problems.

Binge Eating

Binge eating is a frequent precursor to bulimia nervosa and binge eating syndrome. Individuals who indulge in binge eating may eat tremendous quantities of food, well past the point of being comfortably full and possibly to the point of extreme discomfort or even pain. Bingeing may take place over a short period of time, or it may be prolonged—lasting for several hours, sometimes continuing from morning until nighttime. For individuals prone to binge eating, food becomes a focal point of life, with an obsession about what can or cannot be eaten. Eating may take place very quickly and is often unrelated to hunger. Although there may be variation in the types of food chosen, high-calorie, high-fat sweets are favored. Since bingeing is accompanied by a sense of shame, embarrassment, and lack of self-control, episodes usually take place alone, in secret.

Bingeing is frequently triggered by troubled relationships, extreme hunger subsequent to stringent dieting, or feelings of melancholy. While gorging on coveted foods may temporarily improve one's mood, it is usually followed by feelings of depression and low self-esteem. Although these incidents may contribute to obesity , they may also occur in individuals of normal body weight who compensate for binges with excessive exercising or even fasting.

Excessive Exercising

Also known as activity disorder, excessive exercising is an extreme method of weight control. Individuals suffering from this syndrome are compelled to exercise for prolonged periods on a daily basis and to indulge in constant activity to burn excess calories. Eventually they experience a loss of control over the desire to exercise, in the same way that a person with an eating disorder cannot control behaviors relative to eating.

Excessive exercisers suffer from the same obsession with body weight and shape as anorexics and bulimics, and exercise eventually becomes necessary not only for weight control, but also for mood stabilization and self-definition. Utterly powerless to restrain their urge to exercise, they will pursue daily activity in spite of injury or exhaustion, or in places and settings that are completely inappropriate. They are usually accomplished individuals, both professionally and academically, and they may appear to be vigorously fit and healthy. Despite their overtly sound appearance, however, over time they may suffer health consequences far more serious than routine athletic injuries. Drastic weight loss may lead to amenorrhea , which, in turn, may weaken bones and increase osteoporosis risk. Vitamin and mineral deficiencies may develop and electrolyte imbalances may occur, which may lead to cardiac arrest in extreme cases.

Cravings

Cravings for carbohydrate-rich foods cause many bulimics and binge eaters to center their binges around desserts and high-starch foods. Many individuals suffering from disordered eating commonly avoid foods low in carbohydrate and high in fat, and instead seek out excessive sugar, routinely using large quantities to sweeten foods and beverages. This may stem from a physiological and evolutionary need for ample carbohydrate to ensure proper neurological function. Large quantities of carbohydrate eaten in a short time frame are capable of altering neurotransmitter synthesis, producing a calming effect on the brain, and thus may be the impetus for such cravings in certain eating disorders and disturbances.

How Many People Suffer from Eating Disorders?

According to the National Institute of Mental Health:

• Between .5 percent and 3.7 percent of women suffer from anorexia nervosa at some point in their lives.
• Between 1.1 and 4.2 percent of women suffer from bulimia nervosa at some point in their lives.
• Between 2 and 5 percent of Americans experience binge-eating disorder during any six-month period.

Women are more likely than men to develop eating disorders. Only 5 to 15 percent of those with anorexia or bulimia are men, and only 35 percent of those with binge-eating disorder are men.

—Paula Kepos

Weight Cycling

Also known as yo-yo dieting, weight cycling is common in Westernized nations, particularly among young women. Often observed among chronic dieters, weight cycling is an ongoing sequence of dieting, weight loss, cessation from dieting, and weight gain. This final stage of weight gain is particularly detrimental, as the amount regained often exceeds the quantity originally lost, resulting in an increase in overall body weight. As muscle mass accounts for a portion of the lost weight, weight cycling may ultimately slow overall metabolism , with every 5 percent of body weight lost resulting in a 15 percent decrease in resting metabolism. This compensatory mechanism, adapted to help prevent weight loss during times of starvation, eventually prompts further weight gain, frequently initiating a renewed cycle of dieting.

Chronic Dieting

Many individuals with eating disorders report habitual dieting prior to the onset of their illness. Repeated dieting during adolescence increases the risk of eating disorders, with some patients reporting attempts at weight loss as early as age nine. The incidence of eating disorders may be as much as eight times greater among girls with a history of dieting, with the initiation of a weight loss regimen often marking the onset of the eating disorder itself. Dietary restriction may result in alterations in brain chemistry that can further increase anorexic tendencies, while hunger resulting from caloric restriction can set off binge eating, thus establishing a pattern. While most healthy individuals who attempt to lose weight can stop at any given time, depression and major life stresses in combination with habitual dieting can predispose others to develop an eating disorder.

see also Addiction, Food; Anorexia Nervosa; Bulimia Nervosa; Eating Disorders.

Karen Ansel

Bibliography

American Dietetic Association (1998). Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Eating Disorder Not Otherwise Specified (EDNOS). Chicago: Author.

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Washington, DC: Author.

Cassell, Dana, and Gleaves, David (2000). The Encyclopedia of Eating Disorders, 2nd edition. New York: Facts on File.

Cataldo, Corrine B.; Rolfes, Sharon R.; Whitney, Eleanor N. (1994). Understanding Normal and Clinical Nutrition, 4th edition. St. Paul, MN: West Publishing.

Costin, Carolyn (1996). The Eating Disorder Sourcebook. Los Angeles: Lowell House.

Dare, Chris; Szmukler, Georg; Treasure, Janet (1995). Handbook of Eating Disorders: Theory, Treatment, and Research. New York: Wiley.

Escott-Stump, Sylvia, and Mahan, L. Kathleen (1996). Krause's Food, Nutrition, and Diet Therapy, 9th edition. Philadelphia: W. B. Saunders.

Franseen, Lisa (1999). "Understanding and Identifying Eating Problems in Synchronized Swimmers, Part 1." Synchro Swimming USA (Winter).

Garfinkel, Paul E., and Garner, David M. (1997) Handbook of Treatment for Eating Disorders, 2nd edition. New York: Guilford Press.

Rosenbloom, Christine A., ed. (1999). Sports Nutrition: A Guide for the Professional Working with Active People. Chicago: American Dietetic Association.

Woolsey, Monika M. (2002). Eating Disorders: A Clinical Guide to Counseling and Treatment. Chicago: American Dietetic Association.

Internet Resources

McKinley Health Center, University of Illinois at Urbana. "Understanding Eating Disturbances and Disorders: A Guide for Helping Family and Friends." Available from <http://www.mckinley.uiuc.edu>

National Institute of Mental Health. "Eating Disorders: Facts about Eating Disorders and the Search for Solutions." Available from <http://www.nimh.nih.gov>