Eating Disorders

When the topic is addiction, it is common for people to associate it with widely-known addictive substances like drugs and alcohol. However, it is possible for you to get addicted to food, even though it is essential for survival and healthy living. When you have a food-related addiction, you have an eating disorder.

Eating disorders refer to a variety of conditions that arise with abnormal or disturbed eating behaviours. This means that you do not necessarily only have a food-related addiction when you are eating too much. Food addiction can also be related to eating too little.

Eating disorders develop when you have an obsession with food, along with other factors such as your body shape and weight. When left untreated, they can result in grave health consequences, including death.

The history of food addiction

The term food addiction may sound like a recent term but food addiction-related data can be traced back to 1890, when chocolate was categorised as an addictive substance for the first time. Food addiction officially became a term in the 1950s, with organisations such as Overeaters Anonymous established in the 1960s. However, even in the midst of these early developments, it wasn’t until the 80s that the relationship between disorders and general addiction was established.

Researchers noted that people struggling with anorexia nervosa exhibited dependence on the effects of starvation. Over a period of time, their bodies would become tolerant to these effects, pushing them to consume even less food in order to get the same feelings of starvation. When such people attempted to eat normally, they had withdrawal symptoms.

Following the early research of the 1980s, the food addiction issue quickly attracted heavier attention, with regular follow-up research and debates. More relationships were established between food addiction and substance addiction, such as loss of control, use of substances to cope with the withdrawal symptoms of eating disorders, secretive living to hide addictive behaviour and reluctance to quit the abused substance even in the face of the obvious harm to general health.

Today, we have a better understanding of food addiction and its relationship with other types of addiction.

Eating disorders and addiction: Is there a connection?

According to research, around 20 to 30 percent of people that have a problem with alcohol or drug addiction also have an eating disorder. There are a few reasons for this connection. Firstly, eating disorders and drug addiction are both predominantly mental illnesses. Secondly, people tend to develop these problems as a result of the same underlying factors, such as stress, depression, anxiety, self-esteem issues etc.

Although the relationship between eating disorders and addiction does occur in older adults, it is mostly seen amongst younger adults. Some of the factors responsible for this include exposure to cultural body expectations and weight or appearance pressure from peers. The media’s glamourisation of drug and alcohol addiction, coupled with unrealistic expectations of what an attractive person should look like, are additional factors.

Another connection between substance addiction and eating disorders is the fact that the dangers are virtually the same. Eating disorders and substance addiction affect the body and the brain in the same ways. They alter the chemistry and general functions of the brain by triggering a deluge of neurotransmitters in the reward centres of the brain.

Types of eating disorders

There are various different types of eating disorders. These include:

Anorexia nervosa

This is perhaps the eating disorder that most people will have heard of. It is most likely to occur during the teen years, and women are usually more likely to be affected than men. If you have anorexia nervosa, you will see yourself as overweight even when you are dangerously underweight. With this condition, you will regularly monitor your weight and also find yourself staying away from specific types of foods, as well as attempting to severely police the calories going into your body.

The symptoms common to anorexia nervosa include:

• A distorted view of your body image, which can lead to denial of being seriously underweight
• Being severely underweight in comparison to people of the same age and height
• Self-esteem being tied to body weight
• Constant pursuit of thinness
• Restrictive in eating patterns
• Constant thoughts of food, and obsession with collecting recipes that can help achieve the desired body image
• Inability to eat in public and a constant desire to control the environment

Anorexia nervosa puts a big strain on the body and can cause significant damage over a period of time. People with the condition can suffer from infertility, brittle hair and nails and thinning of the bones. Severe cases of anorexia can lead to organ failure and eventual organ shutdown and death.

Bulimia nervosa

Bulimia nervosa is another common eating disorder also seen in adolescents and young adults. It is also more common among women. This condition involves eating an abnormally large amount of food in a short period of time, until the person is extremely full.

When eating, people with bulimia nervosa feel that they cannot stop eating or control how much they are eating. These people also binge on foods that they would ordinarily avoid. At the end of the binging episode, they will attempt to purge in a bid to balance their calorie consumption and relieve the discomfort in the stomach. To help in the purging, they will engage in actions such as forced vomiting, excessive exercise and consumption of laxatives and diuretics.

Although the forced vomiting draws similarities to the binge-eating and purging subtypes of anorexia nervosa, they are not the same. This is because most people with the bulimia disorder are a relatively normal weight and do not tend to become underweight.

The common symptoms associated with bulimia nervosa include:

• Binge eating with no control
• A fear of gaining weight even when they are a normal weight
• Self-esteem influenced by body shape and weight
• Regular episodes of engaging in purging behaviours to prevent weight gain

The dangers of bulimia nervosa may include having an inflamed or sore throat, swollen salivary glands, tooth decay, acid reflux, hormonal imbalances and severe dehydration. In many cases, bulimia nervosa can trigger an imbalance in the levels of electrolytes in the body, such as sodium, potassium and calcium. When this happens, a stroke or heart attack can occur.

Binge eating disorder

The common symptoms associated with binge eating disorder include:

• Eating large amounts of food even when not feeling hungry, until uncomfortably full
• Feelings of guilt and shame about their binge eating behaviour
• Lack of control during binge eating episodes
• Non-engagement in purging behaviours in order to counter binge eating behaviour

The main danger of this eating disorder type is the risk of becoming overweight or obese, which can increase the risk of other conditions associated with gaining excessive weight. These include heart disease, stroke and type two diabetes.

Pica

Pica is a condition that was only recently recognised as an eating disorder. People with pica crave non-food substances such as dirt, soil, chalk, soap, paper, hair, cloth, pebbles and even laundry detergent. Pica is seen most frequently in children, adolescents, pregnant women and other individuals with disabilities.

For the condition to be considered a disorder, there should be no cultural history of the consumption of the particular non-food substance and the substances being consumed must be deemed to be inedible by everyone in the same cultural sphere.

If you have pica, you are at risk of infections, injuries to the digestive system and a deficiency in nutrients. Depending on the substances eaten, there may be poisoning of the body and organs, leading to death.

Rumination disorder

This is another newly-recognised eating disorder. People with this disorder bring up food they have previously swallowed to rechew and then either re-swallow or spit it out. This is normally done within the first 30 minutes after eating a meal. It should not be confused with medical conditions like reflux, as it is completely voluntary.

The disorder can be seen in infants, children and adults. Children and adults with this condition will have to undergo therapy for the condition to be treated. The main danger of rumination disorder is that it may lead to patients restricting the amount of food they eat in public, which may lead to becoming underweight.

Avoidant or restrictive food intake disorder (ARFID)

ARFID is a newly-coined name for feeding disorder of infancy and early childhood. The previously-named condition was a diagnosis reserved for children under seven years old. However, the name had to be changed as the disorder became a diagnosis that goes well beyond early childhood and into adulthood. The condition is also common in all genders.A key feature of this disorder is disturbed eating, either as a result of a lack of interest in eating or a distaste for certain smells, tastes, colours, textures and temperatures.

The common symptoms associated with ARFID include:

• Weight loss or poor development in accordance withheight and age
• Eating habits that impact on social functions, like eating with other people
• Avoidance or restriction of food intake which prevents adequate consumption of a safe number of calories and nutrients
• Development of negative eating habits, such as the inability to eat with or without other people being around

ARFID should not be confused with normal eating behaviours like picky eating, as seen in toddlers and adults, or the avoidance or restriction of eating due to unavailability of food, cultural beliefs or religious practices.

Night Eating Syndrome:People with this syndrome generally eat excessively after they have just woken up from sleep.

Purging Disorder: People with this disorder do not binge eat but they still use laxatives, diuretics, vomiting and excessive exercising to control their weight or shape.

Eating Disorder Not Otherwise Specified (EDNOS): This covers other possible conditions that are similar to eating disorders but do not quite meet all the criteria needed to fit into a defined one.

Orthorexia is one example of such a disorder. Individuals with orthorexia are so obsessed with healthy eating that it negatively impacts their everyday life. Sufferers may remove a complete food group from their diet, in the belief that it is unhealthy for them. This can lead to malnutrition, severe weight loss, difficulty eating outside the home and general emotional distress. Unlike what is seen with other eating disorders, sufferers of orthorexia are not concerned about their weight. Their main focus is on ensuring that they are sticking to diet rules that they have set for themselves.

Eating Disorders and addiction: The dangers of turning to controlled substances for weight control

People with eating disorders that have weight loss as their main goal tend to use other substances to help push their weight loss agenda even harder. In many cases, this means ending up with an addiction in addition to the eating disorder. A good example of this is seen in people with anorexia nervosa who use alcohol in combination with skipping meals to push for further weight loss. This combination has led to the coinage of the term “drunkorexia”.

The excessive use of alcohol can lead to dehydration, which can in turn lead to vomiting. This explains why people seeking weight loss may end up abusing alcohol. Some people that engage in this habit skip meals just so they can drink and shed existing calories instead of worrying about the new calories as a result of food consumption.

People that suffer from“drunkorexia” will get drunk faster when compared to someone drinking on a full stomach. This can trigger a variety of other dangers, such as impaired judgement, passing out, exposure to risky behaviour and being involved in road accidents.

Other substances that may be combined with an eating disorder include drugs (such as cocaine, heroin, marijuana, methamphetamine and benzodiazepines) caffeine, ipecac, nicotine and diuretics.

 Causes of addiction and eating disorders

There are many factors that can trigger addiction and eating disorders. These are covered below:

Genetic vulnerability

Research has shown that there is some genetic basis to eating disorders. It has also been demonstrated that the genetic influence is not a result of any specific gene, but rather is a result of a highly complex interaction between a collection of genes. Non-inherited genetic factors have also been noted as possible factors.

There have been decades of research into the genetics surrounding eating disorders, but the major causes are yet to be properly understood. One reason given for this is the fact that most studies related to the condition are done during the acute or recovery phase of the eating disorder.

Psychological factors

Research into common eating disorders like anorexia and bulimia nervosa has pinpointed a range of personality traits that could be seen before, during and after the recovery from an eating disorder. They include:

It is, however, difficult to conclusively distinguish between the psychological causes of eating disorders and the psychological effects of eating disorders. This is because prolonged starvation can trigger changes in interpersonal characteristics, behaviour and cognition.For example, research has not been able to determine whether depression and anxiety, which mostly coexist with eating disorders, come before or after the eating disorder.

Socio-cultural Influences

Evidence has also highlighted how socio-cultural influences play a role in the development of an eating disorder. Our culture today suggests that only thin women and lean/muscular men are attractive. People who internalise this suggestion are at risk of developing a dissatisfaction with how their bodies look. This can lead to eating disorder behaviours.The proliferation of social media in everyday life has also gone a long way in further cementing this view of attractiveness. Heavily-edited images are passed off as natural expectations of how people should look.

The growth of social media, particularly Facebook and Instagram, has increased our exposure to photoshopped images and thin ideals. Although a direct link to eating behaviours is yet to be established, the appearance-focused nature of social media platforms has been shown to cultivate body image concerns and reduce self-esteem.

Causes and risk factors for addiction among those suffering from eating disorders

Low Self-esteem

In people suffering from eating disorders,low self-esteem can lead to the taking of certain substances to supposedly help with the actualisation of specific body goals. This is exemplified by the use of alcohol, but a plethora of addictive drugs and other substances can also be used. This is especially true in people where the focus of the eating disorder is to lose weight.

People with eating disorders may also use addictive substances to correct self-esteem issues that do not necessarily have anything to do withbody image. For example, they may use drugs for the euphoric high that allows them to feel more confident among a group or to generally act more outgoing.

Body dissatisfaction

People that are suffering from any of the more common eating disorders generally have anxiety and depression because of how they look. This can lead to the exploration of other ways to achieve desired body image, leading to the use of addictive substances.

Internalisation of the Ideal appearance

If you have internalised the image of attractiveness as portrayed by the media, you are at risk of developing an addiction. Such conditioning of the mind could well lead to anxiety and dissatisfaction with your appearance, leading to the use of addictive substances.

Signs and symptoms of substance abuse among those suffering from eating disorders

There are lots of possible substances that may be abused by people suffering from an eating disorder. This means that there are a myriad of possible signs and symptoms that can be seen. They may include:

Effects of addiction among those suffering from eating disorders

In people with eating disorders, addiction can be dangerous. The fact that you are lacking in certain nutrients or are consuming some nutrients in too high a number, as well as the fact that you are either overweight or underweight, can make addiction to certain substances life threatening. Most addictive substances are already very dangerous to the human body, however, when combined with the common eating disorders it could lead to disastrous consequences before addiction professionals have had a chance to help.

Addiction and eating disorder statistics

Eating disorders are a lot more common than many people realise and, in many cases, they exist alongside substance addiction.

There are around 1.25 million people with eating disorders in the UK, with around 11% of that number being male.NHS data shows that around 6.4% of adults surveyed in a 2007 study showed signs of an eating disorder.

Figures from the Health and Care information Centre, released in February 2014, showed an 8% rise in the number of inpatient hospital admissions relating to eating disorders, in comparison to data from 2013. There has been a 34% increase in admissions since 2005. This shows an increase of 7% each year for admissible eating disorders across the UK.

The figures for the actual number of people that develop eating disorders every year and the number of people with eating disorders and addictions remain unclear but with the figures that are available, there is sufficient reason to believe that the true figure is quite high.

Eating disorder treatment

Eating disorder treatment is often designed to address underlying factors as well as addiction. This is because it has been established that eating disorders and addiction usually go handin hand in many cases. The best treatments, therefore, focus on exterminating the root causes of both. Treatments that address both the substance abuse and the eating disorder are used because some people rely on eating disorders to cope with addiction or vice versa.Since both conditions are equally dangerous, the importance of early treatment cannot be overemphasised.

When seeking eating disorder treatment, it is important to work with specialists that are well experienced in the treatment of co-existing eating disorders and addiction treatment. There is no blanket approach to treatment. Therefore, only treatment centres with the right personnel and level of experience can guarantee a positive outcome.

Types of treatment and rehab

Inpatient and outpatient treatment options exist for eating disorders. Inpatient options are best for people who have more severe cases of eating disorders and addiction. These people are often medically unstable and are at risk of suicide. This means that they will need to be constantly monitored for vital signs that will highlight a worsening situation or recovery.

People who are stable and do not need intensive medical care can be treated on an outpatient basis. Partial hospital care may be needed, depending on the extent of the problem at hand. However, most people that are placed in outpatient care have their symptoms under control and do not require round the clock monitoring by professionals.

In some cases, patients are hospitalised in order to treat eating disorders. This is especially true for more severe cases of bulimia and anorexia. The treatment will take place in a standard hospital setting where a feeding tube will most likely be used to ensure that the patient is getting all the necessary nutrients. In the hospital, different types of health professionals may be required to aid in treatment. This is dependent on the type of symptoms exhibited as a result of substance abuse or due to the eating disorder.

Some of the medications that can be prescribed to people with eating disorders include antidepressant and antipsychotic medication. Since these medications can also be abused, management is undertaken only by professionals. A feeding therapy session is often included.

Antidepressants and antipsychotic medications are sometimes prescribed to bulimics who are substance abusers. It is important that these medications are not also abused, so the management of them should be discussed with a doctor. For bulimics, there are programs (both inpatient and outpatient) in which meals are supervised.

FAQs

External Links

• https://www.state.sc.us/dmh/anorexia/statistics.htm
• https://www.webmd.com/mental-health/eating-disorders/anorexia-nervosa/news/20110711/deadliest-psychiatric-disorder-anorexia
• https://drugwarfacts.org/chapter/causes_of_death
• https://www.nationaleatingdisorders.org/substance-abuse-and-eating-disorders