EATING DISORDERS
It is the position of the Academy for Eating Disorders (AED) that anorexia nervosa and bulimia nervosa, along with their variants, are biologically based, serious mental illnesses (BBMI) that warrant the same level and breadth of health care coverage as conditions currently categorized in this way (e.g., schizophrenia, bipolar disorder, depression, obsessive-compulsive disorder).
When you become so focused on food, shape or weight issues that you find it harder and harder to focus on other aspects of your life, this may be warning signs of an eating disorder.
Studies suggest that 1 in 20 people will be affected at some point in their lives. Although eating disorders commonly associated with women, men can develop them as well. Up to 25% of people suffering from anorexia nervosa or bulimia nervosa are male, and almost an equal number of males and females suffer from binge eating disorder.
Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder. Recent studies have found an increase in rates of body image disturbance and eating disorders in Asian countries. Studies conducted among Malaysian university students have found that approximately one in five students were at risk for developing an eating disorder.
Sadly, many people suffering from eating disorders are often reluctant to reveal their condition and many do not ever receive treatment. Studies have shown only about 6% of people who have bulimia seek treatment and about 30% of people who have anorexia seek treatment.
Treatment is particularly important in eating disorders as the mortality rate for people with eating disorders is the highest of all psychiatric illnesses. The sooner you start treatment for an eating disorder, the less severe the eating disorder will be, and the shorter the recovery process. Recovery may take a long time and lots of hard work, but it is possible and there is an effective treatment available.
The exact prevalence of the various eating disorders in Malaysia is unknown. Further research is needed to determine the prevalence of anxiety disorders in Malaysia. The prevalence rate reported here are taken from studies conducted mostly in Western cultures, and where available, Asian cultures like Singapore.
Common types of anxiety disorders include:
- Anorexia Nervosa
- Bulimia Nervosa
- Binge Eating Disorder (BED)
Anorexia Nervosa
Anorexia can affect people of all ages, genders, sexual orientations, races, and ethnicities. Historians and psychologists have found evidence of people displaying symptoms of anorexia for hundreds or thousands of years.
To be diagnosed with anorexia nervosa, the following criteria must be met:
- Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
- Intense fear of gaining weight or becoming fat, even though underweight.
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
Even if all the DSM-5 criteria for anorexia are not met, a serious eating disorder can still be present. Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss.
Development
The average age of onset of anorexia nervosa ranges from 17 to 19 years old. The onset of this disorder is often associated with a negative stressful life event.
The estimated annual Years of Healthy Life lost (per 100,000 people) due to anorexia nervosa was 6.9. The annual years of healthy life lost per 100,000 people from anorexia nervosa in Malaysia have increased by 7.3% since 1990, an average of 0.3% a year.
What are the risks associated with Anorexia Nervosa?
The risks associated with AN are severe and can be life threatening. They include:
- Anaemia (iron deficiency)
- Compromised immune system (e.g. getting sick more often)
- Intestinal problems (e.g. abdominal pain, constipation, diarrhoea)
- Loss or disturbance of menstruation in girls and women
- Increased risk of infertility in men and women
- Kidney failure
- Osteoporosis– a condition that leads to bones becoming fragile and easily fractured
- Heart problems (e.g. cardiac abnormalities, sudden cardiac arrest)
- Death
Prevalence
“It is estimated that the lifetime prevalence rate of anorexia is 1.0%. Between 0.9% and 2.0% of females and 0.1% to 0.3% of males will develop anorexia.
Bulimia Nervosa
Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.
A binge is characterized as eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances.
To be diagnosed with bulimia nervosa, the following criteria must be met:
- Frequent episodes of consuming very large amount of food followed by behaviours to prevent weight gain, such as self-induced vomiting.
- A feeling of being out of control during the binge-eating episodes.
- Self-esteem overly related to body image.
- The binge eating and compensatory behaviours to prevent weight gain happens on average about one a week for 3 months.
Development
The average age of onset of bulimia is between 17 and 21 years old.
The binge eating episodes often begin during or after an episode of dieting to lose weight. The onset of bulimia is also associated with experiencing multiple stressful life events.
About 10 – 15% of people struggling with bulimia may develop anorexia.
What are the risks associated with Bulimia?
The risks associated with BN are severe. People with BN may experience:
- Chronic sore throat, indigestion, heartburn and reflux
- Inflammation and rupture of the oesophagus and stomach from frequent vomiting
- Stomach and intestinal ulcers
- Chronic irregular bowel movements, constipation and/or diarrhoea due to deliberate misuse of laxatives
- Osteoporosis– a condition that leads to bones becoming fragile and easily fractured
- Loss of or disturbance of menstrual periods in girls and women
- Increased risk of infertility in men and women
- Irregular or slow heart beat which can lead to an increased risk of heart failure
Prevalence
“It is estimated that the lifetime prevalence rate of bulimia is 1.0%.
Between 1.1% and 4.6% of females and 0.1% to 0.5% of males will develop bulimia.
Binge Eating Disorder (BED)
Binge eating disorder is a severe, life-threatening and treatable eating disorder characterised by:
- Recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort).
- A feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards.
- Not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating.
To receive a diagnosis of binge eating disorder:
- The binge-eating occurs, on average, once a week for 3 months.
- The binge-eating occurs even when the person is not feeling physically hungry and often happens alone. Many people experience feelings of guilt and shame after the binge-eating episode.
What are the risks associated with Binge Eating Disorder?
The risks associated with BED are severe. People with BED may experience:
- Osteoarthritis - a painful form of degenerative arthritis in which a person’s joints degrade in quality and can lead to loss of cartilage
- Chronic kidney problems or kidney failure
- High blood pressure and/or high cholesterol leading to increased risk of stroke, diabetes and heart disease
Development
Binge-eating disorder commonly begins around mid-20s.
Prevalence
“It is estimated that the lifetime prevalence rate of binge eating disorder is 1.9%.
About 0.2% and 3.5% of females and 0.9% and 2.0% of males will develop binge eating disorder.
References
Hoek and van Hoeken,2003. Review of the prevalence and incidence of eating disorders. International Journal of Eating Disorders, 386-396.
Favaro, A., & Santonastaso, P. (2016). Anticipation of age at onset in anorexia nervosa. European Psychiatry, 33, S57.
Kessler, Ronald C. et al. “The Prevalence and Correlates of Binge Eating Disorder in the WHO World Mental Health Surveys.” Biological psychiatry 73.9 (2013): 904–914. PMC. Web. 22 Apr. 2017.
Pike, K. M., & Dunne, P. E. (2015). The rise of eating disorders in Asia: a review. Journal of eating disorders, 3(1), 33.
Steinhausen, H. C. (2002). The outcome of anorexia nervosa in the 20th century. American journal of Psychiatry, 159(8), 1284-1293.
The National Institute of Mental Health: Eating Disorders: Facts About Eating Disorders and the Search for Solutions. Pub No. 01-4901. Accessed Feb. 2002.
http://www.nimh.nih.gov/health/publications/eating-disorders-new-trifold/index.shtml
http://global-disease-burden.healthgrove.com/l/62958/Anorexia-Nervosa-in-Malaysia#References&s=ref
https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml?utm_source=rss&utm_medium=rss
http://www.nedc.com.au/eating-disorders-explained
https://www.nationaleatingdisorders.org/learn/general-information/what-are-eating-disorders
http://www.nami.org/Learn-More/Mental-Health-Conditions/Eating-Disorders
WHAT CAUSES EATING DISORDERS ?
