Ab Ovo - The Psychology Podcast

Can’t eat just one. Something about eating disorders

In this episode, I talk about eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating.

You can catch me on:
🐦 Twitter at https://x.com/abovotherapy
📸 Instagram at @kkoz_official
💼 LinkedIn at https://www.linkedin.com/in/k-koziara/
📚 ResearchGate at https://www.researchgate.net/profile/Karolina_Koziara

Timestamps:
01:20 Anorexia nervosa
14:02 Bulimia nervosa
21:13 Binge eating

Duration:: 30m
Broadcast on:: 12 Aug 2024
Audio Format:: mp3

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And today I'm gonna talk about eating these orders. Let's go. [Music] So, we're in the middle of summer. People are going on a vacation and we've all heard about a beat body challenge. And since approximately February, we come across news headlines about the perfect apps, how to get lean in 30 days, how to look perfect in two weeks, and so on. And basically, we're bombed with perfect and photoshopped people and recently even AI-generated models. And it's obvious that it has a huge impact on our body image and self-esteem, so I'm not even discussing it here. But in relation to this, I thought that it would be a good moment to talk about eating these orders, which is partially related to the images we're all exposed to. So, eating disorders are a pretty broad field of psychology and psychiatry. And usually when therapists decide to work with eating these orders, they have some additional workshops and certificates because it is very challenging and requires a specific approach to the patients. And I'm not specializing in eating disorders, so my knowledge is pure theoretical, but although I will bring up a second-hand example, which I know from someone else, so that it's going to help me to explain what I'm talking about better. So, from the very beginning, eating disorders are classified in both DSM and ICD classifications, and they are defined as behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions. So, the one thing that should be taken is that eating disorders are not only about food, it's mostly emotional and controlled problem, and the food is a focus, but not the cause itself. Eating disorders are usually serious conditions which affect physical, psychological, and social functioning of approximately 5% of population. So, 5 in 100 people experience some kind of eating disorders. They include anorexia nervosa, which is probably the most popular. They also include bulimia nervosa, binge eating, avoid unrestricted food intake disorder, sometimes referred to as orthorexia, you might have heard about it, other specified feeding and eating disorder, pica, and rumination disorder. I'm not going to talk about all of them, I will focus on anorexia, bulimia, and binge eating in this episode. Eating disorders are most often developed in adolescents or young adulthood, so this is exactly when our body image and self-esteem is formed, and body changes triggered by hormones are the most visible. They can occur at any age and affect any gender, but they are most present in women, and especially anorexia and bulimia are present in women. Eating disorders very often co-occur with anxiety, depression, and other psychiatric conditions, but they are not always present. I mean, the other psychiatric conditions are not always present, some patients are diagnosed with eating disorders as a separate diagnosis, and that's it. Starting with the most common one, anorexia nervosa. This is usually linked to self starvation, weight loss, and abnormally low weight in relation to a person's height, so extremely low BMI. Usually, anorexia is diagnosed when BMI is lower than 18, so these are really, really, really lean or even skinny people, and this might surprise you, but anorexia nervosa, so anorexia itself, has the highest mortality of any psychiatric diagnosis other than opioid use. So if we exclude opioid use, anorexia nervosa is the most deadly psychiatric disorder, so not depression, not schizophrenia, not dementia, but anorexia is among psychiatric disorders, the second most deadly one. And if you look at the patient characteristics, which are usually young girls or young people in general, this is really, really frightening. In anorexia, dieting behavior is primarily motivated by an overwhelming fear of gaining weight or becoming fat, and while some individuals may express a desire to gain weight, their behavior often contradict this claim. So for instance, they consume only small portions of low calorie food and mutually engage in excessive exercise, so they have even greater calorie deficit. Additionally, some individuals with anorexia nervosa may occasionally binge eat, and after the episode of binge eating, they purge through vomiting or misuse of laxatives, which is commonly linked to bulimia, but in anorexia, this can be also present. At first, anorexia nervosa is relatively non-symptomatic, I mean for observance, because it is relatively common that young people gain and lose weight, they sometimes eat more, or sometimes eat less, they are in better or worse mood. So the first phase of anorexia is relatively invisible. Also, patients with anorexia can pretty well pretend they are eating, and they can be very handy when it comes to hiding food. So their family can eat dinner together and they really can see that something is wrong with eating habits of their children. And after some time of self-servation, anorexia gives pretty unpleasant symptoms, which include muscle weakness, of course, because you are on a huge deadly calorie deficit. So these, of course, include muscle weakness, dizziness or fainting because of dehydration, because you can drink, but some of some hydration comes from food as well. If you are not eating, you can experience dizziness or fainting because of dehydration, of course, brittle hair and nails, severe constipation or bloating, this is very common. Osteopenia or osteoporosis, so basically your bones become really easily breakable, reflux for sure, cold intolerance, and in the case of girls, menstrual periods, seeds, so of course you are not menstruating because your hormones are floating up and down, and this is really absolutely out of control. And finally, one of the symptoms is poor concentration, this is very important, poor concentration, and dementia-like symptoms. So if you are not eating, especially if you are avoiding sugar and carbohydrates, your brain is not working very well, so if you are starving, your cognitive performance will be much worse. And one interesting thing that I have heard from a therapist working with eating disorders is that patients are relatively immune to hearing that anorexia is deadly disease. This doesn't cause any change in their behavior whatsoever, but when they are confronted with the fact that the brain is working much worse than it could, it somehow triggers the change, because people don't want to be stupid. And if you are not eating, you are, to some extent, becoming more stupid than you are, or at least you behave as someone more stupid, and your cognitive performance is absolutely below the normal cognitive performance of yours. As I mentioned before, the therapy is very challenging for both sides, so for a therapist and patient, for both of them. And often requires hospitalization, because long-term starvation leads to severe physical problems, such as heart rhythm abnormalities, kidney problems, seizures, and so on. So this, again, I have to say, this is very serious mental and very serious physical condition. So if you see that someone is eating less or someone is dieting excessively, please don't freak out but be alarmed, because this is really, really serious mental condition. And the faster this person gets help, the better, because later it might be too late. The exact causes of anorexia nervals are not fully understood, but certain factors can increase the risk. So for example, genetic factors suggest a hereditary link, so as anorexia often runs in families. Of course, cultural influences, such as the promotion of thinness and by the media and social media, it also plays a role. Additionally, environmental factors, including the onset of puberty, stressful life events, and relationship problems, can also contribute to the disorder. For some individuals, anorexia becomes a way to control areas of their life that feel out of control of their body image, heavily influencing their overall sense of self-worth. So if you don't have control over your life, sometimes eating is the only thing that you can control. And I remember a patient, which was my teacher's client, an 19-year-old college student. Her mother described her as an outgoing and highly achieving individual. However, during her senior year of high school, she became increasingly focused on her appearance, particularly her weight. What began as a simple attempt to eat healthier and simply exercise more, it quickly spiraled into an obsession with food restriction and exercise, counting calories and cutting more and more calories every day. And it's hard to believe, but at the peak point of her disorder, she used to eat 300 calories per day, 300 calories. While an average maintained calorie intake for an adult person, by maintaining the number of calories necessary to keep your lungs and heart and brain functioning, it's about 13-1500 calories daily. And she ate 300 calories. She attempted to eat more and she tried to engage in cognitive behavioral therapy. But the fear of gaining weight was so overwhelming that she still skipped meals, and she had to be admitted to the daily care hospital, where the patients were controlled in terms of the number of calories eaten daily. They were eating their meals with therapies, so basically they were eating the dinner together, breakfast and so on. So the therapies modeled eating behavior of the patients, and additionally, they could observe and control their patients. So they were not controlling them by counting calories and just standing behind the patient and looking at them. But they were handing out eating together and by this behavior, therapies modeled eating habits and eating behaviors. Another disorder, which I will describe today, is bulimia nervosa. It is sometimes confused with anorexia. However, patients with bulimia often cycle between dieting or eating only low calorie or safe foods and engaging in binge eating on forbidden high calorie foods. So they are going up and down between safe, good, low calorie and junk food high calorie. So for example, from Monday to Friday, they stay on low calorie diet and they eat relatively healthy. But on Saturday, the patients claim that they behave like a trash can. They can eat basically any amount of highly processed fatty and unhealthy food. Usually, by any amount, they eat until they are on the verge of vomiting. And then, as a result of overeating and the sense of guilt and the sense of loss of control, binge eating is followed by so-called compensatory behaviors aimed at preventing wane gait, which can include fasting, vomiting, laxative misuse or compulsive exercise. And similar to those patients with anorexia nervosa, individuals with bulimia nervosa are overly focused on thoughts about food, weight or body shape, which significantly and negatively influence their self-esteem. And people with bulimia can be overweight, obese, they can be of normal weight or underweight. So the body mass itself is not an indicator here. So you can have someone of normal weight, you can have someone obese and they still can have bulimia. So eating disorders doesn't necessarily mean that people are underweight or super skinny. Bulimia can... bulimia is not related to body weight or BMI at all. However, if an individual is underweight and shows symptoms of bulimia, they are considered to have anorexia nervosa binge eating. So this is a bit different diagnosis than bulimia nervosa. But let's leave it aside for a while. Let's talk about bulimia. Well, bulimian behaviors can often remain unnoticed, mostly because patients are not losing weight, so family members are not aware of this disorder. And the possible signs that someone may be struggling with bulimia nervosa include frequent visits to the bathroom immediately after meals. So as you can imagine if people eat something, especially if they eat a lot, they almost immediately experience sense of guilt. So they need to go to the bathroom, for example, provoke vomiting and so on. It can also include large quantities of food disappearing, a persistent sore throat due to provoked vomiting, a swollen sliver of glands in the cheeks, dental decay due to the erosion of tooth enamel by stomach acid, reflux, misuse of laxative or diet pills, recurrent diarrhea or acid in anorexia, dizziness or fainting caused by excessive purging behaviors leading to dehydration. However, these are signs described on the basis of interviews with patients and clinical observations. And it is not so easy to spot them as a family member or a friend. Of course, dental decay is visible. However, first, it's not always caused by bulimic behaviors. And second, this happens after a long time of bulimia. So it's not designed, which is visible after a week of all this disorder or two weeks or a month. It usually means several months or even years of bulimia. There was that. So these signs are relatively hard to spot if you're a friend or if you're a family member. Well, bulimia is not as deadly as anorexia, but it can result in potentially life threatening complications such as gastric rupture and dangerous cardiac arrhythmias. So similar to anorexia nervosa, these patients can also have heart problems. And for individuals with severe bulimia nervosa, medical monitoring is crucial to detect and address this potential complication. So this is usually necessary to be not only in psychotherapy, but also to have constant medical monitoring. The most effective treatment for bulimia nervosa is outpatient cognitive behavioral therapy, which helps patients regulate the eating behaviors and manage their thoughts and emotions that sustain the disorder. Sometimes antidepressants like fluoxetting, for example, can also reduce the urges to binge and purge. And of course, family-based treatment, which educates caregivers on how to support adolescents or young people in normalizing their eating patterns may be beneficial in treating people with bulimia nervosa. However, as all eating disorders, this one is also very challenging for both patients and therapies and for the families as well. And it requires a lot of strength and it requires leaving a comfort zone of a patient. So these patients should have continued support in their efforts because it is really really very distressing and very uncomfortable for them. The final disorder I want to describe in this episode is binge eating. Similar to bulimia nervosa, individuals with binge eating disorder experience episodes of consuming large quantities of food in a short time. And it is accompanied by a sense of loss of control and distress over their eating behavior. However, unlike those with bulimia nervosa, they do not routinely engage in compensatory behaviors such as vomiting, fasting, excessive exercise, or laxative misuse. A binge eating disorder can result in serious health complications, first and foremost obesity, diabetes, hypertension, and cardiovascular disease. Because these patients experience very irregular phases of eating. So once they eat 3,000 calories at once, then they are fasting, again, they are eating and so on and usually such binge eating is related to emotional tension or stress. And it serves as a way of coping, as a way of regulating emotions. So this is very similar to binge drinking. If you are accumulating stress from a whole week and you take all the booze on the weekend and you lose control over your drinking, it is the similar mechanism. You are trying to regulate emotions, you are trying to cope and binge drinking, binge eating and engaging in all bingeing behaviors. It has, they have pretty similar purpose, so they are there to serve as some kind of emotional regulation. To diagnose binge eating disorder, at least once a week for 3 months, the patient has to experience binge eating episodes. A company, these binge eating episodes, must be accompanied by a sense of loss of control and at least 3 of the following characteristics. Eating more quickly than usual, eating uncomfortably full, consuming large amount of food, eating alone due to embarrassment of how much one is eating, feeling disgust with oneself, depressed or extremely guilty after a binge. Usually, and this is what therapies who work with eating disorders told me, usually people experience or patients who want to go under therapy, they experience depression and a sense of guilt after binge eating. They rarely realize they consume large amount of food when not physically hungry because they are not really thinking about it, but it happens that they are eating alone due to embarrassment over how much they are eating. So, these are, some of them are more popular, some of them are less common, but in general, 3 of them should be present to diagnose binge eating disorder. As with Blyman or Vozar, the most effective treatment for binge eating is cognitive behavioral therapy, either individually or in a group setting. A group setting is even more efficient because when you are in a group, you see that it's not only your problem. You see that other people experience similar problems, you see how other people cope and this is very, very helpful. Interpersonal therapy has also proven effective along with certain antidepressant medications and usually psychiatrists prescribe light working antidepressants, so they are not very hard, so they are not making you feel like a zombie. But they help you to control your bingeing behaviors. And I think that's all I wanted to tell you about eating disorders. I hope this episode was helpful and interesting to you. Again, sorry for the quality of sound, but the next episode will be much better. Thank you for listening and of course you can message me via social media or an email. Thank you for listening and take care. Bye bye. [Music] [Music] [Music] [Music] [Music] [Music] [Music] [Music] [Music] [Music] [Music] [BLANK_AUDIO]