Eating Disorders

What are Eating Disorders?

It is common in today’s society for individuals to feel dissatisfied with their bodies, worry about food, or engage in dieting. However, when this dissatisfaction and worry becomes extreme or interferes with normal activities and quality of life, individuals are considered to have an eating disorder. Eating disorders therefore describe a range of problems associated with eating, food and body image and include binge- eating disorder, bulimia nervosa and anorexia nervosa.

Eating disorders can affect  both men and women of all age groups, from a range of different backgrounds and cultures. However, they are most commonly detected in female adolescents and young women. While it is a common misconception that eating disorders are lifestyle choices, or attention-seeking attempts, they are in fact mental illnesses which often require psychological and/or physical intervention.

Symptoms of Eating Disorders

Dieting, depression and body dissatisfaction are the most common risk factors for eating disorders, however, some of the symptoms of eating disorders include:

  • Preoccupation with body appearance or weight
  • Weight loss or weight change
  • Constant and excessive dieting
  • Frequent excuses not to eat
  • Social withdrawal and avoidance of social situations involving food
  • Obsessive rituals
  • Sensitivity to the cold
  • Increased mood changes and irritability
  • Loss or disturbance of menstrual period
  • Wearing baggy clothes
  • Anxiety and depression
  • Faintness, dizziness and fatigue
  • Excessive or fluctuating exercise patterns
  • Trips to the bathroom after meals 

Causes of Eating Disorders

Social, psychological and biological factors all contribute to the development of eating disorders:

Social factors include: Media portrayals of the ’ideal’ body as slim and fit, occupations or other pursuits that emphasise body shape and size (for example dancing, gymnastics), Cultural norms that value people on the basis of physical appearance and not inner qualities and strengths, and pressure to achieve and succeed.

Psychological factors include: low self -esteem, low body esteem, feelings of inadequacy or lack of control in life, depression, anxiety, anger, stress, loneliness and perfectionism.

Biological factors include: physical changes that occur in adolescence, genetic, and familial factors.

Binge Eating Disorder

A. Recurrent episodes of binge eating. An episode of binge eating is characterised by both of the following:

  1. Eating in a discrete period of time (e.g. within any 2 hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances
  2. A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating)

B. The binge eating episodes are associated with three (or more) of the following:

  1. Eating much more rapidly than usual
  2. Eating until feeling uncomfortably full
  3. Eating large amounts of food when not feeling physically hungry
  4. Eating alone because of feeling embarrassed by how much one is eating
  5. Feeling disgusted with oneself, depressed, or very guilty afterward

C. Marked distress regarding binge eating is present

D. The binge eating occurs, on average, at least once a week for 3 months

E. The binge eating is not associated with the recurrent use of inappropriate compensatory behaviour as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

Degree of severity is based on the frequency of episodes of binge eating:

Mild: 1-3 binge eating episodes per week

Moderate: 4-7 binge eating episodes per week

Severe:8-13 binge eating episodes per week

Extreme: 14 or more binge eating episodes per week

Anorexia Nervosa

A.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. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents , less than that minimally expected.

B. Intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight.

C. 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 persistent lack of recognition of the seriousness of the current low body weight. 

The DSM-5 suggests two presentations of anorexia nervosa: the restricting type (In which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercising) and the binge –eating/purging type (In which the individual engages in recurrent episodes of binge eating or purging behaviour such as self-induced vomiting or the misuse of laxatives, diuretics or enemas).

Further, degree of severity is based on body mass index:

Mild: BMI > 17 kg/m2

Moderate: BMI 16-16.99 kg/m2

Severe: BMI 15-15.99 kg/m2

Extreme: BMI < 15 kg/m2


Bulimia Nervosa

A. Recurrent episodes of binge eating

B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise

C. The binge eating and inappropriate compensatory behaviors both occur on average, at least once a week for 3 months

D.Self- evaluation is unduly influenced by body shape and weight

E.The disturbance does not occur exclusively during episodes of anorexia nervosa.

Degree of severity is based on the frequency of inappropriate compensatory behaviors:

Mild: An average of 1-3 episodes of inappropriate compensatory behaviors per week

Moderate: An average of 4-7 episodes of inappropriate compensatory behaviors per week

Severe: An average of 8-13 episodes of inappropriate compensatory behaviors per week

Extreme: An average of 14 or more episodes of inappropriate compensatory behaviors per week