Food intake has always been one of man’s main everyday concerns. Meal time is an invitation to family members to get together and communicate. Food is as important to man as the absence of measure in its intake, whether in the form of excessive food consumption, as in the case of obesity, occasional overeating and bulimia nervosa, or in the form of intentionally induced food deprivation, as in the case of anorexia nervosa.

Despite the great progress made in recent years in coping with various severe diseases, modern society starts coming in touch with an epidemic difficult to resolve, the one of eating disorders. In spite of the fact that anorexia and bulimia nervosa are of feminine gender, mostly affecting teenage girls, recently there has been an increase in eating disorder cases, not only in children and adults but also in males.

Genetic, psychological and environmental factors contribute to the development of eating disorders. First degree relatives of individuals suffering from anorexia or bulimia nervosa are more likely to develop an eating disorder. According to recent research findings, hormonal and neurological factors may also contribute to the development of these disorders. Family structure, personality traits, stress, puberty and social-cultural factors may also contribute to the onset and maintenance of the disorder.

WHAT ARE EATING DISORDERS

Most common eating disorders include anorexia nervosa, bulimia nervosa and binge eating disorder. Eating disorders are characterized by extreme feelings, thoughts and behaviors in relation to food, weight and body image.

Anorexia Nervosa

Anorexia nervosa was first described in the 19th century in Great Britain and France, yet references to the condition exist ever since the 17th century. Nevertheless, the systematic study of the disorder first began in the second half of the 20th century while its incidence seems to be steadily growing since the 1930s.

Anorexia nervosa is a severe, in many cases life threatening condition, characterized by a significant reduction in food intake. Individuals suffering from anorexia nervosa become obsessed with what they eat, as well as with counting calories, and have an aversion to all fatty foods. Additionally, they have a distorted image of their body shape and weight, and even when they are significantly underweight they insist that they have to lose a few extra kilos to look good. This whole situation leads to a dangerous loss of weight (approximately below 15% of normal weight).

The main characteristics of the disorder include intentionally induced weight loss, with a BMI below 17.5, intense fear of weight gain and obesity and a distorted body image, which leads the individual to keep up his efforts to lose extra weight, while denying the seriousness of low body weight consequences. In women of reproductive age amenorrhea may be observed, meaning the absence of at least three consecutive menstrual periods.

Anorexia nervosa may affect individuals of all nationalities and social-financial status, yet it develops more frequently in girls who engage in physical exercise and ballet, activities that require a thin figure. During the first stage of the condition, the individual limits food intake to low-calorie, therefore healthy foods, and avoids the consumption of fatty foods and carbohydrates.

The patient thoroughly counts the calories he/she takes in, so as to reduce as much as possible his/her daily calorie intake. One of the main features of anorexia nervosa is the satisfaction the patient feels when he/she succeeds in reducing his/her weight. The particular importance of body shape and weight in evaluating one’s personal value, combined with a poor gastric emptying due to malnutrition contribute to the persistence of the disorder, since indigestion and bloating lead the patient to further reduce meal portions. In the case of the bulimic sub-type of anorexia nervosa, food intake reduction is combined with overeating episodes. Overeating usually ends with self-induced vomiting and may be combined with the abuse of laxatives or diuretics, as a means of getting rid of excess weight. Intensive physical exercise is another means of weight reduction.

Bulimia Nervosa 

Bulimia nervosa is another severe eating disorder characterized by an ongoing cycle of eating behaviors, which usually start with episodes of uncontrolled and excessive food intake. Typically, the patient “gobbles down” in a short time large quantities of mostly high-calorie food (i.e. chocolates, chips, cookies etc). During the episode, the patient feels unable to stop eating. Shortly afterwards, he/she is overwhelmed by feelings of guilt and discomfort and, as a result, takes compensatory measures such as intensive physical exercise, self-induced vomiting and use of drugs (i.e. diuretics and laxatives), which he/she keeps secret. Individuals who suffer from bulimia nervosa are usually of normal weight.

The main behavioral characteristics of patients with bulimia nervosa are recurring overeating episodes and loss of control during food consumption. Large quantities of food are rapidly consumed and the individual feels unable to stop eating and control what and how much he/she eats. In order to prevent weight gain, the patient takes compensatory measures such as self-induced vomiting, use of laxatives, diuretics or other medications, fasting and strenuous exercise. Despite the fact that bulimia nervosa is often considered as a symptom of anorexia nervosa, it may be a distinct eating disorder. It most often affects young women of normal weight or slightly overweight and its prevalence among teenagers amounts to 2 to 4 percent. In comparison to individuals suffering from anorexia nervosa, patients with bulimia nervosa tend more often to suffer from mental disorders. In addition, bulimia nervosa often coexists with depression.

Binge Eating Disorder (BED)

Binge eating was only recently recognized as a distinct eating disorder. BED is characterized by episodes of uncontrollable, compulsive overeating (binge eating), beyond the point of feeling “satisfactorily full”. Not rarely, binge eating episodes are followed by feelings of guilt and distress. Still, BED differs from bulimia nervosa in the fact that it does not involve self-induced vomiting. Nevertheless, there are periods of repeated dieting and this is why the weight of individuals with BED may greatly vary. Once in a while, many people have binge eating episodes.

Binge eating episodes most commonly occur after periods of strict dieting. For the time being, we are in no position to know the exact reasons for which people overeat. Nevertheless, numerous assumptions have been made regarding the causes of binge eating disorder, in addition to the history of dieting some people have.

The most common causes of BED include stress, concern about the course of a relationship, family problems, depression and boredom. Up to now, research findings have given no satisfactory explanation of the problem. However, as mentioned above, the psycho physiological changes which are brought about by strict dieting and the mood changes related to a negative-depressive mood may disrupt the balance of neurotransmitters in the brain, triggering thus binge eating episodes. Given that in the overwhelming majority of binge eating cases the condition does not influence quality of life, patients with BED rarely seek professional help.

Nevertheless, in some cases BED does influence the life of an individual, affecting mental health and taking full control over one’s eating behavior. In such cases, the patient does seek professional help.

Some patients with BED think that what they suffer from is obesity. As a result, they consult a doctor in order to deal with obesity. At this point, it should be noted that patients with BED do not have symptoms of anorexia nervosa, since their BMI is greater than 17.5, nor do they suffer from bulimia nervosa, since they do not use any dangerous methods to control their weight, such as malnutrition, vomiting or use of laxatives.

10 to 30 percent of obese individuals who have binge eating episodes are quite often thought to suffer from BED. According to most experts, an individual is diagnosed with BED only when overweight (BMI>25) or obese (BMI>30). Nonetheless, others do not recognize the fact that BED is a distinct eating disorder and claim that all BED cases should fall under the category of Eating Disorders Not Otherwise Specified (EDNOS).

Main characteristics of Binge Eating Disorder

• Recurrent binge eating episodes i.e. eating in a short time (usually within 2 hours) an amount of food that is definitely larger than what most people would eat within the same period
• Sense of lack of control over eating during the episode (i.e. feeling that one cannot stop eating or control what or how much he/she eats. Binge eating episodes are associated with three (or more) of the following characteristics:
  • Eating much more rapidly than normal
  • Eating until feeling uncomfortably full
  • Eating large amounts of food even when not feeling hungry
  • Eating alone because of being embarrassed about the quantity of food consumed
  • Feeling disgusted with oneself, depressed or very guilty after overeating
• Marked distress regarding binge eating
• The binge eating episodes occur on average twice a week for a period of six months or more
• The binge eating episodes do not occur exclusively during the course of Anorexia Nervosa or Bulimia Nervosa.