Eating disorders, an overview

By Cristiano Antonino On Feb 27, 2023

Eating disorders can be defined as persistent disturbances in eating behavior or behaviors aimed at weight control, damaging physical health or psychological and social functioning, which are not secondary to any known medical or psychiatric condition

They mainly affect adolescents: the age of onset ranges from 12 to 25 years, peaking around age 14 and 17; in recent years, more and more cases with early onset (children) or late onset (adults) have been noted.

Eating disorders affect mostly female persons F:M=10:1 or 9:1) although cases in the male sex seem to be on the rise

According to the Diagnostic Statistical Manual of Mental Illnesses IV-Test Revision (DSM-IV-TR) classification, eating disorders are divided into: anorexia, bulimia, and non-otherwise specified eating disorders (especially the so-called uncontrolled eating disorder, or binge eating disorder).

In a dimensional view, eating disorders are caused and maintained by characteristic dysfunctional beliefs that identify a common psychopathological core:

distorted beliefs about food and eating
distorted beliefs about weight
distorted beliefs about body shape
self-prescriptive attitudes about food.

These ideas interact with other individual and family characteristics, such as perfectionism and the control dimension.

The essential feature common to all eating disorders is the presence of an altered perception of weight and one’s own body image (excessive preoccupation with weight, body shape, and food control).

The etiology of eating disorders is not yet fully known, although the most recent evidence suggests the existence of an interaction between genetic predisposition and specific environmental risk factors.

The cognitive behavioral theory of eating disorders argues that they have two main origins that may operate together

The first is the extreme need to be in control of various aspects of life (e.g., work, school, sports….), which may at particular times in life focus on controlling eating.

The second is the excessive importance placed on controlling weight and body shape in individuals who have internalized the ideal of thinness.

In both cases, in eating disorders, the result is the adoption of severe dietary restriction, which in turn reinforces the need for control in general and control of weight and body shape, in particular.

Subsequently, other processes that contribute to the maintenance of the eating disorder begin to operate; such as social isolation, the occurrence of binges fostered by dietary restriction, the negative effects of binges on the preoccupation with weight and body shape and the sense of being in control, malnutrition symptoms that increase the need to control eating, body and weight control, and avoidance of body exposure, which intensify the preoccupation with weight and body shape.

Cognitive behavioral theory of eating disorders also argues that in a subgroup of individuals, one more of the following four additional maintenance mechanisms may also operate, interacting with the specific eating disorder processes described above: clinical perfectionism, low nuclear self-esteem, interpersonal difficulties, and intolerance of emotions.

There is growing evidence that the disruption of maintenance factors is necessary for the treatment of eating disorders, and it is no coincidence that cognitive behavioral therapy is considered worldwide to be the intervention of first choice, from which one cannot disregard.

Recently some “new” eating disorders have been identified that do not fall under the above official classification, including vigorexia (or bigorexia), orthorexia, pregorexia and drunkorexia.

Anorexia Nervosa: The Risks For Adolescents