Eating Disorders

Eating disorders are complex mental health conditions characterized by abnormal eating habits that negatively impact an individual’s physical and mental well-being. These conditions often involve a preoccupation with food, body weight, and shape, leading to severe disturbances in eating behaviours. Eating disorders can affect people of all ages, genders, and backgrounds, and they have significant physical, emotional, and social consequences.

Types of Eating Disorders

Anorexia Nervosa

Anorexia nervosa is marked by an intense fear of gaining weight, leading to self-imposed starvation and extreme weight loss.  Individuals with anorexia may have a distorted body image and engage in restrictive eating, excessive exercise, and other behaviours to maintain a low body weight.

Bulimia Nervosa

Bulimia nervosa involves recurrent episodes of binge eating, followed by compensatory behaviours such as vomiting, excessive exercise, or fasting to avoid weight gain.  Individuals with bulimia often struggle with feelings of guilt and shame related to their eating habits.

Binge Eating Disorder (BED)

Binge eating disorder is characterized by recurrent episodes of consuming large amounts of food, often rapidly and to the point of discomfort.  Unlike bulimia, individuals with BED do not engage in regular compensatory behaviours, leading to weight gain and associated health issues.

Pica

Pica is a mental health condition where individuals compulsively eat or chew non-food items.  Individuals with pica are often found to have nutrient deficiencies often contributing to the disorder.  The substances eaten are not a part of a cultural practice (i.e. the religious ingestion of clay or medicinal objects or minerals) or as a part of a developmental state. (i.e. children mouthing and eating objects)

Avoidant Restrictive Food Intake Disorder

Avoidant/restrictive food intake disorder (ARFID) is characterized by restrictions in food quantity and/or variety.  Unlike anorexia, ARFID doesn’t entail concerns about body shape, size, or fear of becoming fat. This mental illness can significantly impact growth, development, and overall health.

Rumination Disorder

Rumination disorder is the repeated regurgitation of food for a period of at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out.  The repeated regurgitation is not due to a medication condition (e.g., gastrointestinal condition), or a physical need for more pliable, or pre-processed foods.  The behaviour does not occur exclusively in the course of anorexia nervosa, bulimia nervosa, BED, or avoidant/restrictive food intake disorder.

Other Specified Feeding or Eating Disorder 

Other Specified Feeding and Eating Disorders refers to atypical presentations of anorexia nervosa, bulimia nervosa, and binge eating disorder, among other eating disorders.  These eating disorders are equally serious and as potentially life-threatening as the more typical presentations. 

Causes and Risk Factors

Biological Factors

Genetic predisposition and family history can contribute to the development of eating disorders.  Neurobiological factors, such as imbalances in neurotransmitters, may also play a role.

Psychological Factors

 Low self-esteem, perfectionism, and body dissatisfaction are common psychological factors associated with eating disorders.  Traumatic life events, societal pressure, and cultural ideals of beauty can contribute to the development of these disorders.

Environmental Factors

Societal expectations and media portrayal of idealized body images can influence body image perception.  Peer pressure and societal norms related to weight and appearance contribute to the prevalence of eating disorders.

Treatment and Support

Psychotherapy

Cognitive-behavioural therapy (CBT), dialectical behaviour therapy (DBT), and family-based therapy are commonly used therapeutic approaches.
Individual and group therapy sessions aim to address underlying psychological issues and promote healthier coping mechanisms.

Nutritional Counseling

Registered dietitians play a crucial role in helping individuals establish balanced and sustainable eating habits.

Medical Monitoring

In severe cases, hospitalization may be necessary to address physical complications resulting from malnutrition or other health risks.

How Common Are Eating Disorders?

Eating disorders are relatively common and can affect people of all ages, genders, and backgrounds. The prevalence rates vary depending on the specific type of eating disorder. Some estimates suggest that globally, around 9% of the population may experience an eating disorder at some point in their lives.

Anorexia Nervosa: Estimated prevalence is around 0.3% to 1% of the population.

Bulimia Nervosa: Estimated prevalence is around 1% to 1.5% of the population.

Binge Eating Disorder: Estimated prevalence is around 1.6% to 3.5% of the population.

It’s important to note that these figures are subject to change, and the actual prevalence may be higher due to underreporting and challenges in identifying cases. Additionally, many individuals may struggle with disordered eating patterns that do not meet the specific criteria for a diagnosed eating disorder.

The Interconnection of Dissociation, Eating Disorders, and Dissociative Identity Disorder

The intricate connection between dissociation, eating disorders, and Dissociative Identity Disorder underscores the importance of a comprehensive approach to treatment. Therapeutic interventions that address trauma, promote self-awareness, and target specific dissociative symptoms can be essential in supporting individuals with DID and comorbid eating disorders.

Dissociation, a defense mechanism that involves a disconnection between thoughts, identity, consciousness, and memory, can have profound effects on mental health. When coupled with eating disorders, particularly in individuals with Dissociative Identity Disorder (DID), the complexities of these conditions can intertwine in unique ways. This article explores the interplay between dissociation and eating disorders, with a focus on individuals with DID, and delves into the reasons behind the prevalence of eating disorders in this population.

Understanding Dissociation and Eating Disorders

Dissociation and Its Impact

 Dissociation can manifest in various forms, from mild detachment to severe dissociative disorders. It often serves as a coping mechanism in response to trauma, providing a mental escape from distressing situations.

Link Between Dissociation and Eating Disorders

Research indicates a significant connection between dissociation and the development of eating disorders. A study by Dyer and Dorahy (2017) found that individuals with higher levels of dissociation were more likely to engage in disordered eating behaviours.

Prevalence of Eating Disorders in DID

Individuals with DID frequently experience comorbid conditions, with eating disorders being particularly common. According to a study published in the Journal of Trauma & Dissociation (Brand et al., 2016), nearly 23% of individuals diagnosed with DID also met the criteria for an eating disorder.

Factors Contributing to Eating Disorders in DID:

Trauma and Coping Mechanisms

The trauma that often precedes the development of DID can lead to a complex relationship with food. Eating disorders may serve as a coping mechanism, offering individuals a sense of control in the face of trauma-induced chaos.

Identity Alterations and Body Image

 The presence of distinct identity states in DID may have varying perceptions of the body, contributing to dysregulated eating. A study by Foote et al. (2019) suggests that alterations in identity states are associated with shifts in body image and eating behaviours.

Treatment and Support for Eating Disorder-Relevant Dissociation

Much like dissociative disorders, treatment for eating disorders is varied and needs to be tailored to the specific patient based on how the disorder was formed. Both Eating disorders and dissociative disorders serve a function to the individual, and often the treatment is determined based on the function the disorder serves, or how the disorder was formed, paying particular attention to trauma, or lack thereof, to determine a course of treatment. 

Identifying the symptomatic factors of an eating disorder, weight gain, loss,  and other physical health factors, is crucial for identifying an eating disorder where dissociation is occurring.

Certain actions like binging or purging can be done during a dissociated state, somewhat blocking an individual from identifying with those actions, and making it difficult to determine if an eating disorder is present, even to the individual themselves.

If you are worried about having an eating disorder unknown to you in a dissociative state, speak to your therapist and psychiatrist about any and all worries before altering diet or routine and report any change in physical symptoms.

Sources:

1. Dyer, A. S., & Dorahy, M. J. (2017). Associations between dissociation, childhood interpersonal trauma, and eating pathology: A systematic review. Journal of Trauma & Dissociation, 18(3), 259-281.
2. Brand, B. L., et al. (2016). Separating fact from fiction: An empirical examination of six myths about dissociative identity disorder. Journal of Trauma & Dissociation, 17(3), 338-361.
3. Foote, B., et al. (2019). Dissociative identity disorder and eating disorders: A systematic review. European Journal of Trauma & Dissociation, 3(3), 223-232.
4. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
5. National Eating Disorders Association (NEDA). (https://www.nationaleatingdisorders.org/)
6. Treasure, J., Claudino, A. M., & Zucker, N. (2010). Eating disorders. The Lancet, 375(9714), 583-593.
7. National Eating Disorder Information Centre. (NEDIC) (https://www.nedic.ca) 
8. Dyer, A. S., & Dorahy, M. J. (2017). Associations between dissociation, childhood interpersonal trauma, and eating pathology: A systematic review. Journal of Trauma & Dissociation, 18(3), 259-281.
9. Brand, B. L., et al. (2016). Separating fact from fiction: An empirical examination of six myths about dissociative identity disorder. Journal of Trauma & Dissociation, 17(3), 338-361.
10. Foote, B., et al. (2019). Dissociative identity disorder and eating disorders: A systematic review. European Journal of Trauma & Dissociation, 3(3), 223-232.
11. Hudson J.I., Hiripi E., Pope H.G., Jr., Kessler J. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol. Psychiatry. 2007;61:348–358. doi: 10.1016/j.biopsych.2006.03.040. – DOI – PMC – PubMed (https://pubmed.ncbi.nlm.nih.gov/16815322/)
12. Doris Nilsson, Annika Lejonclou & Rolf Holmqvist (2020) Psychoform and somatoform dissociation among individuals with eating disorders, Nordic Journal of Psychiatry, 74:1, 1-8, DOI: 10.1080/08039488.2019.1664631 (https://news.isst-d.org/eating-disorders-trauma-and-dissociation/)