Eating Disorders
Eating disorders are complex mental health conditions characterized by abnormal eating habits that negatively impact an individual’s physical and psychological well-being. These conditions often involve a preoccupation with food, body weight, and shape, leading to severe disturbances in eating behaviors. 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 behaviors to maintain low body weight.
Bulimia Nervosa
Bulimia nervosa involves recurrent episodes of binge eating, followed by compensatory behaviors 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 behaviors, 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 that frequently contribute 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
Food quantity and variety restrictions characterize avoidant/restrictive food intake disorder (ARFID). 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 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 behavior does not occur exclusively in the course of anorexia nervosa, bulimia nervosa, BED, or avoidant/restrictive food intake disorder.
Other Specified Feeding or Eating Disorders
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 neurotransmitter imbalances, 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-behavioral therapy (CBT), dialectical behavior 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 are crucial 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 behaviors.
Prevalence of Eating Disorders in DID
Individuals with DID frequently experience comorbid conditions, with eating disorders being pervasive. 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. Foote et al. (2019) suggest alterations in identity states are associated with shifts in body image and eating behaviors.
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 determining an eating disorder where dissociation is occurring.
Specific 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.
If you are worried about having an eating disorder unknown to you in a dissociative state, speak to your therapist and psychiatrist about any worries before altering your diet or routine and report any change in physical symptoms.
Personal Experiences With Eating Disorders
I have experienced the full cycle and process of having and treating an eating disorder in an alter.
We were gaining weight, noticing we were overbuying snacks and the boxes and bags were becoming empty quite fast, and we were noticing other signs, things like a lingering vomit taste, and nervousness around the topic of food. It took a while to fully find out that we had an alter specifically based around the food trauma that was caused by a parent.
‘To be plain, my parent fat shamed me while simultaneously forcing me to eat large amounts of food in front of others, in public, and at presentation dinners. It was even culturally embedded in the way my family worked, that when we would eat together, plates would be full, and they were to be cleared before the table was vacated. When alone, or when eating meals outside of public meals, I was actively placed on a weight watchers food only diet. I was shamed, and I was forced to eat small portions of frozen food. I shamed heavily for eating other things. I was encouraged to count calories, encouraged to hide my figure, and to be ashamed of it. I could not handle the constant change in mood and rules around my eating habits that my parent had. One day, I would be chastised for wanting more than a frozen meal, and the next, she would take us to the Chinese buffet, and say I should eat all I want — that I should eat more to make it worth it. – GL
Treatment like this can absolutely lead to the formation of eating disorders, and in a person with DID, this treatment can often be compartmentalized into a single alter in order to disassociate from the actions all together. Given the amount of shame involved in eating disorders, it is not uncommon for people without a dissociative disorder to dissociate themselves from the actions.
It took us over a year to realize what was happening, one of our alters had bulimia.
Instead of treating it properly, we freaked out. We shamed that alter further; we thought of him as harmful or a bad influence on the system; we treated him as an “other”. This made it worse, causing mutual resentment, and a lack of cohesiveness among our system. He knew he had a problem, but we did not know how to help, as we didn’t even think to help through the judgement.
It was only after encountering a close friend with an eating disorder, that we realized we were not being a good head-mate, family member, and friend to our own alter. We would never say the things to our friend that we would our alter about their eating disorder. We felt extreme shame and shock at our own actions toward him.
We began treating him like we would an external source, supporting him by holding him accountable for the missing food when it happened, the vomiting, and the urges to binge and purge. We paid closer attention to his needs, and addressed them in therapy, getting to the source of the disorder, the treatment we received from our childhood.
Slowly, but effectively, he began healing, feeling empowered to do better, knowing he had all of us to back him up and to keep him on track with his healing journey. When he needed to speak about food urges, we were there to listen, we were there to let him write it down and bring the concerns to our therapist, giving him a permanent position as a cohesive, and loving alter.
Even if he falls into a poor pattern again, we will always have the skills to help him, and we are thankful that we found help for him, and most importantly, ourselves. It changed the way all of us think about problem solving within our system, that no system member is malicious, inherently bad, or malformed, no matter their actions.
We are the way we are based on the mistreatment we received that helped form this disorder as a whole, and that is not any of our faults. Realizing this was life-changing, and we hope that the experience will help others seek help for any alters with eating disorders in a kind, gentle, and proper way.” – EJK
Resources:
It is essential to seek resources, even if you are not the alter struggling with an eating disorder. As friends and family of the person with the disorder, it is important to seek support for them in gentle and kind ways. Below are links for those with eating disorders, as well as friends and family, providing online support groups or healthcare provider guidance.
US
https://www.nationaleatingdisorders.org/resource-center
Canada
https://nedic.ca/find-a-provider
International
https://www.feast-ed.org/feast-anad-online-support-groups/
Sources:
- 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.
- 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.
- Foote, B., et al. (2019). Dissociative identity disorder and eating disorders: A systematic review. European Journal of Trauma & Dissociation, 3(3), 223-232.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
- National Eating Disorders Association (NEDA). (https://www.nationaleatingdisorders.org/)
- Treasure, J., Claudino, A. M., & Zucker, N. (2010). Eating disorders. The Lancet, 375(9714), 583-593.
- National Eating Disorder Information Centre. (NEDIC) (https://www.nedic.ca)
- 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.
- 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.
- Foote, B., et al. (2019). Dissociative identity disorder and eating disorders: A systematic review. European Journal of Trauma & Dissociation, 3(3), 223-232.
- 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/)
- 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/)