Eating disorders belong to the group of psychosomatic illnesses. What they have in common: severe disturbances in eating behavior. They are often associated with serious and long-term damage to health. The illness affects food intake or refusal to eat and is associated with psychosocial impairments and a disturbed attitude towards one's own body.
Article overview
What symptoms are typical of eating disorders?
Impairments in eating behavior can manifest themselves through various signs. For most people, eating is a completely normal, everyday process to satisfy hunger. Those affected by eating disorders, on the other hand, are constantly preoccupied with this topic. They associate compulsive behaviors with eating.
Three main forms of eating disorders are distinguished according to the symptoms: anorexia, bulimia and binge eating syndrome.
The most important characteristic of anorexia nervosa is a pathological need to lose weight. Those affected feel an almost panicky fear of gaining weight. They therefore try to give their body as little food as possible. They also make sure that the little food they eat contains hardly any calories. Many patients also exercise frequently and intensively to increase their energy consumption.
Anorexia is accompanied by a body schema disorder. This leads to those affected feeling that they are still too fat even when they are extremely underweight.
In the case of binge eating disorder (bulimia nervosa), on the other hand, sufferers usually have a normal weight but are prone to weight fluctuations. A key characteristic is binge eating followed by vomiting. In addition, patients with eating disorders often use laxatives uncontrollably.
Binge eating disorder (eating attacks with loss of control) is characterized by patients suffering from eating attacks that occur repeatedly. In this behavioral disorder, however, those affected refrain from weight-reducing measures. They lose their sense of satiety and control over their food intake. Even if the binge eating episodes are only short-lived, their frequency can lead to obesity.
In addition, mixed forms of eating disorders can occur. Those affected then exhibit characteristics of different clinical pictures. The term for this is, for example, atypical bulimia or atypical anorexia.
Another eating disorder is pica syndrome. It occurs in patients with developmental disorders, mental disabilities or dementia. These people eat non-edible things such as soil, scraps of paper or excrement.
How many people suffer from an eating disorder?
A recent study from the United States shows that about 0.1 percent of all girls and boys between the ages of 8 and 15 develop an eating disorder in the course of a year. This figure may seem low. However, as eating disorders are associated with considerable suffering and serious health consequences, the illness should not be underestimated.
How are eating disorders diagnosed?
The doctor makes the diagnosis based on the patient's medical history and physical examination. Underweight, overweight and obesity are assessed according to the body mass index (BMI ), the ratio of a person's body weight to their height.
In the case of anorexia, the body weight will be at least 15 % below the normal weight. In girls or women, menstruation often stops, hair loss and tooth damage can occur. Heart and circulatory disorders, kidney disease and gastrointestinal disorders are also possible. For a definitive diagnosis, bulimia must have been present for at least three months and occur at least twice a week. In any case, three of the following five characteristics are required for binge eating disorder:
- Eating without feeling hungry
- Excessively fast eating
- Eating until you feel full
- Eating alone out of guilt
- Emotions such as depression, disgust or shame after binge eating
The Munich-based association ANAD e.V. Versorgungszentrum Essstörungen offers a test for self-assessment of eating behavior. Please note: A self-test gives you a rough orientation. Under no circumstances can it replace a visit to the doctor.
What treatment options are available?
The treatment of eating disorders is based on the two pillars of psychotherapy and nutritional therapy. It can be carried out on an outpatient or inpatient basis. In particularly severe cases, there is the option of longer-term treatment in therapeutic residential groups.
Main goals of the therapy:
- Learning normal eating behavior
- Stabilization of body weight
- Restoration of a positive body image
- Development of a normal feeling of hunger and satiety
- Regaining pleasure and enjoyment in eating
Psychotherapy focuses on treating the symptoms of abnormal eating behavior. These primarily include starvation, vomiting, binge eating and a lack of self-esteem. As far as possible, the causes of the disordered behavior should be identified and psychological balance restored.
In addition to cognitive behavioral therapy, systemic family therapy is also used. This enables those affected to take responsibility for their own eating behavior and body weight. Family-oriented treatment is particularly suitable for young people who are still living at home. Here it is helpful to involve the whole family in solving the problems caused by the eating disorder.
The aim of nutrition therapy is to educate those affected about the symptoms and consequences of disordered eating behavior. In addition, knowledge about an orderly meal structure, optimal portion sizes and healthy foods is taught.
Outpatient therapy
Outpatient treatment takes place several times a week with a registered psychotherapist and is considered under the following conditions
- the BMI is over 15
- regular weight gain with underweight
- no significant bulimic symptoms (e.g. drastic binge eating, frequent vomiting, severe abuse of laxatives)
- Insight and motivation to change eating behavior recognizable
- No risk of suicide
- Intact social environment
Regional self-help groups offer additional support for those affected. Make absolutely sure that a suitable person moderates the meetings. Qualified group leaders can be sufferers who have dealt intensively with their illness and are stable. There are also professionally facilitated groups. These are led by social education workers or psychotherapists.
Inpatient therapy
Inpatient treatment is indicated for very severe and particularly long-term eating disorders and can be considered under the following conditions
- the BMI is below 15
- rapid weight loss that also lasts longer
- considerable bulimic symptoms (e.g. drastic binge eating and frequent vomiting, severe abuse of laxatives)
- risk of suicide
- No intact social environment
- unsuccessful outpatient therapy
Incidentally, inpatient treatment is particularly often necessary for patients with anorexia nervosa, as the exceptional weight loss is associated with an increased risk of death.
Digital technology in therapy
Renowned scientific experts have joined forces in the German Society for Eating Disorders (DGESS e.V.). Among other things, they are researching internet-based therapy services. These are used, among other things, for aftercare following an inpatient stay. You can find information on the current state of research on the association's website .
Prognosis and recovery from eating disorders
Younger patients in particular have a good chance of recovery if treatment is started early. If you or a member of your family is affected by an eating disorder, it is important to seek medical advice as soon as possible. The earlier treatment is started, the better the weight will normalize and those affected will regain a normal life expectancy. In some cases, however, eating disorders remain chronic even under treatment or relapses occur.
The chances of recovery decrease if the disorder begins before the age of 11, the initial weight is particularly low and the eating disorder lasts a long time. Patients with anorexia nervosa are particularly at risk of dehydration or acute organ failure with fatal consequences. Therefore, the signs of eating disorders should be recognized as early as possible and appropriate therapeutic measures initiated.
References
- Spitzer, N. (2016): Perfektionismus und seine vielfältigen psychischen Folgen: Ein Leitfaden für Psychotherapie und Beratung. Springer-Verlag.
- Jacob, G. und Melchers, F. (2017): Ratgeber Schematherapie: Eigene Verhaltensmuster erkennen und verändern. Reihe „Fortschritte der Psychotherapie. Hogrefe-Verlag.
- Sipos, V. & Schweiger, U. (2016): Therapie der Essstörung durch Emotionsregulation. 2.Auflage. Kohlhammer-Verlag.
- Jacobi et. al. (2016): Anorexia und Bulimia nervosa: Ein kognitiv-verhaltenstherapeutisches Behandlungsprogramm. BELTZ-Verlag.