TRASTORNOS DE LA CONDUCTA ALIMENTARIA (TCA)
We have all heard the term “eating disorder” and, for most, it evokes visions of underweight and malnourished (“anorexic”) young women. Although this concept corresponds to a certain type of patient, the reality is that there are different types and manifestations of eating disorders; These disorders can affect men and women of all ages equally and do not always present at extremely low weight.
You can have an Eating Disorder at any weight. Many people with an eating disorder look healthy despite being seriously ill. (1)
So what is an Eating Disorder? It is a biologically influenced disease, typified / classified within mental illnesses (mental health conditions), which involves extreme emotions, attitudes and behavior towards body image and behavior towards eating. It can have serious emotional, social and physical consequences. In fact, those with eating disorders have the highest death rate among mental health disorders.
(1)Nine Thruths Academy for Eating Disorders (AED) (2016)
Eating Disorders are not a choice.
They are complex diseases, they emerge from the combination of behaviors present for a long time, causing physical, emotional and psychological deterioration. They are biologically influenced serious mental illnesses.
A person with an Eating Disorder can look healthy and lead an apparently functional life, despite being extremely ill. (1) The common denominator of most eating disorders is that it begins with dysfunctional diet behaviors towards weight and figure, a product of the strong body dissatisfaction that prevails in our society. (2)
In Mexico, 68% of girls before adolescence, 74% of adolescents and 69% of adolescent boys are dissatisfied with their bodies and more than half in each age group have already started a diet to lose weight . (3) (4)
(1) Nine Thruths Academy for Eating Disorders (AED)(2) Comenzar de Nuevo; Creo que tengo un Trastorno de la Conducta Alimentaria (2012)
(3) Gómez Peresmitré (2001)
(4) Eating Disorders Treatment Health Care Guide de la Academy for Eating Disorders (2016)
Symptoms and signs present
- A state of major malnutrition, acute or chronic, can be associated with severe medical complications that affect every organ, every cell, and every system in the body.
- Precipitous loss, gain, weight fluctuations.
- Lack of expected weight / height gain for a developing child or adolescent.
- Chest pain, heart palpitations, arrhythmias, shortness of breath, and swelling.
- Varied lesions in the mouth (erosion of the salivary glands, caries, lacerations, dental erosions).
- Impairments in bone density.
- Stomach and intestine discomfort, difficulty identifying hunger and / or satiety.
- Gastrointestinal difficulties (delayed gastric emptying, vomiting with or without blood)
- Cold intolerance.
- Dizziness Fainting.
- Sweating episodes.
- Lack of or menstrual irregularities.
- Loss of libido.
Types of disorders
Anorexia Nervosa (AN)
Anorexia nervosa, often referred to simply as anorexia, is a serious, life-threatening medical and mental condition. It is characterized by difficulty maintaining adequate body weight, distortion of body image, and excessive dietary restriction.
It can be accompanied by periods of binge eating and / or behaviors aimed at getting rid of the calories ingested. AN typically begins during early adolescence and some of the warning signs include: sudden weight loss, extreme eating behaviors, eating rituals, hair loss, dry skin, brittle nails, and fine hair growth on the face and body among many others. Approximately 50% of individuals who meet the diagnostic criteria for anorexia may have a full recovery over time, with the best recovery rates being in young patients, with a shorter duration of illness at diagnosis. Unfortunately, the risk of death from anorexia is significantly increased due to medical complications and suicide. (1)
(1)American Psychiatric Association. Diagnostic and Statistic Manual on Mental Disorders, V edition. 2013
Avoidant / Restrictive Eating Disorder (ARFID)
This is a disorder described in DSM 5 since 2013. This disorder is characterized by persistent failure to meet adequate nutritional and / or energy needs leading to one or more of the following: Significant weight loss (or inability to achieving expected weight gain or growth in a child), significant nutritional deficiency, dependence on oral nutritional supplements or tube feeding, and marked interference with psychosocial functioning.
It is often confused with anorexia nervosa because weight loss and nutritional deficiency are common symptoms. However, the main difference between ARFID and other eating disorders is that patients with ARFID do not express concern about weight and shape. Although there is still very little epidemiological investigation of ARFID to date, existing data suggests that ARFID is as prevalent as all other well-known eating disorders.
The vast majority of studies that have investigated the prevalence of ARFID in specialized medical services through the review of records, have retrospectively estimated that around 5% of children and up to 15% of adolescents who attend pediatric clinics and of adolescent medicine could meet the diagnostic criteria (1).
It affects both genders and is more common in children and young adolescents; however, it also occurs in late adolescence and adulthood. It can often be accompanied by other psychiatric diagnoses, such as obsessive compulsive disorder or anxiety.
(1)Thomas et al (2018)
Binge Eating Disorder
Although it affects millions of people worldwide, binge eating disorder is a widely misunderstood eating disorder and one of the least studied at the moment; However, it is the most frequent Eating Disorders in Latin People.
In Latin America, the prevalence is 3.53% and this is an eating behavior disorder that occurs more in men (1). This disease, which involves overeating (binge eating, the characteristic of which is the rapid intake of a large amount of food in a limited period of time, usually two hours), with the feeling of loss of control when eating, with a frequency of episodes of binge eating at least once a week for three months, accompanied by marked distress and at least three of the following: eating without hunger, eating until you feel uncomfortably full, eating very quickly, eating only because of the shame you feel for the amount swallowed, then feel unhappy with oneself, depressed or very embarrassed.
It is estimated that between 30 and 40% of patients who attend obesity clinics suffer from a ToP and as long as it is not resolved, the results will be poor. Binge eating disorder can occur in individuals without obesity.
(1)Kosler et al (2016)
Bulimia Nervosa (BN)
Bulimia nervosa, which is often called bulimia, is an eating disorder characterized by binging patterns (consuming a large amount of food in a short period of time), generating severe discomfort from the food eaten, followed by behaviors aimed at eliminating calories ingested and this happens at least once a week in the last three months.
The typical age of onset is between middle and late adolescence. Early warning signs include the disappearance of large amounts of food, frequent visits to the bathroom after meals, bathing after eating, swelling of the face, among others. Some medical conditions that can accompany bulimia include hydroelectrolyte imbalance (such as sodium and potassium), esophageal and gastric ulcers, dental abnormalities.
Body Dysmorphic Disorder
Body dysmorphic disorder is a body image disorder characterized by obsessive thoughts related to body size, shape, or weight. Negative thoughts can focus on one part of the body or the entire body, causing serious emotional distress, problems with daily functioning and / or extreme efforts to “correct” the perceived failure (diet, exercise, plastic surgery, camouflage with clothing, makeup, wigs, etc.).
It is an eating behavior disorder classified in DSM 5. People with this disorder repeatedly regurgitate food after eating, usually every day. They can re-chew the regurgitated food and then spit it out or swallow it again. The disorder can occur in babies, children, teens, or adults. Unlike vomiting, which is forceful and involuntary (the person does not control it) and is usually caused by a disorder, food regurgitation must be at least a month long and is not due to medication or other illnesses. However, the person may report that they cannot stop doing it.
Between 4% and 26% of institutionalized individuals are believed to have Pica. This is another eating disorder classified in DSM 5, and consists of an irresistible desire to eat or lick non-nutritive or unusual substances such as dirt, chalk, mud, etc.
Other Risk Eating Behaviors
This is a disordered eating pattern characterized by an obsession with healthy eating and avoiding foods that are considered impure, unclean, and / or unhealthy. Orthorexia is rooted in the quality of food consumed and not in the quantity of food consumed (i.e., anorexia / too little food consumed, bulimia and binge eating disorder / too much food consumed). Orthorexia is not an official eating disorder diagnosis or a medically recognized term. It is a descriptive term for observed behavior and is widely used in popular culture. While the term itself is inaccurate, it highlights a very serious and real pattern of eating disorders.
Vigorexia (compulsive exercise)
This disorder is characterized by a significant amount of physical activity that feels mandatory in nature accompanied by a sense of urgency or agitation when people are unable to participate in exercise. Exercise does not have to be of a certain type or performed for a specific time. This is also not an official diagnosis, but rather a descriptive term. PREGOREXIA.
This is not an official diagnosis of eating disorder, but a descriptive term. It refers to the pregnant woman who presents excessive concern for maintaining her body weight, reaching caloric and / or nutritional restriction without concern for the negative effect on the unborn baby.
It is not an official eating disorder diagnosis or a medically recognized term. It is a descriptive term for observed behavior and is widely used in popular culture. While the term itself is inaccurate, it highlights a very serious and real pattern of eating disorders. This term has been coined to describe the combination of insulin-dependent diabetes and risky eating behaviors. People with diabulimia can exhibit any number of eating disorder behaviors, or can only manipulate their insulin and have normal eating patterns.
Science has reported that between 55 and 97% of those who are diagnosed with an eating disorder also receive at least one more diagnosis of physical or mental health impairment. The most frequently associated psychiatric disorders are depressive, anxiety, and personality disorders. If not treated concurrently with eating disorder, concurrent mood and anxiety problems can challenge recovery, even in the most committed and well-intentioned patients. Medical disorders are frequently related to immune, cardiovascular & diseases.
Disorders of the State of Mood (Depression, Disorder Bipolar, Among Others)
In these disorders, the general emotional or mood state is distorted or does not coincide with life circumstances and interferes with the ability to function. You can go from being extremely sad, empty, or irritable (depressed), or you can have periods of depression alternating with excessive happiness and energy (mania). Between 50 and 75% of patients with eating disorders can have a chronic depressive condition known as dysthymia and up to 13% can be diagnosed with a bipolar disorder.
People with anxiety disorders often have intense, excessive, and persistent worries and fears about everyday situations. These anxiety and panic emotions interfere with daily activities, are difficult to control, disproportionate compared to actual danger, and can last a long time. In order to prevent these emotions, those who suffer from it can try to avoid certain places or situations. Some examples are: generalized anxiety disorders, social phobia, specific phobias, and separation anxiety disorder. You can have more than one anxiety disorder at a time. Eating disorders can be associated with up to 56% of anxiety disorders.
Obsessive Compulsive Disorder (OCD)
OCD consists of a pattern of irrational thoughts and fears (obsessions) that lead to repetitive behaviors (compulsions). These obsessions and compulsions interfere with daily activities and cause intense distress. OCD often focuses on certain topics, for example, fear of becoming infected with germs or contracting certain diseases. 40% of patients with eating disorders can have a diagnosis of OCD.
Eating disorders have an increased risk of death from suicide among all mental health illnesses. 1 in 5 people with anorexia make a suicide attempt, and some studies show that up to 60% of people with an eating disorder engage in suicidal thoughts and behavior. Furthermore, up to 40% of those who suffer from an eating disorder can engage in self-injurious behavior.
Fortunately, eating disorders are treatable and suicidal thoughts and behaviors can be managed and controlled.
Source: Mandelli L, Arminio A, Atti A-R, et al. Suicide attempts in eating disorder subtypes: a meta-analysis of the literature employing DSM-IV, DSM-5, or ICD-10 diagnostic criteria. Psych Med. June 2019; 2018; 49(8). Consulted in: https://www.cambridge.org/core/journals/psychological-medicine/article/suicide-attempts-in-eating-disorder-subtypes-a-metaanalysis-of-the-literature-employing-dsmiv-dsm5-or-icd10-diagnostic-criteria/D504EE8F05C69F24780C9329CD80707Ehttps://www.cambridge.org/core/journals/psychological-medicine/article/suicide-attempts-in-eating-disorder-subtypes-a-metaanalysis-of-the-literature-employing-dsmiv-dsm5-or-icd10-diagnostic-criteria/D504EE8F05C69F24780C9329CD80707E [Abril, 2020]
Koutek, J., Kocourkova, J., & Dudova, I. (2016). Suicidal behavior and self-harm in girls with eating disorders. Neuropsychiatric disease and treatment, 12, 787. Consulted in: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4833374/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4833374/ [Abril 2020]
Use & Abuse of Substances
Up to 50% of individuals with eating disorders abuse alcohol or illicit drugs, a range 5 times greater than the general population. Up to 35% of individuals who abuse or depend on alcohol and other drugs also have an eating disorders, a range 11 times higher than the general population.
Attention Deficit Disorder & Hyperactivity (ADDH)
More than 10% of ADDH patients co-occur with an Eating Disorders. In Binge Eating Disorder, up to 30% of patients have a lifetime diagnosis of ADDH. The presence of these two diagnoses results in a more severe psychopathology due to the impulsivity involved.
Post-Traumatic Stress Disorder (PTSD)
PTSD usually co-occurs in people with an Eating Disorders. Those who have experienced traumatic events can become involved in an Eating Disorders to manage their PTSD-related emotions and experiences on their own. Studies have shown statistically significant links between abuse patients and the subsequent development of an Eating Disorders. Tim Brewerton in Psychiatric Times reported that up to 74% of 293 women in residential treatment for Eating Disorders have experienced significant trauma and 52% reported symptoms consistent with a diagnosis of PTSD.
They are a recurring pattern of internal experience and behavior that deviates significantly from the expected and cultural pattern. It manifests itself in the person’s cognitive, affective, interpersonal functioning and impulse control domain. There are different personality disorders, the most frequently associated with eating disorders are obsessive compulsive personality disorder, avoidant personality disorder and borderline personality disorder. Up to 53% of patients with borderline personality disorder meet criteria for an eating disorder.
Neurodevelopmental Disorders (ND)
Up to 20% of those with a severe eating disorder can be associated with a ND. Furthermore, between 46% to 89% of children with TND may have difficulties with eating behavior.