The common drivers and misconceptions around eating disorders

Anorexia nervosa has the second-highest mortality rate of any psychiatric disorder. Yet, the intricacies of eating disorders are too often underestimated. Nutritional therapist Kerry Beeson explains

A wide range of factors can drive unbalanced relationships with food and eating. These include psychological issues, ⁽¹⁾ physical health conditions like diabetes, ⁽²⁾ and even genetic influences. ⁽³⁾ Environmental factors also play a significant role, such as family dynamics, ⁽⁴⁾ participation in elite sports, ⁽⁵⁾ or exposure to social media. ^(6,7) More recently, attention has turned to the gut microbiota, with research suggesting that gut dysbiosis – an imbalance in gut bacteria – may contribute to the development of eating disorders. ⁽⁸⁾

Given the broad spectrum of causes and the diverse ways these issues can manifest, eating disorders are often misunderstood. A common misconception is that they all look the same and revolve solely around weight loss or food restriction. While anorexia nervosa, bulimia nervosa, and binge eating disorder are among the most widely recognised diagnoses, typically involving patterns of food restriction, bingeing, purging, and a fear of weight gain, ⁽⁹⁾ not all eating-related mental health issues fit neatly into these categories. Many individuals experience symptoms that don’t align fully with these diagnoses. These conditions are classified as ‘other specified feeding or eating disorders’ (OSFED).

eating disorders tragically have the second-highest mortality rate among mental illnesses

There are also a variety of other disorders linked to avoiding food for a variety of reasons not connected to weight loss – these are known as ‘avoidant/restrictive food intake disorders’, or ARFIDs. Whilst not yet recognised as an eating disorder, orthorexia is another food-related obsessive disorder in which people become obsessed with eating ‘clean’ or ‘pure’ foods to the point where it hurts their daily lives. Collectively, these other variants form the largest group of eating disorders. Another misconception is that eating disorders only affect certain specific demographics, such as teenage girls who take ‘dieting’ too far. It’s important to realise that eating disorders can affect people of all genders and ages, even children – you may already know someone with an eating disorder, but you don’t realise it. Society’s views on weight and appearance can only serve to make recognition and recovery of these conditions even more difficult.

Potential impacts on physical and psychological wellbeing

The statistics are sobering: eating disorders tragically have the second-highest mortality rate among mental illnesses, with a life lost approximately every 52 minutes. There is often a stigma surrounding the topic of eating disorders, ⁽¹⁰⁾ so it’s vital to spread awareness and educate others about this critical issue.

Like any other mental health condition, eating disorders can make sufferers feel alienated, lonely, and unsure of how to cope. Early intervention can be crucial, so if family or friends notice that someone is starting to develop difficulties around food and food consumption, then it’s vitally important to encourage them to seek help straight away.

Helpful interventions

Just like every person, every eating disorder is different, manifesting in unique ways for each individual. Although often manifesting with obvious physical symptoms such as weight loss/gain, first and foremost, these are mental health disorders. Recovery strategies should, therefore, encompass plans to support both mental and physical health.

Psychological therapies like cognitive behavioural therapy (CBT) and dialectical behaviour therapy (DBT) are among the most well-established methods, helping individuals to manage difficult emotions and reduce disordered eating behaviours. ⁽¹¹⁾ Alongside this, nutritional rehabilitation plays a vital role. This typically includes structured meal planning, correcting any nutritional deficiencies or imbalances such as hypophosphatemia, and supporting a return to regular eating patterns. ⁽¹²⁾ Stabilising blood sugar levels is also important, as fluctuations can affect both mood and appetite, making recovery more challenging. ⁽¹³⁾

In recent years, growing attention has been paid to the role of the gut microbiome. Early research suggests that addressing imbalances in gut bacteria may positively influence eating behaviours. ^(8,14) Medical support may also be needed to address related conditions like depression, anxiety, or hormonal disturbances, which often accompany long-standing eating disorders. ⁽¹⁵⁾

Once diagnosed, recovery strategies should be discussed and carefully planned with the aid of your doctor, a dietician, and other specialist services. It’s very important to work with qualified professionals to make sure that your diet plan is right for the individual, and sufferers shouldn’t attempt to manage the condition alone without the correct support.

References

1. Tan EJ, Raut T, Le LK, Hay P, Ananthapavan J, Lee YY, Mihalopoulos C. The association between eating disorders and mental health: an umbrella review. J Eat Disord. 2023 Mar 27;11(1):51. doi: https://doi.org/10.1186/s40337-022-00725-4. PMID: 36973817; PMCID: PMC10044389.
2. Dean YE, ET AL Motawea KR, Association Between Type 1 Diabetes Mellitus and Eating Disorders: A Systematic Review and Meta-Analysis. Endocrinol Diabetes Metab. 2024 May;7(3):e473. doi: https://doi.org/10.1002/edm2.473. PMID: 38597269; PMCID: PMC11005101.
3. Donato K, Ceccarini MR, Dhuli K, Bonetti G, Medori MC, Marceddu G, Precone V, Xhufi S, Bushati M, Bozo D, Beccari T, Bertelli M. Gene variants in eating disorders. Focus on anorexia nervosa, bulimia nervosa, and binge-eating disorder. J Prev Med Hyg. 2022 Oct 17;63(2 Suppl 3):E297-E305. doi: https://doi.org/10.15167/2421-4248/jpmh2022.63.2S3.2772. PMID: 36479493; PMCID: PMC9710388.
4. Cerniglia L, Cimino S, Tafà M, Marzilli E, Ballarotto G, Bracaglia F. Family profiles in eating disorders: family functioning and psychopathology. Psychol Res Behav Manag. 2017 Oct 3;10:305-312. doi: https://doi.org/10.2147/PRBM.S145463. PMID: 29042824; PMCID: PMC5633277.
5. Currie A. Sport and eating disorders – understanding and managing the risks. Asian J Sports Med. 2010 Jun;1(2):63-8. doi: https://doi.org/10.5812/asjsm.34864. PMID: 22375193; PMCID: PMC3289170.
6. Barakat, S., McLean, S.A., Bryant, E. et al. Risk factors for eating disorders: findings from a rapid review. J Eat Disord 11, 8 (2023). https://doi.org/10.1186/s40337-022-00717-4
7. Bocci Benucci S, Fioravanti G, Silvestro V, Spinelli MC, Brogioni G, Casalini A, Allegrini L, Altomare AI, Castellini G, Ricca V, Rotella F. The Impact of Following Instagram Influencers on Women’s Body Dissatisfaction and Eating Disorder Symptoms. Nutrients. 2024 Aug 16;16(16):2730. doi: https://doi.org/10.3390/nu16162730. PMID: 39203866; PMCID: PMC11356888.
8. Carbone EA, D’Amato P, Vicchio G, De Fazio P, Segura-Garcia C. A systematic review on the role of microbiota in the pathogenesis and treatment of eating disorders. Eur Psychiatry. 2020 Dec 16;64(1):e2. doi: https://doi.org/10.1192/j.eurpsy.2020.109. PMID: 33416044; PMCID: PMC8057489.
9. Website, NHS. (2024, January 23rd). Overview – Eating disorders. nhs.uk. https://www.nhs.uk/mental-health/feelings-symptoms…
10. Brelet L, Flaudias V, Desert M, Guillaume S, Llorca PM, Boirie Y. Stigmatization toward People with Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder: A Scoping Review. Nutrients. 2021 Aug 18;13(8):2834. doi: https://doi.org/10.3390/nu13082834. PMID: 34444994; PMCID: PMC8400545.
11. Linardon, J., Wade, T. D., de la Piedad Garcia, X., & Brennan, L. (2017). The efficacy of cognitive-behavioral therapy for eating disorders: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 85(11), 1080–1094. https://doi.org/10.1037/ccp0000245
12. Garber AK, Sawyer SM, Golden NH, Guarda AS, Katzman DK, Kohn MR, Le Grange D, Madden S, Whitelaw M, Redgrave GW. A systematic review of approaches to refeeding in patients with anorexia nervosa. Int J Eat Disord. 2016 Mar;49(3):293-310. doi: https://doi.org/10.1002/eat.22482. Epub 2015 Dec 12. PMID: 26661289; PMCID: PMC6193754
13. Rania M, Caroleo M, Carbone EA, Ricchio M, Pelle MC, Zaffina I, Condoleo F, de Filippis R, Aloi M, De Fazio P, Arturi F, Segura-Garcia C. Reactive hypoglycemia in binge eating disorder, food addiction, and the comorbid phenotype: unravelling the metabolic drive to disordered eating behaviours. J Eat Disord. 2023 Sep 19;11(1):162. doi: https://doi.org/10.1186/s40337-023-00891-z. PMID: 37726785; PMCID: PMC10507855.
14. Terry, S.M., Barnett, J.A. & Gibson, D.L. (2022)A critical analysis of eating disorders and the gut microbiome. J Eat Disord 10, 154 . https://doi.org/10.1186/s40337-022-00681-z
15. Momen NC, Plana-Ripoll O, Bulik CM, et al. Comorbidity between types of eating disorder and general medical conditions. The British Journal of Psychiatry. 2022;220(5):279-286. doi:https://doi.org/10.1192/bjp.2021.104