The expression “eating disorder” is often associated with anorexia but it includes other unstable eating behavior, such as bulimia or hyperphagia. Contrary to popular thinking, hyperphagia is the most common eating disorder around the world, it even exceeds anorexia and bulimia according to researchers at Harvard University. The consequences in the daily life are multiple. First of all, self-esteem of people suffering from an eating disorder relies almost exclusively on their weight, their appearance and their ability to control it. Dissatisfaction and bodily concerns are omnipresent. Daily functioning is compromised by these obsessive bodily concerns and people suffer often in silence. Self-esteem, endangerment and isolation are common consequences in people suffering from an eating disorder.
Anorexia nervosa
Anorexia first appears as an obsession with thinness. Thus, the feeding phase becomes an ordeal and there are some consequences such as unalterable desire to lose weight, refusal to eat, various control strategies, permanent weight control, etc. It is estimated that 0.6% to 4% of women have suffered from anorexia in their lifetime. Men are much less concerned than women with a prevalence of 0% to 0.16%. Anorexia tends to affect increasingly young people, but the disease mainly affects teenagers of 15 to 19 years. Two types of anorexia can be distinguished: anorexia restrictive (hardly eats and fights against hunger) and anorexia-bulimia (alternates restrictions and binge eating).
The current criteria of DSM-V concerning anorexia nervosa:
1. restriction of food and energy intake leading to a lower weight than the normal weight for the same sex, age and height.
2. intense fear of gaining weight or becoming fat, even if the individual is underweight.
3. altered perception of weight or shape of his own body (body dysmorphic disorder).
4. excessive influence of weight or body shape on self-esteem, or denial of the seriousness of the current low body weight.
Many factors can lead to anorexia. Early puberty can be a major shock for a teenager because of the loss of a lot of physical as psychological marks in a short period. Other factors, such as heredity, family history of depression and anxiety, and personality traits such as impulsiveness and compulsion can also make some people more vulnerable to develop anorexia. Moreover, the social and cultural influence inevitably involved in food disorganization. Today fashion is associated with abnormal skinny models. Media, advertising, fashion, everything is focused on thinness. This explains why it is mostly girls who are affected by anorexia.
Bulimia nervosa
Bulimia is a complex disorder that is specifically characterized by compulsive food intake in which crises take uncontrollable proportions. This is usually followed by a moment of panic activated by the fear of gaining weight. The person then tries to remove excess food by vomiting, by purging or by beginning a drastic food restrictions. Research suggests that 3% to 5% of people suffer from Bulimia nervosa in their lifetime. There are two types of bulimia: with or without compensatory behaviors (laxatives, diuretics, enemas, excessive exercise, etc).
Here are the criteria from the DSM-V for the diagnosis of bulimia nervosa:
1. recurrent episodes of binge eating. An episode of bingeeating is characterized by both of the following:
-the absorption of an amount of much higher food that most people would absorb in a limited period of time (often less than 2 hours).
-feeling of loss of control over eating behavior during the crisis.
2. recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse oflaxatives, diuretics, or other medications; fasting; or excessive exercise.
3. the binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
4. self-evaluation is unduly influenced by body shape and weight.
5. the disturbance does not occur exclusively during episodes of anorexia nervosa.
Many factors can lead to bulimia. Life changes, stressful or traumatic events represent strong factors of bulimia. Personality traits play also a role. For instance, a person suffering from bulimia may have problems expressing anger, or have a hard time controlling impulsive behaviors. Moreover, some genes, hormones, and chemicals in the brain may be factors in developing bulimia. Early puberty can also be the origin of developing binge-eating period. Furthermore, the sociocultural factor is the same for anorexia nervosa and bulimia nervosa. Women are under constant pressure to fita certain ideal of beauty. However, the origin can also come from the family. For instance, parents who think looks are important, diet themselves, or criticize their children’s bodies are more likely to have a child with bulimia.
Hyperphagia
Hyperphagia is also called “bulimia without vomiting” or “severe compulsive eating.” one of its characteristic is toinvolve both men and women. According to various studies, about 50% of people suffer from obesity also suffer from hyperphagia. The mainfactors of consultation are physical problems related to overweightor obesity (heart disease, high blood pressure, high cholesterol, respiratory failure, etc) that’s why people affected by the diseaserarely consult a psychologist. The minimum level of severity is based on the frequency of episodes of binge eating (from “mild” to “extreme”).
The DSM-V grants to hyperphagia the following criteria:
1. Recurrent episodes of binge eating.
2. The binge-eating episodes are associated with three (or more) of the following:
-eating much more rapidly than normal.
-eating until feeling uncomfortably full.
-eating large amounts of food when not feeling physically hungry.
-eating alone because of feeling embarrassed by how much one is eating.
-feeling disgusted with oneself, depressed, or very guilty afterward.
3. Marked distress regarding binge eating is present.
4. The binge eating occurs, on average, at least once a week for 3 months.
5. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
As bulimia or anorexia, the causes of hyperphagia are varied. It may appear as a result of accumulation of different diets, or, some people may have inherited some genes which make them more likely to develop the disease, etc. People who suffer from binge eating disorder often act impulsively and feel like they can not control their behavior. Other causes are related to stress and depression ordue to taking certain drugs, including neuroleptics. Pregnant women may also experience phases of hyperphagia.
Conclusion
Thousands of people around the world are fighting every day against their unstable eating habits. Whether anorexia or hyperphagia, distress is the same and the fight is daily. It is very important to consult as soon as the firsts symptoms appear in order to not sink slowly into the disease. Many specialized centres in eating disorders exist. Earlier the disease will be managed, the more the risk and consequences will decrease.
Words we have learned :
- Endangerment: mise en danger
- Thinness: minceur
- An ordeal: une épreuve
- To grant: accorder
- To inherit: hériter
Bibliography
Keski-Rahkonen, A., & Mustelin, L. (2016). Epidemiology of eating disorders in Europe. Current Opinion in Psychiatry, 29(6), 340–345. doi:10.1097/yco.0000000000000278
Léonard, T., Foulon, C., & Guelfi, J.-D. (2005). Troubles du comportement alimentaire chez l’adulte. EMC – Psychiatrie, 2(2), 96–127. doi:10.1016/j.emcps.2005.03.002
Simon, Y. (2007). Épidémiologie et facteurs de risque psychosociauxdans l’anorexie mentale. Nutrition Clinique et Métabolisme, 21(4),137–142. doi:10.1016/j.nupar.2008.03.006
CHESNEAU Louise & GRISON Noémie