Although eating disorders (ED) were traditionally associated with anorexia and bulimia nervosa -the two best known-, in recent years the range has been significantly expanded. As health professionals gave names to new clinical manifestations (many not yet recognized as such in international psychiatry manuals), they began to establish themselves in the media, in academia and in society in general, terms that until not long ago were completely unknown. Thus, more and more people hear about, for example, Teria (avoidance disorder or restriction of food intake) or Orthorexia (the obsession with eating “healthy”).
“There are a range of eating disorders who do not have all the symptoms to be able to say ‘it is anorexia, binge eating disorder or bulimia’, for example, but the suffering of these patients and the physical consequences are the same, as well as the need for treatment “, explains Juana Pouálisis, a psychiatrist with a vast experience in the subject. Currently, she details, these patients are included in new categories, which facilitates the diagnosis and proper treatment.
What are the most common eating disorders today? What red flags should we look out for?
- Characteristics: It is characterized by the presence of intense food restriction (diet), motivated by dissatisfaction with one’s own body and a stabbing fear of gaining weight. Weight loss is so important (although patients do not recognize its seriousness) that it triggers a picture of malnutrition with all its physical consequences. “There is a distortion of the body image,” says Pouálisis. Compensatory practices such as compulsive exercise or the abuse of laxatives, diuretics or amphetamines can also occur.
- Prevalence: in young women and adolescents in developed countries, the prevalence is 0.5% to 1%.
- Warning signs: .Intense fear of gaining weight .. Distortion of body image (people look fat despite being extremely skinny) .. “Food talking” and “body talking”: talking all the time about food and bodies .. Loss significant weight. Physical signs such as hair loss, loss of menstruation, appearance of lanugo (fine hairs that grow in areas such as the back and that are an attempt by the body to preserve heat may appear) .. Sadness, anguish and irritability .. social isolation.
- Characteristics: They are people who are usually of normal weight or slightly overweight. They have recurrent binge-eating episodes, characterized by an uncontrollable intake of a large amount of food, usually in a period of a few hours. After this binge, they try to “offset” the calories by using extreme weight control measures such as self-induced vomiting, use of laxatives, diuretics, enemas, severe calorie restriction, or vigorous exercise. “They are also obsessed by their figure and their weight (as in anorexia) and usually their self-esteem depends on this,” explains Mexican Eva Trujillo, pediatrician, specialist in adolescents and eating disorders and former president of the Academy for Eating Disorders. There are two subtypes: purgative, which are those that purge with vomiting, laxatives, diuretics, enemas; and non-purgative, those who purge with exercise, fasting or severely strict diets.
- Prevalence: in young women and adolescents in developed countries, the prevalence is 3%.
- Warning signs:Excessive preoccupation with the body Constant fear of gaining weight Repeated episodes of eating excessive amounts of food at one time, with a feeling of loss of control Compensatory practices such as self-induced vomiting or intensive exercise to avoid gaining weight after a binge..Use laxatives, diuretics or enemas after eating .. “Food talking” and “body talking”: talking all the time about food and bodies.
Guillermina Rutsztein, doctor in psychology, associate professor and researcher at the Faculty of Psychology of the UBA, says that together with the team she directs, they carried out a prevalence study that included 1,200 girls between 13 and 17 years old from public and private schools in the city of Buenos Aires and the suburbs. The result was that 10% had some type of eating disorder.
Binge eating disorder
- Characteristics: specialists warn that, although it has much less “press”, this disorder is more common than bulimia and anorexia. It affects a large population of those who are overweight. Pouisis says that it is characterized by the fact that, while following restrictive diets, people often experience the compulsion to eat large amounts of hypercaloric foods in short periods of time, with a great feeling of loss of control. When the compulsive episode comes to an end, feelings of guilt and shame appear. Unlike bulimia, they do not engage in compensatory behaviors (vomiting, laxatives, diuretics or compulsive exercise), to counteract large food intakes. Alejandra Freire, nutritionist of the Bariatric Surgery Service of the Hospital de Clínicas and coordinator of the nutrition area of La Casita, warns: “One thing is the eating disorders that people consult the most and another, those that exist the most in the population but, nevertheless, they do not arrive at the consultation: this is the case of the disorder by binge-eating. ” On the other hand, she says that a factor that increased the incidence of binge eating in young patients who live alone were the applications that offer to bring all kinds of meals, at any time, to their homes.
- Prevalence: Trujillo maintains that it is the most common eating disorder, with a prevalence of 3.54% in the population of Latin America, estimated at 1 in 35 adults in the United States. It is three times more common than anorexia nervosa and bulimia nervosa combined and more common than breast cancer.
- Warning signs:Binge-eating tends to be sneaky since they generate a lot of guilt and shame, so the disappearance of food or money to buy it, as well as finding empty caloric food packages, crumbs or food remains in the rooms, can be signs of Alert .. Frequent weight changes .. Intense feeling of inefficiency, loneliness and emptiness .. Low self-esteem .. It is often associated with other psychiatric pathologies such as anxiety or affective disorders (depression, for example).
- Characteristics: There are three types of Teria (Avoidant / Restrictive Eating Disorder or ARFID): avoidance and disgust at the characteristics of certain foods; fear of choking or vomiting; and lack of interest in eating or feeding. It is a disorder that can develop at any time in life, although it is usually more common in childhood because it is at this stage where the relationship with food, like other habits, is built. Teria’s cases are distinguished by persistence, clinical severity (malnutrition, growth problems, lack of concentration) and social consequences (they avoid going to friends’ houses, to birthdays and isolate themselves), which are some of the signs that they can detect fathers and mothers.
- Prevalence: it was only in 2013 that this condition was defined as an eating disorder and it was included in the DSM-5, the diagnostic and statistical manual of mental disorders. “Its prevalence is still under study, but it is estimated between 5 and 15% in specialized medical centers and around 5% of the child population,” says Trujillo.
- Warning signs :.Nutritional deficit: significant weight loss, but also overweight depending on the food that is restricted .. Growth failure: low height for age and interruption of menstruation .. Cardiovascular problems: tiredness, anemia and fatigue may also occur ..Low self-esteem: as they are ashamed to eat differently, they avoid exposing themselves to situations such as birthdays or dinners in restaurants .. Conflicts at the family level: shouting and arguments can be frequent when sitting at the table .. Difficulties in the school: low concentration and school performance are some of the signs that may occur .. Social isolation: they do not go to friends’ houses, they do not want to go to camp or travel .. They are not encouraged to try anything new: they become extremely exquisite and they reject all food other than what they are used to eating.
Other nonspecific disorders
- Characteristics: Non-specific eating disorders (Osfed) have five main presentations: atypical anorexia, who has all the characteristics of anorexia nervosa except that they maintain normal weight or slightly overweight; the atypical bulimiaIt occurs when it does not meet the frequency and time criteria of the other; purgative disorder, when there are frequent and recurrent episodes of purgation without bingeing; atypical binge eating disorder, when it does not meet the criteria of time and frequency of the other; night eater syndrome, usually manifests itself during the early morning, in an interruption of night sleep or after dinner, being associated with a significant load of stress and a disorderly functioning of life.
- Prevalence: Trujillo explains that these disorders are the most frequent, estimating that they reach 70% of all diagnoses.
Where to turn for help
- Durand Hospital: Tel .: 011 4982-5555 / 5655
- Piñero Hospital: Tel .: 011 4631-8100 / 0526
- Borda Hospital: Tel .: 011 4305-6666 / 6485
- Pirovano Hospital: Tel .: 011 4546-4300
- Argerich Hospital: Tel .: 011 4121-0700
- Garrahan Hospital: Tel .: 011 4122-6000
- Gutiérrez Hospital: Tel .: 011 4962-9247
- La Casita: is a care and prevention center for adolescents and young people and their families. To address the problem that may arise, it works emphasizing the resources of the person and their family system, relying mainly on the peer group. Tel .: 011 4787-5432.
- CITPAD: is a medical institution specialized in anorexia, bulimia and depressive disorders. It has a day hospital. Tel .: 011 4863-7640