Eating Disorders

Eating disorders are not a lifestyle but rather a mental disorder. A person with an eating disorder will be obsessed with thinking about food, their weight and appearance. These thoughts cause severe disruption in eating habits and disruptive behavioural patterns associated with body weight management. The perception of body shape will be distorted and self-image will be abnormally controlled by one's own body shape and the ability to control the diet. Disorders can develop in people of all ages and of any gender.

An eating disorder is a synonym of several diseases. Most commonly known disorders are anorexia nervosa and bulimia nervosa. Individuals with anorexia nervosa experience great fear of gaining weight, even when they are underweight, and often undergo strict dieting or use other methods to lose weight. Bulimia nervosa is a disorder characterised by repetitive periods in which an individual eats a lot of food in a short period of time together with a strong feeling of loss of control of their eating. The individual then tries to get rid of the calories they have consumed by using various repeated and unhelpful methods to prevent weight gain. Binge eating disorder is a disorder that can cause obesity. Individuals then experience repeated and out of control eating outbursts, in which they eat very large amounts of food in a short period of time. An individual that is binge eating does not use methods to get rid of the food they consume. Some individuals have mixed symptoms from anorexia and bulimia but do not belong to a particular category of eating disorders, although there may be serious symptoms of illness. Those cases are classified as unspecified eating disorders, orthorexia being among them, which is characterised by the individual being obsessed with a clean diet.

People with eating disorders are of different weights and have different body shapes, it is a great misconception that it shows on appearance if individuals have an eating disorder. The vast majority of those with an eating disorder are at an ideal weight and even above ideal weight. Eating disorders usually develop as a result of a diet regimen where people initially plan to lose a few kilos or simply go on an extreme diet by starving themselves or getting rid of food in another way. Such diets can end in a vicious circle as the individual never feels light enough and loses sight of what is a healthy body weight and a normal meal. In addition, there can be cases of serious binge eating, even in bursts/episodes where the individual loses control over the amount they eat but then gets rid of the food afterwards, for example by inducing vomiting. Over-exercising or excessive exercise is common eating disorder behaviour. In addition, focusing excessively on muscle mass, taking steroids to build muscle, or taking other substances to minimise fat percentage, can be eating disorder behaviour. This manifestation is common in men but it can occur with anyone.

Eating disorders can be accompanied by great mental dysphoria, anxiety and depression. Individuals with an eating disorder often isolate themselves and do not want to spend as much time with family or friends as they did before. There is a great misconception that an eating disorder is a lifestyle or a fashion phenomenon, an eating disorder is a very serious mental disorder and anyone who is ill needs appropriate treatment. It is never too late to seek help, but if action is taken early enough, a development to serious levels can often be prevented. An eating disorder has the highest mortality rate of all mental disorders.

(This text is partly derived from the national hospital's eating disorder team.)

Anorexia nervosa

Anorexia is a disorder characterised by individuals that lose more weight than is desirable based on age and height. People with this disorder are afraid of gaining weight, even when they are underweight. They tend to undergo rigid diets or use other methods to lose weight. The prevalence of anorexia is 0.5% and the onset is most common between the ages of 14-18.

How does anorexia manifest itself?

Anorexia is characterised by three principles.

An individual restricts dietary intake which results in an individual being lighter than desirable based on ideal weight.
An individual is seriously afraid of gaining weight or becoming fat, even if they are underweight.
An individual perceives their body image or weight in a distorted manner. They develop their self-esteem based on this distorted body image or weight and have little insight into the severity of having a low body weight.

There are two types of anorexia: restricting type and binge-eating/purging type. Individuals with a restricting type do not regularly engage in binge eating or cleansing behaviour (e.g. inducing vomiting, abusing laxatives or using other methods). Persons with a binge eating/purging type regularly engage in such behaviour.

Individuals with anorexia greatly reduce their food intake and even increase exercise to lose weight. Despite weight loss and low body weight, their thoughts revolve almost exclusively on continuing to lose weight and they are very scared to gain weight. These thoughts become an obsession that increases as the disease progresses.

Anorexia has a serious effect on physical and mental health. Common complications include arrhythmias, osteoporosis, muscle deterioration and weakness, dehydration, fainting, dry skin and hair and increased fluffy hair growth throughout the body. It is also common for individuals with anorexia to experience depression, anxiety, compulsion, obsession and more.

Bulimia nervosa

Bulimia nervosa is a disorder characterised by repeated periods of overeating along with a strong sense of having lost control over an eating behaviour. The types can be divided into two parts. On the one hand, when an individual has actually eaten a lot of food, called an objective binge episode and, on the other hand, when it is only a person's feeling that they have eaten a lot of food when they actually haven’t, it is called a subjective binge episode. After each cycle of overeating, the individual tries to get rid of the calories they have consumed by using various repeated and unhelpful disposing methods to prevent weight gain. The prevalence of bulimia nervosa is 1-3%. Bulimia nervosa often begins at the age range of 15 to 29 years, but the onset of the disorder often starts following dieting attempts or stressful events.

How does bulimia nervosa manifest itself?

Individuals with bulimia nervosa eat within a certain amount of time (e.g. within two hours) a large amount of food, which is often calorie-rich. The amount of food goes far beyond what most people would generally eat during the same period under comparable conditions. Individuals experience uncontrollable eating behaviour during binge eating and this often leads to disgust towards themselves and they feel ashamed. Binge eating occurs more often than not in private, even sometimes at night, as individuals with bulimia nervosa are often ashamed of their eating habits. After binge eating, individuals with bulimia nervosa resort to methods to prevent weight gain. Measures such as induced vomiting, excessive exercise or exaggerated fasting (e.g. fasting for 24 hours) are used to clear out the calories. The binge eating and other methods occur at least once a week over a three-month period. Their self-esteem is abnormally dependent on body shape and body weight and they often experience a great fear of gaining weight.

Individuals with bulimia nervosa are often at or above the ideal weight but not underweight like individuals with anorexia. So it can sometimes be difficult for others who are around individuals with bulimia nervosa to see with their own eyes that there is an eating disorder. Symptoms or behaviour that can be noticed are excessive exercise, when a person goes to the toilet on a regular basis after meals and when fat-burning pills or other things are used with the goal to lose weight. Bulimia nervosa can lead to serious health problems such as damage to the oesophagus, arrhythmias, kidney disease and dental damage.

Binge eating disorder

What is a binge eating disorder?

A binge eating disorder or an overeating disorder is a disorder characterised by repeated binge eating. Binge eating is when a person eats a large amount of food over a shorter period than they usually would. During binge eating, the person experiences being out of control.

The cause of binge eating is unknown, but binge eating often occurs after a strict diet or starvation. Normally, individuals with a binge eating disorder do not use disposal methods after binge eating, like individuals with bulimia nervosa do.

How does a binge eating disorder manifest itself?

The main characteristic of a binge eating disorder is repeated uncontrolled binge eating. Individuals with this disorder eat very large amounts of food in a short period of time, usually in private, and experience high levels of not being in control during binge eating. Individuals tend to feel full in an uncomfortable way and are often not necessarily hungry when they start binge eating. They tend to be disgusted with themselves, feel guilty and suffer from dysphoria. Individuals that binge eat usually don’t use disposal methods to get rid of the food they consumed while binge eating.

Individuals with a binge eating disorder usually have low self-esteem and are dissatisfied with their appearance. They often use food to make them feel better or to vent negative emotions.

Binge eating can have a profound effect on the body, which can lead to diabetes, high blood pressure, heart disease, elevated cholesterol and various chronic pain.

Orthorexia

Orthorexia is a disorder that has not been as prominently discussed as anorexia and bulimia, for example, as it is more recent. Orthorexia can be described as an obsession for a healthy and clean diet. Individuals with orthorexia are often obsessed by a particular diet and the quality of their food, they make a great effort in preparing meals and often form specific patterns of an eating behaviour. Unlike people with anorexia or bulimia, individuals with orthorexia are not only aiming to become thinner and lose weight, although this may certainly be the case, but the goal is often to try to maximise physical health and well-being, but it goes to extremes.

How does orthorexia manifest itself?

Individuals with orthorexia focus on a healthy and clean diet, so much so that it goes to extremes. They avoid food they consider to be unhealthy e.g. food containing fat, sugar, preservatives or artificial flavourings. Some seek information on various types of food and their origin e.g. whether vegetables have been exposed to pesticides or whether dairy products come from cows that have been fed with feed mixed with hormones. They also examine the packaging of the product e.g. whether the food can possibly contain plastic particles and whether the food packaging provides sufficient detailed information so that the quality of a particular ingredient can be assessed. This obsession with the quality of food is not due to religious reasons, environmental reasons or animal welfare. Individuals with orthorexia can spend a tremendous amount of time sorting food, weighing food, recording what food they have eaten during the day and planning their next meals. There is great fear that physical and mental health will deteriorate if they eat unhealthy foods or a follow a diet that is not clean.

Individuals with orthorexia often avoid certain types of foods. It can lead to nutritional and/or vitamin deficiencies. If they lose track and eat food that they consider unhealthy or not clean, they become ashamed, start even stricter eating habits, or start fasting. Individuals with orthorexia are at risk of social isolation as many believe that they can only maintain their eating habits in private, and in that way they will not be externally influenced and thus ensure that they have complete control.

Recourses

Recourses for individuals under 18:

Eating disorder team BUGL: The eating disorder team is a specialised team in an outpatient department that has first-hand access to issues where a child or adolescent is likely to have an eating disorder. The eating disorder team provides both diagnosis and treatment. The treatment aims to help a child/adolescent to cope with the illness with the support of parents and professionals. It is important that the child and the parents learn new and better ways to cope with the eating disorder and gain a better insight into which factors hinder recovery. Efforts are being made to promote self-image, body image, social skills and family communication in order to improve long-term well-being and quality of life. A link to BUGL's homepage: https://www.landspitali.is/sjuklingar-adstandendur/teymi-/atroskunarteymi-bugl/

Healthcare: GPs can assess the problem and send a referral to BUGL, for example, with patient consent. A link to information on psychology services in the capital city’s health centres: https://www.heilsugaeslan.is/default.aspx?pageid=eb6f0c2c-dbfd-11e7-9428-005056bc2afe

Student counsellor or school psychologist: It is good to reach out to an individual within the school such as a student counsellor or school psychologist to discuss the issues or to obtain information on appropriate assistance, for example. They can then send a referral to the national hospital with the consent of the student, the national hospital accepts referrals from schools and other professionals, for example.

Psychologists that have a practice: Various psychologists in their practices work on treatments for eating disorders. Psychologists and information about their services can be found in the psychologist database. Psychologist database link: http://sal.is/almenningur/gagnagrunnur-salfraedinga/

Recourses for individuals 18 years old and older:

National hospital eating disorder team: The eating disorder team is a multidisciplinary team that operates both in day care and outpatient departments. The team consists of psychologists, physicians, social workers/family therapists, nutritionists, occupational therapists and consultants. The eating disorder team is located at the Kleppur outpatient department.

The national hospital eating disorder team receives referrals from professionals inside and outside the national hospital, schools and other professionals. A link to the website of the national hospital eating disorder team: National hospital eating disorder team

Health care: GPs can assess the problem and send a referral to the eating disorder team as well as other places with the consent of the patient.

A link to information on psychology services in the capital city health centres: heilsugaeslan.is

A more detailed list of resources in Iceland can be found here.