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The Sensible Psychology Dictionary Psychiatric Diagnoses in Plain English

Eating disorders

DSM Classification

(The psychiatry bible)

Eating disorders

These mental disorders affect eating behavior, purging (self-induced vomiting) and body image.

These include the following specific disorders:

  • Feeding and Eating Disorders of Infancy or Early Childhood: Feeding Disorder of Infancy or Early Childhood
    Pica
    Rumination Disorder
  • Eating Disorders:
    Anorexia Nervosa
    Bulimia Nervosa
  • Binge Eating Disorder

Sensible Psychology Definition

Psychological problems with eating and food

‘Eating disorder’ is an umbrella term for any psychological problem relating to the act of eating and food generally. Such problems are often linked to body image, ‘perfectionism’ and the need for control.

We have separate entries for the most well known eating disorders, but want to briefly clarify here what the DSM IV listings of eating disorders mean.

Feeding disorder in early childhood: Failure to eat properly for an extended period, coupled with failure to gain weight or actual weight loss. Disinterest or active reluctance to eat is extremely worrying for parents as eating is, of course, fundamental to survival.

Pica: Compulsive eating of non food substances (not ‘junk food’) such as soap or wood chippings or even glass.

Rumination disorder: Compulsive repeated re-chewing and regurgitation of food.

Anorexia Nervosa : Fear of becoming overweight (even when chronically mal-nourished) or fear of consuming ‘bad’ foods. A distorted body image where ‘thin’ is seen as ‘fat’. Women and girls are more susceptible than men and boys.(1)

Bulimia Nervosa : Frequent bingeing on quantities of food comparatively much larger than normal (e.g. three loaves of bread), followed by purging through induced vomiting and/or laxative use. Bulimia sometimes, but not always, coincides with anorexia. The bingeing isn’t connected to feelings of hunger but rather to habit and psychological compulsion.

Binge Eating Disorder (BED) occurs when people habitually binge on huge amounts of food when not hungry. Such binges aren’t followed by bulimic purges, however. Bulimic binge eating episodes are often planned ahead of time, so that the binge and purge can be carried out without fear of disturbance. Sometimes, however, people find themselves bingeing when they hadn’t intended to.

All eating disorders can make people feel out of control, isolated and, of course, physically ill.

Possible causes and contributory factors to onset of eating disorders

Eating disorders can be understood as an unhealthy unconscious attempt to meet emotional needs – often for a sense of control over one’s life and perhaps other people – and/or a striving for a sense of perfection. ‘Perfectionism’ seems to be a common behavioural character trait in many people experiencing anorexia and bulimia. Someone who has a distorted body image, for example, may not have a sense of an ‘ideal body weight’ for themselves because nothing could ever be ‘ideal’ enough.

It has been posited that early childhood abuse and feelings of powerlessness can contribute to the development of some eating disorders (2) and that food may be the one thing people feel they can control. It’s also been suggested that one in ten people who suffer an eating disorder may be on the autistic spectrum. (3)

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We also know that group and peer behaviour is very ‘infectious’ (4) and that emotional and behavioural patterns can be learned and spread from person to person. It’s also widely thought that unrealistic and unattainable body images derived from celebrities and models contribute to eating disorders in both men and women.(5)

Whatever the cause (or more likely causes)of an eating disorder, treatment needs to focus on

  • thinking styles
  • the ‘force of habit’ effect of unhealthy behaviours
  • finding healthy ways to meet emotional needs.

Eating disorders and addiction

Eating disorder behaviour patterns very closely follow addictive behaviour patterns; commonly:

  • There is a period of expectation beforehand
  • then a narrowing of focus as the pull to carry out the behaviour grows
  • then a feeling of ‘escapism’ while the behaviour is in full swing
  • and finally a powerful feeling of completion (after, for example, a purge following a binge, or one more meal successfully missed).

As with addiction, the individual with the eating disorder may find they become ‘habituated’, which means the behaviour feels as if it has to become increasingly more extreme to produce the same effect. Starvation and bingeing and purging also produce chemical responses in the body such as pain-numbing natural opiates. It’s essential to explore and take account of possible addictive components in any disordered eating problems.

Eating disorders and the rest of the world

Eating disorders don’t just happen in a vacuum, even though sufferers often feel isolated. Anything we do has ‘ripple effects’ which spread out to affect family relationships, work life and friendships. All this needs to be taken into account when considering how to help.

The sensible psychology approach

We have observed that eating disorders, like all emotional disturbances, have clearly identifiable ‘hypnotic’ characteristics. For example, bingers often report ‘losing track of time’ and ‘forgetting about anything else’ during a binge. Focus on food becomes so singular that people may literally not notice other aspects of life happening around them.

Effective treatment will focus on developing more appropriate thinking styles and using hypnosis as a way of imparting new, healthier, less ‘extreme’ self-imposed ideas and behaviours and – paradoxically – to help loosen the negative ‘hypnotic hold’ of these eating disorder conditions.

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Mark Tyrrell

About Mark Tyrrell

Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.

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Notes:

  1. According to a Royal College of Psychiatrists report in 2008, girls and women are ten times more likely than boys and men to suffer anorexia nervosa.
  2. For example, one study led by Dr Rob Senior for ‘The children of the 90s project’ and published in The British Journal of Psychiatry studied 10,000 women andfound that girls who were sexually abused before the age of 16 were twice as likely to suffer from an eating disorder later in life:
  3. See: Autism and Asperger syndrome: coexistence with other clinical disorders’ C. Gillberg and E. Billstedt, 2000. Acta Psychiatrica Scandinavica, 102: 321-330. See also: ‘Anorexia nervosa and autism spectrum disorders: Guided investigation of social cognitive endophenotypes.’ Zucker, Nancy L.; Losh, Molly; Bulik, Cynthia M.; LaBar, Kevin S.; Piven, Joseph; Pelphrey, Kevin A. Psychological Bulletin, 2007 Nov;133(6):976-1006.
  4. For a wonderful review of the powerful influence of social networks, see: Connected: The Amazing Power of Social Networks and How They Shape Our Lives by Nicholas Christakis and James Fowler, HarperPress, 2011.
  5. See for example: ‘Does interpersonal attraction to thin media personalities promote eating disorders?‘, Journal of Broadcasting & Electronic Media, Volume 41, Issue 4, 1997, Pages 478 – 500 Author: Kristen Harrison.

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