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What is Eating disorders (anorexia, bulimia, hyperphagia) & Treatment

Eating disorders, also known as eating disorders or eating disorders (ACD) are serious disturbances of eating behavior. Behavior is considered “abnormal” because it is different from usual eating habits but mostly because it has a negative impact on the physical and mental health of the individual. CAW affects many more women than men, and often begins in adolescence or early adulthood.

The most common eating disorders are anorexia and bulimia, but there are others. Like any mental health disorder, eating disorders are difficult to categorize and classify. The most recent version of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-V, published in 2014, proposes a revision of the definition and diagnostic criteria for eating disorders.

For example, binge eating, which is characterized by eating a disproportionately large amount of food compulsively, is now recognized as a separate entity.

We currently distinguish, according to the DSM-V:

  • anorexia nervosa (restrictive or associated with hyperphagia);
  • bulimia nervosa;
  • binge eating disorder;
  • selective feeding;
  • pica (ingestion of inedible substances);
  • merycism (phenomenon of “rumination”, that is, regurgitation and remixing);
  • other TCAs, specified or not.

In Europe, another classification is also used, ICD-10. The TCA are classified in the behavioral syndromes:

  • Anorexia nervosa ;
  • Atypical anorexia nervosa;
  • Bulimia;
  • Atypical bulimia;
  • Hyperphagia associated with other physiological disturbances;
  • Vomiting associated with other psychological disturbances;
  • Other eating disorders.

The classification of the DSM-V being the most recent, we will use it in this form.

The CAW is very diverse and its manifestations are extremely varied. Their common point: they are characterized by eating behavior and a relationship to food disturbed, and have a negative impact, potentially serious, on the health of the person.

Anorexia nervosa (restrictive or associated with hyperphagia)

Anorexia is the first TCA to have been described and recognized. We speak of anorexia nervosa, or nervous. It is characterized by an intense fear of being or becoming fat, and therefore a strong desire to lose weight, an excessive food restriction (up to a refusal to eat), and a distortion of body image. It is a psychiatric disorder that affects mainly women (90%) and usually occurs during adolescence. Anorexia would affect 0.3% to 1% of young women.

The characteristic features of anorexia are as follows:

  1. Voluntary restriction of dietary and energy intake (or refusal to eat) resulting in excessive weight loss and resulting in a body mass index that is too low in relation to age and gender.
  2. Intense fear of gaining weight or becoming obese, even in case of thinness.
  3. Distortion of the body image (seeing yourself big or fat when you are not), denial of the real weight and the gravity of the situation.

In some cases, anorexia is associated with episodes of binge-eating, that is, disproportionate ingestion of food. The person then “purges” to eliminate excess calories, including vomiting or using laxatives or diuretics.

Malnutrition caused by anorexia can be responsible for many symptoms. In young women, the rules usually disappear below a certain weight (amenorrhea). Digestive disorders (constipation), lethargy, fatigue or chills, cardiac arrhythmias, cognitive deficits and renal dysfunction may occur. In the absence of treatment, anorexia can lead to death.

Nervous bulimia

Bulimia is a TCA characterized by excessive or compulsive consumption of food (hyperphagia) associated with purging behaviors (an attempt to eliminate the food eaten, most often by induced vomiting).

Bulimia mainly affects women (about 90% of cases). It is estimated that 1% to 3% of women suffer from bulimia during their lifetime (these may be isolated episodes).

It is characterized by:

  • recurrent episodes of overeating (ingestion of large amounts of food in less than 2 hours, with the feeling of losing control)
  • recurrent “compensatory” episodes designed to prevent weight gain (purging)
  • these episodes occur at least once a week for 3 months.

Most of the time, people with bulimia have a normal weight and hide their “crises”, which makes the diagnosis difficult.

Binge eating

Bulimia or “compulsive” binge-eating is similar to bulimia (disproportionate food intake and feeling of loss of control), but is not accompanied by compensatory behaviors such as vomiting or laxatives.

Overeating is usually associated with many of these factors:

  • eat too fast;
  • eat until you feel “too full”
  • eat large amounts of food even when you are not hungry;
  • to eat alone because of a feeling of shame related to the amount of food eaten;
  • feelings of disgust, depression or guilt after the episode of binge eating.

Overeating is associated with obesity in the vast majority of cases. The feeling of satiety is impaired or nonexistent.

It is believed that binge-eating disorders are the most common TCA. In their lifetime, 3.5% of women and 2% of men would be affected.

Selective feeding

This new category of the DSM-5, large enough, includes the selective feeding disorders and / or avoidance (ARFID for Avoidant / Restrictive Food Intake Disorder), which mainly relate to children and adolescents. These disorders are characterized in particular by a very strong selectivity vis-à-vis food: the child only eats certain foods, refuses enormously (because of their texture, color or smell for example). This selectivity has negative repercussions: weight loss, malnutrition, deficiencies. In childhood or adolescence, these eating disorders can disrupt development and growth.

These disorders are different from anorexia because they are not associated with a desire to lose weight or a distorted image of the body.

Few data have been published on the subject, and the prevalence of these disorders is therefore poorly known. Although they begin in childhood, they can sometimes persist into adulthood.

In addition, disgust or pathological aversion to food, after a choking episode, for example, can occur at any age, and would be classified in this category.

Pica (ingestion of inedible substances)

Pica is a disorder characterized by compulsive (or recurrent) ingestion of substances that are not foods, such as earth (geophagy), pebbles, soap, chalk, paper, etc.
If all babies go through a normal phase during which they carry everything they find in their mouths, this habit becomes pathological when it persists or resurfaces in older children (after 2 years).

It is most often found in children who also have autism or intellectual deficit. It can also occur in children in extreme poverty, who are malnourished or whose emotional stimulation is insufficient.

The prevalence is not known because the phenomenon is not systematically reported.

In some cases, pica is thought to be associated with iron deficiency: the person would unconsciously try to ingest iron-rich non-food substances, but this explanation remains controversial. Cases of pica during pregnancy (ingestion of soil or chalk) are also reported, and the practice is even part of the traditions of some countries in Africa and South America (belief in the “nutritional” virtues of ground).

Merycism (phenomenon of “rumination”, that is, regurgitation and remixing)

Merycism is a rare eating disorder that results in regurgitation and “rumination” (chewing) of previously ingested food.

It is not about vomiting or gastro-oesophageal reflux but about voluntary regurgitation of partially digested food. Regurgitation is effortless, without gastric cramps, unlike vomiting.

This syndrome occurs mostly in infants and young children, and sometimes in people with intellectual disabilities.

Some cases of rumination in adults without intellectual deficit have been described, but the overall prevalence of this disorder is unknown.

Other disorders

Other eating disorders exist, even though they do not clearly meet the diagnostic criteria of the categories mentioned above. As soon as a feeding behavior generates psychological distress or physiological problems, it must be the subject of consultation and treatment.

For example, it may be an obsession with certain types of foods (for example, orthorexia, which is an obsession with “healthy” foods, without anorexia), or atypical behaviors such as nighttime binge eating, among other things. other.

Risk factors for eating disorders (anorexia, bulimia, hyperphagia)

Eating disorders are complex and multifactorial diseases whose origins are at the same time biological, psychological, social and environmental. Thus, more and more studies show that genetic and neurobiological factors play a role in the appearance of TCA.

Levels of serotonin, a neurotransmitter that regulates not only mood but also appetite, could be altered in patients with TCA.

Several psychological factors may also come into play. Some personality traits, such as perfectionism, the need for control or attention, low self-esteem, are frequently found in people with TCA. Similarly, trauma or hard-to-live events can trigger or aggravate the disorder.

Finally, several specialists denounce the influence of Western culture that praises slender or even lean bodies on young girls. These may aim at a physical “ideal” far removed from their physiology, and become obsessed with their diet and weight.

In addition, CAW is frequently associated with other mental health disorders, such as depression, anxiety disorders, obsessive-compulsive disorder, substance abuse (drugs, alcohol) or personality disorders. People with TCA have an ability to regulate their impaired emotions. Deviant eating behavior is often a way of “managing” emotions, such as stress, anxiety, work pressure. The behavior provides a feeling of comfort, relief, even if it is sometimes associated with a strong guilt (especially in case of hyperphagia).

The prevention of eating disorders

There is no miracle intervention to prevent the appearance of a TCA.

Given the influence of image and culture on the perception of the body, especially in adolescence, several factors can help children to be well in their skin, to prevent them from developing certain complex physical:

  • Encourage, from an early age, the adoption of a healthy and diversified diet
  • Avoid giving the child a concern about his weight, especially by refraining from following strict diets in his presence.
  • Make the meal a convivial and family moment
  • Supervise the browsing on the Internet, many sites praising anorexia or giving “tips” to lose weight
  • Promote self-esteem, strengthen the positive image of the body, compliment the child …
  • Consult a doctor if there is any doubt about the child’s eating behavior.

Medical treatments of eating disorders

ACTs must be taken seriously and treated as quickly as possible, as they are associated with significant psychological distress. Suicide attempts are not uncommon in people with TCA.
Anorexia is the condition associated with the highest mortality rate: some studies estimate that 10% of people with anorexia die within 10 years of diagnosis.

Medical treatment

ACTs must be taken seriously and treated as quickly as possible, as they are associated with significant psychological distress. Suicide attempts are not uncommon in people with TCA.
Anorexia is the condition associated with the highest mortality rate: some studies estimate that 10% of people with anorexia die within 10 years of diagnosis.

Psychological care

The management of ACTs is based on psychological interventions (individual, family or group) that target abnormal behavior, but which must also improve self-esteem. In young people, the involvement of the family is often necessary. There is no real codified psychological treatment (although several learned societies have made recommendations) and the treatment is often peppered with relapses.

The CAW also has similarities with addictions such as alcoholism. Food compulsions have an addictive potential, which often alters the will to get out of it. However, it is possible to heal completely, especially if the diagnosis and management are done quickly.

The goals of treatment differ according to the disease. In case of anorexia nervosa, the urgency is to regain a normal weight and stabilize it (the recommended body mass index is 18.5 kg / m² at least).

In all cases, the treatment aims to normalize the eating behavior. No study shows the superiority of one therapy over another. The treatment should continue for several months to be fully effective. The most recognized therapies are the following.

Cognitive and Behavioral Therapies (CBT)

The cognitive-behavioral therapies have proven effective in most eating disorders.

They are not intended to understand the causes of the disorder, but rather to

eating habits and changing beliefs about weight and food. By confronting the patient with the situations that anguish him, notably through practical exercises of role-playing or role plays, the CBT gradually allow to desensitize the person to his / her own fears and to restore a food behavior centered on the sensations. physiological (hunger, satiation, satiety).

In general, the therapy is based on weekly sessions, alone or in groups, for 3 to 4 months. It is often asked to keep a diary that helps to identify and control bad behavior.

Interpersonal Therapy (IPT)

Interpersonal therapy is a form of psychotherapy initially developed to treat depression. Several studies show that it is also effective in some people with TCA.

This type of therapy focuses on identifying the person’s social conflicts and current interpersonal relationships, rather than focusing on eating disorders.

It is a brief therapy (12 to 16 sessions), which is unfortunately still not widespread in Europe.


Psychotherapy, the purpose of which is to perform a profound work on oneself, has an interest in the treatment of TCA, generally in addition to the therapies mentioned above. Over a long period of time, it helps to better understand the causes of the disorder, and thus to deeply modify the beliefs and fears that can feed the food problem.

It is important to choose a therapist who is familiar with this type of pathology.

Group therapies

Self-help groups supervised by a therapist have demonstrated their effectiveness, especially if the attack is not too severe, or in addition to a personal therapy. These groups make you feel supported, understood, and motivated to follow the treatment over time.

Family therapy

When the eating disorder concerns a child or adolescent, family therapy is strongly recommended. This type of disorder affects all family members, parents struggling to understand and communicate with their child. The goal of this type of therapy is to mobilize the whole family and maximize the chances of recovery, and increase vigilance against possible relapses.

Other therapies

Several therapeutic approaches, such as art therapy, music therapy, may be offered in combination with the main therapy. They are often a source of motivation and increase adherence to treatment.


In severe cases of anorexia or bulimia, when the person is severely malnourished or at risk of suicide or self-aggression, hospitalization may be necessary. If possible, hospitalization should be done in an institution or service specializing in the management of TCA, which will benefit from a multidisciplinary team (psychiatrist, nutritionist, and psychologist).

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