Recognizing and supporting someone who has an Eating Disorder

"Eating Disorders" represent a group of complex disorders manifested by a persistent alteration in eating behavior.

In Eating Disorders Month, we delve into how these disorders are defined, which warning signs to look out for, and how to most appropriately support those who suffer from them.

Signs and symptoms of eating disorders

Although expressing in different forms, Eating Disorders share two main characteristics:

• an excessive preoccupation with and control over weight and body shape;
• a distorted perception of body image.

These characteristics can significantly damage the physical and psychological health of sufferers due to the resulting dysfunctional eating behaviors (e.g., failure to respond to the hunger/satiety stimulus, food restriction, excessive eating, loss of control, use of compensatory strategies) that inevitably alter the nutritional and psychological status of sufferers.

Thoughts concerning food and body are intrusive, recurrent, very troublesome and such that they occupy a large part of the thinking space thus being very disabling. Contrary to popular belief, low weight is not the only and specific marker of disease, and it is therefore most important to emphasize that there are normal-weight and overweight conditions that can be associated with the presence of Eating Disorders.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies the following categories of Eating Disorders: Pica, Rumination Disorder, Avoidant/Restrictive Food Intake Disorder, Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Other Specified Feeding or Eating Disorder, Unspecified Feeding or Eating Disorder.

Anorexia, bulimia, and Binge Eating Disorder represent the most commonly known disorders. Among developmental age individuals, a very common disorder in early childhood is Avoidant/Restrictive Food Intake Disorder (ARFID), which is expressed by high selectivity in food choices.

Adolescents and young adults at risk

Teens and young adults are more at risk of developing Eating Disorders: in fact, the onset age is most frequently between 15 and 19 years, despite the most recent epidemiological studies have described an exponential increase in early-onset cases and thus a lowering of the age of onset in the preadolescent period (11- 13 years); cases are described even before the age of 10.

Although Eating Disorders have a female prevalence with an approximate ratio of 10:1 between females and males, recent years have seen an increase in cases in the male gender as well, so that it is increasingly common to see early diagnoses in males.

The DSM-5 reports, for young females, a 12-month prevalence of anorexia nervosa of 0.4%, specifying that the data are less clear for males where the pathology is certainly less frequent; for bulimia nervosa the DSM-5 reports, for young females, a 12-month prevalence of 1 to 1.5%. The data is less known for males.

Warning signs and early symptoms

It is important to learn to recognize the warning signs and early symptoms of Eating Disorders. The main signs to pay attention to in order to recognize the onset lie in the excessive attention paid to the weight and body shapes. Sudden changes in usual eating behaviors are a further warning sign; phrases like "I'm not hungry", "I've already eaten" can be a warning sign, especially among the young girls and boys.

Much attention should also be paid to diets (especially if they are managed independently). During adolescence they can be very dangerous and can promote the development of an Eating Disorder. Other warning signs to pay attention to are: sudden changes in mood, tendency to isolate and become irritable, obsessive studying, finding the fridge or pantry emptied, etc.

Supporting sufferers - do's and don'ts

Those suffering from an Eating Disorder are not always aware of the disease, precisely because the symptoms themselves and intrusive thoughts regarding food and the body become the norm for the person, this can make it difficult to recognize them as part of a pathology.
Talking to the sufferer in a nonjudgmental way, with patience and sharing concerns can be a simple but direct way to accompany the sufferer to gain awareness about the need for help.

When confronting those suffering from Eating Disorders, it is important to speak in the first person explaining one's concern by trying to share what one sees without judging those who are suffering ("I'm worried about you," "I feel like you are struggling a lot, how can I help?"). It is not easy to find a way to be close to the sufferer, especially when the illness becomes a tool to finally feel strong and validated. It is important to create an atmosphere of listening and kindness in which one can say one's concern firmly.

Even more important is to never comment on physical appearance and the body, remembering that the central aspects of Eating Disorders have precisely to do with the perception of body image. Phrases such as "You look good" can sound just like a comment about weight. Instead, emphasizing aspects, other than weight, can help the person feel valued and it is more likely that they would be engaged in a helping relationship.

References

• Hay P. Current approach to eating disorders: a clinical update. Intern Med J. 2020 Jan;50(1):24-29. doi: 10.1111/imj.14691. PMID: 31943622; PMCID: PMC7003934
• Herpertz-Dahlmann B. Adolescent eating disorders: update on definitions, symptomatology, epidemiology, and comorbidity. Child Adolesc Psychiatr Clin N Am. 2015 Jan;24(1):177-96. doi: 10.1016/j.chc.2014.08.003. Epub
• Wagner AF, Stefano EC, Cicero DC, Latner JD, Mond JM. Eating disorder features and quality of life: Does gender matter? Qual Life Res. 2016 Oct;25(10):2603-2610. doi: 10.1007/s11136-016-1283-9. Epub 2016 Apr 5. PMID: 27048498.
• American Psychiatric Association, Ed. it. Giuseppe Nicolò, Enrico Pompili (a cura di), DSM-5-TR. Manuale diagnostico e statistico dei disturbi mentali - Text Revision, Milano, Raffaello Cortina Editore, 2023
• http://www.salute.gov.it/portale/donna/dettaglioContenutiDonna.jsp?lingua=italiano&id=4470&area=Salute+donna&menu=patologie