What are eating disorders?
Eating disorders are a complex group of psychological conditions characterized by severe disturbances in eating behaviour and in the way a person perceives their own body. They are not only about food, but involve a problematic relationship with eating, body weight, and self-image.
Today, these disorders are increasingly common, especially among adolescents and young people, and are influenced by biological, psychological, and social factors (Keel, 2016). They can significantly affect quality of life, social relationships, academic performance, and overall health (Pasold, McCracken & Ward-Begnoche, 2014).
How does hunger work biologically?
Eating behaviour is not controlled by willpower alone; it is based on complex biological mechanisms. Hunger and satiety are regulated in the hypothalamus, a key structure of the brain.
Two main centres are involved: the satiety centre (ventromedial nucleus), which sends the feeling of 'I am full' and whose impairment can lead to overeating and weight gain; and the hunger centre (lateral hypothalamic area), which triggers hunger and whose lesion may lead to severe food refusal (Dănăilă & Golu, 2000).
This delicate balance can be disrupted by emotional factors, stress, or unhealthy habits, which explains why eating disorders are not simply 'a choice'.
Common types of eating disorders
1) Anorexia nervosa: characterized by severe food restriction, intense fear of weight gain, and a distorted body image. Affected individuals may perceive themselves as 'fat' even when underweight.
2) Bulimia nervosa: involves recurrent episodes of binge eating followed by compensatory behaviours (vomiting, laxatives, excessive exercise) to prevent weight gain.
3) Binge-eating disorder: marked by frequent episodes of consuming large amounts of food without compensatory behaviours, often associated with guilt and a sense of loss of control (Yeo & Hughes, 2011).
Less known eating disorders
1) Pica: an eating disorder characterized by persistent consumption of non-food substances such as soil, chalk, paper, or ice. This behaviour is not age-appropriate and may indicate nutritional deficiencies (for example, iron deficiency), emotional difficulties, or developmental challenges.
2) Rumination disorder: involves repeated regurgitation of food after ingestion, followed by rechewing or expulsion, without an obvious medical cause. It is common in infants and young children but can also occur in adolescents or adults, often associated with stress or certain psychological conditions.
3) Avoidant/restrictive food intake disorder (ARFID): involves food avoidance or restriction not due to a desire to lose weight, but because of sensory sensitivities (texture, taste, smell), lack of interest in food, or fear of negative consequences (such as choking or vomiting).
Impact on health
Eating disorders can have serious and sometimes irreversible consequences for the body. Physically, they may cause hormonal imbalances, digestive problems, immune-system weakening, and cardiovascular conditions. Psychologically, anxiety and depression, social isolation, and low self-esteem are common.
Treatment is complex and often requires a multidisciplinary approach: psychotherapy, nutritional counselling, and, in certain cases, medication (Agras, 2001).
How common are they?
Eating disorders affect a significant number of people globally. Estimates show that anorexia nervosa affects approximately 0.21% of the population, bulimia nervosa about 0.81%, and binge-eating disorder about 2.22% (Le et al., 2017).
They are more common among women, but the number of cases among men is increasing.
How interest in these disorders evolved
Although problematic eating behaviours have always existed, they were officially recognized as disorders only in the 1970s. Since then, research has advanced considerably, helping develop effective diagnostic and treatment methods (Moreno, 2012).
Social pressure and body image
In today's society, body image is strongly shaped by unrealistic standards promoted through social media, advertising, and popular culture.
Young people are constantly exposed to idealized beauty models, which can lead to constant comparison, dissatisfaction with one's body, and the desire to reach an unrealistic ideal. This pressure contributes significantly to the development of eating disorders (Mutruc, 2021).
Warning signs that should concern us
Early recognition of warning signs can make a major difference: obsessive concern with weight, calories, or dieting; avoiding meals or inventing excuses not to eat; frequent bathroom visits after meals; excessive physical exercise; sudden weight changes; social isolation; feelings of guilt after eating.
These behaviours should not be ignored, especially if they persist.
Body dissatisfaction and its effects
Body dissatisfaction is extremely widespread and appears more frequently among women (McLean & Paxton, 2019).
It can lead to lower self-esteem and reduced confidence in one's abilities, depressive and anxiety symptoms (Paxton et al., 2006), excessive preoccupation with diet, calories and weight control, adoption of unbalanced eating behaviours (severe restriction or binge episodes), and avoidance of social situations due to shame or discomfort related to one's body.
In the long term, these effects can damage the relationship with one's own body, as well as interpersonal relationships and daily functioning. In addition, body dissatisfaction significantly affects quality of life, contributing to lower emotional well-being and higher levels of stress and frustration (Griffiths et al., 2016).
Why is intervention important?
Eating disorders are often hidden and may progress over time without being noticed. The earlier the intervention, the greater the chances of recovery.
It is important to understand that these disorders are not due to a lack of willpower, but to complex factors that require support, empathy, and specialized intervention.
Cătălina Șuică, Autonomous clinical psychologist and Adlerian psychotherapist