Physical and Psychological Effects of Eating Disorders
Eating disorders is a broad term that encompasses conditions that come about as a result of unhealthy eating habits. As such, these disorders involve either excessive or insufficient food intake, which results in harmful effects to an individuals mental as well as physical health. Furthermore, these disorders are at times characterized by severe concern or distress about body shape or weight. Common conditions that fall under this category include anorexia nervosa, binge eating disorder and bulimia nervosa. Such conditions commonly affect individuals during their teen years or even during adulthood, affecting both men and women.
Anorexia nervosa is characterized by a relentless pursuit of what most individuals perceive as ideal thinness, emaciation and an intense fear of weight gain. As such the individual is therefore obsessed with their body image and typically engages in extremely disturbed eating behavior. Consequently, most people who suffer from anorexia, usually see themselves as being overweight, and may engage in poor eating habits such as starving themselves even in cases where they are clearly malnourished. Further, people suffering from anorexia typically become obsessed with weight control, food and eating, attempting to find a balance that works. Bulimia nervosa on the other hand, entails episodes in which one eats abnormally large amounts of food with an accompanying lack of control over such episodes. However, these episodes are then accompanied with compensatory behaviors such as excessive exercise, fasting, forced vomiting or the excessive use of diuretics or laxatives, at times even a combination of such behaviors may be observed. Individuals suffering from bulimia are usually of the ideal weight or at times even slightly overweight, but similar to those suffering from anorexia, also have a fear of gaining weight, and are at times even desperate to lose weight, due to unhappiness with their body shape and weight.
Binge-eating disorder, refers to a condition in which an individual has completely lost control over their eating, and due to their incessant eating habits with a lack of any remedying behaviors as is observable in bulimia nervosa, have gained excessive weight and are therefore either obese or overweight. In a potentially vicious cycle, such individuals may experience distress or shame due to their binge eating, which may drive them to eat even more.
A recurring theme within most eating disorders is therefore a constant preoccupation with food and weight, while in the case of the first two, a fixation with weight control is in most cases to blame. While the causes of eating disorders are not yet clearly defined, the National Eating Disorders Association (NEDA, 2004) certain psychological, interpersonal and social factors may contribute to eating disorders. Psychologically, low self esteem, depression, loneliness, anger, anxiety or feelings of inadequacy usually predispose an individual to eating disorders. Further, troubled relationships, a history of abuse either sexual or physical, as well as a history of ridicule or teasing on the basis of weight or size. In terms of social factors, cultural definitions of beauty that seem to glorify thinness and place significant emphasis on having an ideal body weight, may pressure individuals into developing eating disorders. In some cases however, biological factors may be to blame for the development of eating disorders, current research shows that eating disorders run in families and establishes significant genetic contributions to such disorders. Further research is still being carried out to establish the possibility of there being biological or biochemical causes of eating disorders, including the role played by hormones (NEDA, 2004).
Eating disorders undoubtedly have various consequences, both physical and psychological, due to the fact that the unhealthy eating habits result in a situation in which the individual eats more than their body requires or at times less than what is required, which in turn may affect their weight, resulting in weight related health concerns. Furthermore, in cases where the individual engages in behaviors such as vomiting, excessive exercise, as well as abuse of diuretics and laxatives, undesired physical side effects such as an inflamed sore throat, or even intestinal distress may result.
Physical Effects of Eating Disorders
The most common effect of eating disorders is usually either weight gain or weight loss, depending on whether the condition results in excessive intake or under nutrition. In the case of anorexia nervosa, due to the lack of proper and adequate nutrition, an individual may become malnourished, leading to thinness, as the body tries to meet the energy requirements through gluconeogenesis, lipolysis and glycogenolysis. As such, muscle and fat tissue is therefore broken down in an attempt to restore normal glucose levels, leading to muscle wasting and loss of subcutaneous fat. Inevitably significant weight loss usually accompanies such situations in which the individuals intake is less than body requirements. This lack of adequate nutrition may also lead to sluggishness, lethargy, and a constant feeling of tiredness. Further, due to the lower intake of essential minerals and vitamins, other health problems such as anemia, osteoporosis, or osteopenia may also result. Osteoprososis and osteopenia refer to a condition in which the bone mineral density is reduced due to bone resorption or malabsorption of minerals such as calcium and vitamin D. This results in brittle bones that predispose the individual fractures, more so to the hip and spine. This lack of bone growth may also at times translate to loss of height.
In the case of anemia, the malabsorption of minerals and vitamins such as iron and cobalamin may result in iron deficiency anemia, which could further contribute to lethargy and sluggishness observable in most cases of under nutrition, as well as faintness. Other conditions that may also come about as a result of malnutrition include lower blood pressure and oedema due to the lack of sufficient plasma proteins, poor wound healing, brittle hair and nails.
Eating disorders such as anorexia nervosa may also at times lead to hormonal imbalances that may translate into disrupted and irregular menstrual cycles, while in extreme cases it may lead to infertility. The loss of body fat that usually accompanies anorexia may result in a situation where the woman is unable to produce estrogen, a hormone that plays an integral role in the ovulation process. In cases where menstruation and ovulation are suppressed for very long periods, infertility may come about as an adverse consequence.
Poor eating habits, in which the individuals intake is less than body requirements, as is usually the case in chronic anorexia, heart problems may also occur, due to the chronic lack of sufficient minerals and energy. Further, the muscle wasting usually occurs in the heart muscle as well, leading to weak muscles incapable of pumping blood effectively to the rest of the body. This poor circulation combined with the existing anemia usually results in circulatory problems as well as arrhythmias, hypotension and bradycardia.
In the case of bulimia nervosa, the observable physical effects mostly resemble those of anorexia nervosa, more so in cases where the individuals nutritional intake is actually less than body requirements, resulting in the various effects of malnutrition already described above. Other observable physical effects are however due to the undesirable behaviors that usually accompany episodes of over eating, such as forced vomiting, excessive exercise, abuse of laxatives and diuretics, and fasting.
In cases where the affected individual practices forced vomiting, the loss of electrolytes and resultant electrolyte imbalance may lead to irregular muscular activity, such as heart palpitations or tetany. Dehydration may also occur due to the loss of body fluids at a higher rate than the rate of fluid absorption. Further, the corrosive nature of the acid content within vomit may result in a sore throat, as well as loss of enamel within the teeth. Bad breath, or halitosis, may also result due to the constant vomiting as a result of the action of digestive enzymes degrading the gums and tissues within the mouth. Forced vomiting may also lead to involuntary vomiting, such that the individual is unable to retain food even in cases where they would wish to do so. Other potential long term effects of forced vomiting may be acid reflux, as the sphincter covering the stomach may become lax over time and lead to a reflux of stomach content. Due to constant erosion by acid, a Mallory-Weiss tear, which are small tears observed within the esophagus, characterized by vomiting blood. Swollen jaws and salivary glands may also be observed in certain cases of forced vomiting.
The abuse of drugs such as laxatives and diuretics may also bring about significant observable side effects. For instance use of diuretics may lead to hypotension and dehydration, as the body struggles to replenish fluid lost through urine. Further, due to the electrolyte losses that may accompany such fluid losses, the individual may experience electrolyte imbalances in the form of muscle cramping and weakness as well as arrhythmias and palpitations. In some cases, the malnutrition may worsen due to a loss of appetite, resulting in further weight loss. In cases where abdominal laxatives are abused, side effects such as irritation of the digestive system, constipation, bloating, as well as temporary weight gain due to the temporary effect the laxatives have on water retention. In cases where there is long term abuse of the laxatives, dependence may develop. In cases where drug abuse and forced vomiting are combined, severe dehydration accompanied by consequences such as blurry vision, confusion, headaches and muscle weakness may be observed.
The lack of vitamins such as vitamin B 6 as well as minerals such as folic acid, may lead to nerve damage within the brain, as well as in various parts of the body, resulting in a number of neurological problems such as seizures, confused thinking, numbness and peripheral neuropathy.
On the other hand, excessive intake may also result in a number of health problems for the individual involved. For instance, in cases where there is excessive intake, there usually is the inevitable aspect of weight gain. The progressive weight gain usually leads to obesity, which in turn predisposes those affected to a number of health risks, such as type 2 diabetes, high cholesterol, heart disease, gastrointestinal problems, osteoarthritis, high blood pressure, gall bladder disease, sleep apnea and joint and muscle pain.
When it comes to type 2 diabetes, obesity usually predisposes an individual to this condition in the sense that it leads to insulin resistance. Normally the fat cells within the obese individual usually release a protein referred to as the pigment epithelium derived factor (PEDF) which through a chain of interactions and events, leads to the desensitization of the muscles and livers to insulin. The pancreas is then forced to produce more insulin to counteract the negative effects that come about as a result of this desensitization. The pancreas then becomes overworked and with time the pancreatic cells may stop producing insulin altogether, leading to type 2 diabetes (Crowe, Wu, & Economou et al 2009). The undoubtedly high cholesterol content in the foods that such individuals eat, also leads to high blood cholesterol levels, which if combined with the increased lipid deposits within the body, may lead to heart disease. The continued deposits of cholesterol and lipids within the coronary blood vessels reduce blood supply to the heart muscles and may at times lead to coronary heart disease and myocardial infarction therefore heart attacks.
The extra weight that usually comes with obesity normally puts significant extra strain on bones and joints due to the extra weight, leading to joint and muscle pains as well osteoarthritis. In addition to loss of cartilage due to overloading of the joints, obesity also according to Pottie, Presle et al (2006) leads to osteoarthritis due to the dysregulation of lipids, through the misbehavior of various adiponectines. The gaining of weight, especially in the trunk as well as neck areas usually predispose the individual to obstructive sleep apnea due to compromised respiration. The sleep apnea may consequently result in lack of sleep which may then translate into impaired metabolism as well as hormonal imbalances which result in even more side effects. High blood pressure and hypertension is usually observed in most obese individuals due to obstructive sleep apnea (OSA), as a result of the activation of the sympathetic nervous system which leads to increased peripheral resistance as well as an increased heart rate. Further, obesity may also lead to hypertension through insulin resistance, hyperleptinemia and elevated aldosterone and angiotensin II levels.
Psychological Effects of Eating Disorders
In addition to physical effects, eating disorders usually lead to a number of psychological effects ranging from withdrawal and avoidance, low self esteem, poor self concept, impulsivity, depression, lack of social interaction, anxiety and poor coping behavior, as well as self injury and self mutilation. In some cases, eating disorders usually co-occur with other psychological disorders such as obsessive compulsive disorders and bipolar disorders.
Withdrawal and avoidance behaviors usually come about as a direct result of the individuals shame in their behavior, as they are aware that they are engaging in unacceptable behavior. As a result, they opt to withdraw from as well as avoid any form of social interaction in order to avoid any rebuke or criticisms that they may encounter in case they opt to engage in social interaction. This withdrawal may also come about as a result of the ridicule and teasing from their peers that may usually be meted out to individuals suffering from eating disorders, more so those who are overweight. Furthermore, these individuals may also resort to withdrawal as a result of constant discrimination on the basis of weight. Due to being overweight, these individuals may find themselves struggling to fit in and develop the sense of belonging every human craves for.
As a result of the constant ridicule and discrimination, these individuals may develop a poor self concept. Seeing as a major part of an individuals perception of themselves is usually the influence of how other around them perceive them, constant rejection may lead to poor self conception. Considering that self concept for an individual suffering from an eating disorder will most likely be linked to their weight and body image, a negative self concept is likely to be the end result, as a negative body image and an obsession with achieving the ideal body weight. This negative self concept that is observable in almost all individuals suffering from eating disorders normally translates to very low self-esteem. In a society that values body image, and attaches significant importance on beauty as well as body size, an individuals conception of self worth, would undoubtedly be measured against such a marker, which would mean that it is essentially both a cause of eating disorders as well as a psychological consequence, in a cycle that is self perpetuating. Due to a poor judgment of oneself as well as a poor attitude over the same, an individual may become fixated on their body weight, more so within a society that values thinness resulting in them becoming overly concerned with their weight and as a result their nutrition and the food they eat. Over time, due to poor eating habits, this judgment may actually fail to improve, at times even worsening, as the individual may perceive themselves as worthless due to their inability to achieve the ideal weight, resulting in even poorer eating habits. A study by Grubb, Sellers, and Waligroski (1993), affirms this assertion, as its findings demonstrate a direct correlation between rated attractiveness and self esteem. The findings of Pastore, Fisher and Friedman (1996) further serve to reinforce the above inferences and assertions, as the researchers found a significant correlation between abnormal eating habits, increased weight and low self esteem, further suggesting that the relationship between low self esteem and eating disorders is indeed a causal one, more so due to social pressures based on societys definition of and fixation on thinness as the ideal marker that each individual must aspire to achieve. Individuals who do not like their physical body image are therefore more likely to have a lower self esteem if compared to individuals who have a positive body image.
Due to the self esteem issues, as well as problems fitting in and the lack of a positive self concept, most individuals suffering from eating disorders are also likely to develop depression. Due to the perceived inability to meet the ideal body size, and the resulting unattractiveness, may lead to a chronic state of low mood and an aversion to activity. Such individuals may also constantly feel sad, worthless, irritable and hopeless due to their perceived powerlessness when it comes to controlling their weight, more so for individuals who are either obese or overweight. In addition to these factors, constant rejection due to the individuals body weight by their peers may also result in a depressed mood. Further, the lack of proper and healthy social interaction, may also lead to an individual becoming even more depressed.
Finally, most individuals who suffer from eating disorders also experience numerous episodes of anxiety, mostly due to their obvious obsession with their weight and their diet. Such individuals are constantly anxious over whether or not their eating habits have resulted in weight gain, more so those who suffer from anorexia as well as those who suffer from bulimia nervosa. The potential interaction with others, as well as the fear of other peoples reaction towards them, may actually predispose such individuals to anxiety, as they are unsure of how they are going to be received by others, and it is this uncertainty that usually translates into anxiety as well as obsession.
All in all, most of the psychological effects of eating disorders usually stem from societal as well as peer pressures the individual may encounter and therefore attempt to satisfy or strive to avoid.
Crowe, S., Wu, L., Economou, C., Turpin, S., Matzaris, M., Hoehn, K., Hevener, A., James, D., Duh, E., & Watt, M. (2009). Pigment Epithelium-Derived Factor Contributes to Insulin Resistance in Obesity. Cell Biology, 10(1), 40-47.
Grubb, H., Sellers, M., & Waligroski, K. (1993). Factors Related to Depression and Eating Disorders: Self-Esteem, Body Image and Attractiveness. Psychological Reports, 72(3), 1003-1010.
Hudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry. 2007; 61:348-58.
National Eating Disorders Association (2004). What Causes Eating Disorders?. Retrieved from http://www.nationaleatingdisorders.org/nedaDir/files/documents/handouts/WhatCaus.pdf
Pottie, P., Presle, N., Terlain, B., Netter, P., Mainard, D., & Berenbaum, F. (2006). Obesity and osteoarthritis: more complex than predicted! Annals of the Rheumatic Disease, 65(11), 1403-1405.
Pastore, D. R., Fisher, M., & Friedman, S. B. (1996). Abnormalities in weight status, eating attitudes, and eating behaviors among urban high school students: Correlations with self esteem and anxiety. Journal of Adolescent Medicine, 18, 312 . 319.