Symptoms of eating disorders (anorexia, bulimia, hyperphagia)

The CAW is very diverse and its manifestations are extremely varied. Their common feature is that they are characterized by disrupted eating behaviour and relationship to food, and have a potentially serious negative impact on the person’s health.

Anorexia nervosa (restrictive or associated with hyperphagia)

Anorexia is the first CAW to be described and recognized. We’re talking about anorexia nervosa, or anorexia nervosa. It is characterized by an intense fear of being or becoming fat, and therefore a strong desire to lose weight, excessive dietary restriction (up to a refusal to eat), and a deformation of body image. It is a psychiatric disorder that affects mainly women (90%) and usually appears during adolescence. Anorexia is estimated to affect 0.3% to 1% of young women.

The characteristic features of anorexia are as follows:

Voluntary restriction of food and energy intake (or even refusal to eat) leading to excessive weight loss and resulting in a body mass index that is too low for age and gender.

Intense fear of gaining weight or becoming obese, even if you are thin.
Distortion of body image (seeing oneself as fat or fat when one is not), denial of the actual weight and severity of the situation.
In some cases, anorexia is associated with episodes of binge-eating, i. e. disproportionate food intake. The person then “purges” to eliminate excess calories, such as vomiting or using laxatives or diuretics.

Malnutrition caused by anorexia can be responsible for many symptoms. In young women, periods generally disappear below a certain weight (amenorrhea). Digestive disorders (constipation), lethargy, fatigue or chills, cardiac arrhythmias, cognitive deficits and renal dysfunction may occur. If left untreated, anorexia can lead to death.

Bulimia nervosa

Bulimia nervosa is an APTT characterized by excessive or compulsive food consumption (hyperphagia) associated with purging behaviours (attempt to eliminate ingested food, most often by induced vomiting).

Bulimia nervosa 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 hyperphagia (ingestion of large amounts of food in less than 2 hours, with the feeling of losing control)
recurrent “compensatory” episodes, intended to avoid weight gain (purging)
these episodes occur at least once a week for 3 months.
Most of the time, people with bulimia nervosa have a normal weight and hide their “seizures”, which makes diagnosis difficult.

Bulimic hyperphagia

Bulimic or “compulsive” hyperphagia is similar to bulimia (disproportionate absorption of food and feeling of loss of control), but is not accompanied by compensatory behaviours, such as vomiting or taking laxatives.

Hyperphagia is generally associated with several of these factors:

eat too fast;
eat until you feel “too full”;
eat large amounts of food even when you are not hungry;
eat alone because of a feeling of shame about the amount of food eaten;
feeling of disgust, depression or guilt after the episode of hyperphagia.
Hyperphagia is associated with obesity in the vast majority of cases. The feeling of satiety is altered or even non-existent.
Binge-eating disorders is considered to be the most common APD. During their lifetime, 3.5% of women and 2% of men would be affected1.

Selective feeding

This new category of the DSM-5, which is quite broad, includes selective eating and/or avoidance disorders (ARFID, for Avoidant/Restrictive Food Intake Disorder), which mainly concern children and adolescents. These disorders are characterized in particular by very high selectivity towards food: the child eats only certain foods, refuses many of them (because of their texture, colour 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 body image2.

Few data have been published on the subject and therefore little is known about the prevalence of these disorders. 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 the compulsive (or recurrent) ingestion of substances that are not food, such as earth (geophagy), stones, soap, chalk, paper, etc.
If all babies go through a normal phase in which they put everything they can find in their mouths, this habit becomes pathological when it persists or reappears in older children (after 2 years).

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

Prevalence is not known because the phenomenon is not systematically reported.

In some cases, pica is associated with iron deficiency: the person may unconsciously seek to ingest iron-rich non-food substances, but this explanation remains controversial. Cases of pica during pregnancy (ingestion of soil or chalk) are also reported3, and the practice is even part of the traditions of some African and South American countries (belief in the “nutritional” virtues of the earth)4,5.

Merycism (the phenomenon of “rumination”, i.e. regurgitation and remastication)
Merycism is a rare eating disorder that results in the regurgitation and “rumination” (chewing) of previously ingested food.

This is not vomiting or gastroesophageal reflux disease, but rather a deliberate regurgitation of partially digested food. Regurgitation is effortless, without gastric cramps, unlike vomiting.

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

Some cases of rumination in adults without intellectual deficiency have been described, but the overall prevalence of this disorder is unknown6.

Other disorders

Other eating disorders exist, even if they do not clearly meet the diagnostic criteria of the categories mentioned above. As soon as eating behaviour generates psychological distress or physiological problems, it should be the subject of consultation and management.

For example, it may be an obsession with certain types of food (e.g. orthorexia, which is an obsession with “healthy” foods, without anorexia), or atypical behaviours such as nocturnal hyperphagia, among others.