Eating Disorders are a set of problems that disturb people’s feelings and thoughts about nutrition. Eating disorders can cause social, psychological, physiological and academic problems and affect the quality of life considerably.
Among the causes of eating disorders; low self-esteem, depression, worthlessness, abuse, past life experiences, family characteristics, parental attitudes and many more reasons. (Keçeli,2006) The attitudes and behaviors that individuals develop towards food can be indicators of reactive behavior they develop against the causes of eating disorders.
According to the American Psychiatric Association (APA,2013), eating disorders; He divided it into four parts: anorexia nervosa, bulimia nervosa, binge eating disorder, and unclassifiable eating disorders. According to recent studies, Orthorexia Nervosa is frequently seen in individuals.
1.1. History of Eating Disorders
Eating disorders first appeared in Egyptian illustrated Persian manuscripts and Chinese descriptions on parchment paper. As a result of the researches, between 400 and 500 BC. In 1689, Richard Morton defined anorexia nervosa for the first time in an article he wrote “phthisiologia, or a treatise of consumptions” and started to take place in the medical literature. In 1789, Naudean in France shared a case that resulted in severe loss of appetite and death as a result. Anorexia was defined by William GULL in 1874 and took its place in psychiatric terms. In 1930, primary pituitary insufficiency and anorexia were separated from each other and entered the literature as a differential diagnosis. After the 1930s, psychoanalytic theorists, pioneered by Sigmund Freud, made explanations on the subject. In 1938, Nicole defined anorexia nervosa as a serious illness and said that food refusal was different from hysteria. Gerald RUSSEL was the first to distinguish bulimia nervosa from other eating disorders and thus was written in the DSM-3 diagnostic book. In 1950 Hilde Bruch evaluated anorexia as the only syndrome. Binge eating disorder is mentioned for the first time in history at the International Eating Disorder Conference in 1992.(Keçeli, 2006)
1.2. Anorexia Nervosa:
Anorexia nervosa, which is the Greek term for “loss of appetite”, has been distinguished by a decrease in eating, refusal to eat, and the resulting weight loss (Ertekin, 2010).
Individuals’ refusal to eat and their desire to lose weight can be explained by many reasons. The treatment method can be beneficial if it is done by considering the principle of uniqueness of the individual.
Developing individual treatment methods can make treatment more effective.
Anorexia Nervosa patients refuse to eat and may develop a hostile attitude towards food. Patients with anorexia are quite weak and may feel guilty when they eat food. Although the main reason is seen as body image distortions, the dynamic approach suggests oral fixation. According to the psychoanalytic approach, an anorexia patient refuses to eat and protects himself against the fantasies of conceiving orally. (Aydın,2007) This protective behavior occurs with the reluctance of oral feeding. Individuals try to get rid of the anxiety-causing situation by refusing to eat, and not eating begins to reduce anxiety. People lose weight by not eating. Weakened individuals are content with their feelings of weakness. Over time, this feeling of weakness combines with feelings of inadequacy and they never think that they can reach the desired weight. This situation, which consists of different reasons, can cause perception disorders over time and pushes the patient into a vicious circle. Individuals who lose weight to get rid of anxiety; Worries about losing weight, becomes aggressive and gets lost in this causal circularity.
The person who is interested in the weight loss situation, which he has taken to the center of his life in time, cannot be satisfied with the body he sees in the mirror and may exhibit aggressive attitudes towards his social environment.
The word bulimia, which is the Greek word for “ox hunger”, is a disease that tries to prevent weight gain with uncontrolled, excessive, frequent eating and subsequent vomiting and purging behavior.(Keçeli, 2006)
Bulimia Neurosa is an eating disorder with clinical findings such as overeating, obsessive behaviors for weight control, dissatisfaction with shape and appearance. (Emral,2009) Although these people have a normal weight, they have risk factors. Risk factors include perceptual distortions from western culture, obesity, having a strict dieting environment, and lack of self-confidence. It is mostly about 1% of young western women. Individuals often develop physical problems following weight control and eating disorders. (Emral,2009) .
According to DSM-V, disease levels were determined by taking the compensatory behaviors of the patients as reference. Compensatory behavior of individuals once or three times a week causes them to be in the group of mild patients. Patients in the intermediate class perform vomiting behavior four to seven times a week.
Patients in the severe group engage in compensatory behavior eight to thirteen times a week. Persons experiencing the most severe level of the disease, on the other hand, perform fourteen or more vomiting behaviors per week.
Patients are aware of their disease, but it may not be possible to notice bulimia patients from the environment. Dissociation from the disease takes many years after these individuals, whose body perceptions are impaired, place the habit of compensatory behavior in their eating episodes. People who are sick apply to medical support to get a diagnosis after the discomfort caused by their diseases and mood changes. Although bulimics are dissatisfied with the conflict, they reject social support because they see their illness as a source of shame. They think that this disease, which has become a part of their existence, is not understood by their environment. A non-judgmental and unconditional attitude is of great importance in the treatment of these people who develop a conditional understanding of love and acceptance regarding their own bodies. Pharmacological support alone is not enough, people should definitely receive psychotherapy support.
1.4. Binge Eating Disorder:
Eating much more than a standard person can eat under normal conditions, continuing the eating behavior until he feels an uncomfortable fullness, and eating behavior despite not being hungry is a disorder in which shame and guilt are felt (Keçeli, 2006)
The binge behavior is seen intensely when people feel stressed, inadequate and deficient. Because people cannot eliminate the stress factor, they want to eliminate the anxiety. When they get instant pleasure from food, they think that their anxiety decreases. With the resulting cycle, people create a new eating pattern for themselves.
In the treatment of binge eating disorder, the eating pattern of the person should be studied, and a treatment process should be followed in cooperation with the psychiatrist and dietitian in other medical interventions.
1.5. Unclassifiable Eating Disorders:
Eating at night for which no standard definition can be made, emotional depression, overeating, self-starvation, selective eating disorders or nutritional behavior disorders that occur in accordance with various personal principles. (Keçeli, 2006) Unclassifiable eating disorders are treated based on individuals’ own life stories and generalization should be avoided. Trauma treatment, drug therapy and cognitive therapies can be effective.
1.6. Orthorexia Nervosa: Orthorexia comes from the combination of two words in Greek, orthos means right and oreksiya means appetite. It is used to mean a healthy eating obsession. This was first done in 1997 by Dr. He used it in an article by Steven Bratman. They experience intense weight loss by obsessing over healthy eating in an unhealthy way, obsessed with the quality of the food consumed, not the quantity. It has not been found in the DSM diagnostic book until now (Bratman, 1997).
These people do not trust food manufacturers and do not believe that food is hygienic. Due to the belief they have developed that most foods are unhealthy, they cannot develop a diet and become extremely weak. It is also common to think that food will make them gain weight or make them sick. In the treatment process of orthorexic individuals, as in the treatment of other eating disorders, a multidisciplinary approach should be acted and people should receive pharmacological and psychotherapeutic support.