There is a pandemic of eating disorders in the world
Eating disorders (hereinafter referred to as RCP) are becoming an increasingly common problem that women and men around the world have to live with every year. Bukva talked about their causes and treatment of RCP with Natalia Naumova, a member of the Association of Doctors and Psychologists “Eating Disorders: Therapy and Prevention”. Naumova is an analytical biochemist, a researcher at the Venice Institute of Molecular Medicine, a researcher at the University of Paris-Saclay, and a member of the European Association for Clinical Research.
— Could you explain from a scientific point of view what RCP is?
Eating disorders (ECDs) are a group of eating disorders characterized by abnormal eating habits. Usually, this is accompanied by a person’s pronounced concern about weight and body shape, but not always. RCP is characterized by excessive attention to food, the division of food into “safe” and “dangerous”, exhaustion of oneself by diets and constant concern about weight. Essentially, a person’s entire life with RCP revolves around eating or avoiding it.
The medical classification of RCP is being revised all the time. Each updated version of the ICD (International Statistical Classification of Diseases and Pedigree) and the DSP (Diagnostic and Statistical Manual of Mental Health Disorders) introduces new RCP disorders, classifies a large number of groups, types and subtypes. In general, all RCPs can be divided into two main groups – those characterized by dietary restrictions (with or without episodes of purging) and those characterized by episodes of binge eating (with or without episodes of purging).
There are the main RCPs, such as anorexia, which consists in a severe restriction of nutrition by number or group of foods, regardless of the presence of appetite; bulimia, accompanied by bouts of uncontrolled overeating, followed by a desire for purification: artificial vomiting, the use of enemas, the use of diuretics and chemicals); compulsive (emotional) overeating, characterized by regular consumption of large amounts of food and a feeling of loss of self-control, after which a person experiences psychological discomfort; orthorexia, or orthorexia nervosa, which consists of an unhealthy obsession with healthy eating (not yet classified by the DSP).
There are at least 5-6 subtypes and types of anorexia: with and without episodes of purging; with body image disorders and body dysmorphic disorder (a mental disorder, a type of neurosis in which a person is excessively concerned about even a minor defect or feature of his body.) and without body image disorders, and so on. Therefore, this issue is complex.
If there is a suspicion of RCP, then you need to contact a specialist who will conduct a comprehensive diagnosis, as a result of which he will determine the specific type of RCP and offer appropriate therapy. It should be a qualified doctor who, first of all, will do no harm and, most importantly, can build a trusting relationship with the patient. It is easier with a psychologist, psychotherapist and psychiatrist because they know how to establish such relationships. Unlike therapists, pediatricians, endocrinologists or gynecologists. For example, a woman comes to an ordinary gynecologist with long-term amenorrhea (lack of menstruation in a sexually mature woman, due to endocrine reasons, in particular those related to weight loss and food restrictions), who treats amenorrhea as a hormonal failure, not realizing that the problem is in the plane of the psychology of eating disorders. The same goes for endocrinologists, therapists and pediatricians.
I insist that doctors of all specialties should have basic questionnaires that have already been developed by specialists and are used all over the world. They are short and effective and will help suspect RCP and recommend that the patient go for a consultation with an RCP specialist. But at the moment, there are certain difficulties in Ukraine, given who can really be a “specialist” in RCP. Q In Ukraine, a large number of people call themselves nutritionists, coaches in healthy eating, almost every fitness trainer who has completed two-week courses gives advice on nutrition.
Such pseudo-specialists have 100 thousand subscribers on social networks, sell weight loss programs, hold marathons, and so on, but they are not doctors, which creates a danger for those who, having RCP, get to them.
Psychiatrists or psychotherapists who specialize in RCP should work with significant RCP. Even the most talented psychiatrist who specializes in PTSD or sexual abuse will not be effective when working with a patient with RCP. We train psychologists, psychotherapists and psychiatrists, hold long-term meetings, refresher courses once a month, helping to gain skills in diagnosis and therapy, and, which is important for me, work correctly with patients in order to prevent relapses and periods of exacerbation.
Currently, many scientists believe that even different types of RCP are, in fact, one disorder, complex, where each disorder can be a continuation of another and they replace each other gradually depending on the phase and psychological state of the patient. Very often, bulimia or compulsive binge eating can be the phase of anorexia in the recovery phase. It will be difficult for a non-specialist to distinguish such nuances and understand which approach can help a particular patient in a particular phase.
— Different forms of the disorder that can replace each other. It’s like the flu: either a cough or a fever. That is, it’s all influenza, but these are different stages.
Absolutely. Therefore, it requires a specialist, and therefore I am very careful in classification.
— What are the causes of RCP?
A complex of causes and factors. First of all, genetic prerequisites. For more than 20 years, a huge amount of scientific research has been carried out in the field of RCP genetics, screenings of large samples of patients. We clearly know which genes are responsible for them. These are individual genes or associations of genes (there is such a thing as “gene linkage” or “gene association”). Such genes can include or exclude certain biochemical processes, the creation of certain proteins, the production of enzymes, neurotransmitters, and so on. This has an impact on endocrine processes. Therefore, when it comes to causes, I always start with genetic causes, which are a prerequisite for the development of RCP due to certain triggers – psychological, social, physiological, etc. Although it is customary to look for the causes of RCP primarily in the social and psychological plane, these causes lead to the occurrence of RCP only if there are genetic and physiological prerequisites.
Let me give you an example. Not everyone who eats too much chocolate develops diabetes. It only develops in those who have a genetic predisposition. This is also the case with RPH. Not everyone who has a traumatic psychological experience or who has been bullied about extra pounds will develop RCP. That is, there is a genetic predisposition, and only then biochemical and endocrine changes are turned on, which can be a trigger.
Most often, RPH really begins in adolescence, during the period of hormonal readjustments of the body. They are the ones who trigger and turn on RPH, but, again, not in everyone, but only in those who had genetic prerequisites, and in those who are in inadequate social conditions – toxic family, friends, school, and so on.
“Often in adolescence, 14-16-year-old girls and boys, who have not thought about nutrition before, suddenly gain weight, because the body is readjusting. And if family or loved ones say: “You are fat”, then the teenager begins to go on diets, starve and dissatisfaction with the body begins…
This is the most classic example. Men, by the way, are often harder. They are more likely to be ashamed to ask for help because you are a man – you are strong. Well, or the men themselves think that now they will work out the ideal of themselves, pull themselves together and correct themselves.
— By force of will.
Yes. By the way, about willpower. The path of willpower is a dead-end path for all patients with RCP, it is a loop. At one point, there is a feeling of guilt that provokes an attack, no matter what – purifying or restrictive, or refusal to eat at all. There are patients who refuse water, or who prefer to move their fingers or sleep standing up, because this is how energy is burned, I’m not kidding. There was a boy who was evacuated during the war, this is a very atypical case, it was ARFID (Food Avoidance/Restriction Disorder (ARFID) – a disorder in which people avoid certain foods), and anorexia, he ran back and forth on the train in order to burn calories and not get fat. All the way, while the train was going, he was running.
Once a patient called me and cried that he could not vomit after overeating, because he could not move – he had to crawl on all fours to the bathroom to induce vomiting and do a cleansing for bulimia. It can be physiological self-loathing, gastrointestinal pain or psychological self-loathing, self-blaming. This can be a point of “understanding.” At this point, the patient turns on and says: “No, I’m stronger, I’ll do it now, I’ll pull myself together and from today I’ll stop the RCP.” For a while, he is held together by willpower and motivation if he is a perfectionist, and most patients with RPH are perfectionists. And this patient goes into a conditional proper diet and lifestyle, usually orthorexia and compulsive sports, on which it is possible to function for a long and effective time. Until a new episode of exacerbation of RCP occurs.
“Is it control?”
It is hypercontrol of yourself, your lifestyle, your body, weight, calories. There are patients who avoid certain foods that are a trigger for them. For some, it may be chips, for others, chocolate. A person functions perfectly and suddenly, under the influence of the environment or stress, eats a piece of chocolate – and that’s it. This is the all-or-nothing principle.
“He can’t stop any longer.
Yes. That is, it is not possible to solve the problem on your own, simply by willpower, this is possible only when working with a psychotherapist or psychiatrist. It is important to work through the moment – all or nothing, then recovery from RCP will begin, because it’s all or nothing. That is, either I eat only right, avoiding unhealthy and triggering foods, or I break down and eat everything I see. It’s about compulsive overeating, it’s about dramatization. It’s like a girl who didn’t get a response after 3 minutes to a text message sent and – “That’s it, he doesn’t love me.”
— Is it normal to compare it with addictions, alcohol or drugs, for example?
Absolutely not. All scientists who study RCP, all members of our Association and scientists around the world are fighting against the use of the term “food addiction”, especially addiction to sweets – it does not exist, from the point of view of biochemistry, from the point of view of biology. Food is a physiological need, like breathing, like fluid intake. There can be no dependence on respiration or water intake.
— It’s about the all-or-nothing concept. There are alcohol-dependent people who are tied. And so they drink a little and then they can’t stop.
Yes, but that’s where the similarities end, because you won’t die if you don’t drink alcohol, but you will die if you don’t eat, as happens with anorexics.
“It’s a disorder, not an addiction, right?”
Absolutely. We don’t use the word “addiction” at all, because it’s not scientific, it’s not true, it’s something of a kind of anti-science.
— Can RCP be cured? Because RCP is a complex problem that is associated with a certain reaction of the body to stress. A person may think for years that he or she has been cured, but the situation is stressful and the RCP returns.
I will answer optimistically. Not because I’m an optimist, but because I’m a scientist who works with years of research on large samples, and that’s why I have facts to be optimistic about. Yes, it is possible to recover from RCP.
At least it will be possible to live at the paid level, without going out during periods of exacerbation and always be in long-term remission, if there is a competent approach. What is a competent approach? This is, first of all, the teamwork of specialists in RCP, first of all, ideally a psychotherapist or psychiatrist, plus an endocrinologist or a therapist-endocrinologist, if it is a woman, then a gynecologist, and accompanying specialists (gastroenterologist and so on). This is a team work of specialists who will help stabilize the patient at the first stage of treatment, because it is necessary to work with the psyche and physiology at the same time. A nutritionist, ideally a nutritionist, will select a diet. It’s a start.
“A doctor is a person who has a medical education and understands how the body functions from the inside, knows anatomy, physiology, and biochemistry.
Absolutely. A doctor must have a medical degree. I still believe that such people can be biologists. Who work in the scientific and methodological field, at the intersection of science and medicine. I am such a scientist and I believe that the most effective is the cooperation of scientists and doctors forming one team.
Teamwork is important to get the patient into a stable phase. Then there is the responsibility and work of the patient himself, who must realize his vulnerability and manage it. For example, an athlete has a certain set of injuries, so he should not give excessive loads and be careful with the injured part of the body. With RCP, it’s the same: knowing what the trigger is, not necessarily nutritional. These can be social triggers – toxic communication, work, as well as physiological ones (poor sleep, overload, illness).
— That is, you need to understand what exactly can start the RCP process again and have certain skills, how to behave in order to avoid relapse?
A person must understand the factors that can destabilize him or her and lead him into a destructive state. For some it is RCP, for others it is neurosis, for others it is destructive behavior, for others it is alcohol abuse or drug use, and so on. Specifically, in a patient with RCP, this is an inadequate coping strategy (a psychological strategy and a way for a person to cope with a stressful situation, a concept that combines cognitive, emotional and behavioral strategies that are used to cope with the demands of everyday life).
Simply put, it’s an unhealthy way to overcome anxiety. You can’t cure anxiety because you were born with it, so I started with genetics. It is a person’s responsibility to be prepared for such situations, to have a support group, the help of specialists, and to master self-help techniques. You’re vulnerable, but you have to be able to deal with those triggers that trigger anxiety.
That is, not to work with anxiety itself, but with triggers. You can’t change the situation of war, you can’t change the situation of divorce or the death of a loved one. But you can, with the help of, for example, a psychotherapist, with the help of yoga techniques, healthy sleep, walks, art therapy, sex, communication and something else, learn to cope with anxious situations that, of course, will arise in life, because life is something that cannot be controlled, there is stress in life, and this is normal.
Or to put it simply: we are tactile. Focusing on tactile sensations helps a lot. This is a massage, a spa, a hot shower: when you feel water on your skin, it helps to stop endless thoughts and dialogues in your head. It’s about the fact that you see the trigger and understand that you have to take preventive action very quickly. Even before going to a specialist, you can breathe, you can go for yoga, jogging, and socialize. It is very important to have support. There are many methods of support, family therapy. Patients with anorexia, especially adolescents, must undergo family therapy in parallel with treatment. Their parents should be involved in the therapy process and undergo counseling too. If it is an adult patient, then their partner should ideally be involved and able to provide support. Ideally, the social environment should be the first link to whom you will turn for help. Support should help not to enter the exacerbation phase. This is a psychological safety cushion that every patient with RCP should have.
— How not to be ashamed to tell your loved ones about RCP?
It is absolutely impossible to be ashamed, it is absolutely destructive. RCP is a common disease. There is no shame in getting sick. We are not ashamed if we have the flu, diabetes, if we break a leg, or if we have visual impairments. In the same way, we should not be ashamed of the RCP.
Author: Natalia Naumova is a Candidate of Biological Sciences, analytical biochemist, nutritionist, consultant on healthy eating and endocrine disorders, researcher at the Venice Institute of Molecular Medicine and researcher at the University of Paris-Saclay. Member of the European Association for Clinical Trials. She is a recipient of international scientific awards, including the Fulbright Prize in the United States and several European awards, including the Marie Prize Curie. Member of the Association of Doctors and Psychologists “Eating Disorders: Therapy and Prevention”. Scientific consultant at “KARTUSHYNSKA. CLINIC».