New Insights Into Eating Disorders

For all of its benefits – instant news updates, global communication, and a sense of community – social media isn’t without risks, such as cyberbullying, online predators, and often dangerous viral trends.

Social media often presents distorted portraits of body image. A 2023 study found that “Social media usage is a plausible risk factor for the development of eating disorders. Research from Asia suggests that the association is not unique to traditionally Western cultures.”

The Primary Care Companion for CNS Disorders has published news, research, and reader insight that offers new, informed perspectives on eating disorders and the global health issue it presents. This week, we’re presenting summaries of three of the more recent pieces we’ve published – along with links – for further review.

How Do Eating Disorders Influence Fertility In Reproductive-Aged Women?

Eating disorders (EDs) are prevalent among women of reproductive age. And they typically crop up before starting before pregnancy. The three most common EDS include:

• Anorexia nervosa (AN) involves dietary restriction, low weight, fear of weight gain, and lack of concern about malnutrition.
• Bulimia nervosa (BN) includes binge eating and compensatory behaviors like vomiting or laxative misuse.
• Binge eating disorder (BED) involves recurrent binge eating with feelings of guilt.

With all of this in mind, a team of researchers wanted to know how these disorders might affect reproductive health and how they could mitigate whatever risks might exist.

To that end, the researchers reviewed PubMed literature, up to March 27, 2023. In their analysis, the team included search terms related to pregnancy, eating disorders, fertility, and associated outcomes. The authors then singled out and reviewed articles relevant to the impact of EDs on fertility and perinatal outcomes.

The researchers found that the lifetime prevalence for common EDs hovers around 6 percent, with higher rates among women seeking fertility treatment. Their findings include:

• EDs can impact fertility through weight changes affecting hormone levels and menstrual cycles.
• Behaviors like binge eating and dieting can lead to overweight and obesity, further affecting fertility and response to treatment.
• EDs are associated with polycystic ovarian syndrome (PCOS), complicating fertility.

In the perinatal period, EDs alter maternal weight, shaping obstetric outcomes. Both high and low maternal BMI elevate risks such as gestational diabetes, hypertensive disorders, and preterm delivery. Active ED symptoms during pregnancy raise risks for cesarean section and preterm delivery. The research also revealed that EDs are linked to perinatal anxiety and depression, influencing maternal and infant health.

EDs also affect offspring health through maternal weight and nutritional status, altering fetal development and even long-term outcomes. Maternal EDs are linked to adverse neonatal outcomes like low birth weight and preterm birth. This can also change breastfeeding duration.

Screening for EDs in reproductive-aged women is crucial, the authors conclude, especially during fertility treatment and perinatal appointments. Tools like the SCOFF questionnaire and the Prenatal Eating Behaviors Screening (PEBS) Tool help identify ED symptoms.

Treatment primarily involves outpatient behavioral therapies, but severe cases may require hospitalization. Early treatment of EDs can improve fertility outcomes and reduce perinatal risks.

That being said, the researchers insisted that the scientific community must gather more data, including postpartum screening tools and specific treatments for pregnant and postpartum women.

Teenagers Appear to be ‘Spreading’ Mental Illness

A study published in JAMA Psychiatry suggests that ninth-grade students can “infect” their classmates with mental disorders.

The Finnish nationwide cohort study analyzed more than 700,000 individuals born between 1985 and 1997. It found that students exposed to peers with mental disorders in ninth grade were more likely to develop similar conditions themselves. This increased risk lingered even after adjusting for parental, school-level, and area-level factors.

Key findings include:

• A higher “transmission” risk, at least 5 percent, when multiple classmates had mental disorders.
• The risk appeared to be most significant in the first year after exposure, increasing by up to 9 percent for those with one diagnosed classmate and 18 percent for those with multiple classmates.
• Mood, anxiety, and eating disorders were most strongly linked to this elevated risk.

The study suggests that mental disorders might be socially transmitted within adolescent peer networks. Researchers defined “exposure” as having one or more classmates diagnosed with a mental disorder in ninth grade and tracked the participants until they received a mental disorder diagnosis, emigrated, died, or until the end of 2019.

The researchers proposed several mechanisms for this phenomenon, including the normalization of mental disorders through increased awareness and the influence of peer social networks.

For example, prolonged exposure to a peer with depression could lead to the development of depressive symptoms through emotional contagion. The study emphasizes the need for further research to understand how mental disorders spread within peer networks and to develop effective prevention and intervention strategies in school settings. Finally, these findings could help reduce the societal and economic burden of mental disorders.

Readers Address Unrecognized Eating Disorders

In a letter to the editor published in PCC, Ahmed Naguy and Bader Alamiri discuss a variety of aberrant eating behaviors that aren’t formally recognized in the existing major psychiatric classification systems (DSM-5-TR and ICD-11). These behaviors, although still under-researched, are gaining attention and might warrant official acknowledgment at some point.

The authors describe several disorders now categorized under “other nonspecified feeding or eating disorders:”

1. Orthorexia nervosa: An obsession with healthy eating, focusing on the quality rather than the quantity of food.
2. Anorexia nervosa by proxy: A condition where a mother with anorexia nervosa projects her body image concerns onto her child, potentially leading to malnutrition and stunted growth.
3. Pregorexia: Unhealthy behaviors during pregnancy, such as extreme dieting and excessive exercise, aimed at avoiding pregnancy-related weight gain, which can harm both mother and fetus.
4. Anorexia athletica: A sport-related eating disorder involving unhealthy eating and weight control behaviors to maintain low body weight for competitive advantage.
5. Hypergymnasia: Excessive exercise as a means of weight control, sometimes seen in athletes.
6. Drunkorexia/alcoholimia: Restrictive eating patterns to enhance alcohol effects and avoid weight gain.
7. Picky/fussy/faddy eating: Limiting food variety, potentially leading to dietary deficiencies, sometimes seen in adults and related to avoidant/restrictive food intake disorder.
8. Emetophobia: An irrational fear of vomiting that leads to food restriction and weight loss.
9. Gourmand syndrome: A preoccupation with fine food associated with right anterior cerebral hemisphere lesions, resulting in impulse control issues.
10. Feederism: A paraphilia involving sexual arousal from feeding partners to encourage weight gain.
11. Diabulimia: The intentional omission of insulin by type 1 diabetics to lose weight, significantly reducing life expectancy.
12. Bigorexia nervosa: An obsession with one’s body being too small or not muscular enough, more common in males and considered a specifier for body dysmorphic disorder.

Finally, the authors argue that these behaviors highlight the need for broader diagnostic criteria and more research. Understanding these disorders better could lead to more effective treatments and interventions. And it could also address a range of disturbed eating patterns that current classifications fail to encompass.