Can you have an eating disorder without body image issues?

In this blog post, we will answer the question, “can you have an eating disorder without body image issues?” and look at what eating disorders are and their types. We will focus on what avoidant/ restrictive food intake disorder is, the symptoms, causes, and risk factors. Finally, we will look at the treatment and prevention of avoidant/restrictive food intake disorder.

Can you have an eating disorder without body image issues?

Yes, it is possible to have an eating disorder without having body image issues. Many people believe ‌eating disorders are centred around beauty standards, attractiveness and the influence of media on body image and appearance. These are risk factors for developing eating disorders.

However, these are not the only causes of eating disorders. Research has shown that body image is a secondary factor in the development of eating disorders. Body image and being thin can also be justified by people with eating disorders as a way to convince themselves that their disordered eating is necessary.

Reasons ‌one can develop eating disorders without body image issues

The reasons ‌one can develop disordered eating without having a connection to body image include:

As a coping mechanism

Eating disorders can be considered as a form of addiction just like gambling or alcohol addiction. Addictive behaviour can take the form of extreme exercising or dieting, purging, food restriction or fasting. These behaviours are linked with releasing endorphins which are feel good hormones.

The same way a person addicted to drugs feels when they use their drug of choice, is the same feeling a person with disordered eating gets when they achieve their targeted weight, binging etc. it takes up most of your time and you cant think of anything else. Eating disorders can be a way of coping when life feels out of control.

When the mind has a lot of stressors, people can tend to look for something they are in control over that makes the feel happy and worthy.

Genetics

Just like other mental illnesses, eating disorders are believed to be genetic. People with immediate family members (parents or siblings) with eating disorders are at a greater risk of developing eating disorders themselves. Specific brain chemicals and genomes have been linked to an increased probability of developing ED.

While more research needs to be done on this, this finding can help those struggling with ED understand their condition and also create awareness of how serious EDs are.

Response to trauma

Eating disorders can be a complex response to trauma and are used as a way of self-distraction and as a way to seek attention as well. For many people with feelings of shame, fear, guilt or fear, they can use eating disorders as a way of ‘disappearing’ or even use their bodies to reflect their trauma.

Some people with EDs unknowingly punish their bodies as a proxy for what is happening in their brains.

The Diagnostic and Statistic Manual has classified avoidant/restrictive food intake disorder, and this is an eating disorder that is not related to body image. We will now look at it in detail.

What is avoidant/restrictive food intake disorder(ARFID)?

It is an eating disorder that involves extreme restrictions on the amounts of foods and types of food one takes. It is mostly confused with anorexia nervosa as it can have similar symptoms. The only difference is that, unlike anorexia, people with ARFID have no worries about their body image, size or shape.

The disorder can affect both children and adults. In children, it can cause weight loss and delayed weight gain and growth. In adults, it can cause dangerous weight loss, and make it difficult for one to maintain basic body functions.

Causes of ARFID

There are no definite causes of ARFID but there are risk factors that can increase the chances of one developing it. Some health experts believe that people with this disorder have had an unpleasant experience with food, i.e. choking or vomiting after eating that makes them anxious about food, or extreme sensitivity to food texture or taste.

Most people at a high risk of developing ARFID include:

• People with ADHD
• People with autism
• Children who have never outgrown picky eating

Symptoms of ARFID

Some of the symptoms of ARFID include:

Physical signs

• Constipation
• Trouble concentrating
• Severe weight loss
• Stomach cramps
• Slow heart rate
• Lack of appetite
• Abnormal menstrual periods
• Fine body hair growth
• Dry skin, hair and nails
• Feeling cold all the times
• Dizziness or fainting
• Muscle weakness
• Weakened immune system
• Thinning of hair on the head
• Swollen feet
• Poor healing of wounds

Behavioural signs

• Extreme fear of vomiting/choking
• Difficulty eating with others
• Wearing layers of clothes to stay warm/hide weight loss
• Drastic restrictions in the type and amount of food eaten

Management and treatment of ARFID

Many people deny having ARFID and only seek treatment when their condition is serious or life-threatening. The most challenging part of treatment is getting the individual affected to accept treatment. Most of those in treatment centres are coerced/forced into treatment by their loved ones which make treatment long and tedious.

The goals of treatment are:

• Begin nutritive rehabilitation to regain weight
• Stabilize weight loss
• Get a personalized meal plan from a dietician
• Treat underlying psychological issues
• Eliminate purging or binging habits and other disordered eating patterns
• Develop long-term positive behaviour patterns

Treatment includes strategies like:

Medication

Some healthcare providers recommend the use of a prescription nutritional supplement to help the body regain weight. They can also prescribe medication to treat anxiety and depressive symptoms which are common in people suffering from eating disorders. Some psychotic medication like olanzapine is good for weight gain. Some other medications help with period regulation.

Nutritive counselling

This helps in restoring a healthy relationship with food and eating patterns, teaching healthy approaches to food, teaching the importance of nutrition and eating balanced meals and helping restore normal eating patterns.

Psychotherapy

Individual counselling helps in changing the thinking (cognitive therapy) and behaviour (behavioural therapy) of the individual with an eating disorder. Therapy helps the person accept and get committed to treatment, address distorted thinking patterns surrounding food, develop new skills in dealing with negative thought patterns and behaviours and also solve interpersonal conflicts.

Family and group therapy

Family support is crucial in the life of a person recovering from an eating disorder. They must understand and be aware of the symptoms and warning signs of the disorder. Group therapy with those going through the same is also important in opening up without feeling judged and getting realistic and workable solutions from others.

Hospitalization

This is necessary for those with severe weight loss resulting in malnutrition or those with severe mental and physical effects of ARFID. This includes those with heart complications, depression or suicidal thoughts, ideations or trials.

Conclusion

We have looked at the reasons one Can develop eating disorders without having body image issues. We have also discussed in detail an eating disorder called ARFID. This is a disorder classified in the DSM-V, that one can get without having no worries about their body image or weight.

We have discussed its symptoms, risk factors and people at a high risk of developing the disorder. Finally, we have looked at the treatment options available for ARFID. If you have any questions or comments, please let us know in the comment section below.

Frequently asked questions: eating disorders without body image issues

Can you have ED without dysmorphia?

Yes, it is possible for one to have an eating disorder without body image issues, but not anorexia.

What are three examples of disordered eating behaviours?

• Rigid routines and rituals surrounding food
• Feelings of shame and guilt surrounding food and eating
• Frequently dieting, avoiding and skipping meals

What is orthorexia?

It is an unhealthy focus on healthy eating. People with anorexia obsess about nutritive eating to a point where it affects their overall well-being.

Citations

Ferguson K. (August 1, 2018). Not all eating disorders are related to body image. Retrieved from https://www.thestar.com/life/health_wellness/opinion/2018/08/01/not-all-eating-disorders-are-related-to-body-image.html

WebMD, What Is ARFID? Retrieved from https://www.webmd.com/mental-health/eating-disorders/what-is-arfid

NEDA, Avoidant Restrictive Food Intake Disorder (ARFID). Retrieved from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/arfid