DISORDERS OF NUTRITION AND DIET
Nutrition and Eating Disorders
Nutrition and Eating Disorders (or Eating Disorders)
They are characterized by incorrect behavior regarding the diet itself, with excessive or limited ingestion of food or inappropriate behavior (APA, 2013). All these behaviors compromise the social life and health of patients affected by these diseases and represent one of the most frequent causes of juvenile disability associated with a high risk of mortality. Eating disorders classified in DSM 5 (Diagnostic and Statistical Manual of Mental Disorders) are divided into six main diagnostic categories:
- Nervous anorexia
- Bulimia nervosa
- Binge-eating disorder
- Rumination Disorder
- Avoidant / Restrictive Disorder
Most eating disorders are found between the ages of 15 and 25, in particular the age group in which anorexia and bulimia nervosa begin is adolescent between 15 and 19 years (Raevuori, Hoek and Susser, 2009). Adolescence is a very particular period in the life of each individual, important physical changes are faced, as well as purely psychic ones. In this particular moment of both physical and psychic growth, children enter the common "adolescent crisis", both in relation to themselves and to the outside world that surrounds them. From here, personal identity begins to be defined through self-realization, confrontation with peers and the search for one's autonomy (Turnbull, Ward, Treasure and Jick, 1996). A greater adolescent onset also appears to be linked to stressful events such as high school exams, early emotional disappointments or parental divorce.
Eating disorders also occur in pre-adolescent age, and this figure has been increasing exponentially in recent years, and the age at which the first diets are undertaken is falling rapidly. From some studies (Shapiro, Newcomb and Loeb, 1997; Maloney et al. 1989) it emerged that as early as 8 years old girls start worrying about their weight and body shape, they start diets even if they are normal weight or even below the normal weight. More recent data shows an increase in early onset cases, partly due to a lowering of the age of menarche, but also to an anticipation of the age in which adolescents are exposed to the ideals of beauty / thinness through the internet and to the various media. The early onset of an eating disorder also involves a greater risk of developing permanent secondary damage, especially as regards the bones and central nervous system that have not yet reached full maturity in adolescence.
The age of onset of BED (Binge-Eating Disorder) is located later than the other diagnoses, with a significant peak in early adulthood. The onset of anorexia and bulimia at an older age are increasingly frequent, although there are currently few studies on this subject. This carries a greater risk of chronicity and comorbidity with psychiatric disorders such as anxiety and depression. Dissatisfaction with their body image is very high in patients aged between 14 and 17 years, about 10% of these girls react to this dissatisfaction with a calorie restriction or with the selection of food that frequently results in a Disorder of the eating behavior (Faravelli, Ravaldi, Truglia et al. 2006). For the reasons listed above, early intervention is essential, especially in a delicate phase such as adolescence, a well-integrated treatment (collaboration between psychologist, doctor and nutritionist) has a high level of effectiveness that leads to avoiding the chronicity of the disorder.
The treatment of choice for these disorders is cognitive behavioral therapy (CBT) as reported in the NICE guidelines (2017). Improved Cognitive Behavioral Therapy (CBT-E) deals with the maintenance processes of eating disorders more than with those that led to its onset, although often the triggering and maintenance factors may coincide and overlap, it also focuses mainly on thoughts (cognitive part), and on the behaviors that are involved in their maintenance mechanisms (Fairburn, Cooper and Shafran, 2003).
Dr. Deborah Fasoli
Psychologist - Psychotherapist
Dr. Letizia De Mori
British Psychological Society