Eating Disorders

Eating disorders are mental illnesses characterised by abnormal eating habits that negatively impact a person's physical or mental health. They are commonly managed by psychiatrists and clinical psychologists but can have significant oral health implications, making it essential for dentists to be aware of these conditions.

Types of Eating Disorders

Eating disorders include:

• Anorexia Nervosa (AN): Characterised by restricted energy intake leading to significantly low body weight, intense fear of gaining weight, and a distorted body image.
• Bulimia Nervosa (BN): Involves recurrent binge eating followed by compensatory behaviours such as purging or excessive exercise.
• Binge Eating Disorder (BED): Marked by recurrent episodes of binge eating without compensatory behaviours.
• Pica: Persistent eating of non-nutritive substances.
• Rumination Disorder: Repeated regurgitation of food.
• Avoidant/Restrictive Food Intake Disorder (ARFID): Significant nutritional deficiency due to avoidance based on sensory characteristics or fear of aversive consequences.
• Other Specified Feeding or Eating Disorder (OSFED): Eating disorders that do not meet the full criteria for AN, BN, or BED, such as night eating syndrome and purging disorder.

Signs and Symptoms

Symptoms vary with the type and severity of the disorder, including:

• Physical Symptoms: Weakness, fatigue, sensitivity to cold, reduced libido, amenorrhoea, and unexplained hoarseness due to frequent vomiting.
• Oral Health Complications: Tooth decay, cavities, xerosis, dry lips, burning tongue, and parotid gland swelling.
• Long-term Effects: Osteoporosis, cardiac arrest, electrolyte imbalance, kidney failure, and brain atrophy.

Diagnosis

Diagnosis involves a combination of medical history, physical examination, and psychological assessment. Important diagnostic tools include:

• Medical Evaluation: Complete medical and psychosocial history, neuroimaging using fMRI, MRI, PET, and SPECT scans to detect organic causes.
• Psychological Assessment: Clinical interviews and psychometric tests such as the Eating Attitudes Test (EAT), SCOFF questionnaire, and Eating Disorder Examination Interview (EDE).

Causes and Risk Factors

The exact causes of eating disorders are unclear, but both biological and environmental factors play a role. Notable risk factors include:

• Genetics: Family history of eating disorders or other mental health conditions.
• Psychological Factors: Body dysmorphic disorder, anxiety, depression, and OCD.
• Cultural and Social Influences: Media idealisation of thinness, peer pressure, and cultural norms.
• Environmental Influences: Child maltreatment, social isolation, and parental influence.

Treatment

Treatment varies by disorder and severity and often involves a multidisciplinary approach:

• Psychotherapy: Cognitive behavioural therapy (CBT), acceptance and commitment therapy, dialectical behaviour therapy, and family therapy.
• Medical and Nutritional Interventions: Proper diet, nutrition counselling, and medications like antidepressants or antipsychotics.
• Inpatient and Outpatient Care: Depending on the severity, treatment can range from hospitalisation to community programmes.

Barriers to Treatment

Barriers include individual factors such as stigma and fear, and systemic factors like financial limitations and lack of access to specialised care. The COVID-19 pandemic has exacerbated these barriers by increasing isolation and anxiety, disrupting routines, and making access to resources more difficult.

Outcomes

Recovery rates for eating disorders vary, with full recovery rates between 50% and 85%. However, eating disorders have the highest mortality rates among mental illnesses, with anorexia nervosa being particularly lethal due to complications like cardiac arrest and suicide.

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By understanding the complexities of eating disorders, dentists can better recognise the signs and provide appropriate referrals, contributing to a holistic approach in managing these challenging conditions.

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Self-assessment MCQs (single best answer)

Which of the following is characterised by restricted energy intake, intense fear of gaining weight, and a distorted body image?

Which oral health complication is commonly associated with frequent vomiting in patients with eating disorders?

Which of the following is NOT considered a type of eating disorder?

Which diagnostic tool is specifically designed to assess eating attitudes?

What is the primary purpose of Cognitive Behavioural Therapy (CBT) in the treatment of eating disorders?

Which factor is NOT typically considered a risk factor for developing eating disorders?

What is the estimated full recovery rate for eating disorders?

Which eating disorder is particularly lethal due to complications like cardiac arrest and suicide?

Which of the following is a common barrier to treatment for eating disorders?

Which psychological assessment tool is commonly used to screen for eating disorders in clinical settings?