Selin Çelen
Clinical Psychologist 
Hiwell Online Terapi Platformu

Although there are different types of eating disorders, which is a nutritional behavior in which the person shapes the act of eating according to its mental state rather than physical hunger, the two most common types are anorexia nervosa and bulimia neurosis. The foundation of the eating disorder is laid in childhood, but it starts to be seen in adolescence depending on development. During childhood and adolescence, there are some risk factors such as depression, social media influence, violence, sexual abuse, peer bullying, and parental pressures. In adults, it is observed after the age of 20. Eating disorders have physiological effects as well as psychological effects. Considering all these, it is very important to empathize with people with eating disorders and make them feel that we are with them.

Eating disorders can occur for many reasons such as restrictive diet, prohibitions, the need to be perfect, the desire to be liked and desired. The causes of eating disorders, which occur when the relationship between the person and food is disrupted, mostly include dissatisfaction with body appearance and the desire to be healthy. In order to compensate for their dissatisfaction, people who base their value on their weight and body appearance may engage in behaviors such as restrictive diets, detoxes, starving themselves, vomiting, using laxatives-diuretics, and excessive exercise. These actions cause the person's relationship with eating to deteriorate. The physical effects of this disorder, its detection and what to consider when approaching these individuals are very important.

The foundations of this disorder are laid in childhood, but it starts to be seen at the age of 13-14 depending on development. Anxiety disorders, depression, social media influence, psychological and physical violence, sexual abuse, peer bullying, losses and parental pressures during childhood and adolescence are among the main causes of eating disorders. For this reason, it is very important to take all risk factors into consideration and intervene early.

According to research, the prevalence of eating disorders in our country is 3 percent on average. This rate is 2.33 percent in adolescents and 4.03 percent in adolescent girls. In a study conducted on female university students, it was reported that Anorexia Nervosa ranged between 0.1-4 percent and Bulimia Nervosa ranged between 18 and 20 percent. The rate of anxiety disorders in people with eating disorders was also found to be over 60 percent.

According to ANAD, an association based in Chicago that fights against eating disorders, about 1 in 10 people worldwide are affected by this disease and at least 9 percent of the world's population has an eating disorder. However, during the pandemic period, the incidence of eating disorders has increased in the world and in Turkey, although it is not seen clinically. According to the ANAD Association's research findings on children and adolescents; 42 percent of girls in grades 1-3 want to lose weight, 81 percent of 10-year-old children are afraid of being fat, 35-57 percent of adolescent girls diet fast, fast, vomit on their own and use diet pills or laxatives. Eating disorders are the diagnostic group with the highest risk of death. Especially in the Anorexia Nervosa group, the risk of death is around 10 percent in developed countries.

A SENSITIVE AND CAUTIOUS APPROACH

If there is an individual around us who is suspected of having an eating disorder, it is very important to approach them in a very sensitive way. Because these individuals can be quickly triggered by any positive or negative comment from their environment. Comments such as 'You look beautiful', 'You are not overweight', 'Have you gained weight?' or 'Have you lost weight?', whether positive or negative, can have an effect that can mobilize the person to act on their eating habits. Instead of such questions, it is much more important and valuable to empathize, to ask and meet their feelings, to learn about their needs, to embrace them with compassion, to be motivational, to make them feel safe and not alone.

DIAGNOSIS IS MORE IMPORTANT THAN TREATMENT

It is very important to determine the root causes of the eating disorder before treating it. Increased food consumption, losing control while eating, starving oneself, following a restrictive diet and then overeating cycle, vomiting after overeating, losing weight in a short time, doing too much physical activity, eating in secret, calculating calories, menstrual irregularity or menstrual cessation are among the symptoms of this disease. After determining these causes, the relationship between the causes and consequences of dissatisfaction with one's body appearance is examined in detail and studies are carried out. During the examination, mostly; self-confidence, perfectionism, failure, inadequacy, and beliefs about not being liked and loved are worked on. In addition to these, a number of behavioral intervention methods are applied to repair the relationship with eating. Various methods such as awareness and tracking of hunger and satiety signals, being at peace with forbidden foods, transitioning from restrictive diet cycles to sustainable nutrition, exploring past diet experiences, alternative behavioral actions, creating new coping methods, and ensuring emotional regulation are used. Cognitive Behavioral Therapy, Dynamic Therapy, EMDR Therapy, Mindfulness, Schema Therapy, Dialectical Behavior Therapy are among the therapy schools used in the treatment of eating disorders. 

IT ALSO HAS PHYSICAL EFFECTS

Eating disorders have physiological as well as psychological effects. Some of these disorders are given as follows:

• Cardiovascular problems
• Growth and developmental delay in cases with early onset,
• Decrease in bone mass,
• Stomach irritation and bleeding,
• Erosion of tooth enamel and tooth decay,
• Low potassium value,
• Tendency to sleep,
• Heart rhythm disorders,
• Fatty liver disease,
• Dry skin,
• Increased hair growth,
• Constipation
• Low body temperature,
• Hair loss,
• Failure to menstruate in women...

AN INDIVIDUAL UNABLE TO COPE WITH ITS EMOTIONS...

Eating disorders are not just about emotional hunger. In emotional eating disorder, people may consume more food than usual when they feel any emotion. This eating behavior, which usually occurs with negative emotions, is actually used as a coping method. An individual who feels negative emotions such as failure, inadequacy, feeling under pressure, anger, etc., engages in eating behavior and often feels regret afterwards. However, eating behavior is also observed following positive emotions as well as negative emotions. The reason for the eating behavior that comes with positive emotions is that the person wants to reward itself. Emotional hunger is frequently seen in emotional eating. However, on the basis of every eating behavior, the person actually eats in many emotions such as hunger, satiety, sadness, grief, distress, anger, regret, and happiness. Since the individual cannot tolerate and cope with the emotion they are experiencing, they try to manage and relax this feeling through the act of eating. Therefore, we can use the term emotional hunger at this point. However, using the act of eating with emotional hunger and the method of coping with the emotion or event experienced in this context is not a functional solution. At this point, finding more useful and healthy coping methods would be a better solution.