Which eating disorder is the most dangerous?

Eating disorders are considered to be the most ‘lethal’ of conditions under the umbrella of psychiatric diagnosis. Whilst all psychiatric conditions carry a risk, the harm related to eating disorders is significantly heightened. This is because eating disorders tangibly affect the body in dramatic ways. The symptoms of disordered eating inscribe themselves on the body, creating a range of physical health effects and deteriorations that can threaten both health and quality of life.

When we think about eating disorders, we may initially picture the ‘classic’ symptoms of anorexia, bulimia, or binge-eating disorder. However, the experience of eating disorders can be wide-ranging. With over ten diagnosable types of eating disorders, it is important not to make sweeping generalisations about what an eating disorder ‘looks like.’ These types of stereotypes can cause more harm and can potentially lead to mis (or even missed) diagnoses.

For that reason, it is important to understand the basics of each type of eating disorder. We can do this best by learning how they manifest. In order to acknowledge their differences, it is essential to consider the specific harm associated with each condition. This can be achieved through careful assessment of symptoms and effects, as well as the application of clinical and research-led statistics.

Eating disorders: What are they?

Around 1.25 million people in the UK live with an eating disorder. The eating disorder charity Beat defines eating disorders as ‘serious mental illnesses affecting people of all ages, genders, ethnicities and backgrounds.’

They indicate that eating disorders occur when someone uses disordered eating ‘as a way to cope with difficult situations or feelings.’ This can lead to specific behaviours such as restricting food intake, eating very large amounts of food in one instance, or using behavioural or medical aids (such as laxatives) to dispose of food that has been consumed. Beat reiterates that eating disorders are ‘not all about food.’ [4] Although eating disorders manifest in feeding and eating habits, our relationship with food can be revealing of our current mental state, as well as the relationship we have with others and ourselves. Eating disorders are frequently linked to body image. However, they can also be associated with other forms of personal distress.

Eating disorder is an umbrella term for a list of conditions with a broad, ranging symptomatology. Some examples of eating disorders include:

• Anorexia
• ARFID
• Binge Eating Disorder (BED)
• Bulimia
• Night Eating Syndrome (NES)
• Orthorexia
• OSFED
• Pica
• Purging Disorder
• Rumination Disorder
• UFED

Anorexia

Anorexia (also known as anorexia nervosa) is an eating disorder characterised by restricted eating practices. This means that individuals with anorexia will strictly limit their food intake. This often leads to dangerously low body weight. A study suggests that anorexia nervosa symptoms are experienced by around 8% of people with an eating disorder.

ARFID

ARFID is short for avoidant restrictive food intake disorder. Individuals with ARFID often experience specific food aversions and may find it very difficult to try new foods. This can lead to people eating less than is recommended, as well as eating a less balanced diet. This can lead to weight loss and nutritional deficiency. A study suggests that around 5% of people with an eating disorder live with ARFID.

Binge Eating Disorder (BED)

Binge eating disorder (or BED) is defined by two key elements:

1. Consuming ‘large amounts of food’ in a specific time period
2. Feeling that these periods are out of control, and subsequently experiencing guilt

Binge eating is usually defined as large food consumption within 2 hours. Binge eating disorder is one of the more prevalent eating disorders. A study suggests that around 22% of people with an eating disorder live with binge eating disorder.

Bulimia

Bulimia (also known as bulimia nervosa) is a kind of condition that, on the surface, may appear similar to a binge eating disorder. Individuals with bulimic tendencies may find themselves in cycles of restriction and binge eating. The binge-eating is typically followed by ‘compensatory behaviour’ to negate the effects of bingeing. These behaviours include self-induced vomiting, the use of laxatives and diuretics, fasting and extreme exercise. An estimated 19% of individuals living with an eating disorder fall within the diagnostic criteria for bulimia.

Night Eating Syndrome (NES)

Night Eating Syndrome (or NES) focuses on eating behaviours that happen in the evening and during the night. Individuals with NES may:

• consume over 25% of their daily calories after dinner
• wake during the night and subsequently eat

For a diagnosis of NES, the instances of nocturnal eating occur twice a week or more.
NES is experienced by an estimated 1.5% of the American population.

Orthorexia

Orthorexia nervosa is sometimes considered as akin to anorexia. It is associated with ‘an obsession with healthy eating,’ which can lead to severe weight loss and malnourishment. Eating behaviours are often rigid and routine and are linked to specific ‘rules’ around what types of foods are perceived as healthy. These dietary rules can become more intense over time. Orthorexia differs from anorexia as the weight-loss element is ‘absent, hidden or subordinated to ideation about healthy eating.’ The estimated prevalence of orthorexia is quite broad, with studies indicating a range from 6.9% to 75.3% of the population.

OSFED

OSFED stands for Other Specified Feeding and Eating Disorder. Eating disorders are diagnosed with quite strict guidelines. A diagnosis of OSFED may be given when behaviours do not exactly map onto another diagnosis, but there is evidence of anorexic, bulimic and binge-eating tendencies present. 47% of individuals living with an eating disorder are diagnosed with OSFED.

Pica

Pica is characterised by the urge to consume non-food items. The objects that people may eat range but can include:

• earth or soil
• raw starches
• ice
• charcoal
• ash
• paper
• chalk
• cloth
• baby powder
• coffee grounds
• egg shells

A diagnosis is given when this type of eating happens for over a month. 10-30% of children experience symptoms of pica. An estimated 4% of adults may engage in this type of eating. Pica may be more prevalent for individuals with a learning disability or mental health condition. It is also experienced more widely among pregnant women.

Purging Disorder

Purging disorder may seem similar to bulimia, but it is distinct from it. It is experienced when individuals purge (including self-induced vomiting, or the use of laxatives for weight loss medications) in the absence of binge eating. Statistics on purging disorder are not fully conclusive, however, they suggest that 2.5 to 4.8% of teenage girls experience this condition.

Rumination Disorder

Rumination disorder is classed as a ‘functional gastrointestinal disorder,’ wherein individuals regurgitate their food. Individuals may re-swallow their food, which may then be regurgitated again. This cycle can last for several hours following a meal. Rumination disorder is thought to be underdiagnosed. It has been linked to emotional neglect in infancy, distress and mental health issues.

UFED

A diagnosis of Unspecified Feeding or Eating Disorder is typically given when individuals report ‘clinically significant eating disorder symptoms’ but do not match the diagnosis of other eating disorders. Studies suggest that over a third of women with a diagnosis of OSFED and UFED have a diagnosis of a mental health condition.

The danger of eating disorders

With eating disorders, the question is less about which disorder is the most dangerous. Perhaps a more apt question may be, in which way is each type of eating disorder dangerous? Each type of eating disorder carries a whole host of physical and psychic threats specific to itself.

Eating disorders and mortality

Anorexia nervosa is oftentimes cited as the most dangerous eating disorder due to its alarming mortality rate; anorexia has the highest mortality rate among mental health conditions. Each year, approximately 5.1 deaths per 1000 are due to anorexia. 20% of these deaths are linked to suicide—deaths related to bulimia average around 1.74 per 1000 people each year.

Mortality risk is heightened in all instances of eating disorders. This is because long periods of restriction, bingeing and purging all carry serious health effects. They can lead to malnourishment, dangerous spikes in blood sugar levels, severe depression and physical damage to the oesophagus and gastrointestinal system. Pica, too, carries risk, in the sense that the urge to consume non-food items could lead to the ingestion of unsafe objects. Orthorexia can lead to severe malnourishment, which can then lead to organ failure.

Psychological Distress

Eating disorders carry a range of very serious physical health problems. These can range from osteoporosis, to cardiovascular problems and tears in the throat tissue. But eating disorders leave a mark on the mind, as well as the body.

Eating disorders can be characterised by rigid routines and obsession or by impulsivity and lack of control. Living with an eating disorder can seriously damage an individual’s confidence, happiness and quality of life. For some people, it can make life feel no longer worth living. This can then lead to social withdrawal and, depression, and in some cases, suicide. Social withdrawal can lead to missing milestones such as passing exams, finding employment, and starting a relationship or a family. Eating disorders are typically longitudinal conditions, meaning that the effects of these disorders can be felt for years or even decades.

Treatment for eating disorder recovery

Accessing eating disorder treatment may feel overwhelming. However, research indicates that a large number of individuals in treatment experience full remission or significant alleviation of eating disorder symptoms. At UKAT, we offer confidential and professional advice at our centres nationwide. Whether you are looking for anorexia nervosa treatment, support for pica, or advice on bulimia treatment, we are here to help you. We aim to empower you to learn how to take control healthily in order to reconfigure your relationship with food.