In the United States, over 2.7 percent of adults have eating disorders and over 13 percent of adolescents will develop an eating disorder by the age of 20. The prevalence rate for females is more than double that of males, although males are more likely to underreport eating disorders due to factors such as stigma, substance use, and masking of their disorder by restrictive diets in sports or fitness training (Strother, 2012). Eating disorders are much more common in Western cultures, potentially due to the prevalent use of social media and the unrealistic body expectations instilled on these platforms. Feeding disorders are more common than eating disorders and have a prevalence rate of around 26% in infants and children in the general population (Galai, 2022).
So, what are eating and feeding disorders? Although they seem like similar concepts, it is important to differentiate between the two. Feeding disorders are more commonly associated with infants and children and refer to restrictive or abnormal eating habits due to food preferences or intolerances. The three types of feeding disorders are avoidant/restrictive food intake disorder (ARFID), pica disorder, and rumination disorder. ARFID involves restricting food intake by avoiding certain types of foods with specific color or texture. This may be due to the children’s food preference or simply an overall lack of interest in food. PICA refers to when children eat non-food substances, like chalk, earth, plastic, etc. This disorder cannot be explained by another mental disorder and is not problematic unless it causes health problems. Rumination disorder refers to when a child constantly spits up partially digested food and either rechews it or spits it out (Anxiety and Depression Association of America, n.d).
Eating disorders, on the other hand, are more common in adolescents and adults, and usually involve a psychological basis for their unhealthy eating behaviors. The three types of eating disorders are anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Anorexia nervosa is most common amongst young women and adolescent girls. It is similar to ARFID in that restrictive eating leads to abnormal weight loss but the motive is different. Individuals with AN have a distorted body image and a pathological fear of gaining weight. This leads to excessive dieting and extreme measures of food restriction like purging, resulting in unhealthy weight loss. Bulimia nervosa refers to the recurrent pattern of binge-eating and compensatory behavior (usually vomiting). Individuals with BN also have a distorted body image and may have other related symptoms like chronic sore throat or heartburn from excessive vomiting. Binge-eating disorder refers to binge-eating without compensatory behavior. Individuals with BED have lack of control with their eating and are very likely to have comorbid obesity. They often feel disgusted or embarrassed by their eating habits and are more likely to be depressed (Anxiety and Depression Association of America, n.d).
Unlike feeding disorders, eating disorders are major mental health conditions that require the proper diagnosis and treatment from a healthcare professional. Eating disorders are highly associated with major psychological problems, like distorted self-image, anxiety, or depression and are one of the most life-threatening types of mental disorders. Every year, an estimated 3.3 million people die from eating disorders due to numerous factors such as adverse health effects, decreased quality of life, and suicide (van Hoeken, 2020). Therefore, it is important that we be able to recognize eating disorders and differentiate them from simply overeating or dieting so that individuals with such disorders can get the help that they need.
Eating disorders in teens. Eating Disorder Hope. (2022, February 26). https://www.eatingdisorderhope.com/risk-groups/eating-disorders-teens#:~:text=Teenage%20Eating%20Disorder%20Statistics&text=Studies%20have%20determined%20that%3A,an%20eating%20disorder%20%5B1%5D
Galai, T., Friedman, G., Moses, M., Shemer, K., Gal, D. L., Yerushalmy-Feler, A., Lubetzky, R., Cohen, S., & Moran-Lev, H. (2022). Demographic and clinical parameters are comparable across different types of pediatric feeding disorder. Scientific Reports, 12(1). https://doi.org/10.1038/s41598-022-12562-1
Lindvall Dahlgren, C., Wisting, L., & Rø, Ø. (2017). Feeding and eating disorders in the DSM-5 ERA: A systematic review of prevalence rates in non-clinical male and female samples. Journal of Eating Disorders, 5(1). https://doi.org/10.1186/s40337-017-0186-7
Strother, E., Lemberg, R., Stanford, S. C., & Turberville, D. (2012a). Eating disorders in men: Underdiagnosed, undertreated, and misunderstood. Eating Disorders, 20(5), 346–355. https://doi.org/10.1080/10640266.2012.715512
Types of eating disorders. Types of Eating Disorders | Anxiety and Depression Association of America, ADAA. (n.d.). https://adaa.org/eating-disorders/types-of-eating-disorders
U.S. Department of Health and Human Services. (n.d.). Eating disorders. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/eating-disorders
van Hoeken, D., & Hoek, H. W. (2020). Review of the burden of eating disorders: Mortality, disability, costs, quality of life, and family burden. Current Opinion in Psychiatry, 33(6), 521–527. https://doi.org/10.1097/yco.0000000000000641
Gaslighting refers to the act of manipulating someone into doubting their own judgment or sanity. Often, the term is used in abusive relationships but has been increasingly more prominent in medical settings. Gaslighting in medicine can happen between doctors and patients, which often compromises the trust in a doctor-patient relationship. Gaslighting is dangerous because it is often subtle and difficult to detect. The victim and those around the victim often don’t realize it is happening, yet it can have lasting effects on the victim’s self-esteem (Fraser, 2021).
Most often, medical gaslighting occurs when a doctor knowingly or unknowingly dismisses a patient’s symptoms or concerns, causing the patient to question his/her own judgment or self-reporting abilities. For instance, a patient comes into the hospital complaining of a headache. The doctor, at the end of his long shift, runs a couple simple diagnostic tests and does not find anything serious. The doctor tells the patient that it is nothing serious and that it will pass with time. The patient, who is still in pain, has failed to receive the treatment they need and now begins to question their own judgment. They may think, “maybe I was too sensitive and I didn’t need to go to the hospital” or “maybe I failed to give a proper report of my symptoms.” Then, the patient may feel a lowered sense of self-esteem. This is medical gaslighting (Au, 2022).
Medical gaslighting was particularly prominent among long COVID patients. Long COVID patients are patients that have lingering effects from contracting COVID-19, such as brain fog, difficulty focusing, memory loss and problems with mobility. Because COVID-19 is a relatively recent and under-researched disease, many doctors were unsure of the causes and treatment of long COVID symptoms. Therefore, many long COVID patients reported that their symptoms were dismissed by doctors because doctors didn’t have enough knowledge about the
condition. Not taking seriously the concerns of long COVID patients, who clearly had symptoms, is a form of medical gaslighting (Au, 2022).
Gaslighting is also common in obstetric medicine. Gaslighting in obstetric medicine consists of making decisions on behalf of the mother, acting without the mother’s consent or blaming the mother for unfavorable outcomes. Gaslighting in this field is especially prevalent due to the general discrimination against women in medicine. Historically, clinical trials and treatment recommendations have been tailored toward men. Also, there is a history of women’s health problems being dismissed because of the false assumption that they are being hysterical or irrational. For such reasons, women are at higher risk of medical gaslighting. One example is traumatic childbirth, which refers to the trauma due to feelings of helplessness and horror during childbirth. In many cases, the traumatic experiences during childbirth can lead to higher risk of postpartum depression and anxiety and detachment from the child. However, to obstetric doctors, these experiences are seen as normal and routine. This can lead mothers to question their own sanity or mental fortitude (Fielding-Singh, 2022).
One of the key tenets of medicine is trust between doctors and patients and the mutual understanding that the doctor is acting in the best interest of the patient. However, medical gaslighting can completely compromise this trust and lead to mistrust and animosity between doctors and patients. This is why it is crucial that we are able to understand and recognize gaslighting when it happens and intervene. As a patient, it is important to have a friend or family present during check-ups and get second opinions from different doctors to make sure that they are not being manipulated. As a doctor, it is important to treat all patients with the same level of respect and allow them to have autonomy in their decision-making. Doctors and patients must be able to work together to produce the best possible results for the patients.
Mental health disorders are prominent in today’s society, with the two most common conditions, anxiety and depression, being the leading cause of disability. In an attempt to find new therapeutic approaches to treating mental health conditions, there has been a growing interest in the role of diet and nutrition on mental health. Numerous studies have suggested both the therapeutic and detrimental role of certain diet patterns on mental health disorders. The two most prominent case studies are the therapeutic effects of the Mediterranean diet and the detrimental effects of the Western diet on mental health pathology (Firth, 2020).
The Mediterranean diet consists of high consumption of fruits, vegetables and fatty fish and low consumption of red meat. This diet pattern has been associated with reduced incidence of depression. On the other hand, the Western diet, which consists of high consumption of saturated fats and low consumption of fish, has been shown to have detrimental effects on mental health. In a corroborating study, children who ate more vegetables, fish and fruits, were less likely to have ADHD, whereas consuming fast food and soft drinks was associated with high incidence of ADHD (Clay, 2017). This phenomenon calls to question which nutritional factors in these diets contribute to their effect on mental health (Lachance, 2015).
One potential factor is the effect of carbohydrates on the brain chemistry. Highly glycemic foods (high in carbohydrates) have been associated with depression and have even been shown to induce depressive symptoms in healthy volunteers (Firth, 2020). A possible mechanism for this observed effect is the rapid fluctuations in blood glucose levels. A highly glycemic diet induces a compensatory response, in which blood glucose is lowered to accommodate the high glucose diet. This decrease in blood glucose then triggers the release of several hormones such as cortisol, adrenaline, growth hormone and glucagon, which have been implicated in leading to anxiety and irritability (Firth, 2020). The hormonal fluctuations due to rapid changes in glucose levels may help explain the detrimental effects of Western diet on mental health. However, it is important to note that a highly glycemic diet is also associated with obesity and diabetes, which may affect mental health. Although causality cannot be assumed, the effect of the consumption of carbohydrates on the brain offers a promising mechanism for how food affects mental health.
Another potential factor is the immunostimulatory effect of high calorie meals rich in saturated fats seen in Western diets. Foods high in saturated fats have been shown to stimulate the immune response and induce an inflammatory effect on the body (Lachance, 2015). Such inflammatory effects have been associated with depression. On the other hand, in controlled trials, anti-inflammatory drugs have been shown to decrease depressive symptoms (Firth, 2020). Mediterranean diets typically have anti-inflammatory effects, which may explain the reduced incidence of depression in individuals with the Mediterranean diet.
Additionally, our diet patterns can alter our gut microbiome, or the trillions of bacteria, viruses and archaea that live in our gut, which may have an effect on mental health. The gut microbiome has the ability to interact with and regulate the brain in various ways through neurotransmitters and hormones. Probiotics and certain diet patterns can potentially disturb the equilibrium in the gut microbiome and consequently affect the gut’s regulation of emotion and mood in the brain. For instance, a study found major depressive symptoms were associated with altered gut microbiome (Firth, 2020). Additionally, when fecal gut microbiota from humans with depression were transferred to healthy rodents, it seemed to induce depressive symptoms in the rodents (Firth, 2020). These findings suggest the role of gut microbiome in the regulation of brain pathways and consequently mental health.
Lastly, there are certain nutritional deficiencies in the Western diet that may help explain the difference between Western and Mediterranean diets. Deficiencies in vitamin B12, B9 and zinc have been shown to cause depressive and dementia-like symptoms (Lachance, 2015). These nutrients are believed to be building blocks of numerous essential monoamine neurotransmitters, like serotonin, norepinephrine and dopamine. The reduced synthesis of these neurotransmitters in individuals with Western diets may be a possible reason for the high incidence of mental illness.
Mental health is an ever-growing concern in our society. Despite recent developments in intervention methods, only about one in three patients receive effective treatment (Lassale, 2018). Therefore, it is crucial to look for new, more effective ways to treat individuals with mental health conditions. Although diet by no means can be a replacement for professional help, the recent findings on the relationship between food and mental health point promise the potential for nutrient supplements and dietary changes as a viable intervention method. A healthy diet not only can have therapeutic effects on the brain, but also improves an individual’s general lifestyle and every day functioning. At this point, it is hard to assume that foods have a direct causal effect on mental health. However, further research must be done to establish this intricate relationship.