- Nutrition and Eating Disorders (or Eating Disorders)
They are characterized by incorrect behaviors regarding nutrition itself, with excessive or limited ingestion of food or inappropriate behaviors (APA, 2013). All these behaviors compromise the social life and health of patients affected by these pathologies and represent one of the most frequent causes of youth 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
Binge eating disorder
The majority of eating disorders can be found between the ages of 15 and 25, in particular, the age group in which anorexia and bulimia nervosa start is the adolescent age between 15 and 19 (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 mental growth, the boys enter the common “adolescent crisis”, both towards themselves and the outside world around them. From here, personal identity begins to be defined through self-realization, comparison with peers and the search for one’s own autonomy (Turnbull, Ward, Treasure and Jick, 1996). A greater onset in adolescence also seems to be connected to stressful events such as final exams, the first emotional disappointments or the parents’ divorce.
Eating disorders also occur in the pre-adolescent age, and this figure has been increasing exponentially in recent years, furthermore the age at which the first diets are undertaken is decreasing rapidly. Some studies (Shapiro, Newcomb and Loeb, 1997; Maloney et al. 1989) have shown that as early as 8 years of age girls begin to worry about their weight and body shape, they start diets even if they are normal weight or even below normal weight. More recent data show an increase in early-onset cases, partly due to a lower age of onset of menarche, but also to an earlier age at which adolescents are exposed to the ideals of beauty/thinness through the internet and various media. The early onset of an eating disorder also leads to a greater risk of developing permanent secondary damage, especially with regard to the bones and central nervous system that have not yet reached full maturation in adolescence.
The age of onset of BED (Binge Eating Disorder) is later than other diagnoses, with a significant peak in early adulthood. The onset of anorexia and bulimia in older age are increasingly frequent, even if at the moment there are few studies in this regard. This leads to an increased risk of chronicity and comorbidity with psychiatric disorders such as anxiety and depression. Dissatisfaction with one’s body image is very high in patients aged between 14 and 17, about 10% of these girls react to this dissatisfaction with a calorie restriction or with food selection which frequently leads to a feeding 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 which leads to avoiding a chronic 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, even if often the triggering and maintenance factors can coincide and overlap, furthermore it focuses mainly on thoughts (cognitive part), and on behaviors that are involved in their maintenance mechanisms (Fairburn, Cooper & Shafran, 2003).