The new food disorders: anorexia nervosa, binge-eating, uncontrolled night feeding syndrome

Over 3 million Italians suffer from an eating disorder, and more and more often the sick are very young. Anorexia nervosa, bulimia, binge-eating or uncontrolled night feeding syndrome They are not only pathologies, they are unique, complex stories, which must first be included and then cared for. THE Food disorders feed on the deception of controlmaking the cure an arduous and delicate challenge. We talked about it with Elisa Valteroni, psychologist and psychotherapist at the Strategic Therapy Center of Arezzo, author of anorexies – get to know and treat food disorders. Theory and clinical cases.

Why does the title of the book speaks of anorexies to the plural?

« I could start citing Irvin Yalom, who suggested » look from the window of your patients, try to see the world as your patient sees it « . Here, it is from this window that can be seen Many and different anorexies, because many and different girls, boys, women and men stumbled in food disorder. The title, therefore, on the one hand emphasizes respect for the uniqueness of each personal history of food disorder and on the other underlines the need for formalization and sharing with a public public and the scientific world of the many protocols of treatment of the short-strategic evolved strategic model, that is, rigorous and heterogeneous care practice for the different faces of what in the diagnostic and statistical manual of mental disorders 5-trick is defined as an eating disorder and Nutrition ».

Why is it so important to start from this window of the person?

«Because it is only from there that the clinician can tune with the patient, that is, approaching at the relational level, to understand the problem and tend to his solution. It is from that window that the short strategic model evolved comes to the diagnosis-operationa tool that allows you to know the functioning of the problem to the present and direct the treatment maneuvers in a targeted way from the first meeting ».

How to distinguish disorders

What are then, in addition to the well-known anorexia, bulimia, binge-eating disorder, the « new » paintings of food and intervention disorder? How do we distinguish them? « In anorexia, for example, in which the subjective perception of fat or swelling throughout the body or in an area of ​​it, is associated with the massive food restriction, pure anorexia has been distinguished from that with exercising, in which it is precisely the structured or unstructured motor activity to represent the main factor of persistence and chronicization of the disorder. The paintings of youth (in puberty and adolescence) from adults are then distinguished from adults since they require methods of building and maintaining the relationship, as well as different individual and family intervention techniques, in order to maximize the possibilities of care. The book also presented the advancements in the care of vomiting, that is, of the obsessive and compulsive eating to vomit; of the Binge-Eating Disorder, understood as the alternation between a restrictive diet and the binges, which can also include exercising; of bulimia, intended in a closer way to the etymological meaning of the word « hunger from ox », that is, like the unstoppable push to eat not primarily based on the biological need for hunger; uncontrolled night feeding syndrome, contradist from episodes of night binges in the time between dinner and going to sleep or in the awakening during the night; Food disorder in teenagers belonging to the so -called sexual and gender minorities, a situation that can present peculiarities in the diagnostic evaluation and treatment « .

What does it mean to get sick of a food disorder?

«To answer I could use many and meticulous technical terms but they would not be able to really represent the meaning in people’s lives, that’s why I do it by reporting the words of some of my patients. Anorexia, for example, for S. of 13 years is « I feel fat all day and at night, I feel and see fat throughout the body and when I eat the belly and the legs it is as if they exploded. So I feel guilty, I feel unworthy, I feel incapable of control, I can no longer study with this feeling of being a useless object and then what does it make to eat if I do. » Vomiting for A., ​​17 years old, is: “I wake up thinking about what I would like to eat and vomit, I look for the foods I like and if I do not find them, I go to buy them. I only fall asleep when I am exhausted with the vomiting! Vomit, in fact I don’t recognize myself anymore but it’s stronger than me … « ».

Who are the most affected subjects? And why are food disorders among the youngest eating disorders?

«Young people are the most affected subjects and the age group between 13 and 25 years old is the one that has seen in recent years an increase in the prevalence of eating disorders. Answering the question about why it is not as simple as we would perhaps like, as these pathologies are multicious, that is, psychological, genetic, biological, relational and social factors contribute in the appearance of a food disorder but the specific etiological (i.e. causal) role has not yet been clarified « .

Are there risk factors?

«There are characteristics associated with greater vulnerability with the development of a eating disorder, such as perfectionism; obsessiveness; Compulsiveness; impulsiveness; the accentuated sensitivity to the negative judgment, to criticism; the difficulty in regulating emotions. Precisely in consideration of the vulnerability factors, in recent years, clinical experience and scientific research have detected the increase in the role of content and activities on social media in contributing to body unusual and the development and maintenance of a food disorder « .

What role does the network play in the spread of eating disorders?

« In general, the increase in activities in social platforms such as the sharing of photographs and the comment of images based on aesthetics is related to the push for thinness, the internalization of the ideal of a lean body, dissatisfaction with one’s weight and with the concern of how one’s body may appear to others. Moreover, among the patients with food disorder there is a tendency to use social media in a way that reinforces the disorder itself, that is, the functional research activities of social support are not privileged, the viewing and comparison of objectivized bodies and content, that is, those that promote the subtle ideal of a body and encourage to resist hunger « .

What consequences are there for families when does anyone suffer from a food disorder at home?

«The impact can be devastating. Parents are constantly exposed to the experiences of anguish, fear, frustration, impotence and anger. Usually they tend to respond to the food pathology of the child by alternating communication and hyperprotective relational models -of encouragement and plea with correct diet -, to criticalism models and also of threats, always supported by the intent to shake their son towards healing « .

What are the main labors of the parents?

«First of all in bringing the child to specialist attention. In fact, it can be very difficult to lead the young man to a minimal awareness of having a problem and the request for help. After that, the main effort lies in maintaining adherence to treatment in meals, motor activity, vomiting, but above all of the crises that inevitably accompany the healing path of the son « .

What to do if you think you have a eating disorder or do you think your child may have it? Who to contact?

«Food disorders are psychological pathologies for which the treatment of election is psychotherapy. Also, we must not underestimate that they involve organic dimensions (all body districts are in fact affected) and nutritional that must be carefully evaluated and monitored over time by health specialists. The main national and international guidelines for teenagers identify in timely outpatient treatment with the involvement of the family the intervention to be privileged, that is, the one that has the best result of care and the lower risk of recurrence. Clearly when the first level of outpatient care did not lead to improvement or there were no organic conditions, or the individual and/or family resources compatible with this type of treatment, there are more intensive levels of care that require hospitalization in hospital wards or specialized structures « .