“Like a skeleton, covered only with skin.” For example, the English physician Richard Morton described an unusual patient in 1684. The 18-year-old woman was extremely malnourished, but otherwise apparently healthy.
Morton was at her end, treating her with everything from fragrant bags to anti-hysterical water. She recovered briefly but died a few months later.
According to doctors, this is one of the oldest documented cases of the eating disorder anorexia.
The disorder is still as life-threatening as it was in the 17th century, and the most deadly mental disorder in existence. But unlike in Morton’s time, eating disorders are no longer rare.
Anorexia, bulimia and binge eating disorder (BED or binge eating) together affect up to 9 percent of the population – twice as many as just 20 years ago.
Even with current therapies, physicians and those involved often have to watch helplessly while the patient languishes before their eyes. But a number of new studies may change that.
It uncovered what is going on in the minds of people with eating disorders, and the results pave the way for a new therapy that removes the disorder from the mind via electromagnetism.
Corona leads to increase
Anorexia, in which a person starves themselves, is perhaps the most well-known eating disorder, but accounts for less than 10 percent of all cases. The other 90 percent is roughly evenly distributed between two forms of overeating.
In bulimia, a person first eats a lot, but then throws up the food, which keeps the body weight fairly constant. In BED, food is not pushed up, which increases the risk of overweight or fluctuating weight.
Between 2000 and 2018, the number of eating disorder diagnoses has more than doubled. Part of the increase is probably due to the increased focus on the disease, but other factors also come into play. For example, researchers suspect that the increased use of social media presents users with unrealistic body ideals that trigger eating disorders.
Recently, the corona pandemic led to a further increase in the number of diagnoses. The virus and the shutdown led to fear and social isolation in many people, emotions that can trigger eating disorders. A study shows that by 2020, the first year of the pandemic, 15 percent more people were diagnosed with an ‘eating disorder’ than in previous years.
But not everyone has the same risk of an eating disorder – women, for example, are more than men, and they make up about 90 percent of all patients with the disorder. However, the number of men is increasing.
The risk also depends on a particular trait. This is the finding of an important new research project led by the Swedish psychologists Emma Forsén Mantilla and Andreas Birgegård.
Researchers have long known that there is a link between eating disorders and mental health problems, such as low self-esteem. However, doubts have been raised as to whether eating disorders are the cause or the result of the problems.
The Swedish psychologists found in three large studies between 2015 and 2021 that the disease is largely a result of the patients’ self-image. The researchers tracked the physical and mental health of thousands of women with eating disorders for up to nine years.
The most notable finding was that the course of the disorder could be predicted for years by measuring the women’s level of self-blame at the time of diagnosis. The more likely the women were to blame themselves when they were diagnosed, the greater the risk that nine years later they would not be able to get rid of their eating disorder.
This indicates that a high degree of self-blame contributes to eating disorders and is not just part of the symptoms. In contrast, other elements of self-esteem, such as self-control, self-confidence, and self-protection, did not have a significant impact on how patients fare subsequently.
The mirror image is distorted
The Swedish study also confirms that anorexia is the most serious form of eating disorder. The disorder is accompanied by a great fear of gaining weight, and patients consider themselves fat, even though the mirror and weight tell a completely different story. As a result, anorexic patients starve to the point that their lives are in danger, and on average they live 10-20 years shorter than other people.
Several researchers have tried to find out if people with anorexia really think they are fatter than they are, but the results have never been unequivocal.
In 2019, German psychologist Ida Wessing got 38 young women, half of whom suffered from anorexia, to look at and feel their own bodies. They were then asked to estimate the circumference of their upper arm, thigh and waist by drawing a circle with the same circumference. After this exercise, the women with anorexia underwent a treatment program of several weeks, after which they had to do the exercise again.
The results showed that all women perceived themselves as thicker than they actually were. The healthy women, however, were the most realistic, and their estimates were only 12 percent higher than reality. Women with anorexia thought their bodies were 33 percent larger than they actually were. This figure had dropped to 25 percent after treatment.
But similar studies come to slightly different conclusions. For example, an Italian study from 2020 showed that anorexic patients know their body shapes very well, but that they feel they are fatter than they are emotionally.
Compulsively fed patients
Treatment for an eating disorder usually includes dietary advice to help normalize weight and psychoeducation to help patients understand and manage their illness. This is supplemented by psychotherapy, which addresses the underlying emotions and problems behind the disease.
In anorexic patients, it is crucial to gain weight as quickly as possible, but it can be very difficult. Patients will often go to great lengths to avoid eating and will resist strongly if, for example, their parents try to force them to do so. Then they will either digest the food before the body has a chance to absorb the nutrients or train hard to burn the calories.
Anorexic patients therefore often require constant supervision and end up in hospital in many cases. Here it may be necessary to force them through a tube to hold the weight. But even when the weight returns and the mental state stabilizes, it often goes wrong again.
In a major study from 2017, American psychiatrist Sahib Khalsa reviewed 27 previous studies on the treatment of anorexia. It showed that more than one in four patients who have fully or partially recovered after treatment relapse and start starving themselves again.
The risk of relapse is greatest three months after the end of treatment, which is why patients often go into treatment again and again for years. It is not uncommon for anorexic patients to be regulars in a hospital for 10 to 30 years.
The need for more effective treatments is therefore great. And as traditional therapies have improved in recent years, researchers are beginning to think in new directions. For example, a promising treatment uses powerful magnets.
The method, called TMS (Transcranial Magnetic Stimulation), is based on new knowledge about the origin of eating disorders in the brain and affects the brain activity in certain brain centers with electromagnetism.
In 2018, British researchers focused the magnetic field on an area of the frontal lobes that reduces the ability of anorexic patients to deal with certain emotions. The trial led to improvements in a number of patients – especially in their mood and overall quality of life.
The therapy is far from complete, but the researchers have high hopes for it. The procedure is hand-held and only takes a few minutes without any inconvenience to the patient.